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

Now’s your chance to catch up on posts you may have missed. Here they are – the 10 most popular with you, guests to this website.

As usual, the three in bold text had the most “likes” on Facebook. But this time there was no competition – the post below about the progression to chronic migraine had far more likes than the other two. So you might want to check that one out if you’re dealing with chronic migraine, or know someone who is.

  1. Are You Taking These Common Medications (that could hurt your brain?)
  2. Chronic Migraine: Losing the Ability to Control Pain
  3. Thyroid Headache
  4. Sore Muscles? The Migraine, Headache and Depression Connection
  5. Doctors: Use This Tool To Diagnose Chronic Migraine
  6. “Coming Out” As A Migraine Sufferer (and why we don’t)
  7. Migraine With Aura – Less Blood Flow – Less Thinking Power?
  8. So You Still Think Emotions “Cause” Migraine?
  9. Stabbing Pain In Head: What’s the diagnosis?
  10. Yes, Children Get Cluster Headache Too
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Diagnosing Children with Vertigo, Dizziness, Balance Issues…

Although medical professionals have dealt with balance issues in children for a long time, the focus has probably always been more on adults. But there is a growing acknowledgement that dizziness, vertigo, and other balance issues are very important to diagnose in children as early as possible.

As with many conditions, vestibular disorders not only cause problems in the present, but also in the future. Developmental problems and learning disabilities are two of the issues that commonly go along with vestibular disorders in children. That means that they may suffer both physically and mentally, not to mention emotionally, if the problem is left undiagnosed.Balance, dizziness and vertigo in children

There are many tools that specialists have today to help them come to an accurate diagnosis. For example:

  • Questions: Talking with the doctor, and filling out questionnaires, can help the doctor understand medical history, family medical history, and related conditions (such as already diagnosed hearing loss). This step is critical.
  • Simple clinical examinations: This includes basic testing such as having the patient stand with eyes closed and hands across their chest, or having the patient walk with eyes open or eyes closed.
  • Rotational chair testing: This test places the patient on a chair which rotates at a certain speed. Special goggle measure eye movement after the spinning stops.
  • Electronystagmography (ENG) Testing: Also used to measure eye movements.
  • Video Head-Impulse Test (vHIT): An increasingly useful and easy test where goggles are places on the child’s eyes to measure eye movement. This, as with many tests, helps measure inner-ear problems.
  • Hearing tests: A number of tests can be done for children and even infants. In fact, some doctors recommend that all newborns be tested for hearing loss.

These and many other tests can help narrow down the source and related issues to vestibular problems in children, such as loss of balance and dizziness.

Once all the tests have been done, what is the likely diagnosis? There is no one dominant diagnosis, but the most common is actually migraine. Child migraine may not look like adult migraine, and balance problems may be the only symptom you notice. But diagnosing and treating early can help avoid a host of problems.

Other common diagnoses:

  • Benign paroxysmal vertigo of childhood: Also very common, and often difficult to differentiate from migraine.
  • Inner ear malformations
  • Visual disorders
  • Head trauma

This is not an exhaustive list.

If you suspect balance or dizziness problems in your child, it’s very worth it to have them tested. The purpose of this article is not to give all the possibilities, but to give you some idea of the types of testing that may be needed.

Many parents may be concerned that testing will lead to unneccessary prescription drugs. The reality is, although parents need to be wise and cautious, there are many excellent treatments for dizziness and vertigo that can help avoid problems with learning and development, as well as further disorders down the road.

Sources and resources (for doctors and patients):

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Migraine Treatment: Vestibular Rehabilitation

If you suffer from dizziness, vertigo, or a feeling of imbalance, you might benefit from vestibular rehabilitation. Vestibular rehab will probably be a part of your overall treatment if you have dizziness or similar symptoms as a part of your migraine disease.

The word “vestibular” in this case refers to issues relating to balance, in particular related to the inner ear. But that doesn’t mean that there needs to be a structural problem – or anything visible at all, that is causing balance problems.Vestibular Rehabilitation Can Help!

Vestibular symptoms can extend beyond just dizziness and/or vertigo, to include:

  • nausea
  • visual disturbances
  • headaches
  • neck stiffness/pain
  • anxiety/depression

So what does vestibular rehabilitation involve?

This is one of many helpful migraine-related treatments that can be given by a physiotherapist. Vestibular rehabilitation therapy involves specific exercises depending on your condition and medical history.

For example, if your doctor has identified an actual inner ear issue, some exercises will help to counter that problem. If you experience more dizziness when you’re moving around, certain exercises will help with that.

Sometimes treatments are categorized in three groups: habituation (treating problems related to motion or visual stimuli), gaze stabilization (treating problems related to eye movement, or to compensate for other problems), and balance training (improving general steadiness).

Some exercises may actually help to “heal” your condition. But many vestibular problems are permanent. So many exercises can actually counteract the problem, or compensate for one deficiency by using other senses.

