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

by James on 10 May 2012

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?

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Precision Tinted – Especially to Fight Migraine

by James on 7 May 2012

There has been an increasing interest in tinted glasses for migraine patients.  Although tinted glasses are nothing new, research is beginning to bring us some decent science behind using tinted glasses to fight migraine symptoms (see for example this from USA Today:  Special tinted glasses may stymie migraines).

There are a number of different approaches.  Of course, quality sunglasses have helped a lot of people.  There are also custom made precision tinted glasses, where a patient is tested and given a tint that seems to help them the most.

But even custom made precision tinting is an imprecise science, as we continue to learn more about how migraine impacts the brain.  And such a service may not be readily available where you are, or within your price range.

However, there is another option.  There is increasing interest in precision tinted non-prescription glasses that can be produced at a lower cost in higher quantities.  This can be done because certain tints seem to help migraineurs in general, and so lenses can be produced for migraine patients in general instead of being custom made.

Now Available: A New Lens Designed to Fight Migraine

TheraSpecs
(These are all the same pair of TheraSpecs – it’s the pictures that are tinted differently!)

There’s a new precision tinted therapeutic lens – and the good news is, it wasn’t developed by some engineer in a office building who doesn’t know anything about migraine.  These glasses were developed by Hart Shafer and his wife Kerrie Smyres.  Many of you will know Kerrie from her blog, The Daily Headache.

This means that the glasses were tried and tested over time by someone dealing with real migraine attacks.  (I’ve followed and communicated with Kerrie for many years – I know she’s the real deal)

For example, here’s Hart explaining how they had found some lenses that worked well, but…

But they were far from perfect. When she wore them she also always put on a baseball cap and often held her hands up beside her eyes to block light from the sides and reflections behind. The glasses simply let in too much light from around the lenses, especially from above. That’s when we started talking about the ideal glasses for people who suffer like she does.

Once Hart and Kerrie had come up with a design they liked, they sent them out to various other migraineurs, myself includes.  The reports that came back were good.

I’m still experimenting with the ones I have – Indoor TheraSpecs – but I did know right away that I liked them.  Here are some of the reasons why:

  • They are light weight.  What migraineur wants something heavy pulling on their face?
  • They have a wrap-around design.  That means that they block out light from the sides, while still giving you a good field of vision.
  • They’re flexible and strong.  They’re not going to break easily – they’re built to last, as an investment in your health.

There’s more.  There are indoor and outdoor versions, meaning that the indoor ones are lighter (great for under flourescent lights you can’t escape or in front of a computer screen) and the outdoor ones are polarized, which cuts down glare (seriously, if you’ve never tried polarized sunglasses, you’ll be amazed at the difference).

James in TheraSpecs

If you have migraine, and especially if you’ve found that fluorescent lights or computer screens bother you (either when you have a migraine attack or when you don’t), this is an excellent option to consider.  Many people have been very surprised at the different that can be made with precision tinted glasses such as the TheraSpecs.

I won’t go into any more detail, because the TheraSpecs have an excellent website of their own with lots of information.  If it helps, though, I will say that I am not being paid or given a commission to promote these glasses.  I have seen the product, and I’ve been watching the research over the past few years, and I believe that the evidence is there.  Take a look and see what you think.

If you’ve tried the TheraSpecs, leave a comment and let us know what you thought!

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Sugar and Migraines?

by James on 3 May 2012

Is there a connection between sugar and migraines, or as we like to call them, migraine attacks?  Could sugar be a hidden cause or trigger behind many migraine attacks today?

We should start by admitting that there is a difference of opinion about just how much sugar consumption impacts migraine symptoms.

Sugar and migraines

 Some say that it’s a major cause or trigger, but most would admit that there is a connection between blood sugar levels and at least some migraine attacks.

To understand the connection, we need to clear up some misunderstandings about sugar.  There are all kinds of terms floating around, like "unrefined sugar" (wow, that sounds natural!), or course there’s "natural sugars" (as opposed to supernatural sugars, I suppose) and "sugar from natural sources".

What sugar does…

When we talk about blood sugar, what we’re referring to is glucose.  All these different types of sugars (and we could talk about all the different kinds in foods) impact glucose levels in the blood, though to different extents.

So if you want to make it real simple, you can simply say that carbohydrates such as sugar will raise your blood sugar levels.

But here’s the rub – they change glucose levels to different degrees, and on different time tables.

For example, if you eat a raw carrot, it’s sweet (if it’s a good one).  It will raise your blood sugar levels.

If you eat a white bagel, it might not taste as sweet, but it will raise your blood sugar levels too.

However, there’s a difference.

Sugar packaging

 You could say it this way, to use a very rough analogy.  The sugars in the carrot are carefully packaged up, using a lot of scotch tape and wrapping paper.  The sugars in the bagel are hardly packaged up at all – in fact, you just pop open the lid and there you are.

So the when you eat the bagel, the package is very quickly opened and your blood sugar levels rise very quickly.

When you eat the carrot, your body unwraps the sugars slowly, and so your blood sugar levels don’t spike the same way – the glucose is gradually added to your blood stream over time.

Now there are other differences with different types of sugar, which can make the situation much more complex.

So could sugar cause migraines?

But we do know that the migraine brain does seem to have a special alarm that goes off when there are sudden changes.  This could do with hormones in your body, with temperature, with sudden exercise, environmental changes, any number of things.

So these things do not cause migraine, but they can trigger migraine attacks.

What is the relationship between sugar and migraines?

Let’s be clear.  This does not mean that eating too much sugar will cause migraine.  In other words, neither is sugar a direct cause, nor could anyone get migraine disease by eating too much sugar.

But if you’re a migrianeur, predisposed to migraine attacks, eating a lot of sugar – and here we’re talking about "poorly packages" sugars – could lead to more attacks, more symptoms.

How?

It could simply by that alarm that goes off when there are sudden changes in the body.  But for some people, it could be something more.

For example, some have noticed a "cumulative effect" – eating sugars over two or three days, for example, may trigger an attack.

Others have found that if they completely cut out refined sugars, they lessened or eliminated their migraine attacks after a time.

There could be some complex reasons for this relationship.  We do know that glucose, insulin, and nitric oxide are closely related.  We’ve talked about glucose, and if you know anyone with diabetes you know a little about insulin.  But people with diabetes are also likely to have impaired nitric oxide pathways.  Problems with these pathways could lead to problems with insulin, and with blood sugar levels.

A study in 2009 suggested that migraineurs are also more likely (than the general population) to have impaired nitric oxide pathways.

This could be at least one other clue into why migraineurs may be more sensitive to refined sugars (and refined flours and any poorly packaged carbohydrates) than most people.

Migraineurs should be cautious about blood sugar level spikes.  One way people often address this is by using the Glycemic Index.  Others have completely cut sugar out of their diets for several months.

What have you tried?  Any success stories?

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From Current Studies: What Migraine Treatments Work?

by James on 1 May 2012

New guidelines have just come out based on the evidence we currently have for migraine treatment.  We’ll talk about some of the guidelines in a moment, but first there are some key things to remember.

Caution: Dangerous Waters Ahead!

These guidelines were created by checking out the studies that have been published to date.  This means that we do or do not have high quality studies that show successful treatment using [whatever medication or supplement].  If we don’t have enough quality studies, the item will be lower on the list.

We should also note that the guidelines are talking about what works in general, NOT what works for you or what is best for you.  Some treatments high on the list are also high in side effects.  Or they may be dangerous for certain people.  Or they may not work well for your particular type of migraine.  Do not take this as a list of what to try first.  Something lower on the list may be something far better for you that something on the top.

This list also doesn’t address combo-treatments, such as MigreLief (with magnesium, feverfew and riboflavin).

