Better Nerve Blocks for Migraine and Cluster Headache (videos)

As patients have found relief from sphenopalatine ganglion (SPG) blocks, researchers have been looking for ways to make the procedure easier for the patient.

The SPG block is not a new procedure. In fact, as Dr. Alexander Mauskop points out in a recent article (Sphenopalatine ganglion block for migraine and cluster headaches), it was used over a hundred years ago.

Today the research is continuing. Although the SPG block is considered a temporary solution, there is some evidence that there may be a longer term benefit, with some patients reporting that their attacks lessen even after the initial benefit of the block wears off.

But there have been problems with the procedure. Some doctors have used long Q-tips inserted in the nose, but the procedure is uncomfortable and it’s unclear how much medication actually reaches the SPG.

Sometimes needs are also used, and anesthetics.

But new devices are being developed to make the procedure a lot easier and more effective. A device is placed in the nose, and a small spaghetti sized catheter is gently released, getting the medication directly to the SPG with a minimum of discomfort.

Two similar examples are shown in the videos below, to give you an idea how the procedure works. The first is the Allevio (a short patient-friendly video), the second an actual patient with the Tx360, and the third the Tx360 again (a longer video explaining the procedure to doctors).


Child with sore arm = Child with Migraine ?

“Oh, she’s just trying to get out of going to school again.” So in spite of the supposed pain, Emma is rushed to the car and off to school she goes.

But is she really trying to avoid school? Or is the pain a sign of something more physical – like migraine?

Girl in creekWe don’t usually associate sore body parts with migraine, but we should. Migraine patients know that the pain can affect the whole body.

But for some people, particularly children, there may be pain in some location – such as the stomach, an arm, or a shoulder, for example – but no headache at all, or perhaps no headache at the same time.

Abdominal migraine – most common in children, but also happening in adulthood – is well known. There may be no headache at all, but possible stomach pain, no appetite, nausea, and pallor (going pale).

But what about other parts of the body? A family case has been reported – probably a genetic trait – where a child would have recurring pain in childhood which seemed to become more typical migraine in adulthood.

We’re not just talking about any pain, of course. Most children are going to have some kind of pain, often unexplained pain.

But a study from this past September (Familial Migraine Limb Pain Syndrome (MLPS): Three Generations and Seven Year Follow-up) has shed a little more light on this type of migraine pain.

This time, the pattern could be seen in a family over three generations. The syndrome is known as migraine-limb pain syndrome (MLPS), which actually could refer to pain related to migraine or cluster.

Body pain in children - migraine?In these cases, the intensity of the pain varied. Although the pain seemed to follow a migraine pattern (temporary, often accompanied by other symptoms), it did not always occur at the same time as other symptoms.

Here are some of the observations in the study:

  • Pain began as early as age 8, or as late as age 30.
  • It lasted between 5 and 52 years.
  • Pain was one-sided, although the side may change in the next attack.
  • Headache could appear before, during, or after body pain.
  • In adults, some attacks included body pain, but no headache.
  • Most patients experienced some kind of aura at some time. Elderly people had more aura and less severe headache.
  • Common pain sites were an arm, shoulder, chest, and neck.
  • The syndrome could be inherited from only one parent.

Even during attacks of body pain, patients acted like they were having a migraine attack – that is, they wanted to withdraw, and were often pale.

The researchers note that leg pain is also a manifestation of MLPS.

Obviously, studying one family is not a massive study. However, this study is more important than it looks.

Why? Well, we already know that pain in other parts of the body is a common issue in migraine. We also know that many people don’t report – or even think about – pain in their hand or leg when they’re also dealing with migraine nausea and severe migraine headache pain.

So this issue is probably a lot bigger than we realize. And if doctors and patients were more aware, they might be able to catch migraine earlier, and find better treatment. Also, as the researchers note, they could avoid common misdiagnoses (such as pressure on a nerve, myalgic encephalopathy/chronic fatigue, and arthritis).

The good news is that typical migraine treatments seem to successfully treat MLPS.

What kind of body pain have you experienced in connection with your migraine attacks? How long did it take for you to find a proper diagnosis?

Read more at Medscape: Limb Pain May Be Unrecognized Manifestation of Migraine


10 Highlights from the past 3 Months (November 2015 edition)

Daith piercings, sleep masks and hypnic headache – all in the top ten posts from the last three months. Check out the ones you might have missed – especially the ones in bold, which were the most “liked” on Facebook.

  1. Why You Should Ignore the “Daith Piercings for Migraine” Hype
  2. Headache Waking You Up? Could Be Hypnic Headache.
  3. Sleep Master: A New Kind of Face Mask to Help You Finally Sleep
  4. Warning Flag: Do you have non-headache pain?
  5. What Triggers New Daily Persistent Headache?
  6. Drug Shortages: Good News Turning Into Bad News
  7. Is this Study a Step Closer to Migraine Blood Tests?
  8. Don’t Tell Me “It will make you stronger” (but it might)
  9. Does Vegetarian Cheese cause Migraine?
  10. The Colour of Migraine?

Perforated Septum Head Pain?

Is it possible to have perforated septum head pain? Is a perforated septum actually causing your headaches – and should you be looking into surgical solutions?

Nose holes

Photo courtesy Enokson

We’ve talked before about a deviated septum (see Is a Deviated Septum giving you a headache?). But what about a perforation?

Your nasal septum is, of course, that bit of cartilage between the right and left parts of your nose. And it’s not just there to make you look beautiful or hold up your nose. Your nasal septum helps the air flow properly from the tip of your nose to the back, where it gets carried to the lungs. A well functioning septum helps your nose stay clear and keeps air moving where it should.

However, some people do develop holes in the septum. They might not even notice, depending on the size and location of the perforation.

This hole might be caused by complications from surgery, cocaine use, certain diseases, or even excessive nose picking (more common than you think!).

(Yes, there can also be a direct perforation caused by a nasal septum piercing for a nose ring. I’m not getting into that – daith piercings was enough for one month – but do your research about the risks, and proper care after piercing. A small nasal septum piercing may close entirely on its own eventually.)

Again, there may be no symptoms at all, or they may be minor ones. Commonly examples of symptoms – nose bleeds, crusting, and nasal obstruction (including a “stuffy nose”).

You also may experience pain in your nose.

Although it may not be common to get headache directly from a perforated septum, obstruction and pain in your nose would likely trigger a headache attack.

So yes, it’s probably entirely possible to have perforated septum head pain. But that doesn’t mean that the perforated septum is the only trigger – it may be a combination of factors that triggers your headache or migraine attack.

If you are experiencing significant symptoms from a perforated septum, you are entirely justified in connecting that with your head pain. So yes, it is worth talking to your doctor about possible solutions.

Your doctor may recommend you simply try regular rinsing with salt water, and applying lubricating gels. This may be enough to ease the problem.

Surgery is an option, but not an easy one. There is a high rate of failure in this type of surgery, and the larger the perforation the harder it is to close.

You are wise to do your research, and find a doctor who has experience in this type of surgery – and who will be honest with you about the possible outcomes.

For more information:


Good News for Children with Vertigo

What causes vertigo in children? Common causes would have to include the inflammatory diseases known collectively as otitis media. Otitis media will often go away by itself, and the symptoms can be managed by mild pain killers. In some cases, antibiotics may be needed. If the disease keeps returning, your doctor may recommend “tubes” in the ears to help drain the fluid. (More about Middle Ear Infections)

But next to that, there are many children who have vertigo which is harder to diagnose. If the eardrums look normal, and there are no inflammatory diseases, what’s the solution?

Well, we have good evidence that the most common cause of this vertigo is migraine. According to one study (see Various causes and clinical characteristics in vertigo in children with normal eardrums.), migraine and benign paroxysmal vertigo of childhood (BPVC) account for over half of the cases of vertigo, the rest being more tricky.

How can this possibly be good news?

Well, catching migraine early in life leads to some major benefits later one. Also, getting a proper diagnosis (as opposed to “just lie down if you feel dizzy… maybe it’s stress…”) can lead to much better treatment.

Child VertigoResearchers and health professionals are still trying to figure out what to do with dizziness in migraine, especially if it is a major and repeating symptom. Sure, we know some clear types of migraine where vertigo is common, but the rest of the cases are harder to classify.

So we have a category that we call “vestibular migraine”. In vestibular migraine, the vertigo is moderate to severe, and it happens multiple times. At least 50% of the episodes have some of those common migraine symptoms, such as a one-sided headache. But sometimes the vertigo just comes by itself.

Some of these attacks can last for hours – even days. And if the symptoms are severe (even if there’s no headache), the patient will be completely unable to carry on with normal activities.

But the good news is that these episodes can be treated with typical migraine medications and treatments (which also further confirms their connection to migraine disease).

Last month a report came out of Boston Children’s Hospital, illustrating some of their experience with children with vertigo, and in particular vestibular migraine (Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic.).

When the patients tried the following medications (all of which are drug types used for migraine), 80% or more were successfully treated:

  • tricyclic antidepressants
  • cyproheptadine (an antihistamine)
  • topiramate
  • triptans

Gabapentin, which is an anticonvulsant, was also used. It was effective in 25% of cases.

If your child complains of dizziness (and possibly nausea), and is also getting some headaches (not necessarily at the same time), talk to your doctor as soon as possible. If there is no obvious ear problem, there’s a good chance that migraine is to blame.

Because any of these diseases (migraine, otitis media, BPVC) can have a major impact on your child’s normal activities and development, it’s very important to get proper treatment as soon as you can.

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