Do “Pain Diaries” Slow Recovery?

Everyone knows that you should keep a headache diary in order to better understand your symptoms and triggers, right? Or – could this practice actually make things worse?

Pain diaries are actually used for many different conditions, and they’re used for different reasons.
Pain diaries
What if these diaries were actually increasing our perception of pain? Or our fear of pain? What if, instead of making things better, they were making things worse?

Dr. Robert Ferrari has done some research into the use of pain diaries for chronic pain. In a study published in 2010, it was found that patients who completed a daily questionnaire seemed to have worse and more frequent symptoms than the control group.

Last year a new study came out, focusing on recovery from lower back pain. After three months, 79% of the control group had recovered, while only 52% of the “diary group” had recovered.

Are diaries making the symptoms “seem” worse? Or are they actually making things worse?

It’s tempting to make a comparison here with headache and migraine diaries. But the reality is, the purpose of a headache diary is more than just letting your doctor know how disabled you are, or how intense your pain is.

What is a headache diary actually for?

  1. It helps you identify symptoms. Headache disorders can be difficult to diagnose properly, and can be accompanied by a host of unexpected symptoms. Keeping a diary helps prevent misdiagnosis.
  2. It helps you identify triggers. If you find that your headache symptoms come once a month, or every spring, during most thunderstorms, or often after that glass of wine – that can help you better fight the attacks.
  3. Yes, diaries can also help doctors and patients understand the intensity of the pain and level of disability from pain and other symptoms. This helps with decisions about treatment as well.
  4. These diaries can also help others understand migraine disease and headache disorders. They can help with future research.

In the case of headache and migraine diaries, the information can be a big part of the solution. Even if they make you “notice” your pain more, the long term benefits can be tremendous.

That being said, it may not be wise to keep a diary every day for a lifetime. When things are stable, sometimes it may be better to set the diary aside, at least for a time.

But in general, the benefits seem to outweigh any issues for most patients.


Migraine: Doubling the Risk of Stroke?

It isn’t news that migraine patients are at increased risk for stroke and cardiovascular disease. We’ve been talking about it for many years (check out Migraine and Heart Disease: 7 Critical Things to Know Now).

Migraine: Doubled Stroke Risk?But w’re still a surprisingly long way from understanding the relationship.

In the new book, Headache and Migraine Biology and Management, edited by Dr. Seymour Diamond, Dr. Michael Star and Dr. José Biller summarize the relationship between stroke and migraine with aura in particular.

The estimate is that people who have migraine with aura have roughly double the stroke risk of the general population. If they also smoke, the risk is tripled. If they smoke and use birth control pills, their risk is septupled (that’s seven times the risk – I was just looking for an excuse to use the word “septupled”).

Of course there are various types of stroke. Ischemic strokes, caused by blood clots in the brain, are the most common. Hemorrhagic strokes, caused by bleeding in the brain, have also been linked to migraine (see Increased risk of hemorrhagic stroke in patients with migraine: a population-based cohort study. from 2013).

But why the increased risk? Some theories:

  • Biological differences in the body of a migraine patient, such as low levels of high-density lipoprotein (HDL – “good cholesterol”) and high levels of c-reactive protein.
  • A genetic connection between migraine and stroke.
  • Migraine medications that increase the risk of stroke (a concern with triptans, although this remains controversial).
  • The migraine chain-reaction itself may trigger a stroke (for example, migrainous infarction.

Although a lot of research has been done, we still have a long way to go. The very fact that we have no obviously dominant theory may tell us that there is a complex web of reasons why migraine and stroke are related.

Once again, although “double the risk” sounds scary, the risk is still low. If you maintain a generally healthy lifestyle, your risk is still low even though you suffer from migraine.

Still, it is something that needs to be considered as you try to find a balance in your treatment.

via: People Who Suffer Migraine Headaches May Be at Double the Risk of Stroke


Child Migraine: A Sign of Celiac Disease?

Although many people who do not have celiac disease have still found relief from their migraine attacks from a gluten free diet, a recent study suggests that migraine attacks may actually be a sign of celiac disease in children.

Celiac disease is an immune reaction to to eating gluten, a protein in wheat, barley and rye. It is diagnosed by blood tests and endoscopy, a method to check the tissue of the small intestine.

However, there are early indications of celiac that should tell doctors that these tests should be done. Although there are sometimes few or no symptoms, most commonly people with celiac experience digestive problems. In children, this may show itself as stomach pain and may lead to developmental problems.

Of course, stomach pain may also be a sign of abdominal migraine in children. In the case of celiac, though, the pain will typically strike after eating.

Child Migraine and GlutenIn a 2013 study, researchers found that neurological symptoms may also be an early sign of migraine. A third of the children had neurological symptoms, and the most common was headache and/or migraine.

