Several registered dieticians recently weighed in on some popular foods that may not be as healthy as we think.

It seems like there has been a recent explosion of frozen yogurt shops… the kind where you walk in, pick up a container and fill it with your choice, or choices of frozen yogurt.  Then the fun part begins… filling your cup with lots of toppings.  Some of them are healthy, like berries, and bananas, and lots of them are tasty like chocolate chips, rainbow sprinkles, and marshmallows.  By the time your cup is weighed, you may be looking at a 500 calorie treat… not the 100 calorie one you thought you were going to have when you walked into the shop.  There is also the myth that frozen yogurt is full of healthy probiotics for digestive health, and can give your body an immune system boost. That may not be true. When yogurt is made into frozen yogurt the level of healthy bacteria usually declines, so you may not be getting the same health benefits you would by having a cup of regular yogurt.  Katherine Booking a registered dietician, and co-founder of Appforhealth.com said “I would rather opt for a small portion – about a half-cup serving of the real deal… regular ice-cream.  If I am going to indulge, I really want to enjoy my indulgence.”

Gluten-free foods are showing up more often on grocery shelves. Gluten is a protein found in many grains, including wheat, barley and rye. For people with celiac disease, or those with gluten sensitivity, gluten-free is not a choice.  However, many gluten-free foods are now marketed to the general public as health foods.  The problem is that some processed gluten-free products are made with significant amounts of added sugar, saturated fat, and preservatives.  If you don’t have gluten issues, you may want to think twice before eating gluten-free products, thinking it’s a healthier way to eat. On the other hand, we have found that some people with headaches are sensitive to gluten, and limiting(“low-gluten”) gluten may help the headache situation.

Reduced fat peanut butter has become an increasingly popular option to the traditional form of peanut butter.  In the long run, however, it may not be the healthiest choice.  ”Reduced-fat peanut butter adds artificial sweeteners, only to save 0.5 grams of saturated fat per serving, and ten calories” says Cristina Rivera, registered dietician, and president of Nutrition in Motion PC.  She believes the fat reduction is not worth it, and the taste becomes artificially sweet.  Eating regular peanut butter also allows you to reap the full benefits of the heart healthy fats in peanuts.  ”Natural or organic is the best option, and if you are worried about high calorie content, just be sure to practice portion control, 1 to 2 tablespoons is a serving” says Rivera…..Time Healthland May, 2012

Researchers at the Headache Center of Rio, in Rio de Janeiro, Brazil evaluated whether different varieties of red wines would trigger migraine differently.  The researchers were also curious to see whether varying levels of reseveratrol and flavonoids made a difference.  Reseveratrol is an active ingredient found in the skin of of red grapes.  It has long been known to reduce the risk of heart disease.  Flavonoids are compounds found in fruits and vegetables and can provide antioxidant benefits. The study focused on migraineurs who considered themselves regular wine drinkers, and who also reported a relationship between wine intake and migraine attacks.  The patients were asked to drink half bottles of various red wines.  The wines included merlot, cabernet sauvignon, malbec and tannat.  The participants were asked to take a minimum break of 4 days in between each wine testing. Approximately 87% of the patients experienced a migraine at least one time within 12 hours of having wine.  However, just 54% reported migraine attacks on at least two occasions, and 33% reported migraine attacks in all 4 wine testing sessions.  When the researchers compared the wine types in the patients who had at least two migraine attacks after trying all four wines, the malbec and tannat varieties triggered migraine more often than the merlot or cabernet sauvignon.

The researchers concluded that the migraineurs studied, who all stated red wine was a trigger for them, did not get migraines most of the time.  Interestingly though, while  the tannat and malbec wines used were most responsible for triggering migraines, they also had the highest amount of flavonoid content!  Before you consider changing your choice of red wine however, keep in mind that the researchers believe controlled studies are needed to confirm their observations…. Headache  The Journal of Head and Face Pain   May 2012

A recent study led by the Mayo Clinic, and life insurer, Aviva USA reported that 3 out of 4 women studied were somewhat, very or extremely stressed.

