Profiling is so dangerous, isn’t it?  I mean, seriously.  As soon as you say something like “most migraineurs are women”, you’re leaving out huge numbers of us who ain’t.  Or if you say “migraineurs tend to be fat” you beg all kinds of questions – is it due to the medication they’re taking?  The time they spend in bed?  Is obesity a migraine trigger?  Are we “blaming” people who are overweight?  Did I just use the “f-word” in this post??

Sure, profiles are interesting.  Maybe they allow us to focus more on women instead of men, since they have more migraine attacks.  Wait!  I don’t like that idea either.  We all need help, and we’re all very different!

But these types of generalities can be useful – as long as we’re careful with them.  They can point to tendencies.  To possible biological realities of migraine disease.  And to possible treatments.

But don’t tell me migraineurs are all depressed, or all women, or all f … frugal… or whatever.

This is actually more of a comparison than a profile.  What’s the difference between those with chronic tension-type headache and those with chronic migraine – from The Journal of Headache and Pain.

This study may be even more useful in understanding chronic tension-type headache.  After all, a lot of the right column is pretty well known.  This is particularly true for weight issues (a struggle for migraineurs due to medication, and also a very possible factor in developing chronic migraine) and pain drug use (medication overuse is a HUGE factor when it comes to chronic migraine).

Could alcohol use influence chronic tension-type headache?  Or lifestyle issues related to a lower education?

But one of the problems with a study like this is that many people seem to have both conditions.  And there is increasing evidence that both conditions are related.

Do you suffer from chronic tension-type headache?  Have you found a direct link with alcohol consumption in particular?  Or, as a migraineur, have you found weight loss to be a help?  Or quitting smoking?

For more details:  Epidemiological profiles of patients with chronic migraine and chronic tension-type headache.

From the Headache and Migraine News Blog

Chronic Tension-Type Headache and Chronic Migraine: Profiles

I’ve been getting a lot of questions regarding the ginger and sumatriptan study, so we’re going to take the time to talk about a few more details.

Obviously one study is not enough to change treatment practices around the world.  However, the researchers were motivated to study ginger because it had already shown great promise as a migraine treatment.

Previous Ginger Studies

First of all, ginger has been regularly used for many related conditions – vertigo, motion sickness, and pain conditions being the most well known.  Also, previous studies have shown very little problem with side effects.

Ginger is currently being studied to alleviate dental pain and inflammation.  And one study suggested that it works about as well as ibuprofen for menstrual pain.

Products containing ginger, such as Gelstat Migraine, have already helped many people fight migraine symptoms.  Gelstat Migraine has been studied in clinical trials, and the results were promising.

An older 1990 report showed that patients taking ginger during and after their attack were able to reduce frequency and severity of migraine.

Ginger Dosage in the Trial

In this trial, patients were given 5 capsules of either 50mg of sumatriptan or 250mg of ginger (these ginger capsules are 350mg).  Everyone was to take one capsule when a headache was coming on.  They didn’t know which they had (this was a double-blinded randomized controlled clinical trial).

This is actually a very low dose of ginger.  As you’ll see below, others have recommended a higher dose, even up to a gram or two a day as a preventative.  Ginger supplements are commonly 500mg and higher per capsule.

More on the study results

The patients had been generally diagnosed with migraine many years before, and they typically had several attacks per month.

Ginger and sumatriptan results were similar, with sumatriptan generally performing slightly better for actual headache pain.

250mg of ginger was used in this study, as mentioned above.  Previously 500mg had also been recommended, repeated every 4 hours up to 1.5 to 2g per day for 3-4 days.  Another report found that a woman found relief using similar amounts of ginger powder (1.5-2g) as a daily supplement.

The bottom line

The researchers of this study concluded that ginger should be preferred to sumatriptan because of the lack of significant side effects.  The only reported issue with ginger was indigestion (4% had some issues here – interesting considering that many people take ginger for digestion!).  But some patients taking sumatriptan experienced dizziness, vertigo, heartburn, and/or sleepiness (20% with one or more issue).  In the end, patients were slightly more satisfied with ginger as a migraine abortive.

Researchers are now calling for more study into what dosage is most effective.

This was also a short term study.  Longer term studies will help demonstrate if ginger can continue to fight migraine over the long term in individual patients.

For more on the study read the original post here.

