A recently published study explored the unique character of cluster headache in women.  Cluster in women has not been studied a lot because it’s so rare.  In fact, cluster in men is rare, but it’s much more common in men than in women.

So how are woman clusterheads unique?  Here are a few of the findings:

• Women tend to develop cluster at a younger age
• About half the time, symptoms improve with pregnancy
• Women generally don’t respond as well to sumatriptan (nasal spray/injection), but respond better to inhaled lidocaine.  Women tend to be less responsive to preventatives in general.
• Women tend to have more attacks per day
• Cluster attacks are more likely to be triggered by migraine triggers
• Women are more likely to have pain in the jaw, cheek and ear
• Comorbid conditions for women are more likely to include asthma and/or depression
• Women tend to have shorter aura duration than men

The researchers admit that one drawback of this study is that often cluster patients do not get properly diagnosed, or people are diagnosed with cluster when they have something else.  Finding a large group to study is very difficult with a rare condition such as cluster.

To read more of the details, check out Female cluster headache in the United States of America: What are the gender differences?

From the Headache and Migraine News Blog

Cluster Headaches may ease in Pregnancy (and other surprising facts about women and cluster)

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Although the famous ice cream headache (also known as brain freeze, or more officially headache attributed to ingestion or inhalation of a cold stimulus) was first studied seriously almost 45 years ago, it’s still somewhat of a mystery.  But a new study in the USA may be giving us clues not only about ice cream headache, but about other types of headaches as well.

British neurologist Dr. R. O. Smith, began studying brain freeze in 1968.  Since then, there are several interesting facts that have come to light.  For example:

• Brain freeze seems to be more of a problem in warmer climates
• It doesn’t seem that any permanent damage is done
• Nerves in the roof of your mouth seem to trigger changes in blood vessels, triggering the pain
• Migraine patients seem to be more susceptible
• An ice cream headache can trigger a migraine attack in migraine patients

Photo courtesy of Tom Newby Photography

The new study, entitled Cerebral Vascular Blood Flow Changes During ‘Brain Freeze’, confirms the blood vessel theory.

So what seems to be happening?  First, typically, something cold comes into contact with the roof of your mouth.  Quickly, blood vessels dilate (get bigger around), allowing for more blood flow.  In particular, the anterior cerebral artery seemed to react.  This may be a response to ensure that the brain stays warm.

Researchers believe that pain may occur at this point because of the sudden rise in pressure from the increased blood flow.

Soon after, the blood vessel constricts, presumably to keep the blood flow from getting to high.  At this point, the patient’s pain recedes.

This type of headache is an interesting one to study – because it’s easier than most to study in the lab.  You can’t usually sit around waiting for a migraine attack to start, but a brain freeze is easy to trigger.  Because researchers believe that these types of headaches may have a lot in common with migraine headaches and post-traumatic headaches, for example, studies like this may provide clues to help us treat those as well.

For more, read this summary from the American Physiological Association: Changes in Brain’s Blood Flow Could Cause ‘Brain Freeze’.  For more general information about the causes and treatments of brain freeze, see Stop the pain of ice cream headache!

From the Headache and Migraine News Blog

Ice Cream Headache (Brain Freeze!): A New Study

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Using ketamine for pain is not a new idea.  But I think we’re going to see it get an increasing amount of attention in the months ahead.

A few weeks ago, NPR featured a news story on the use of ketamine for depression.  Ketamine, originally developed as a human anaesthetic, has since been used for various applications in medicine.

 It’s also used as an illegal drug, gaining fame as "K", "Vitamin K" or "Special K".

In recent years there has been sporadic interest in using ketamine for pain.  It’s a difficult drug to study, because it tends to be rather obvious that you’ve taken it.

But it has been suggested as a treatment for cluster headache, familial hemiplegic migraine, chronic daily headache, and migraine, as well as other types of pain.

Ketamine is a neurological drug, classed as a NMDA (N-methyl-D-aspartate) receptor antagonist.  It is believed to work in a number of different ways in the brain – relating to calcium channels, serotonin, and glutamate – terms that will be familiar with migraine researchers in particular.  In fact, ketamine has been especially useful in the treatment of headache or migraine that just won’t go away and isn’t responding to other kinds of treatment (refractory).  It’s given as an IV or intranasal treatment.  Of course, this means it’s way down on the list of treatments that will be given – it’s rare and even when it’s tried it’s often not successful.

However, with the growing interest in ketamine for depression, the game changes.  You can bet that there will be increased interest in ketamine for chronic pain conditions, which often come hand in hand with depression.