The researchers looked at the relationship between a woman’s financial situation, stress and overall health.  About 82% of the women said they were uncomfortable with their financial situation, and 58% of the women reported weight gain in the last 10 years.  The number jumped to 68% among extremely stressed women.  However, nearly 4 out of 5 women considered themselves in good health.  The study concluded that finances were the primary factor for stress among women aged 30 to 54.

Dr. Philip Hagen of the Mayo clinic said “People may not think of it this way, but we all make important decisions every day. Most of the women reported feeling healthy but they also reported significant rates of two important health risk factors – weight gain and stress that contribute to chronic health conditions and a poorer quality of life in the long run.”  Hagen concluded that simple lifestyle changes, and taking small steps every day can help women lower their risk of health problems, which may enable them the opportunity to have a better, and healthier life…… TimeHealthland    May 18, 2012

A propensity to anxiety is a physical, inherited illness, as is migraine. It is not psychological! By viewing certain key structures in the brain, such as the amygdala, one can almost predict who has anxiety. Even at age 5, in a child with separation anxiety, the amygdala is larger than normal, and fires more often. Anxiety could almost be termed “the overactive amygdala syndrome.”

The amygdala is part of the larger limbic system. Other limbic structures include the thalamus, hippocampus, hypothalamus, along with the anterior cingulate gyrus and the orbitofrontal cortex. The amygdala warns of incoming dangers, after processing multiple incoming sensory inputs. Amygdala connections are vast, with direct connections to:

1. The hypothalamus, triggering fight-or-flight responses,

2. The locus ceruleus (in the pons), increasing the output of norepinephrine, with
a resulting rise in blood pressure, heightened response to fear, and level of
alertness,

3. Various other structures, such as the periaqueductal gray matter, modulating aspects of our fear response.  The amygdala regulates the tone of our emotions, and is hyper reactive in anxious patients.

The hypothalamus initiates our fear response; when it overreacts, the resultant anxiety is out of proportion to the actual threat. The hypothalamus may trigger an overproduction of corticotrophin release factor, adding to the anxiety response. The thalamus is our integrating relay station, with a vital direct connection to the amygdala.  The thalamus plays a vital role in regulating sleep and eating patterns, which often are disrupted in anxious patients. The hippocampus is crucial for memory, and it holds the memories that trigger the fear response.  It is also important in the development of post-traumatic stress disorder by holding on to the traumatic memories.

Anxiety is a necessary and universal emotion. With anxiety that originates from a real or perceived threat of danger, one experiences an increase in heart rate, blood pressure, diaphoresis, and other physical accompaniments to anxiety. At times, anxiety comes across as excessive worrying, and this leads to avoidant behavior. Hypervigilance is an excessive focusing of one’s attention on a possible danger or perceived danger.

When we think of anxiety, it is usually revolving around a problem or threat in the future.  Fear, on the other hand, can be a very intense emotional reaction to a danger or threat that is in the present.  We react to immediate dangers with the “fight-or-flight” response.  Fear and anxiety, to some extent, are crucial for our existence.  Fear allows us to escape from imminent threats; anxiety allows us to prepare for future problems.  Anxiety, at least in low or moderate amounts, helps motivate many people to achieve.  When someone crosses from moderate to high anxiety, it usually will interfere with the ability to perform.  The triggers for fear and anxiety may be internal or external.  With internal triggers, one may have panic attacks that accelerate, feeding on themselves, in part because the associated tachycardia can convey the message that a serious physical problem is imminent. External triggers involve situations that may trigger phobias, or severe anxiety.  These may include social situations, crowded or closed-in spaces, tests or other performances,etc. This leads to avoidant behavior, as anxious patients will tend to avoid these situations.

Pharmacotherapy is important in treating anxiety, but it is by no means the only treatment.  For those with severe pain and psychological comorbidities, “it takes a village” to treat a patient, and we get these other villagers involved. They may include psychotherapists, yoga or Pilates instructors, biofeedback specialists, etc.