From the Headache and Migraine News Blog

Ginger and Sumatriptan: More Information

Researchers at the University of California have discovered a new genetic link to migraine – and a rare sleep disorder – that may get us closer to the cause of migraine than ever before.

First, a note.  Last week on Facebook, Damien Higgins posted the following:  There was Migraine News today that made many of the international news channels and you havnt even mentioned it!!! this page is not exactly on the ball, is it!!!http://news.sky.com/story/1085914/hope-for-migraine-sufferers-after-genes-find

Well, I have no particular excuse for not mentioning this story sooner, other than to say that this website has not yet reached the level of perfection that I or Damien may want!

That being said, many stories hit “international news” and are really hardly worth mentioning, in my opinion.  Honestly, a lot of migraine news is old news, poorly reported, blown out of proportion, or in reality not useful.  And sometimes it’s worth taking the extra time to research the news a little more before repeating the same thing here.

Regarding genetics and migraine, we’ve discussed a lot of discoveries here.  In fact, back in 2010 we talked about a similar news story – Found: Genetic Link to “Basic” Migraine

We’ve also talked about something critical to understand – Migraine: Why Genetic Studies haven’t Solved all our Problems.

In Damien’s defence, however, this news story is worth mentioning.  And I won’t claim that the Sky news report is overblown, although most migraineurs are probably tired of seeing the same old headline – “Hope for Migraine Sufferers…”!

Study Overview

First, we need to be cautious about claiming that we’ve “finally found the genetic cause of common migraine”.  This is not the first time genetic mutations have been linked with common forms of migraine.  There are some unique things about this study which we’ll discuss in a moment, but it’s a tricky thing to prove that a genetic mutation is the cause or even related to “most” migraine attacks.

Researchers were actually looking at two conditions: Migraine and Advanced Sleep Phase Syndrome.  This sleep syndrome causes you to go to sleep earlier (ie in the evening) and get up earlier (ie between 1 and 5 am).

Researchers found two families in which many members had both conditions (in this case, the sleep disorder would be called familial advanced sleep phase syndrome).

To make a long story short, it was discovered that two related gene mutations were highly associated with both conditions.

Now mice who had one of these mutations (CKIδ-T44A) were also researched.  These mice had a lower threshold for cortical spreading depression (CSD), a storm that sweeps across the brain that is considered a key part of the migraine chain reaction.  In other words, they were more likely to get CSD.

These mice were more sensitive to pain, and astrocytes (certain neurological cells) showed increased calcium signalling, which may relate to parts of the migraine reaction as well.

Now the research on CKIδ-T44A and the mice and migraine is not new.  Neither is the link between these two mutations and advanced sleep phase syndrome.  However, the link with the two mutations and the two conditions – migraine and advanced sleep phase syndrome is.

You might be a little underwhelmed that we’re just talking about two families, and a rare sleep disorder, and just another two mutations after we’ve already linked others with migraine.

However, this is how a lot of good research starts.

These mutations are linked.  And the most important finding may not be the mutations themselves, but what they point to.

For one thing, they both influence a special protein known a connexin 43 (Cx43).  Even if these particular genetic mutations don’t turn out to be common in migraineurs, there could be other factors that are impacting Cx43, and so that might be the direction that future research takes.

I’ve intentionally avoided getting into all the specific mechanisms of these mutations in order to focus on the practical implications.  But if you’re interested in the more technical aspects, you can read the study abstract:  Casein Kinase Iδ Mutations in Familial Migraine and Advanced Sleep Phase and a discussion of the findings at Gene Mutations Tied to Migraine, Sleep Disorder.

From the Headache and Migraine News Blog

Another Genetic Link to Migraine?

Today’s podcast covers some recent migraine news.  Here are some of the links mentioned:

• Topiramate in pediatric migraine
• Trigger factors reported by adolescents with migraine
• Childhood migraine tied to history of infantile colic
• Popular Chinese medicine used for migraines could be FATAL, warn health watchdogs
• Migraine sufferers likely have brain abnormalities, study finds

From the Headache and Migraine News Blog

Migraine in Kids and Teens, Dangerous Herbs, and Migraine Brains (podcast)

How many people are dealing with migraine in the United States?  Is it really a big issue, or just something that the media has blown out of proportion?

Researchers at the Department of Psychology at the University of Mississippi used already published studies to estimate just how serious the problem is, based on how many people experience migraine attacks over a three month period.

Among the general population, over 16% had experienced migraine or severe headache over the past 3 months.  (This included either migraine and “severe headaches” or else migraine and probable migraine).