Although increased interest doesn’t mean this should be the drug of choice for most people, it does mean that more research will be done.  It may be a treatment that will help a few patients whose pain is seemingly unstoppable.

For more on the background of ketamine, read Ketamine and MDARs in the treatment of neuropathic pain from Dr. Jan M. Keppel Hesselink.  For a review of the studies on ketamine for other types of pain aside from headache, read Ketamine in Chronic Pain Management: An Evidence-Based Review

From the Headache and Migraine News Blog

Watch for it – Ketamine for Migraine and More

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In the musical by Meredith Willson, The Music Man, the main character is a con artist named Harold Hill.  Trying to pass himself off as a band leader, he claims he’s developed a new system to learn music, known as "The Think System".  Instead of learning how to hold the instrument, and how to read notes, the musician simply thinks about the music, and the rest comes naturally.

Although there’s certainly some truth somewhere in Hill’s theory, most of us would recognize that there’s more to playing an instrument than just knowing a tune.

At Stanford School of Medicine, researchers are trying to find out just how much we can control chronic pain with the mind.  Now – a clarification.  They’re not trying to figure out if we can ignore the pain.  This is not "just get back to work and ignore the pain like I do".

Instead, they’re theorizing that we could be trained to actually make biological changes in the body to fight pain.

This is, of course, nothing new.  Biofeedback techniques are very common in migraine treatment, and have been very successful.

Here’s what the researchers at Stanford say:

We all consciously and unconsciously control our brain for every activity we initiate, every thought we have, and every emotion or sensation we experience.  Until recently, it has been unclear as to what extent we can learn to control brain activity—more specifically, the activity of specific brain regions–and what impact that control would have on us.  Well-defined regions of the brain are responsible for the perception of pain…

So researchers set out to see if patients could control a region of the brain known to impact pain (the rostral anterior cingulate cortex (rACC)), and if healthy patients and patients with chronic pain could use that control to actually make a difference.

Dr. Christopher deCharms developed software enabling patients to see their own brain activity almost instantly.  They used heat to expose a patient to pain (notice – we’re not talking about so-called "imaginary pain"), and then they gave patients suggestions about how to reduce the pain.

Remember, all this was related to seeing brain activity and learning to control it.  It wasn’t just about controlling pain with the tips from the researchers.

Compared to patients who didn’t have real time information about their brain activity, the patients had 23% more control over pain, and 38% control over pain "unpleasantness".  Meaning that this was not a placebo response.

Those with chronic pain (8 patients) also found they could decrease pain by 64%, showing that this research could have a very practical application – not just for those suffering from pain from something like a recent accident or surgery, but also those who have suffered chronic pain for years.

The researchers recognize, of course, that this was a very small study.  They also need to go to the next step – to discover how long the improvement lasts, and how this could be used to help constant pain.

This is not a cure for chronic pain, but it could help patients to significantly lower their pain without need for drugs.

More on the study:  Learned Volitional Control Over Brain fMRI Activation and Pain

From the Headache and Migraine News Blog

The Think System: How much can we control pain?

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There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics.  Why?

First of all, a number of studies have suggested that many – perhaps most – perhaps even 80%-90% – of these patients actually have migraine.

So chances are you should be taking migraine meds instead of sinus meds.

A study published in Neurology in 2002 (Lipton et al) looked at patients with migraine who also supposedly had sinus headaches.  Patients were given analgesics, antihistamines, and/or decongestants for their headaches.  About half were dissatisfied with these treatments.

These patients then took migraine medication for two of their "sinus headaches" – in this case, sumatriptan.  Surprise surprise, 73% had pain relief within 2 hours.  45% were pain free within two hours!

Antihistamines, decongestants, antibiotics – all big business.  But what if most were being given to the wrong people?

The misdiagnosis likely has to do with the high prevalence of congestion and other sinus headache symptoms in migraine.  Many people don’t realize that congestion is common in a migraine attack, or even nasal discharge.  And many doctors are confused as well.

But what if you’ve had a proper work-up, and you believe you do have a sinus infection?  (More on how to differentiate between a migraine attack and sinus headache here)  Chances are you should still say NO to antibiotics.

Most often, sinus headaches from an infection are due to a virus infection – and a virus infection will not be helped by antibiotics.

A recent study in the Journal of the American Medical Association confirms this in real life.  85 adults with uncomplicated acute sinusitis were given an antibiotic, and 81 were given a placebo.  (see Author Insights: Treatment of Acute Sinusitis With Antibiotics Often Futile)

At 3 days, there was no difference between the groups in quality of life or symptom relief.  At 10 days, there was no difference between the groups in quality of life or symptom relief.  No difference!

