Discoveries & Stats

28 February 2024

Headache in Epilepsy Patients: Let’s talk about triggers.

The connection between headache and epilepsy is no secret. The challenge is that both symptoms often emerge from deep in the brain – an organ so incredibly complex that we’re really only starting to understand it.

Epilepsy, migraine, headache, and seizures...

A recent study investigated triggers of seizures and also headaches in patients with seizures. Might the same things be triggering both? If so, might this point to a connection in what causes both? (More information here: Exploring Shared Triggers and Potential Etiopathogenesis between Migraine and Idiopathic/Genetic Epilepsy)

The study was published this month in the journal Clinical Neurology and Neurosurgery. 809 patients who had epilepsy were studied – in this case, patients who had genetic related epilepsy or epilepsy with no known other cause (idiopathic).

Researchers found that there were indeed some similar triggers. Patients most often cited stress as a trigger for both seizures and headache. As we’ve talked about before, “stress” is not a simple cause – stress is, in fact, related to all kinds of physical and lifestyle factors, which makes it very difficult to study.

But that brings us to the second most commonly reported trigger for both – sleep deprivation. And this was related to #3 on the epilepsy list, fatigue.

All of these things could speak to getting out of your normal routine and not getting enough rest. That’s not to say the patient is to blame necessarily – there are 100 reasons this may occur, many of them completely out of our control, as we all know from experience.

One more interesting note. Patients with migraine and epilepsy were also more likely to have menstruation-triggered seizures (catamenial epilepsy). This naturally makes researchers ask questions about hormone fluctuations and both conditions. And yes – in some women sleep problems do go along with that time of the month.

The researchers in this study were especially interested in asking questions about a shared cause of headache/migraine and epilepsy. But there’s a practical point here too. Patients and their doctors can fight back by focusing on these triggers – in particular, sleep schedules. That may mean identifying another condition (such as a sleep´disorder), or working on changing environmental or lifestyle factors that can improve sleep. For some people, improving sleep may mean a significant lessening of other symptoms.

12 February 2024

Cryoneurolysis Treatment for Headache?

James Discoveries & Stats 0

Cryoneurolysis is a treatment that has been used for chronic pain, but what about headache?

You may have already guessed from the prefix “cryo” that this has something to do with cold, and you’re right. In this case, it’s extreme cold – we’re not talking about ice packs.

When we use cryoneurolysis to treat pain, it’s called cryoanalgesia. There are other applications, but that’s the one that’s important to us at the moment..

Cryoneurolysis involves inserting a probe (a “cryoprobe” – no kidding) into the body to apply extreme cold to a speficic area, usually nerve tissue. The cold breaks up some of the tissue, interrupting the pain signals that are carried by the nerve. The nerve will actually regenerate over time, making this a temporary procedure – although at times the regeneration may improve your symptoms.

Now we know that for many types of headache, simply cutting off a certain pain signal from a certain nerve isn’t the answer, and may cause more problems than it solves. However, when we have a more specific understanding of where the pain is coming from, this may be a useful procedure, although it isn’t widespread yet (for headache conditions).

When you see the word “neuralgia” – a certain kind of nerve pain – that’s a clue that this type of treatment might be useful. Patients have received surgery for occipital neuralgia, for example, a certain kind of head pain from certain nerves. This 2021 study is an example of the work that’s being done for this type of condition.

Trigeminal neuralgia is another example. A study is starting in Norway to investigate the usefulness of cryoneurolysis for this very painful condition.

Cryoneurolysis has its drawbacks, which we’ve already mentioned. Its use for headache is not widespread. But it also tends to be unpredictable in its duration. How long will the pain relief be? That may vary quite a bit. And it is still a surgery.

However, researchers continue to investigate because it’s a relatively easy procedure, with few side effects. If it’s found to be useful, it can also be a very cost-effective treatment. And although the duration of relief may be unpredictable, it can last for a long time in some patients – much longer than the pills people are taking that only last a few hours at best.

For a technical overview of some of the other uses of cryoanalgesia besides headache, check out The applications of cryoneurolysis for acute and chronic pain management from 2023. For a more user-friendly summery, read Freezing Nerves, An Effective Way To Treat Chronic Pain.