Not surprisingly, the group with the most migraine attacks was women between 18 and 44.  In this group, the number skyrocketed to 26.1%, or more than 1 in 4 women.
Migraine was significant even in groups we don’t often think about.  For example, in men 75 or older, 4.6% had experienced severe headache or migraine over 3 months.

As you might imagine, headache was a major reason for visits to emergency.  As we’ve discussed before, although headache usually doesn’t require a visit to emergency, it is often imperative to go right away – in certain cases it can save your life.  Head pain turned out to be 5th on the list of reasons why people visit emergency (I’m sure other common reasons include chest and abdominal pain, and things like strains, sprains, and wounds like bruises or cuts).  For women, it was #3 on the list.

The researchers also noted that, not only is migraine itself a serious public health problem, you need to figure in common comorbid conditions.  These would include things like depression, irritable bowel syndrome, heart conditions, and epilepsy.

So the answer is – no, the media hasn’t overblown the issue.  Even in the last three months, chances are that among your 20 best friends, between 3 and 5 have had at least one significant attack in the last 3 months.  That doesn’t include other related conditions, and the many other symptoms and “between-migraine-attack” issues that many experience.

Researchers, governments, schools, churches, families, work places, other organizations – they should be talking about migraine and looking for ways to help with the burden so many people bear.

Study abstract:  The Prevalence, Impact, and Treatment of Migraine and Severe Headaches in the United States: A Review of Statistics From National Surveillance Studies.
➫More migraine statistics

From the Headache and Migraine News Blog

Migraine in the USA: Just How Big is the Problem?

What have you missed out on because of a headache or migraine attack?  That was our most recent poll question.  Here are the responses:

Of course, the poll was asking what the most important event was that you’ve missed.  This will vary from person to person.  But it should also be pointed out that most of us miss many of these events, not just one.

Perhaps more often than not, we still attend the event, but do not enjoy it / are less productive / don’t really appreciate it.

Thanks for your responses!  Would you like to share about a specific event that you’ve missed?  Leave a comment!

From the Headache and Migraine News Blog

Headaches and Migraine: Life Interrupted (poll responses)

It’s the latest migraine gadget that everyone is talking about.  It’s the Cefaly Anti-migraine Device!

The Cefaly device is another application of neuro stimulation technology.  Specifically, it’s transcutaneous electrical nerve stimulation (TENS), which delivers an AC electrical pulse to the supraorbital nerve.

How do you use it?  In this case, the device is used as a preventative.  It’s placed on your forehead for a few minutes each day.

A study published this month in the journal Neurology tried the device or a placebo (sham device) on 67 patients.  The patients who used the real Cefaly device (group 1 below) showed a significant decrease in “migraine days” each month:

Now that may not look like a major improvement, but it did mean a decrease of 30%.  And that’s an average – some saw a much greater improvement (38% had a drop of 50% in migraine days or more).

Convenient?  The device has been compared to the visor worn by Geordi La Forge in Star Trek the Next Generation.  I must protest – it looks more like the crown of an alien princess.  It’s a band that goes on the forehead – small, easy to use, and drug-free.

Currently it comes with a significant price tag – US$368 on amazon, and $239.99 at Costco in Canada, for example.  This will certainly keep a lot of people from giving it a try.

On the other hand, the initial results are encouraging for a device that’s non-invasive and not likely to give you the side effects that drugs would.  If it works for you, several more pain-free days each month would probably be worth the cost.

But it is good news to see more of these devices being tested and hitting the market, because we’re learning more and more about what works best and for whom.

Study:  Migraine prevention with a supraorbital transcutaneous stimulator
Cefaly website (international)
Cefaly Canada website

From the Headache and Migraine News Blog

20 minutes a day with an anti-migraine device…

According to recent research, women who have migraine with aura are at an increased risk for “cardiovascular events”.

This study was actually an investigation into the Women’s Health Study, a large study, which we’ve talked about before, which collected all kinds of information about thousands of women over 15 years.

What were the biggest risk factors for cardiovascular events (CV), such as heart attack and stroke?

1. High Blood Pressure
2. Migraine with Aura
3. Diabetes
4. Family History of Heart Attack
5. Current Smoking
6. Obesity

That’s right, migraine with aura came in as the #2 risk factor for women.

There’s no doubt that this study will increase interest in the study of migraine and heart problems.  The connection between the two is not yet understood, although theories are beginning to emerge.

