Posts Tagged ‘migraine’
March 16, 2012 | 
Author During recent studies it is estimated that migraineurs experience nausea 92% of the time during some of their attacks. This common symptom associated with migraines often leaves patients unable to take an oral triptan medication and keep it in their stomach long enough to absorb the medication. Although there are injectable or intranasal triptans available, not all patients feel comfortable giving themselves an injection or do not like the taste associated with the intranasal form. There is a new transdermal sumatriptan patch that is currently in phase III of study and will hopefully be available to migraine sufferers by prescription soon. The benefits of the transdermal sumatriptan include bypassing the GI system and the liver and the medication is able to be absorbed properly into underlying tissues. The transdermal sumatriptan also does not cause any further nausea associated with the migraine. The transdermal patch had significant results of pain relief and freedom from nausea, photophobia and phonophobia at the 1 and 2 hour mark.
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According to some studies, as many as 75% of treatment-seeking fibromyalgia patients also experience migraine or tension headaches. While there is no definitive correlation between the two conditions, migraine and fibromyalgia share several triggers and symptoms. These include numbness in extremities, average onset in adulthood, and co-morbidity with depression. Sensitivity to light, sound and touch as well as a higher incidence in women are also common symptoms for both conditions.
Dawn Marcus, MD at the University of Pittsburgh Medical Center published a study in Clinical Rheumatology in 2005. Only 24% of the fibromyalgia patients evaluated said they did not have troublesome headaches. Of 70 migraineurs tested, about 40% reported a significant number of physical tender points consistent with symptoms of fibromyalgia. Fibromyalgia patients “tend to have this nervous system that is more sensitive to pain stimuli, says Dr. Marcus. Like migraineurs, “they tend to identify pain earlier and perceive things as painful quicker.”
While these findings may link the two conditions, the connection is not crystal clear. Brian Walitt, MD at Georgetown University Medical Center says many of his fibromyalgia patients have symptoms consistent with migraines, such as light sensitivity, but the pain “doesn’t have the same migrainous course.” Experiencing a trigger that might start a migraine does not necessarily follow a similar pattern in those with fibromyalgia. ”Its a tough issue.” Headwise Volume 2, Issue 1
For many migraineurs, there is a desire to push oneself mentally and physically on pain-free days. There may be a temptation to fulfill family, work and social responsibilities on days when one doesn’t have a headache. Unfortunately, the added stress of over-compensating may actually put you at greater risk for migraine.
Dr. Robert A.Nicholson, MD, a clinical psychologist with the Mercy Clinic Headache Center in St. Louis tells his patients “Given the way the body is designed and has adapted to the environment around them, it’s important they be consistent with the way they live their lives.” Being aware of potential triggers, like lack of sleep, and stress can be crucial in managing headaches.
On days when they are migraine-free some people may be tempted to work straight through on a work project, or “shop till they drop” at the local mall. Dr. MaryAnn May MD, of the Neurological Center for Pain at Cleveland Clinic advises patients to eat six smaller, more frequent meals throughout the day. ”That way they don’t have the big drop off with the decrease in blood sugar, which can stimulate a stress reaction internally and trigger a headache.” For many migraineurs, there is a sense of guilt for feeling like they have let someone down because of a headache. Inevitably, they may feel obliged to overcompensate to others, leaving less time for themselves.
While it may be human nature to “seize the day” when one is pain-free, keep in mind that pushing oneself too much can be a set-up for a migraine. One patient summed it up well…”On those days my fiancee always tells me to take it easy and relax, but I don’t listen. I feel so empowered and want to accomplish everything when I’m not in pain, I can’t help it. When I feel like I’m borderline, then I proceed with caution.” Headwise Volume 2, Issue 1 Jim Distasio
There is a new article just out on a theory: that bipolar and migraine both have, as an important component, inflammation: cytokines, part of the inflammatory process, are involved. They feel that possibly if we attack the inflammation we may help both conditions.
I was convinced before that inflammation, and the immune system, were crucial in migraine pathogenesis. I did a large article on the immune system, cytokines and helper/suppressor cells, in the journal Headache. That was about 1988. We actually found that those with migraine have higher helper to suppressor cells, somewhat the opposite of AIDS patients; therefore, once people have full blown AIDS, they can’t mount an inflammatory response, and theoretically their headaches should be better. There is actually evidence for this(a German study), but AIDS pts. get headaches from other causes.
I have published on bipolar(the immune articles and bipolar are on this site, Archived Articles), and there is evidence that inflammation may also be important in depression, as well as pain/headaches.
A major challenge will be to find safe treatments that influence the immune system; we do not want to use cortisone, due to the side effects, particularly long-term. Most immune-influencing drugs have long-term side effects, but not all. Further research in this area may lead to better treatments.
Along these lines, research into glial cells, the modulating(regulating) and supporting cells of the nervous system, has been accelerating. Glial cells influence the immune system, and are an important newer target for drug development; not just for headache, but for depression, and maybe multiple sclerosis and other CNS diseases.
