10 Highlights from the past 3 Months (May 2016 edition)

Quite a variety of posts were your favourites over the past three months. Here they are, in case you missed any, listed most popular first. The three in bold text also had the distinction of most likes on Facebook.

  1. Migraine Brain Attack: Just How Serious Is It?
  2. What Does Tinnitus Sound Like?
  3. Are You Taking These Common Medications (that could hurt your brain?)
  4. Chronic Migraine: Losing the Ability to Control Pain
  5. Why Headache Patients Are Running from Esomeprazole (Nexium) and other “Heartburn” Drugs
  6. Thyroid Headache
  7. Silent Migraine Symptoms – Should I Be Worried?
  8. Migraine as Virtual Reality (Don’t Miss This Video)
  9. Nose Powder for Migraine? Why Would I Want That?
  10. RhinoChill Cools the Brain and Body – Could it Stop Migraine Symptoms?
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Giving Yourself Injections (Poll Results)

Have you ever had to give yourself an injection? I have. Not fun.

That was the question in our most recent poll, and here are the results:

Self-Injections Poll ResultsOver 55% of you said “yes”. And I’m sure many of those would be talking about multiple injections.

Taking medications via a needle is a common method to stop a migraine attack after it starts. Medications such as sumatriptan and dihydroergotamine may be injected to get the medication into your system faster.

The downside is that a migraine patient may be more sensitive to pain, and may be suffering from nausea, and using a needle may be a very big deal.

But medical technology is starting to give us other options. Some delivery systems may be almost as good – or as good – or even better than injections.

Take for example nasal sprays and nasal powders, needle free injection systems, and skin patches.

If you find injections helpful, but very difficult to do (due to the pain, or other reasons), talk with your doctor about some of the many options out there.

While you’re here, check out the right side bar of the website for the latest poll!

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Thyroid Headache

On the one hand, the existence of thyroid headache is obvious and intuitive. But once you start looking into treatment, things get more interesting.

The thyroid is a part of the endocrine system, a system which puts regulated amounts of hormones in the body. We often think about the relationship between reproductive hormones and migraine, but there are many changes in the body which can trigger migraine attacks, or which can be related to other types of headache.

Thyroid HeadacheAnybody – babies, men, women, teens – anyone can have a thyroid dysfunction (the symptoms can be different – see this example of hypothyroidism). There are various types of dysfunction, though the most common is hypothyroidism – an underactive thyroid.

Sometimes headaches, often tension-type headaches, will progress right along with problems with your thyroid. A properly treated thyroid condition will clear up the headaches as well.

But thyroid and headaches can have a more complicated relationship. Just because you have a thyroid condition and headache, doesn’t mean you have thyroid headache. Thyroid problems can also be comorbid with headache and migraine. That means that someone with a thyroid condition is more likely to also have migraine, or tension-type headache. Treating the thyroid condition may be a part of the solution. But although the diseases may be related, and even have a common basis, they may need to be treated independently.

Should I be Concerned about Thyroid Headache?

Although many doctors may present diagnosis and treatment of conditions such as hypothyroidism as an open-and-shut case, it’s not always so easy for someone struggling with headaches. Why?

For one thing, anytime you’re dealing with more than one disease, things can get very complicated. Take for example what Jean, a HeadWay subscriber, wrote:

I have been a sufferer from many years, but since being diagnosed with Hashimoto’s [a form of Hypothyroidism] and subsequent treatment for that, attacks have skyrocketed out of control leading to being hospitalized frequently. Doctors now agree that the thyroid treatment is responsible for these attacks and are really at a loss how to proceed. At the moment I’ve stopped the thyroid treatment which I know can only be a short-term measure…

Yes, it is possible for the treatment to trigger more headache attacks (this may be temporary).

Also, because the thyroid can affect so many parts of the body (and so lead to symptoms such as depression, weight gain, poor concentration, dry skin…), there could be a number of other things causing the symptoms. There is some debate, for example, about the need to do more than just the standard test (a TSH test). Testing free T3 and free T4 may also smoke out related conditions that could be triggering headaches and other conditions.

A number of specialists recommend at the very least the free T3 and free T4 tests along with the TSH test, but even here there is debate about how to interpret the results. If you’re concerned about thyroid and headaches, consider seeing a specialist who has experience treating both.