But the link is not new.  We’ve known for some time that there’s an increased risk of cardiovascular problems in migraineurs, and not just women who have migraine with aura (for example the same researcher, Dr. Tobias Kurth, reported that men with migraine seem to have an increased risk of heart attack).

Some good news has also come from the Women’s Health Study – for example, women with migraine with aura are less likely to be disabled after stroke.

Even with migraine, your risk is probably low unless it’s combined with other factors above.  Still, this is a reminder that migraine can be dangerous, and it does need to be treated.  It should also raise awareness for migraineurs and their doctors that they should be cautious of other risk factors, including medications that may increase their risk.

For more, read Migraine and Heart Disease: 7 Critical Things to Know Now.

For more on the study:  Migraine with aura confers high CV risk in women

From the Headache and Migraine News Blog

Migraine with Aura: Higher heart attack risk than smoking and diabetes?

Every once in a while headlines go flashing around in the media that give a completely wrong impression.  For example, I’ve recently seen these headlines:

• Migraine triggers may not cause severe headaches
• Report: Migraine triggers may not be so potent
• Migraine “Triggers” May Not Cause Migraines After All

What impression do you get from these headlines?  First, you might think,”Oh, we used to think that certain ‘triggers’ (ie chocolate, weather, MSG) caused migraines, but now with new research we know that they don’t!”

Worse, someone might think,”Oh yeah, I have a coworker like that.  She blames everything for her headaches.  Maybe now she can start taking some responsibility.”

Now if you’ve only read the headlines, you’re going to be surprised about what the articles are actually about.

The actual study

Yes, there was an interesting study done, published by the journal Neurology (ahead of print on the 23rd of January 2013 – Provocation of migraine with aura using natural trigger factors).  The study was small (just 27 patients), and studied only 2 “triggers” – bright/flickering lights and exercise.  Although patients said that these were triggers for them, only a few reported migraine attacks after exposure (a few from exercise, none from bright lights).

That’s it?  Yup.

Of course, this raises a whole boatload of questions.  How long after the exposure were patients monitored?  What type of bright/flickering lights?  How much exercise?  Of course, the study answers these questions – but that’s not the point.

The point is – what does this really tell us about migraine triggers?

Well, there’s one thing that the study suggests.  The triggers that some patients report may not always immediately trigger a migraine attack.

That’s it.  And that’s not a big news story.

Migraine Trigger Myths?

Are we just believing myths about triggers?  Let’s take a quick look at a few…

• MYTH:  A “migraine trigger” is something that causes a migraine.  Actually, a trigger could “cause” an attack, in the sense that you wouldn’t have had the attack at that time if it weren’t for a certain trigger.  But actually, no one knows the “cause” of migraine, and to call a trigger a cause is, in the opinion of this author, an over simplification.
• MYTH:  We used to think that various things “triggered” migraine attacks, but now we know better.  Actually, the trigger controversy is nothing new.  For many years doctors and researchers have debated about how much influence triggers, particularly common triggers (ie chocolate, bananas, flickering lights…) have on migraine.  They have debated about whether it’s better to avoid them or not.
• MYTH:  Everyone with migraine has to fear the same triggers.  Nonsense!  Triggers are different in everyone.  Though there are things that commonly trigger migraine attacks, those things may not be a problem at all for some people.
• MYTH:  If X is a trigger for you, X will always result in a migraine attack.  Absolutely untrue!  Let’s say raw onion is a migraine trigger for you.  That does not mean that every time you eat raw onion you will get a migraine attack.  That may be true for some people, but not others.  It’s likely that a number of triggers are working together – once you’re exposed to too many for you, an attack begins.  So on a good day with few triggers, X may not lead to any problems.
• MYTH:  Avoiding triggers will cure migraine.  Not only will it not “cure” migraine, avoiding triggers will not always mean you won’t get any attacks.  Migraine isn’t that predictable.  In many cases avoiding triggers can lead to fewer attacks – in rare cases no attacks at all.  But there are no guarantees.
• MYTH:  A migraine trigger will always immediately result in a migraine attack.  Actually, there’s a lot of disagreement over this one, particularly when it comes to food.  Sure, an attack will often come almost right away.  But some believe that triggers could impact you a day or even several days later.  That makes it very hard to study exactly how triggers work.  What if exposure to trigger X on Tuesday leads to a migraine on Wednesday – but only if you’re also exposed to Y on Wednesday?  See the problem?