8 February 2024

Seniors with Migraine: More Likely to have a Car Accident?

James Discoveries & Stats 0

Are older drivers with migraine more likely to have a car accident? If so, why? A recent study at the University of Colorado Anschutz Medical Campus, sponsored by AAA, asked this question.

Perhaps most interesting were the things that weren’t likely to increase risk of vehicle accidents. First of all, seniors (ages 65-79) who had a history of migraine were not, in general, more likely to be involved in car accidents. They weren’t worse drivers, they weren’t at a higher risk. Good news so far.

However, these drivers did tend to drive a little less (no surprise there). And they also tended to have more “hard braking events”. But no increase in accidents. So at least their reflexes are still good!

The researchers also failed to find a connection between certain medications and accidents, although there may not have been enough information in this particular study to come to a hard-and-fast conclusion.

But here’s the twist. Older drivers who experienced new migraine did have a higher chance of accidents. In fact, in the group who experienced their first migraine symptoms over the past year, the risk of car accidents was three times higher than in the other groups (people who had already experienced migraine, or those who had never had migranie symptoms).

Why would this be? Were these people simply not used to the symptoms? Is it possible that new medications were to blame (although it seems like this wasn’t the case)?

Is it possible that some of these cases were not actually migraine? This is an interesting question, because as we all know, sometimes getting a proper diagnosis can take much longer than a year. Also, finding a good treatment can take longer than a year.

While we don’t know exactly why the risk goes up for newly diagnosed migraineurs 65 and over, it’s worth it to be aware of the potential risk. Lead author of the study, Dr. Carolyn DiGuiseppi, puts it this way:

These results have potential implications for the safety of older patients that should be addressed. Patients with a new migraine diagnosis would benefit from talking with their clinicians about driving safety, including being extra careful about other risks, such as distracted driving, alcohol, pain medication and other factors that affect driving.
Carolyn DiGuiseppi (Study: Older Drivers Newly Diagnosed With Migraines at Increased Crash Risk)

The researchers also recommend that future studies take a closer look at “timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes”. With a significant increase in risk, it would be helpful to know exactly why this is the case. Is it the case for a certain type of migraine? A certain type of treatment?

If you’re 65 or older and have been newly diagnosed, be sure to do your research and if possible see a headache specialist, not just a family doctor. And be aware that migraine can have a significant affect on various parts of your life, even if you’re not in pain at a specific moment.

You can read the study abstract for yourself here, in the Journal of the American Geriatrics Society: Migraine headaches are associated with motor vehicle crashes and driving habits among older drivers: Prospective cohort study

via: Older adults with newly diagnosed migraine disorder three times more likely to have motor vehicle crash (ScienceDaily)

3 February 2024

More “Stigma”, More Migraine?

James Discoveries & Stats 0

A recent study published in Neurology took a look at how stigma may affect migraine disabilty.

I put “stigma” in quotations in the title, not because it’s not real, but because sometimes it’s defined in different ways. This study used a very helpful measure, using a tool called the Migraine-Related Stigma (MiRS) questionnaire. MiRS divides stigma into two categories:

“feeling that others viewed migraine as being used for secondary gain” – for example, someone thinks you’re using migraine as an excuse to get out of work, or to make people sorry for you.
“feeling that others were minimizing disease burden” – for example, someone says “it’s just a headache – deal with it”.

These are very helpful categories, and most of us know exactly what they’re talking about from personal experience.

Researchers have noticed that, in the case of many diseases, stigma seems to actually affect outcomes. In other words, maybe your treatment won’t help as much if people around you are minimizing your symptoms. So – is the same true for migraine?

You would think that there would be some corrolation – for example, the person who has more “headache days” in a month is likely to experience more stigma. And you would be right – that is exactly what happens.

But one of the more interesting findings in this study was this: even if you account for that, even if you take away the factors of more or less headache days, or even the symptoms and severity of the attacks, stigma still seems to increase disability (or disability leads to more stigma). If you experience stigma, you tend to be more disabled (even between migraine attacks), and have an overall poorer quality of life.