The list does help doctors prioritize what to consider.  If you’ve tried a number of things and haven’t tried something high on the list, it may be time to ask your doctor about it.

Highest rated treatments

Here are some of the highest rated treatments for migraine.  There are four categories:

Lowest rated treatments

These are the items that had a negative rating, meaning that they’re not recommended at this time:  Lamotrigine, Clomipramine, Acebutolol, Clonazepam, Nabumetone, Oxcarbazepine, Telmisartan, montelukast.

Everything in-between

Of course, just because something isn’t on the top of the list doesn’t mean it’s not an excellent, helpful treatment for many people.  For example, very close to the top were well-recognized treatments such as amitriptyline, zolmitriptan, feverfew, naproxen sodium, riboflavin (vitamin B2), and magnesium.

It should also be noted that Botox migraine treatment was not a part of these studies.

For some of the medications that are being used today, check out Migraine Medications: So many choices.

To read more details about the new studies with all the little details, visit Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults and Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults.

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Chronic Daily Headache vs. Chronic Tension-Type Headache

by James on 30 April 2012

Confused about the difference between chronic daily headache and chronic tension type headache?  Let’s talk about it.

This month a report came out about the use of Botox for various headache disorders.  The meta-analysis (a study of earlier studies) concluded that Botox had been helpful for "chronic daily headache" and "chronic migraines", but had not yet been proven useful for "episodic migraine" or "chronic tension-type headache".

Now of course this doesn’t prove too much – just that the studies so far seem to show that Botox is more useful for people with some diagnoses and not for people with other diagnoses.  It could mean some have been studied more than others, or that we have not yet found the right type of Botox treatment, or it could mean that Botox simply isn’t useful in some conditions.  We don’t really know.

But what stood out to me was the use of the term chronic daily headache.  What does that term actually mean?  And why is it different from chronic migraine or chronic tension-type headache?

Having not read the full study, I’m not sure how the authors are using the term, but I suspect from the abstract that they’re taking it from the studies they’re using.  Which makes things even more tricky.

Chronic Daily Headache (CDH) is not really a specific term for a headache disorder, but a general term.  This means that chronic migraine and chronic tension-type headache could both be called chronic daily headache.

CDH could be:

  • chronic cluster headache
  • chronic migraine
  • chronic paroxysmal hemicrania
  • chronic tension type headache
  • hemicrania continua
  • new daily-persistent headache
  • short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

With all of these disorders, attacks come either constantly or at least 15 days a month.  CDH are a huge problem.  It has been estimated that up to 5% of the population have significant CDH symptoms.  Most have chronic migraine.

Often CDH is related to the overuse of medication (such as triptans or acetaminophen / paracetamol, in which case you may be diagnosed with one of the above and medication-overuse headache, or it could be diagnosed as one or the other.

Because of the confusion over the terminology, or simply ignorance about the classifications, many patients are diagnosed with chronic tension type headache when they really have a different type of CDH.

Chronic Tension-Type Headache starts with episodic tension-type headache.  In other words, first the patient has the occasional TTH, and later ends up with chronic TTH.  Usually there’s pain on both sides of the head, feeling like a pressing or tightening.  Physical activity probably won’t make it worse, but there is sometimes some mild sensitivity to light or noise, and possibly a little nausea (but not vomiting) – one, but not all three.

Chronic migraine, in contrast, usually starts with migraine attacks which eventually become chronic.  The symptoms are migraine-like.

Now with both chronic migraine and chronic tension-type headache, your doctor will want to rule out other conditions.  It is possible to have the symptoms of chronic TTH, and yet actually have a different diagnosis.

If you have been diagnosed with CDH, try to get a more specific diagnosis.  Why?  Because as research continues, there are treatments that will be more likely to help you depending on which type of chronic condition you have.  The more you can narrow it down, the quicker you can get treatment that works.

For more of a breakdown of CDH types, see the National Headache Foundation’s topic sheet on Chronic Daily Headache.

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