stroke

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:

14 July 2023

Migraine when you’re 60+ >> A few important observations

James Discoveries & Stats, Information, Treatments 0

A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.

It might be useful to get a quick overview of some of the report’s findings.

Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.

But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.

If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.

How is 60+ Migraine different?

Attacks may not be different, but they can change throughout life. For example, many older adults find that:

Their headache pain is now more often two-sided
They may be less sensitive to light and noise
They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
Sometimes the attacks are less severe
They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement

How is 60+ Migraine diagnosis different?

Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.

Cardiovascular issues in general are important to check as well.

The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.

It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.

How is 60+ Migraine treatment different?

Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).

CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.

However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.

Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.

If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.

Article: Migraine After 60: What You Need to Know
Report: Episodic Migraine and Older Adults

11 August 2022

Is Vitamin B12 a Migraine-Fighter?

James Discoveries & Stats, Treatments 0

Is vitamin B12 – otherwise known as cobalamin – a migraine-fighter? Researchers from the USA think it may be. With the obligatory “more studies are needed” disclaimer.

Best Practice & Research Clinical Anaesthesiology

We’ve actually talked a lot about vitamin B12, because it’s already well known for its important roles, related to migraine. You may remember that testing homocysteine levels may be one way to detect migraine, because this test may show deficiencies in B6, B12 and folate. High levels may not only be a sign of migraine, but also depression, and blood clots. Read more at A Blood Test For Migraine?.

We also talked about how heartburn drugs may relate to a B12 deficiency, which is why migraine patients may want to avoid these medications. NSAIDs (e.g. ibuprofen) may also cause problems with B12 levels, if used too often.

But actually, there have been many studies on B12, as these researchers point out in their 2020 paper, published in the journal Best Practice & Research Clinical Anaesthesiology, titled Utilization of B12 for the treatment of chronic migraine. In fact, for 70 years we’ve been talking about B12 and migraine, thanks to a study in the Netherlands in 1951.

The researchers discuss some of the relationships between B12 and migraine. But one of the biggest is the relationship with nitric oxide (NO), which we’ve also discussed often. B12, in its active form (hydroxocobalamin), helps control levels of NO. Here is just part of the explanation of the paper:

While the pathogenesis of migraine is not fully understood, NO is an important contributing element, and its effects can be mitigated through the scavenger action of vitamin B12. Patients experiencing migraine have neurogenic inflammation and vascular dysfunction, enabled by increased release of NO and homocysteine. N0 is an endothelial-derived vasodilator, and oxygen radical that plays a role in cell signaling [46]. Multiple factors. including CGRP. stimulate N0 production. NO turns on a pathway resulting in vasodilation of smooth muscle. Clinically, NO serves as a factor in pain pathways, including chronic pain, inflammation, central pain sensitization, and hyperalgesia via cyclic guanosine monophosphate {cGMP) contingent activity.
Utilization of B12 for the treatment of chronic migraine

It’s technical stuff, but if you’re at all familiar with migraine, you’ll recognize some of the connections here.

There are also many studies that directly show a decrease in migraine with B12 supplementation. However, these researchers warn that the studies were generally small, and that we need to see larger clinical trials, especially trials that only involve B12. This is always tricky, because sometimes a supplement only works, or may work better when taken with other supplements. But we need to know somehow how much B12 by itself affects migraine.

As mentioned above, B12 can also help the body avoid blood clots, leading to conditions such as stroke, which has also been known to be related to migraine for many years.

Other B vitamins have also been important in migraine treatment.

So in the end, these researchers basically say that there are many positive studies, and it makes sense from what we know about migraine that B12 plays an important role. But we need more studies. If only to find out who this may help. Is it only people with a deficiency? Is it only those with a certain type of migraine? We’re not sure.

Meanwhile, make sure you have good levels of B12 in your diet. Dairy products and eggs (eggs are pretty amazing, actually), salmon and tuna, beef and especially organ meats, are all high in vitamins and especially B12. If you’re vegan, you may be especially prone to B12 deficiency, so talk to your doctor. Some foods are fortified with B12, but you may need to look at other options.

Supplements may also help vegans and non-vegans in their fight against migraine. Garden of Life mykind Organics Vitamin B Complex is recommended by ConsumerLabs and also highly rated by customers. Consider talking to your doctor about your B vitamin levels.

B12 does seem to directly lower migraine attacks in some people, but even if it plays a smaller role in conjunction with other things, a proper level is critically important to your overall health.

16 December 2021

Migraine and Irregular Heart Beat

James Discoveries & Stats, Information 0

Patients who have migraine with aura are more likely to suffer from a certain type of irregular heartbeat, according to a recent study out of Switzerland.

The condition is known as atrial fibrillation. Atrial fibrillation occurs when the heart’s upper chambers beat out of sync with the lower chambers. You end up with an irregular, and often rapid, heartbeat.

The study does not show that migraine is causing the problem, only that the two conditions often come together. And there are a number of reasons why this may be – a medication you’re taking may increase your risk of heart problems, or obesity, or even a genetic disposition. A next step would be to try to figure out what the connection is between migraine and atrial fibrillation.

However, multiple studies have suggested that patients with migraine, and especially those with migraine with aura, have an increased risk of heart conditions. Studies like these are another reminder that migraine patients should especially take care of their heart health.

Now many people may not even notice this heart problem. If you do, you may or may not feel your heart “fluttering”. But you may notice weakness or fatigue, lightheadedness or dizziness, and maybe some chest pain.

Atrial fibrillation can be dangerous because it can lead to blood clots and stroke. The researches in this study review explain the practical steps you and your doctor may take:

In practical terms, screening for atrial fibrillation in patients who have a long history of migraine might be reasonable, whereas in patients with stroke or other disorders and migraine extensive screening for atrial fibrillation should be performed like in all patients without migraine.
Migraine and Atrial Fibrillation: a Systematic Review

In other words, it might be something you want to ask your doctor about, especially if you’re a long-term migraine with aura sufferer. If you know you have increased risk of heart disease, your doctor can help you lower your risk.

1 December 2021

Migraine or Stroke? New Stats.

James Discoveries & Stats 0

Yes, sometimes migraine looks like stroke. But let’s lay some important groundwork.

Most strokes are ischemic stroke. When there is a blockage to an artery going to the brain (such as a blood clot), the brain won’t get the oxygen it needs. Very quickly, brain cells begin to die. It’s a medical emergency.

Stroke is one of the leading causes of death worldwide, as well as a major cause of disability.

Typical symptoms include slurred speech or trouble understanding what others are saying, numbness or paralysis (often on one side of the body, such as half of the face), vision problems, dizziness, and a sudden headache. More helpful information can be found at the Mayo Clinic article about stroke. Scroll down for tips on what to do if you suspect a stroke.

Yes, other conditions can “mimic” stroke – but be on the safe side. If you have good reason to suspect a stroke, get the person to emergency treatment immediately.

To further complicate matters, migraine patients may be at increased risk of stroke (see for example these estimates).

But although it’s important to check for stroke right away, doctors and patients need to be aware that other conditions may mimic stroke. A recent study from Hungary gives us some more information.

For example, peripheral vestibular dysfunction was found to be the most common stroke mimic. This means dizziness, which can also mean problems walking properly, and nausea. This alone accounted for almost a quarter of the stroke mimics.

Migraine was down the list, but it still accounted for almost 8% of the stroke mimics. So to put this in perspective, if it looks like someone is having a stroke, less than 2% of the time, it may be migraine.

But there’s a way we can further narrow things down. If the patient is young, female, and at low risk of stroke, there’s a much higher chance that the symptoms are not, in fact, from stroke.

Why does this matter? You still need to go to the emergency room, right?

Yes, but it matters because once you’ve ruled out stroke, you still need to find out what’s going on, and treat it. Migraine is one of the main alternate culprits, because it, of course, can cause headache, but also dizziness, vertigo, paralysis, speech problems, and vision problems. So it’s important to treat, because it is also one of the leading causes of disability.

Find ways to reduce your stroke risk, and be sure to take migraine seriously as well.

Read more about this study here: Ischemic stroke mimics: A comprehensive review