hypertension

6 June 2019

Does Migraine Increase Pregnancy Risks?

A study out of Denmark, published last month in the journal Headache, is raising serious concerns about the link between migraine and certain pregnancy risks. How can mothers with migraine give their babies the best possible opportunities for good health?

In the study, researchers used population registries and identified 22,841 women with migraine who became pregnant, compared with 228,324 pregnancies where there was no migraine. They then identified several areas of increased risk for the women with migraine, including:

pregnancy associated hypertension disorders
miscarriage
low birth weight
preterm birth
birth defects

There was also a higher risk of several complications after birth, such as febrile seizures.

The most concerning issue was that the increased risk seemed to be there whether or not migraine was treated – suggesting to the researchers that it was migraine disease itself that increased the risks in pregnancy, not the treatment or lack of treatment.

Although there are some weaknesses with this study, it does seem to confirm other studies that also indicate risks in pregnancy due to migraine. It’s difficult to tell exactly how medications come into play, but the researchers seem to think that medications are not explaining the risk.

At first, this may sound like information that you can’t use. After all – if there’s no improvement with treatment or without treatment, who cares? But several things need to be kept in mind.

This study only found some associations with migraine, and further study will be needed to confirm. This is not to say that treatment is will not help you and your baby during pregnancy.
Anytime there is an indication of increased risk, what can you do? You can decrease your risk in other areas. If there is a risk of hypertension, there are ways to lower your risk.
Just because there is an increased risk does not mean it’s a high risk. This is very important to remember – the risk from migraine is still low.
Pay attention to your own symptoms and talk to your doctor about them. A registry based study like this one relies a lot on minimal information collected after the fact. There are a lot of issues that may cause headaches, migraine, and changes in your symptoms. It’s not “just normal” in pregnancy.

For a summary of migraine changes during pregnancy, you may find this infographic helpful: Migraine During and After Pregnancy

Also, for a discussion of dealing with migraine and headache during pregnancy, and assessing medication risks, read The Myth-Busting Guide to Migraines and Pregnancy

And may your baby be healthy – and may you be healthier than ever – in the months ahead!

To read the whole study, or the abstract, see Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine

27 March 2017

Migraine + Migraine-related = Expensive

James Discoveries & Stats, News 0

Insurance companies, governments, and in the end – we the migraine patients – spend a LOT of money on treatment. And it’s those who are suffering the most, and who are the most disabled, who are going to have the highest expenses.

Dr. Kenneth E. Thorpe from Emory University in Atlanta, USA, recently put together a paper showing a different perspective on the cost of migraine in society.

Very often we look at the cost of migraine treatment as an individual thing – days lost to migraine, medications taken, time in the hospital, due to migraine . . .
Migraine + Comorbid Conditions
But this overlooks something very important – migraine does not always come alone. There are a number of other diseases and disorders that tend to come along with migraine. These are known as “comorbid” conditions.

Here’s an example from Dr. Thorpe’s paper, using USA stats only. In 2015, about $5.4 billion dollars were spent in the USA for treating chronic migraine (yes, that’s only chronic migraine – this does not include all the other types of migraine, never mind related headache disorders). 5.4 billion!

Now, what does it cost for chronic migraine + comorbid conditions? Over $40 billion.

Wow. Just taking the 5.4 billion per year – let’s cure migraine and use the money to solve world hunger! (Ok, I’m being simplistic – but seriously, there are things we could do with 5.4 billion…)

So what are these comorbid conditions? Some of the top ones included mental and mood disorders, arthritis, hypertension and heart disease.

As disability increased, so did the cost. And disability was worse with more comorbid conditions (remember, many chronic migraine sufferers have several comorbid conditions).

Dr. Thorpe made the important observation that we really do need to treat the “whole person”. It may be easy to give someone with a “headache” a “pill”, but migraine patients need treatment that takes into consideration other conditions and their own health risks and medical history.

For us as patients, we need to be aware of other conditions and symptoms that we may forget about because we’re focused on the PAIN of migraine.

Dr. Dawn C. Buse offers this note for her fellow doctors and specialists:

In general, people with more comorbid conditions use greater health care resources including medical appointments, hospitalizations, medications, and even phone calls to providers. Comorbidities are more common in chronic migraine. They make treatment more complicated and are associated with worse outcomes. I recommend that all providers screen for common comorbidities and treat or refer as appropriate.

In other words, doctors should be aware of the possible comorbid conditions, and should think about treatments that can help the whole person.

Read more details from NeurologyAdvisor: Comorbidities Have a Significant Impact on Chronic Migraine Health Care Costs

6 March 2017

Candesartan for Migraine

James Medications 6

Recently a HeadWay subscriber mentioned a treatment that has been working well for her, and I realized that I haven’t mentioned it before. So here is a brief description of candesartan and its use in migraine treatment.

Candesartan is sold under the brand names Atacand, Amias, Blopress, and Ratacand, although it’s also available as a generic drug. It’s classified as an angiotensin II receptor blocker (ARB). ARBs are often used to treat hypertension, and candesartan is no exception. But antihypertensive drugs are also used as migraine preventatives.

In 2013, a study compared candesartan with a more common migraine preventative, propranolol. The study concluded that 16mg daily of candesartan was comparable to 160mg of propranolol – both led to fewer days with migraine symptoms. (see A comparative study of candesartan versus propranolol for migraine prophylaxis)

Sometimes we make the mistake of thinking that just because we’ve tried a certain kind of drug, we shouldn’t bother trying similar drugs. But the truth is that every drug – even sometimes different versions of the same drug, can have a different effect on an individual. That’s why candesartan can help a patient when propranolol might not, or vice versa.

As always, talk to your doctor before trying any medication. You may not need 16mg – a lower dose may be helpful. Candesartan is NOT for use by anyone who may be pregnant.

Another bit of good news is that candesartan may be a better option for patients concerned about weight gain.

If you’re interested in trying a new preventative medication, talk to your doctor about candesartan. It’s now an often recommended option.

15 February 2016

Headache After Eating? Common Causes and Fixes

James Information, Tips 3

It’s not uncommon to get a headache after eating, but it’s certainly not something you should ignore. The causes and the symptoms can be serious enough to affect your life in a big way.

These types of headaches can vary – pressure between the eyes, throbbing on one side of the head, a tight feeling … and each headache may have a different source. Headaches after a meal?

There is not always a simple cause and effect relationship. Eating can cause some complex changes in the body, depending on what you eat, how much, and when. Some researchers have called the gut a “second brain”, because of the somewhat independent and complex way that it sends signals to the rest of the body.

If you’re experiencing headache after eating, here are a few things to investigate:

Headache Triggers: It is possible that certain foods are triggering neurological changes in your body which lead to migraine attacks. Migraine may or may not involve a headache, and the headache may vary in severity. However, if the pain is throbbing and you’re sensitive to light and/or sound, it’s very likely that migraine is involved. Talk to a doctor about your symptoms, and start keeping a diary including symptoms and foods you have eaten.
Sugar Levels: Changes in sugar levels may be triggering migraine attacks or they may also lead to other types of headache (see Sugar and Migraines?). Symptoms may also include anxiety, weakness, and lightheadedness. In many cases, extreme highs and lows in sugar levels can be avoided by eating regularly throughout the day, eating balanced meals and avoiding refined sugars and flours. However, if the headaches persist, your doctor can run some tests and try to track down the problem. This may be more common in people who are underweight.
Food Allergies or Intolerance?: There is a generally accepted definition of a food allergy, which is an immune reaction that occurs soon after you eat, often involving itching or hives, headache, nausea, and/or trouble breathing. Things get more controversial, however, when we start talking about food intolerance and “delayed” food allergies. Skin or blood tests are sometimes used for allergies, but they may not show other types of intolerance. Common substances that may trigger headache (including, but not necessarily, a headache from migraine disease): alcohol, MSG and related additives, and artificial sweeteners.

There are certain things that are unlikely to cause headache after eating, such as hypertension. This is a belief that has been circulated on the internet, but a headache from high blood pressure is extremely rare, and is a medical emergency.

However, this is not to say that blood pressure is in no way related to headache, and it is not to say that salt may not be involved.

Many of us do eat too much salt, and there is a correlation with more headaches. In many cases, salty foods are also laced with MSG (see above).

So what can I do about these headaches? Here are the top suggestions:

See your doctor: It is not normal to get a headache after eating. See your doctor and explain your symptoms to her, before relying on painkiller which may only make the problem worse and are unlikely to address the underlying cause.
A healthy diet: For most of the causes of this type of headache, a healthy diet is actually the answer. Watch out for refined foods, especially sugars and artificial sweeteners, refined flours, and additives. Eat regularly, and don’t consume a lot of sugary or alcoholic drinks without eating something healthy at the same time.
Stay hydrated: You can actually overdo this one. However, you should be drinking liquids throughout the day and during/after meals. Sugary drinks (including juices) should be rare. Water is your friend.
Elimination diets: There are a number of diseases and conditions which could trigger headache after eating. Depending on what your doctor suspects from your symptoms and medical history (you’ve been to see your doctor, right), she may suggest eliminating gluten, or aged foods (many cheeses), nuts, caffeine, or other common suspects. Again, keeping track of what you eat is key here.
Check the environment! Sometimes the cause is something you would never think of. The lighting or air circulation in the place you always go to eat, for example. Heating foods up in plastic containers. Think about the environment and things that are always there when/before the headache strikes.

We all want a simple solution, but in this case the solution may take some time to track down. Do make sure your doctor takes your headache seriously, be patient, and in most cases you can cut down on or eliminate the headaches with some trial and error.

1 April 2013

High Blood Pressure and Headache

James Information, Medications 8

The general consensus is that high blood pressure does NOT cause headache. (I could add that it could be the case in rare and serious situations – the times when your blood pressure is so high that you need to go immediately to the emergency room).

However, chronic pain may cause temporary high blood pressure (usually not dangerous).

Some medications for headache may cause high blood pressure if taken often (such as ibuprofen).