Taking medicine alone is considered passive coping and is not sufficient for those with severe anxiety.  People are best off when they exercise regularly, and learn relaxation, whether they are based in yoga, Pilates, tai chi, deep breathing, biofeedback, or meditation.  We need to promote this “active coping” as a vital component of treating chronic pain and anxiety.  The addition of psychotherapy, primarily cognitive/behavioral, is also important.  It is vital to locate an excellent therapist, and for the patient to stick with that therapist for at least four to six months.  While short-term therapy is better than no therapy, we believe that the ideal time frame is one or more years.  It takes some time to integrate the ideas of therapy into our lives.  Self-help books, while somewhat useful, do not replace a great therapist; neither does talking to a close friend or relative.  A great therapist can be life-changing…..

A trial to begin soon will be one of only a few ever done to test prevention treatments for any genetically predestined disease… and  is unprecedented in Alzheimer’s research. This study is actually the first to concentrate on people who are cognitively normal, but at a very high risk for Alzheimer’s, according to Dr. Francis S. Collins, director of the National Institutes of Health.

The participants will be mostly derived from an extended family of 5,000 people who live in and around Medellin, Colombia.  This family is believed to have more members with Alzheimer’s than any other family in the world.  For those in the family who have specific genetic mutations for the disease, cognitive impairment usually begins around 45 years of age… and full-blown dementia around 51.  Dr. Eric M. Reiman, is the executive director of the Banner Alzheimer’s Institute in Phoenix, and a lead researcher in the study.  He said that while a relatively small percentage of people with Alzheimer’s have the genetic early-onset form of the disease like the Colombian family, the trial will help answer questions that apply to the millions of people worldwide who develop the conventional form of it.

The drug used in the trial is Crenezumab, which attacks the formation of amyloid plaques in the brain. Amyloid are protein fragments the body produces normally.  In people with Alzheimer’s the fragments accumulate to form hard plaques.  If the drug is successful in forestalling memory or cognitive problems, and plaque formations, scientists believe that prevention or delay of the disease is possible… and that the answer lies with targeting the amyloid years before dementia develops.  There are researchers elsewhere who have other theories as to the underlying cause of the disease.

Dr. Francisco Lopera, a Colombian neurologist, and leader of the study said Crenezumab was partly chosen because it appears to be safer than other drugs.  Lopera, who has worked with the Colombian family for decades, and has witnessed firsthand their agony sees the trial as a personal victory.  ”This is an opportunity that they were waiting for a long time.  This is the first time we can give them hope.”  And the world hope as well…….. The New York Times   May 15, 2012

Preventatives on the left, abortives on the right, and me stuck in the middle

This is a post taken from excerpts from comments I shared between another migraine patient and I in regards to preventive migraine treatment. I wanted to share it in a blog post, as I didn’t want the information to be overlooked in the comments section. With that said, here is my non-medical, non-authoritative, non-expert, simpleton opinion. If you haven’t tried preventatives to decrease the frequency of the migraines or other headache conditions, I absolutely think you should.

The American Academy of Neurology (AAN) just issued new guidelines on preventive medications for migraines, and listed them according to “proven to be helpful” and “probably helpful.” Drugs that were “proven” to be helpful were given a “Level A” rating. Among the A rating drugs “proven” to be helpful, one triptan made the list, and it was Frovatriptan (Frova). The other medications receiving a Level A rating were the following: [1]

Divalproex sodium (Depakote)
Sodium valproate (Depacon)
Toprimate (Topamax)
Metoprolol (Lopressor, Toprol-XL)
Propranolol (Inderal)
Timolol (Blocadren, but no longer sold under that name in the U.S.) [1]

Personally, I have not had any luck with the anticonvulsants reducing the frequency of migraine attacks, and I can’t tolerate the side effects either. Some patients, including myself, refer to Topamax colloquially as “Dopamax”, as it can make some patients feel like their mind has turned into mashed potatoes. My mind felt slower, my wit duller, and I couldn’t ever find my car keys. I still can’t find my cars keys most mornings, so the latter example may only apply to me. Matter of fact, do a search for the slang word “Dopamax” (a completely made up word by patients on the medication) on Google and you will see over 14,000 results. However, this drug has received a Level A rating as proven effective from the AAN, and it is widely reported as helpful in a great deal of patients in reducing the frequency of migraine attacks. All of our bodies are different, and this might just be the medication you need for relief. I know of migraine patients that swear by it, and you couldn’t take it out of their medicine cabinet with a SWAT team, so this may be a medication you want to talk to your doctor about adding to your arsenal.

Next, I would try an herbal supplement (I know, I know, don’t give me that look) called Butterbur, that is used as a headache preventive as well. It is widely reported that Native Americans used the root of Butterbur to treat headaches and some types of inflammation. There are also a variety of double-blind studies that show that Butterbur is effective for reducing the frequency of migraines, and may even relieve a migraine in progress.[3] One of the better known and recommended forms of this herb is a patented drug called Petadolex. I take this medication and I do believe that it has helped in reducing the frequency of migraine attacks, but I have not had any success with it relieving the pain of the attack once it has started. I like Petadolex, as they have a patented process for removing all of the unnecessary alkaloids from the Butterbur that can be toxic to the liver and may cause some cancers, leaving only the good stuff to prevent migraines. I order my Petadolex online and I am signed up for monthly delivery. I order from here: http://www.petadolex.com/

I have also had some success with a beta-blocker called Metoprolol (Lopressor, Toprol-XL) and take this medication daily. Propranolol (Inderal) and Toprol-XL are recommended by the American Headache Society as a preventative for migraine headaches. [3] Both of these medications received a Level A rating by the AAN as well and are stated by the AAN as a proven effective medication for the prevention of migraine attacks. [1]

Another factor you may want to consider is your diet, and the amount of essential vitamins you are fueling your body with, such as vitamin D, magnesium, vitamin B6 and vitamin B 12. Studies have shown that a lack of these essential vitamins can lead to a host of health problems, including migraines. [4] [5] Unfortunately, none of these essential vitamins are included in sufficient amounts in the junk food most of us put into our bodies, so you might need to talk to your doctor about taking supplements. I have done extensive research with Oreos and chocolate cake, but I have no solid evidence that they are increasing my vitamin levels sufficiently, the rigorous research continues . You might also need to have your vitamin D levels checked, as many people, not just migraine patients, have a low level of vitamin D, which can cause all sorts of problems, including headaches.

Other over the counter medications that were rated as “probable efficacy” in the prevention of migraines were: magnesium, riboflavin, histamine SC, and the herbal supplement feverfew. [2]  Feverfew has been used for centuries in Europe, and many people find relief from acute pain from migraine, and well as a reduction in frequency of attacks. [2] I have had some luck with feverfew in combination with magnesium, vitamin B2, vitamin D, and certainly think you should give it a try if your doctor approves. Feverfew can increase a bleeding risk, much like aspirin, so be certain you have talked to your doctor before taking this supplement

Some antidepressants can work as a preventive for migraines as well, and may help with the depression and anxiety often associated with migraine patients. Talk to your doctor about which medications might be right for you.  

Other things I would suggest are getting some exercise. Slow, moderate, exercise (e.g. walking, Pilates, Yoga, Tai Chi, etc.) are good ways for migraine patients to get some physical activity, without the overexertion that can trigger a migraine in some patients. So grab the leash and take the dog for a stroll or find a local facility to try some of the suggested activities. Even using videos at home can be effective, and can be bought cheaply over the internet.  I have also found that getting a massage can help reduce the tension and anxiety that can trigger my migraines, and can be a wonderfully needed break from the hustle and bustle of daily life. I actually have a prescription for one massage a week (Thank you Dr. Robbins!) and these work wonders for relaxation and releasing tension in muscles that trigger my migraines.

You may also want to try aromatherapy. I have had success with peppermint oil and rub it on my temples and forehead, as this can give that tingling feeling that can sometimes help reduce pain and the smell of peppermint can help with the nausea. I also rub this on my pillow when I have a migraine so I can smell the peppermint, as my sense of smell gets so strong during an attack that I can smell my dogs like they are in my lap. I also like the product CryoDerm, which is a topical roll-on ointment that contains Menthol as the active ingredient. I rub this on my neck, shoulders, temples, and forehead when I feel tension or a headache starting to occur and it can help ease muscle tension and sometimes keep the headache from progressing as quickly.

As you probably are aware, you are going to have to try combinations of these medications and supplements, play with the dosages, and give them time to work. Don’t expect to see any change until at least a month or so of taking them per your doctor’s orders. Basically, I have to take a shotgun approach to treating my migraines, as there is just nothing in existence I have found that stops the migraine in its tracks. Even when I have to go to the ER (maybe once a year) for strong opiate and nausea medication injections, when everything else has failed, it doesn’t stop all the pain, but it does reduce the pain and nausea allowing me to finally go to sleep, which allows my brain to “reboot” as I call it.

Finally, read and learn as much as you can about your specific headache condition, as knowledge is power, especially in the world of a migraine patient. Many doctors are not aware or as educated as they should be in the treatment of headache disorders and medications, and in the end, your body and input to your doctor is going to determine what works best for you.

If you are suffering from headaches of any type, and your current method of treating them isn’t working, talk to your doctor about adding preventatives to your treatment plan to decrease the frequency of attacks. If your book shelf doesn’t look like mine, and your medicine cabinet does not contain the copious amounts of preventatives and supplements that mine does, perhaps it should.

As always talk to your doctor about these medications and supplements before you begin taking them, and get their educated opinion on what they think you should try or what could be contraindicated for you based on current medications you are taking. Remember, I am just a migraine patient, and all I am sharing is my opinion based on my personal experience of living with chronic migraines for over 30 years. You should always talk to your doctor before beginning any exercise, medication, or herbal supplement program.

Please feel free to share your experiences and what you have found that works best for you. I hope my comments are of some use to those of you suffering. Take care of yourself, give yourself a break, remember you are not alone, and as always, try your best to “Keep Calm and Carry On.”

Wishing you all the best in life and your treatment,

Jeff Poleet
Chronic Migraine Patient

References:

1. Silberstein S, et al “Evidence-based guideline update — pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78: 1337-45.

2. Holland S, et al “Evidence-based guideline update — NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society” Neurology 2012; 78:1346-53.

3. Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A (December 2004). “Petasites hybridus root (butterbur) is an effective preventive treatment for migraine”. Neurology 63 (12): 2240–4. PMID 15623680.

4. European Journal of Neurology (2004;11:475-7), Genomics Research Centre (GRC) at Griffith University in Brisbane.

5. “Journal of Headache and Pain”; The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?; S Prakash, NC Mehta, AS Dabhi, O Lakhani, M Khilari, ND Shah; 2010

*Additional Sources and article review: By John Gever, Senior Editor, MedPage Today
Published: April 23, 2012; Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania. Full Article may be read at: http://www.medpagetoday.com/MeetingCoverage/AANMeeting/32304?utm_source=share&utm_medium=mobile&utm_campaign=medpage%2Biphone%20app

DISCLAIMER: I am not a healthcare provider, and I do not provide any medical advice, diagnosis or treatment. The information presented here is designed for general informational purposes and discussion only, and is not intended to replace a physician’s judgment about the appropriateness or risks of a procedure, medication, product or diagnosis. Always consult your doctor about any medical questions or conditions you may have.

New research in The American Journal of Sports Medicine shows that younger athletes, and those who are female show more symptoms and take longer to recover from a concussion than athletes who are male or older.  While researchers have known that girls run a greater risk of experiencing concussions than boys playing the same sports, this new research also looks at the effect of both age and sex on a range of symptoms.  The study suggests that anatomical differences make girls and younger athletes more vulnerable after a concussion, and may need to be managed more carefully after a concussion.