It is very important for migraine and headache patients to think in terms of whole-body health, because every system in the body is inter-connected. Be aware of, keep track of, and tell your doctor about, “smaller” symptoms that you’re noticing (such as dry skin, heavy menstrual bleeding, difficulty concentrating). These things could help your doctor diagnose something that could have gone unnoticed.

Be aware that what you eat, medications you take, your lifestyle, hormonal changes – all these things could have more of an impact on your health than you realize.

Dr. Robert Cowan says it well in his book The Keeler Migraine Method, talking about “Health Maintenance”:

This catchall phrase gets bandied about a lot in health care circles and the popular press. The concept is quite simple: it means taking care of yourself and not doing stupid things to your body. Of course, this is easier said than done. In addition to the migraineur’s responsibility to be self-aware, vigilant, and mindful of the things that can make headaches worse, health maintenance also simply means living a healthy life. Most headache sufferers report that their headaches get worse when they have the flu or some other chronic illness, but other, more subtle health issues, such as thyroid problems, vision problems, or chronic stress can also exacerbate headaches. Regular checkups with your primary care physician are important for this reason, if not others.

In other words, an important approach – but not always so easy!

For more information

A great overview is this short article on thyroid headache and other migraine/headache connections. For an in-depth overview, check this article from the University of Maryland Medical Center on Hypothyroidism.

For some discussion of free T3 and free T4, check out these articles:

Also, be sure to check out What Your Doctor May Not Tell You About: Hypothyroidism: A Simple Plan for Extraordinary Results which discusses free T3 and other levels to test, as well as important related topics such as migraine. Also – similar title, different book – the extremely highly rated Living Well with Hypothyroidism: What Your Doctor Doesn’t Tell You… That You Need to Know.

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Botox recommended for Chronic Migraine, says American Academy of Neurology

The American Academy of Neurology has officially come out in support of Botox, or onabotulinumtoxinA, as a treatment for chronic migraine.

In last week’s print edition of the journal Neurology, new guidelines were released for the use of Botox for chronic migraine, and certain other conditions. The strongest evidence was for Botox as way to increase the number of “headche-free” days for patients with chronic migraine. But there was also moderate evidence that it could improve overall quality of life, as affected by the headaches from chronic migraine.

Practice Guideline Update Summary on BotoxOn the other hand, the AAN is not recommending Botox for tension-type headache (even it it’s chronic) or for episodic migraine.

In other words, if you’re considering Botox, make sure you’ve been diagnosed with migraine, and that you have at least 15 days a month with a migraine attack.

These recommendations are not suggesting that Botox is the first treatment to try or the best treatment for chronic migraine. However, it is another treatment that’s worth trying to decrease headache days.

If you’re thinking of trying Botox, be sure to check out How to be Safe with Botox (10 tips).

Here’s the summary sheet of the updated Botox guidelines from the AAN (pdf).

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Why You Should Not Accept the “Stress” Diagnosis of Migraine

The doctor confirms what you suspected – you’re “stressed”, and that’s why you’re getting all these “headaches”. No worries, the exams will be over soon . . .

During the recent World Migraine Summit, I mentioned in my interview that we should be very cautious about accepting the “stress” diagnosis when it comes to migraine. This caused a few raised eyebrows, since “stress” is often at the top of the list for migraine triggers and reducing stress is a constant theme in migraine treatment. So what was I talking about?

First, I need to stress (no pun intended) that I am not saying that there is no relationship between stress and migraine. It’s pretty clear that there’s a connection – perhaps multiple connections.

But just what is the connection?

Migraine-Stress Link: Not so clear?

Stress does not equal Migraine!Today I spent some time again reviewing trials and papers related to migraine and stress. In spite of the fact that researchers can claim multiple clinical trials relating stress and migraine, there’s a danger in thinking that all these trials “prove” that stress “causes” migraine, or that stress “triggers” migraine attacks. Now we know that the “cause” of migraine is much more complex than stress. But neither can we jump to the conclusion that it’s “stress” that is triggering our attacks, even though that could be the case sometimes.

Let’s say that patients with more migraine experience more stress. Is the stress triggering the migraine, or is the migraine triggering the stress? Could be both!

Let’s say that more stress tends to precede a migraine attack. Why? Because the stress triggers the migraine attack? Or are there other factors going along with the stress that are actually triggering the attack (late nights, more coffee, irregular mealtimes)? It’s not an easy question.

Some of the studies include things as “stress” that you might not expect. For example, are hormonal changes “stress”?