Because the exercise program can be so complex (though not difficult) and based on your specific condition, medical history, and even family history, it is best to see an expert rather than just doing a search on YouTube.

However, if you have already been diagnosed and discussed your condition with a condition, there are some basic exercises that may help. Be sure your doctor has checked to rule out other treatable causes of your symptoms, and that you’ve discussed the exercises with her.

If your exercises make your dizziness continually worse, you encounter hearing problems or a feeling of ear fullness/pain, or you have significant back/neck pain, stop the exercises and see your doctor right away.

For more information, including exercises to try, check out:

Vestibular therapy can be an important part of your migraine treatment. If these types of problems are ignored, other treatments may be less effective. It will be harder to be mobile, to eat properly, and to have a generally improved quality of life.

If you suffer from imbalance, talk to your doctor. There are good treatments available.

For more information:

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What causes the symptoms of a concussion?

Confusion, sensitivity to noise, drowsiness, headache – these are some of the symptoms that may occur minutes, or even days, after a concussion. But exactly what causes concussion symptoms?

Concussion is a type of brain injury usually caused by a blow to the head, although it can be caused by any whiplash-type motion, even if the head is never touched. This is another way to see that helmets protect the skull, but can never give 100% protection against concussion.

A concussion is not structural damage that can be seen in a typical CT or MRI scan. The damage actually goes down to the cellular level.

Brain tissue is very soft – think soft butter. When the brain tissue is pushed against the skull, or suddenly twisted, the brain cells themselves can twist and tear.

Cells are like little factories, with highly developed communication systems tying them together. When the little factory is damaged, a number of things can happen.

For example, important materials may “leak” out of the cell, no longer properly contained. Communication between cells may break down. Normal balance is lost. And those little factories go into high gear to try to get everything working again. They may start to produce more of certain things that your brain may have trouble dealing with, such as free radicals or inflammation.

Clean upThink of a city after a war, or riot. Bricks are lying everywhere. Normal communication is broken down. There may be looting. But hopefully most citizens are trying to get things back to normal. Meanwhile, nothing is normal. Buildings may not be recognized. Family members may not know where other family members are. There are gas leaks, fires, and broken pipes.

Sometimes things that should be helping can cause other problems – a fire hose causing flooding in a nearby room, police cars blocking roads.

Remember that this is all happening on a cellular level. It’s incredibly complex, and it’s not easy to see what’s going on from the outside, which is why it’s taking researchers so long to understand the details.

Usually, the brain regains its normal function within a couple of weeks. However, there may be parts of the injury that do not resolve. This can lead to long term problems, such as post concussion syndrome, or chronic traumatic encephalopathy (CTE), a condition occurring late in life in people who have had repeated brain trauma (such as people who played contact sports).

Though we still have a lot to learn about concussion, we’ve come a long way in the past few years. Understanding what is going on in the brain after a concussion is helping with the development of new treatments.

For example, if there are too many free radicals in the brain, could we use antioxidants (as a patch or oral supplement) to clean things up faster, and maybe avoid long term issues?

Meanwhile, if you get a concussion, see a doctor. Be sure to rest and stay away from computer screens and heavy mental activity for three days. Let your doctor know if new symptoms appear, or if some don’t go away.

More tips here: What Should You Do If You Think You Have Had a Concussion?

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Medication Overuse Headache: Overrated?

Everybody is talking about medication overuse headache (MOH). There is a big push to cut down on drugs and to find alternatives. But is it possible that we’re over-emphasizing the problem?

At last month’s meeting of the American Headache Society in San Diego, organizers set up a discussion on the topic – is MOH actually a thing?

Ok, the thesis was “Medication Overuse Headache is a Proven Entity” – true, or false?

Taking opposite sides were Dr. Richard Lipton (“true”) and Dr. Ann Scher (“false”) (two experts who have actually worked together on a number of projects in the past).

The discussion is, of course, a lot more nuanced than that. Just what is MOH? What medications can cause MOH? How much of a certain drug is too much? Are there permanent consequences to MOH? Or is it easily resolved?

Medication Overuse Headache: How big is the problem?Dr. Scher brought up an important point. Common current advice is to limit abortive medication to 2x per week or less. Medications that should especially be avoided include opioids and butalbital combination medications. So the question is – How many are being harmed vs helped by this advice?

That is the bottom line, right? Whatever the details may be, is the current focus, the current common advice, actually helping patients?

For example, is it better to take a little too much (no, we’re not talking about multiple doses per day here), or to completely quit the medication?

Few would disagree that MOH exists in some form, but there is not equal evidence for every medication.

Dr. Alexander Mauskop, who kindly reported on this discussion for us (see The existence of medication overuse headache is debated), actually advocates the use of daily triptans for a few patients. Other doctors would be horrified by the thought.

The heart of the discussion really isn’t whether or not medication overuse headache actually exists. The question is – where is it really a problem, and how can it be treated? And the truth is, we have a long way to go before we’ll have good answers to these questions. It’s good to see the discussion moving forward.

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