The research suggests that girls may have more symptoms because of higher estrogen levels, which may fuel brain injury. Younger athletes can be at greater risk because their brains are not fully developed.  The findings also highlight the risks of treating children and teenagers as “miniature adults.”  Mark Hyman, who wrote “Until it Hurts : America’s Obsession With Youth Sports and How it Harms Our Kids,” said “The brain and head of a small child are disproportionately large for the rest of the body. The result is that their heads are not as steady on their shoulders.  When they take a big hit in a football game or are slammed with an elbow in a soccer game, their brains move inside their skulls.  That’s when concussions occur.”

Barbara Wirtz’s teenaged daughter, a soccer player sustained a second impact syndrome.  While bending down to pick up a ball, another player accidentally kicked her in the face.  At the ER she was stitched up, though noone realized she had a concussion as well.  A few weeks later when a player ran into her, she fell to the ground, having a seizure.  Doctors told her she had experienced a second impact syndrome which occurs when a child or teen sustains a hit before a concussion has healed. Wirtz’s daughter is fine, but mom has become more vigilant in watching her daughter from the sidelines.  ”I think we’re better at assessing the symptoms of a concussion now.  ”We’re a little more watchful and demanding that coaches don’t keep her in if there’s any question at all that she got knocked around.”    The New York Times   May 11, 2012

Yesterday’s blog talked about parenting with chronic pain. Taking it a step further, and a nod to mother’s day this Sunday, you may want to check out mommigraine.blogspot.com/. This woman offers insight, along with a dose of humor that moms with migraines can appreciate…..

All parents know it’s not fun taking care of the kids when you have the flu, or a severe head cold. You may ask your child to to bring you a Kleenex box when you are in bed, but it’s an occasional situation.  However, having  chronic pain has the potential for changing relationships within a family. Daniel Kantor, MD, president-elect of the Florida Society of Neurology believes chronic pain can reverse family dynamics. “The parent no longer feels like a person taking care of the child. Sometimes, it can feel like the child is taking care of the parent.”

The best way to combat the stress of parenting with chronic pain like migraine is to talk openly to your child about it. Kids want to hear two things from their parents… information and reassurance.  If you have kids at various ages, it would help to talk to them individually as well in age-appropriate ways.  Allowing your child to voice his or her concerns regarding your pain is crucial… they may have anxieties or concerns you may not be aware of.  One boy thought his mom had more pain when he asked her to come to his soccer practice.  You don’t want to leave your child with that thought… so letting them tell you their fears is important for both of you.

Giving your pain a name can begin the dialogue of explaining why you hurt. Reassuring them that you are not going to die from it will help ease your child’s anxiety.  Letting them know that just because you have this condition does not mean they will get it can also help.  One mom who suffers from fibromyalgia sees herself making bank “deposits” ahead of an important function she does not want to miss.  The week of her daughter’s dance recital she took it extra easy, and asked the dance teacher if she could pick up her daughter early from the dress rehearsal the night before… making sure her daughter did not miss her part in the rehearsal.  Mom was able to get a good night’s sleep that night, and felt better prepared for the recital the next evening, when she made a “withdrawl.”

Focusing on what you can do , rather than what you can’t can help keep things positive.  While rock-climbing may not work, a walk in the park may be just fine.  Asking for help is okay too… knowing other parents who might like to swap watching the kids can offer some relief, as well as allowing your child to have a friend over when you are feeling okay.  The reality is that chronic pain may restrict some of the activities you would like to do with your child, and there are things other parents may be able to do that you can’t do.  However, one mom summed up her parental challenges in this simple, and pragmatic way….. “Chronic pain does interfere with the kind of parent I’d like to be.  There are things other parents can do that I can’t.  But what she really wants from me is to be with me – and that I can do.”      WebMD   May, 2012