There was a good point that some have tried to make from this study (and I’m not blaming the study itself for the headlines).  That is, many migraineurs assume that certain things will always trigger an attack, and so they avoid things that could help them.  This may relate to nutrition, but it’s especially true of exercise.  The benefits of moderate exercise, done properly, are in most cases going to far outweigh the problems.  There are ways to minimize exercise headache and migraine.

Sure, they headlines did their job – they grabbed attention.  But for so many who don’t bother to read the information carefully – particularly people who “know someone with migraine” – the headlines can be very misleading.

While we’re on the topic, here are 12 ways to Evaluate Migraine News.  And more information about tracking down migraine triggers.

From the Headache and Migraine News Blog

Migraine Triggers: Don’t Believe the Headlines (and the myths)

A fascinating new study about the connection between lightning and migraine attacks is opening up a conversation about much more than just flashes of light.

Although some still question the weather and migraine connection, there’s really very little doubt that changes in weather can impact migraine attacks.  The real question is, what kind of weather?  And just how much can a change of weather trigger migraine symptoms?

Because weather is complex (as we’ll see again in a moment), it’s notoriously difficult to study headache and weather and nail down exactly what in the climate is triggering the symptoms.

But before we go any further, let’s take a look at the new study.

Lightning and Migraine

Patients were chosen from Ohio and Missouri (USA).  They recorded their symptoms in a headache diary for 3-6 months.

Instead of just checking to see if there were storms in the area, or reported lightning, the team got a lot more specific.  They calculated whether lightning had struck within 25 miles of the migraineur’s home, actually using data from ground sensors.

And that meant that they could check for specific information about the lightning strikes.

Here are the results:

Researchers then calculated out some of the other things that may trigger a migraine attack – such as changes in barometric pressure.  They still found that patients were 13% more likely to have a migraine attack when lightning struck.

The results were clear:  Lightning triggers migraine attacks.

Why lightning?

But the question remains – why?

Lightning isn’t just a random flash of light.  And that’s why this opens up such an interesting and far-reaching area of research.

For example, one theory is that changes in ions in the atmosphere may trigger an attack.  In lightning, electrical charges are carried by ions.  

Or, it could be a change in the ozone.  Yes, lightning creates ozone in the air, and you can smell it after a thunderstorm.  There are also nitrogen oxides (NO), precursors to ozone (incidentally, we already know that NO and migraine are connected – read Deeper into Migraine, Glucose and Insulin…).

How about electromagnetic pulses?  There has been research into how these pulses or sferics could impact migraine patients.  Some patients (though a minority) seem to be impacted by these radio waves.

But there’s more.  There’s something key that increases the likelihood of lightning – dust.

Dust, asthma, and migraine…

Dust isn’t just powder, of course.  It’s a complex ecosystem all its own.  Dust travels the globe, and may contain spores, ions, bacteria and viruses.

Feeling sick before the lightning hits?  Or is your asthma acting up?  Could it be that you’re inhaling particles that are triggering an attack?  Particles that may be partially “cleaned up” after the lightning storm?

Incidentally, lightning isn’t the only thing that comes along with dust.  Dusty air often comes along with low barometric pressure, warm air, wind, and rain.  Interesting that a 1981 study found that “phase 4″ weather was more likely to trigger migraine attacks – low pressure, warm fronts and humidity.  Connection?

Conclusion

This study was limited, partly because it couldn’t take into consideration seasonal changes (diaries were kept for half a year or less).  But also because there are so many related factors that go into weather patterns.

But we do know this:

• It has been confirmed again that weather can trigger migraine
• Lightning seems to be one of the factors that triggers migraine and headache
• There are a series of complex interactions that may be involved, including airborne dust particles, microorganisms, changes in air composition, and more

Hopefully this study will help us understand more about the relation of migraine to asthma, and the impact of changes in the atmosphere on migraine and other conditions.

For more information:  All the World’s a Stage … for Dust (NASA); Headache – Atmospheric Radiation Link Explored (Cephalalgia); Lightning and its association with the frequency of headache in migraineurs: An observational cohort study (Cephalalgia); Research Ties Lightning to Onset of Headache, Migraines (University of Cincinnati); En’lightning’ the impact of atmospheric conditions in headache (Cephalalgia)

From the Headache and Migraine News Blog

Lightning and Migraine: More than just a Flash of Light