The full list, most common first:

  • Migraine/headache
  • attention-deficit/hyperactivity disorder
  • epileptic seizures
  • slowed mental development
  • cerebellar ataxia (a type of brain damage affecting motor skills)
  • behavioural disorders

Celiac disease can be very serious in children because of the way it affects their development. It is very important to catch it as early as possible.

There is good news for children with celiac and migraine. When the children went on a gluten-free diet, it helped with the migraine attacks. The same was the case with the epilepsy symptoms.

Although we don’t yet have a standard blood test for migraine, in children it may be wise to test for celiac disease, especially if there are additional reasons to suspect that it may be present.

Study: Celiac disease with neurologic manifestations in children.


Fainting and Migraine Revisited

Some of you may remember the infographic from 2013 about fainting and migraine, a summary of tips for migraine patients.

We could say that there are at least three ways in which fainting is related to migraine:

  1. Migraine patients seem to be more likely to faint in general (that is, not necessarily during a migraine attack).
  2. A patient may actually faint during a migraine attack. Though not common, it does happen.
  3. Patients with certain types of headache disorders (including migraine) are more likely to have fainting spells.

Fainting and MigraineSome patients have headache and fainting spells, and it’s not possible to diagnose them with a specific type of migraine or headache. But patients with migraine with brainstem aura (formerly known as basilar migraine or basilar-type migraine) may experience vertigo or even fainting. In fact, this type of migraine was also known as “syncopal migraine”, the word syncopal refers to fainting spells.

Migraine attacks associated with fainting may in some cases be genetic.

If you or someone you care for experienced fainting spells along with migraine, it is important to do a little research:

  • First, are there any other family members who experience either fainting or migraine attacks, or both? Knowing this will give your doctor important clues as to your condition.
  • If you experience fainting and migraine, it is wise to see a specialist (a neurologist). The two may be related, but it is also easy to misdiagnose your condition. Also, if possible, you do want to get a specific diagnosis, not just “migraine”. What kind of migraine?
  • Sometimes, fainting spells and seizures (due to epilepsy) can be confused. Fainting does not always mean you remain motionless, and seizures are often not the violent ones we all hear about most often. Migraine and epilepsy are related disorders. Again, seeing a specialist will help rule out som serious conditions.

If you find you are feeling faint, or fainting, during migraine attacks, make note of this and other symptoms, and mention them to your doctor. Whether your fainting turns out to be migraine-related or not, there are steps you can take to improve your quality of life. But you do need to do your homework first, to get the best treatment possible.


Child Migraine: Time to Fight for Better Treatment

We’ve talked in the past about how far behind we are in the field of migraine treatment for children. Far behind where we should be, and far behind where we are in treatment for adults.

A new study sponsored by the Migraine Research Foundation has brought the discussion to the forefront yet again.Child Migraine: Better treatment, please.

The study used Electronic Health Record data to see how 40,000 teens and children with migraine were treated. The news was generally not good.

First, of those who were actually prescribed medication, 15.8% were prescribed an opioid. Considering the wide range of treatments available today, and the many problems with using opioids as treatment for migraine, this number is very high. (Note: This is not to suggest that opioid treatments are never appropriate. Only that the evidence increasingly shows that they should be way down the list of things to try. Prescribing so much of this type of medication indicates that treating children and teens with migraine is many years, even decades, behind where it should be.)

It should be noted that opioids were far more likely to be given in the emergency room. Emergency room health care workers may still not be aware of some of the other options available to quickly treat a severe migraine attack.

Next, only 16.1% were prescribed an “evidence based” medication. Again, we’re talking about medication that has good scientific evidence behind it.

Now at first glance, I’m not quite as worried about this statistic. There are many excellent non-drug treatments for children, including biofeedback and supplements. I would not necessarily want doctors to jump to medication first-thing.

However, if I’m reading the numbers correctly, this actually represents 35% of children and adolescents who were prescribed medication.

In other words, the vast majority were not being prescribed the best medication to fight migraine.

Finally, only 46% were prescribed medication at all.

Again, I’m not necessarily worried that doctors are not going to drugs as the first and best option. However, these numbers and years of experience in this field tell me that a good number of doctors are probably telling patients to “just live with it”, when better options are available.

An interesting side note to the study. The researchers compared treatment in metropolitan and non-metropolitan areas, and discovered to their surprise that the doctors in the non-metropolitan areas were doing a better job at prescribing medications with good evidence behind them. So just because you’re in the city doesn’t mean you have better options – that small-town doctor seems to be doing a great job.

It is very difficult for doctors to stay up with the latest research in every area. All right, impossible. This is not an anti-doctor study by any means (and again, there is a lot this study doesn’t tell us).

However, it is a reminder that migraine in children and teens is a serious issue which needs to get more attention. If you’re a doctor, this is certainly something to think about. If you’re a parent, you can focus on your child and take responsibility to make make sure they are getting good treatment.