How exactly do you decide what stress is, and how do you measure it? What if biological differences in the brain of a migraine patient actually make them more aware and more sensitive to stress (as this study suggested)? In other words, the same amount of stress in person A may trigger and attack in person B because person B’s brain is wired differently (they have migraine disease).

This might explain another study that found there weren’t as many stressful events before a migraine attack as you might think. Could it be that the same stresses are worse for the person who already has migraine – or that the early symptoms of migraine (before the headache begins) simply add to the stress?

Some researchers point to successful anti-stress lifestyle changes. More sleep, better eating habits, coping skills, exercise – but wait. Do these things help because they lower stress? Or is there another reason?

None of this proves, either way, the affect of stress on migraine. But it does suggest there could be a complex web of relationships – going both ways.

And it could very well be that the relationship comes from the disease, not the disease from the stress.

A couple of years ago a report made the headline – “proving” that stress caused headaches (the very fact that this made headlines may point to the doubts that many people still have!) (see “Proof” that Headaches are caused by Stress?). The large study showed that increased headache correlated with increased stress. People with more headaches were more stressed. Ya think?!

Dr. Todd A. Smitherman from the University of Mississippi says it well:

Problematically, the overwhelming majority of studies on stress as a headache trigger have relied on either retrospective or prospective patient reports of stress. What is needed are experimental studies that directly manipulate stress, measure resulting physiological changes, and try to link these changes to subsequent headache activity.

So we need to give people controlled amounts of stress to really see the relationship. Do you see why more studies haven’t been done?

Patients and Doctors Speak Out

Why is this such a problem? The problem is this – patients and doctors are missing important problems that could be solved because they are saying that it’s “just stress”.

Take for example this example from journalist Jo Waters, who was investigating the stress-diagnosis relationship (The doctor says you’re just stressed. But could it be more sinister?):

Some patients dismiss their symptoms as stress too … Jade Smith – another patient I’ve interviewed for the piece above – admits she put all her symptoms down to stress – even though she was in constant pain from head to toe. The problem was that she was going through a stressful time at work so stress seemed to be the obvious cause of all her ills. Later though when her symptoms of depression lifted she was still left in pain. When she mentioned it to her doctor he diagnosed fibromyalgia. [source]

Think of the pain that could have been saved!

Sadly, patients often miss the real diagnosis – and/or the most effective treatment – because they are putting their symptoms down as caused by stress.

AngelinaB commented here, saying her doctors kept telling her it was “stress” and “depression”. When she started keeping a diary, she found no relationship.

Winny said her doctors were missing her cancer diagnosis:

Have had the same thing happen to me with a cancer diagnosis. Not only was I stressed but I was deemed (literally) hysterically wanting a hysterectomy because I calmly and clearly stated something was “wrong” because of many many issues. I was told that I needed to take a “vacation” from gyno doctors for a couple of years. In 2 years I was in the kind of shape you could not mistake my problems.

Just take a vacation? Really?

And consider this patient who only found relief as a POW!

Neurologist Dr Giles Elrington from the National Migraine Centre in the UK has said:

If I had a pound (£) for every patient I see who is told their headache is down to stress, I’d be a rich man. Saying headaches are just down to stress won’t do. While stress, or the let-down period after stress, can trigger migraine attacks, it occurs in only 10 per cent of cases. The reality is that there are lots of other triggers, including dehydration, skipping meals, lack of sleep, disruptions to the body clock, poor posture and hormone changes — yet these are often overlooked.

A Balanced Response to Stress

So what do we do with all this information?

First, we do not accept the “it’s just stress” “take some time off” “wait until exams are over” “any problems in your marriage?” “calm down” “it’s your female emotions” “it’s just your personality” “try to cope better” diagnosis.

Instead, keep looking for other causes and triggers beyond stress.

AND ALSO consider behaviours that can reduce stress and help your body better handle stress – and give you other benefits. Absolutely – regular exercise, good sleep habits, a good diet, avoiding destructive thinking – these are almost certain to provide a benefit!

At the same time, chances are that you would still have migraine attacks if you lived on a beach (with excellent sunglasses) sipping coconut milk and listening to your favourite music all day. It’s not just stress.

Keep looking for other triggers, other causes, other treatments.

If your doctor keeps prescribing vacations after a 1 minute interview, find another doctor.

Is stress related to migraine? Of course. But if we overblow the relationship, we will miss some very serious problems that could be solved.

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