In fact, researchers pointed this out: People with fewer than 5 headaches a month, but who often or very often experienced stigma, had a worse quality of life than those who had over 25 headaches a month and yet never experienced stigma!

One other interesting note: Researchers did not see a major difference between men and women regarding stigma – both experienced it to about the same degree.

Now of course there are a lot of numbers we’re playing with here (and you can check out the study for yourself here: Migraine-Related Stigma and Its Relationship to Disability, Interictal Burden, and Quality of Life), so there could be a number of reasons why one thing is causing another thing or not.

However, there does seem to be a general picture emerging:

Migraine patients still often experience stigma from others (about 1/3 said “often” or “very often”)
That environment of stigma may be increasing migraine disability

In the end, you are you – you are not the other person, and you have a limited ability to control what they do or say. Yes, we do need to speak out when we can to help others understand and be more informed (while listenening to other points of view as well). Advocates with websites like this one or those who have various media platforms are certainly helping get the word out.

And sometimes just recognizing the problem can help us think through it. There are times when we need to be aware that someone else is just not understanding, and that no one really knows how we feel.

Migraine is serious, and can have a long lasting impact on health and on your life in general. Let’s keep working together to make migraine stigma a thing of the past.

For another perspective on this study, check out: For people with migraine, feelings of stigma may impact disability, quality of life

9 January 2024

Chronic Headache after Stroke

James Discoveries & Stats, Information, Medications, Treatments 0

It’s common to get a headache along with a stroke, or even in the days afterwards. But there is a significant percentage of patients who end up with chronic headache in the months and even years that follow.

It’s very difficult to study post-stroke headache and post-stroke pain in general. For one thing, we don’t understand exactly why it happens (in many cases), which means that we’re not always sure that the chronic headaches are a result of the stroke. Also, the connection between migraine and stroke is well known (see for example Migraine: Doubling the Risk of Stroke?). So it could be that many patients are experiencing a progression in migraine symptoms that may have happened with or without the stroke itself (see the 2019 study Headache after ischemic stroke).

However, typically, chronic headache connected to stroke has a more tension-type headache quality. It can be severe, but it usually lacks some of the tell-tale migraine symptoms such as sensitivity to light and nausea. Usually, but not always. The pain also tends to be more constant, and get worse over time.

There are some common known causes of post-stroke headache. For example, you may be experiencing a side effect from your medication.

But once we get past those common causes, things get a lot more difficult. (Stanford Medicine had the rather discouraging comment regarding post-stroke pain in general – “Medical treatment for post-stroke pain is generally disappointing”!)

At this point, it seems that post-stroke headache, or chronic headache after stroke, is as complex and variable as any kind of headache when it comes to treatment.

If you have experienced chronic headache symptoms after having a stroke, there are some important steps that you need to follow:

Record as much information as you can about your symptoms. When did they start? Have you noticed anything that triggers them? What are your symptoms? Are they constant, intermittent, increasing?
Talk to a doctor or specialist as soon as possible. As mentioned above, there are some common known causes. The solution may be obvious, and you can save yourself a lot of trouble by finding the right treatment early.
Consider talking to a headache specialist, and make sure she or he knows your medical history. You may need to look at current best treatments for this type of headache, but knowing your medical history (including details about your stroke(s)) may help the specialist find better customized treatments for you.
Take care of yourself. Relying only on the next medication can set you up for long term problems. Plus, many of the medications used for chronic post stroke headache have side effects that you’ll need to deal with as well. Eating healthy food, getting proper rest/sleep, engaging in face to face social activities on a regular basis, and slowly and steadily working on an exercise plan under your doctor’s care can make a huge difference. This should go along with medications or treatments that your doctor may recommend.

One treatment that has been used for post-stroke headache is rTMS – repetitive transcranial magnetic stimulation. rTMS is non-invasive and does not involve drugs. Instead, it uses magnetic pulses to stimulate certain parts of the brain. Researchers at the Birmingham VA Medical Center believe that using rTMS along with exercise could lead to better results. They are currently working on a study with veterans in the USA to test their theory.

More resources: