Menu

Neurology

Another Weapon against “Rebound Headache”?

, , 0

A major concern among migraine patients (and their doctors) is what we sometimes call “rebound headache” or “medication overuse headache”. The perhaps over-simplified idea is that taking “too much” medication may make your headache symptoms come back worse than ever, or more frequently.

But this explanation can be misleading, partly because the whole concept remains very controversial. Just which medications lead to more headaches? And if migraine medication “causes” migraine, what’s the treatment?

In spite of a lot of misunderstanding regarding these types of migraine attacks, the ultimate goal really isn’t to take “less medication”. The goal is – you guessed it – less migraine! If you’re taking a painkiller or migraine medication and your symptoms are worsening over time, it may simply be time to try something different. Even if you end up taking more pills, you may be able to start a trend of fewer and fewer headaches.

How so? For example, if you find yourself taking a painkiller or more every single day, and your headaches are only getting more severe as the months pass, not to mention side effects from the medication, one option is to try a daily preventative – something that has been tested properly specifically as a daily medication.

Though information is limited about certain types of medication for certain types of migraine, every once in a while a study comes out that prioritizes a certain kind of medication for a certain type of migraine – such as rebound or medication overuse. And that’s the case with a study published in the journal Neurology last month.

The drug is atogepant, a calcitonin gene-related peptide receptor antagonist, sold under the brand name QULIPTA (you can read more about atogepant here). It’s a preventative taken orally each day. And in spite of the fact that rebound type migraine attacks are notoriously difficult to treat, atogepant seems to make a significant difference.

In the study, patients took one or two dose per day (it was the same amount either way – 60mg total). Patients had 2-3 few days a month with migraine, and 3 fewer days with other medications. For those with medication overuse headache, that means about a 50% reduction in headaches for almost half of the patients. Many of the patients actually no longer met the official criteria for medication overuse headache by the end of the study.

The best results overall came for patients spreading out the daily preventative in two doses.

Once again, this is not a silver bullet that works for everyone. But the results are very good considering how difficult this type of condition can be to treat. Study author Dr. Peter J. Goadsby notes:

Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications. This could lead to an improved quality of life for those living with migraine.

Dr. Peter J. Goadsby

This is one of those clinical trials that, although preliminary, can be useful immediately. Any medication showing positive results for medication overuse is worth moving up the list for those who are struggling with increasing headache and migraine symptoms.

You can read more about the study here: Could preventative drug be effective in people with migraine and rebound headache? The study itself is here: Efficacy of Atogepant in Chronic Migraine With and Without Acute Medication Overuse in the Randomized, Double-Blind, Phase 3 PROGRESS Trial

More “Stigma”, More Migraine?

0

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

Stigma - pointing finger

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:

  1. “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.
  2. “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

Cluster Headache Patients: Watch Out for Related Issues

0

It’s no surprise that cluster headache has a major impact on life, leading to significant disability, sick days, loss of productivity and family time. But what is less known is that cluster is also connected to other diseases that can make life challenges even greater.

man on street in pain

A study out of Sweden, published this month in Neurology, looked at the common types of diseases and conditions that tended to go along with cluster headache.

What we’re talking about here are “comorbidities”, that is, diseases and conditions that tend to go together. The term makes no comment on what caused what – did one cause the other? Are they the result of a common root? Is the treatment for one triggering the other? Or were more issues diagnosed because the patient was already seeing a specialist (e.g. a neurologist)? Those are separate questions.

For cluster patients, the most common comorbidities were neurological. In fact, they were diagnosed with far more neurological conditions than the reference group. That would include things like migraine, and depression.

Other types of conditions that tend to be more common in cluster headache patients include:

  • Eye diseases
  • Respiratory
  • Gastrointestinal
  • Musculoskeletal systems and connective tissue

On the positive side, there are some areas of disease that are less likely in cluster patients, such as:

  • Blood and immune system
  • Endocrine and metabolic
  • Pregnancy/childbirth related
  • Cardiovascular (from previous studies)
  • Diabetes (previous studies)

However, when cardiovascular conditions do go along with cluster, they tend to significantly increase disability.

Also, the study gives an important reminder. Although cluster is much more common in men, it does attack women, and can lead to even more disability and comorbid conditions in them.

So what is the value of knowing this information? Is there anything you can do about it?

First of all, because one may cause or trigger the other, it is important to be aware of and treat both (or all) conditions. Because resolving one may help resolve the other.

Second, sometimes other conditions can be ignored because of the incredible pain of cluster headache. The patient may not be thinking about other conditions, or the doctor may not think to ask (especially if it is outside their area of specialty).

Third, some treatments may be preferred, or avoided, once a diagnosis of comorbid conditions is made. Maybe there is a treatment that could make the other condition(s) worse, or a treatment that could help both.

So if you are suffering from cluster, do be aware of some of the most common other conditions to look for. A more in-depth eye check-up, a closer look at stomach problems, and so on, could resolve a lot of symptoms.

For more, including information about economic/work-related issues, see the full study: Multimorbidity and Sickness Absence/Disability Pension in Cluster Headache Patients and Matched References: A Swedish Register-Based Study

This Is Your Migraine Brain. On A Roller Coaster.

0

Yes, this is indeed a serious article about a clinical trial that was published in the journal Neurology this summer. What happens when migraine patients go on a (virtual) roller coaster?

roller coaster

You may be thinking – why would someone with migraine go on a roller coaster anyway? You can set your mind at ease. Not of these patients was actually having a migraine attack at the time. Which is the whole point.

Migraine brains are simply different – even between attacks.

This was a small study with 40 people, 20 of whom suffer from migraine. During the roller coaster ride, migraine patients did experience more discomfort. They were:

  • far more likely to experience motin sickness
  • far more likely to be dizzy

…and their symptoms were more intense and lasted longer than the control group.

Researchers also measured brain activity of the people in the clinical trial and found that they were able to “see” differences in brain activity between the migraineurs and the controls. Some of the differences in brain activity matched what we already have seen in migraine, and parts of the brain that regular movement were also affected.

Study author Dr. Arne May discussed the purpose of the study:

People with migraine often complain of dizziness, balance problems and misperception of their body’s place in space during migraine. By simulating a virtual roller coaster ride, our study found that some of these problems are not only magnified in people who experience migraine, but they are also associated with changes in various areas of the brain. By identifying and pinpointing these changes, our research could lead to a better understanding of migraine which could in turn lead to the development of better treatments.

Arne May, MD, PhD quoted in ScienceDaily

We’ve already seen connections between motion sickness and migraine, and dizziness and migraine – and of course there’s vertigo and cyclic vomiting syndrome. Motion sickness may be a warning sign for other conditions later in life, and should never be ignored. And, of course, we’ve talked about vestibular migraine before.

This study is another reminder that migraine affects all of life, not just those times when the patient is having a migraine attack. It also strengthens the link between migraine and other motion-related conditions.

For those who do suffer from dizziness, or motion sickness, but not from migraine – be sure to talk to your doctor. These symptoms may be a sign that you’re more susceptible to migraine. Paying attention and even finding treatment early on may be a major help later in life.

For more, read the study abstract here: Brain Processing of a Visual Self-Motion Study in Patients With Migraine: An fMRI Study

Headaches and Vision Loss – Idiopathic Intracranial Hypertension

0

A new study provides more clues about a condition that can give you headaches – and might also cause permanent vision loss. The condition? Idiopathic intracranial hypertension (IIH).

Image from a retinal scan
retinal scan

“Idiopathic” means that the cause is unknown, although we are learning about risk factors. “Intracranial hypertension” refers to pressure in the skull.

Everyone has protective fluid around their spinal column and around the brain, called cerebrospinal fluid. But sometimes this fluid starts to build up in the skull, leading to symptoms such as headaches, vision changes (such as double vision), and a rhythmic sound in the ears (pulsatile tinnitus). It’s important to get symptoms such as these checked by your doctor as soon as possible, because they could have a number of causes, including a tumour.

In fact, intracranial hypertension itself could be a result of a brain tumour. But again, what we’re talking about today is idiopathic – we’re assuming that your doctor or specialist has already ruled out various direct causes.

Headaches from this condition are another example of why you need to get to the doctor if you have new headaches, or a significant change in your symptoms. In this case, you may start to have headaches, or the “normal” headaches you have might start to get significantly worse.

One of the possible consequences of being misdiagnosed or not getting early treatment could be a permanent loss of vision. The pressure involved actually puts pressure on your optic nerve. Vision symptoms may include partial blindness, “blind spots”, or double vision.

A recent study in the journal Neurology suggested two key risk factors. First, areas in which it was more likely for patients to be “deprived” of certain economic factors such as housing, education, and access to services, tended to have a higher risk. But even more clear was another link.

Cases of IIH have been rising – and that rise has followed the rise in obesity. This confirms an earlier study.

We also know that IIH is more common in women, ages 20-50. Both doctors and patients need to be aware of this strong link, so that they can diagnose early and get the proper treatment (which involves surgery, using a shunt to release the pressure).

Learn more:

Load More

Back To Top
The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.