In the USA, 1 in 5 antibiotic treatments is given to someone with sinusitis.  That’s a HUGE number of people in one country alone getting a medication they don’t need, that won’t help them!

And those were patients who most likely really had sinusitis.

Now take the few that remain – should we give them antibiotics?  Most likely not.

That’s millions of people with so-called sinus headache – almost all of whom should should NOT be taking antibiotics (or antihistamines, or decongestants…).  And that probably means you, sinus headache sufferer.

In a world where we’re more and more concerned about the personal and worldwide impact of overuse of antibiotics, it’s time we cut those millions of prescriptions.  If you’re not sure, do some research and be sure that you not only have a sinus infection, but an actual bacterial infection (not viral), AND that it’s worth it to take the antibiotics.

Unless you’re in that tiny minority, do yourself and us a favour – get a proper diagnosis, and if you need to take something that will actually help you.

From the Headache and Migraine News Blog

Sinus Headache: Say NO to Antibiotics!

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We know that people start having migraine attacks as very young children.  It’s hard to say if there’s an age when migraine starts, because the younger we are the harder it is for us to recognize and express the symptoms.

I may have had migraine as a child – but I’ll probably never be sure how early, because I just didn’t know what was going on.  I just knew that I "didn’t feel well".  In fact, I didn’t often think it consciously – it just was the way it was.

But a new study raises an interesting question – could colic actually be a sign of migraine in babies?

Parents with Migraine – Babies with Colic

The study simply shows that mothers who have migraine are more likely to have babies with colic.  For the uninitiated, colic is diagnosed when a baby shows signs of distress (such as crying or screaming) for an extended period of time (several hours) for no discernible reason.  Usually it happens at the same time every day, and lasts for several weeks.  [more on colic here]

How much more likely are migraineur Moms to have babies with colic?  Twice as likely – pretty significant.

Genetics and Causes

Fine, but what does that have to do with children or babies with migraine?  Are the babies showing signs of migraine when they have colic?

Maybe – but let’s not jump to conclusions.

We do know that parents with migraine are much more likely to have children with migraine, because migraine has a genetic factor.  It would be interesting to see if these babies grew into migraineurs.

Even if the babies don’t technically have migraine, if we could find the link, we might be able to stop migraine before it starts.  What if (for example), the babies had a genetic mutation that adult migrianeurs also had?  What if they had a defect that could be corrected early on through minor surgery?

Ease Migraine, Ease Colic

If there is a link, could we ease colic in similar ways that we ease migraine?  For example, would a colicky baby do better in an environment with less light and noise?  It may be that finding a link could help not only to stop migraine but ease colic in the first place.

Colic: The Dark Side

The dark side of colic is something we don’t want to talk about.  Colicky babies are also more likely to be shaken – leading to severe disability and even death.  So the question we have to ask is – how can we support parents, who themselves are dealing with disabling symptoms and pain of migraine – when they have a baby with colic?  How can we keep a very difficult situation from getting worse?

For now – the key word is…

This study may seem to raise more questions than it answers – and it probably does.  So for now, the key word is probably support.  How can doctors better support mothers with migraine?  How can we all help parents who are going through this difficult time?

If you know someone dealing with an infant with colic – especially when the parent has migraine – could you give them a little extra help today?

Meanwhile, the study will hopefully lead to more research in this area.  Wouldn’t it be great if we could recognize and treat the next generation of migrianeurs – before they reach the age of 5?

via Babies’ Colic Linked to Mothers’ Migraines

From the Headache and Migraine News Blog

Could we Stop Migraine – At the Start of Life?

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Killing migraine-triggering neck pain – what’s the best way?  A recent study looked at a related question.

Last week we were talking about the pain that comes along with migraine – of which neck pain is at the top of the list..  We also were talking about how other issues – painful issues, such as neck pain, can lead to migraine.  A new study published this month in the Annals of Internal Medicine (an academic journal published by the American College of Physicians) looked at three ways that people dealt with neck pain – and what worked the best.

The study looked at three groups of patients – those taking medication, those using exercise (therapeutic exercise done at home), and those taking chiropractic treatment.

After twelve weeks, here are the results.  The chart below shows the % of patients who experienced at least 75% relief:

The clear winner was chiropractic, with 57%.  Of those taking medication, only 33% found that much relief.

But there’s more.  A year later, 53% of those who received chiropractic treatment still had 75% relief, and only 38% of those on medication.

My chiropractor always urged me to do exercise at home on top of regular adjustments.  This study seems to suggest he was right.  It would be interesting to see how people fared who used a combination of treatments.

From the Headache and Migraine News Blog

Methods that are Really Fighting Neck Pain

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Migraineurs are dealing with a lot more than just head pain, according to a poll we recently conducted here at Headache and Migraine News.  The pain of migraine comes in many forms – and sometimes pain comes from the migraine attack, while at other times a problem in another part of the body can trigger a migraine attack.

In this case, however, we were talking about pain during a migraine attack.  Visitors were asked Other than your head, where do you experience the most pain (during a headache/migraine attack)?

It’s no surprise that neck pain and migraine pain are closely related.  A full 71% of migraineurs said that they experienced neck pain during migraine.

Following that was other, with 8%, starting a list of other parts of the body where people experience pain.

Stomach is next on the list – very common (some people experience stomach pain instead of headache during a migraine attack – see more on abdominal migraine).

Back was next, and then skin (perhaps referring to cutaneous allodynia), and finally arms, legs, chest and feet.

In this poll, visitors were only allowed to choose 1 answer.  But now it’s time to find out all the other kinds of pain that migraineurs experience.  The new poll is similar – except that you can choose multiple answers.  I’ve also added more possible responses:  Other than your head, where else do you sometimes/always experience pain during a migraine attack?  Add your votes now!

From the Headache and Migraine News Blog

Poll: Migraine Pain more than a Headache

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Women (and men) with chronic headache conditions know that headache can impact every area of life.  But different symptoms can impact different people in different ways.  And headache doesn’t have an equal impact on every area of life.

A recent study in Italy focused on how primary headaches (ie migraine and chronic tension-type headache) impacted the sex lives of women.  This was a small, simple study meant to introduce an important topic.

100 women were a part of the study.  All were headache or migraine patients.

Of course it’s not surprising that headache disorders impact sexuality.  It was common for the patients to have unusually low sexual desire, to have problems with sexual function, and to worry about sex (sexual distress).

Although it was common, the problems were still in the minority.  For any given issue, most women did not have a major problem.  (In fact, we know that sometimes migraine attacks bring with them increased sexual desire)

However, if 1-in-4 or 1-in-5 women have a particular problem, the numbers are still unusually high.

What perhaps makes this study most interesting, however, is the difference in patients diagnosed with chronic tension-type headache.

Although both migraineurs and tension-type headache patients often reported low sexual desire and pain during sex, the women with chronic tension-type headache were significantly more likely to develop sexual distress.  In fact, a full 45.5% – almost 1 in 2 – reported distress about sex.

Knowing about the risk for these symptoms should help patients, partners and health professionals deal with the issues.  Sometimes being aware is all that is needed to pay special attention and find extra help.

Read the abstract here:  Sexual Function and Distress in Women Treated for Primary Headaches in a Tertiary University Center.

From the Headache and Migraine News Blog

Headache and Female Sexuality

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A University of Mississippi study is drawing attention to migraine in HIV patients.  The study, first published online in November, points out that chronic migraine is a chronic problem for those with HIV.

200 HIV / AIDS patients were a part of the study.  53.5% reported headache symptoms.  14.56% met the criteria for episodic or chronic tension-type headache.  And a whopping 44% were diagnosed with migraine – with 27.5% meeting the criteria for chronic migraine.

27.5% with chronic migraine is very significant.  In fact, it means that those with HIV/AIDS are 13 times more likely to have chronic migraine than the general population.

And that’s not all.  The more severe the HIV disease, the worse and more frequent the migraine attacks became.  However, duration of the disease and number of prescribed antiretroviral medications did not make a significant difference.

This study certainly highlights the need to study the relationship between HIV and migraine, but it also helps to zero in on treatment of symptoms for HIV patients.  Often, because of the HIV disease, other issues are suspected when the patient has headache pain.  But now we know that tension-type headache and migraine are extremely common.  Hopefully this will help patients get the proper treatment sooner.

The researchers also had an interesting side note.  More often than usual, patients with HIV/AIDS had migraine attacks with some atypical features- for example, a two-sided migraine, or migraine with a pressing/tightening quality.  The researchers still felt comfortable diagnosing these as migraine based on other criteria.  But some doctors might miss a connection due to somewhat abnormal symptoms.

via: Research Yields Insights About HIV-Related Headaches

From the Headache and Migraine News Blog

Attention given to HIV Patients with Migraine in new study

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