For comments, doclarryrobbins@aol.com
Refractory headache basically is “what to do for difficult, frequent headaches when things have not easily worked”. I started the Refractory Headache Section of the American Headache Society 11 years ago; we have spent a decade defining refractory headache(my new article, a 10 year study on refractory headaches using a unique refractory scale, is on homepage here on this site, and is open access on The Journal of Headache and Pain).
There are many subsets to the topic of refractory headaches: refractory to preventives and refractory to abortives…..adolescent refractory headaches….refractory in older folks(after age 65, for instance)….pathophysiology(or, what is going on in the nervous system in refractory patients..including neuroimaging, such as fMRI and DTI)….Treatment, both inpt. and outpt(I have published extensively on these options, some of which is on this site…opioids/MAOI’s/Botox/Stimulants/Daily Triptans)……and the role of medication overuse. Medication overuse must be distinguished from Medication Overuse Headache, which is much different..some overuse the meds but do not have rebound, or withdrawal, headache from the drugs/caffeine overuse. More on this later on…
For comments, doclarryrobbins@aol.com
Just released research indicates that middle-aged women are approximately 40% more likely to become depressed if they have migraine headaches.
The study, conducted at Brigham and Women’s Hospital, Boston suggests that the risk of depression stays raised even if the pain stops. “For women at least, migraine is a risk for depression.” “But there’s no good biological reason why the link would not apply to men,” says lead author Tobias Kurth, M.D. Previous research suggests that the risk of depression rises as the severity of migraine increases. Kurtz said he and his colleagues will address that issue in the future.
Jason Rosenberg, M.D., director of the Johns-Hopkins Headache Center who was not involved in the study said “Its been well-known that migraine and depression occur together much more commonly than can be explained by chance.” However, Rosenberg cautions that the participants in the study were over the age of 45. ”Most women develop migraine when they are well under 40.” ”An older population could skew the results one way or the other.”
While there is no simple explanation for a migraine-depression relationship, frequent migraines may bring on depression by lowering a person’s quality of life, and biological factors may be involved as well….. CNN.com 2/22/12 Matt McMillen
For some people whose migraines are triggered by certain visual patterns, precision-tinted glasses seem to help. According to Jie Huang, associate professor of radiology at Michigan State University, people who have migraine, accompanied by “aura” such as flashes of light may benefit from the glasses. In a study Huang led, patients looked at various “stressful” patterns wearing three different pairs of glasses. Patients with a history of migraine felt less discomfort when looking at the patterns through the precision-tinted glasses.
A company called Axon Optics applies a rose-colored tint called FL-41 to eyeglasses. The tint works to block the wavelengths of light that can trigger migraines and can be added to most eyeglasses. The company’s website is www.axonoptics.com/natural-migraine-relief-products/….. Cephalagia
The department of pediatrics at a hospital in France recently published results from a study of children and adolescents looking at the prevalence, and type of migraine triggers. In 100% of the patients studied, at least one migraine trigger was reported by the patient and/or was the parents’ interpretation.
The most common trigger noted was stress, reported by more than 75% of the patients. Lack of sleep followed with 69%, and warm climate posted at 68% of the patients studied. Playing video games ranked 4th in most common migraine triggers, with nearly 64% of the patients reporting it triggered a migraine.
While playing video games may not be a common trigger for adults, stress and lack of sleep are frequent triggers for children, adolescents and adults….. The Journal of Headache and Pain 2011
We hear discussion regarding migraine triggers all the time. Why do they start and why do they stop? Hormonal fluctuations, stress, and barometric changes are just a few triggers of migraine onset. Recently however the question “how does migraine stop?” was posed to several leading headache specialists. While understanding that drugs can bring about the end of a migraine attack, the investigators wanted to know if there is a “natural” conclusion to a headache. Are there triggers of termination? Robert E. Shapiro, MD, PhD at the University of Vermont believes the end of a migraine attack is the final round in a sequence of events rather than the subsiding of the initialed triggered circumstance. Sleep is the most common terminator of headache. Reports dating to Hippocrates suggest that taking a nap can resolve a headache. Vomiting is also a termination trigger. Dr. Shapiro points out that sleeping and vomiting can particularly help children with headache.
It seems likely that migraine termination is an active process, and is not related to the events that triggered the attack…. Headache The Journal of Head and Face Pain January, 2012 Andrew H. Ahn, MD, PhD; K.C. Brennan, MD
For many migraineurs, the headaches they experience do not always feel the same. At times one may feel a dull, generalized headache that occurs with aura. At other times, the migraine may be felt on one side of the head, but it throbs, and nausea and vomiting are also present. John Rothrock, MD at the University of Alabama explains that the symptoms of migraine can vary for each person, and that there may be a progression of symptoms with each attack. Consequently, if migraine is allowed to advance unchecked it can become tougher to treat.
Stopping the headache in the early stages or “right away” can be most effective. However, for many people, headaches may escalate even with early intervention, and additional therapy may be needed. For others a “full-blown” headache may appear after waking up… consequently the therapy used may be again different.
As Dr. Rothrock suggests, the concept of “stratified” care acknowledges there is a dynamic nature to migraine… that each attack can evolve and build into a more severe attack. By selecting a therapy based upon the intensity and symptoms, you will hopefully be able to better control your migraine attacks…. Headache The Journal of Head and Face Pain January, 2012
