James

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Posts by James Cottrill:

16 February 2017

Concussion: What Kind of Rest is Needed?

A large study is questioning some of the common wisdom regarding treatment of concussion in children.

We’ve talked a lot in the past about concussion (which is a brain injury), especially related to sports injuries. Concussion needs to be taken seriously – it could result in ongoing symptoms. Recent recommendations include being very cautious of activities that could result in another concussion, and getting sufficient rest after the injury.

In particular, cognitive rest. That is, avoiding (for example) reading, homework, and video games. (For more, see the 2014 study Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms)

But while getting rest and avoiding activity with a risk of concussion seems to be the best, does that mean that the child or teen should lie in bed all day? Apparently not.

A study involving 3063 children and teens (up to the age of 18) compared patients who returned to physical activity (within 7 days) with those who were restricted to more “conservative” rest. The question – which group was experiencing more postconcussive symptoms at 28 days?

Postconcussive Symptoms in Children and Youth As you can see from the chart, those who went back to physical activity within 7 days were significantly less likely to have the unwanted symptoms.

Depending on who you talk to, there seem to be two dangers. First, keeping your child away from any physical activity seems to be a danger. Activity is all the more critical to growing children and teens – it can play an important part in their recovery. But the other danger remains – not taking the concussion seriously, and putting the child right back into the sport that caused the injury in the first place.

A slow and cautious return to low-risk physical activity, with limited brain-work for a while, seems to be the best advice.

For more on the study, see the abstract: Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Also see Early return to physical activity after concussion may reduce post-concussive symptoms at the New York Headache Clinic.

13 February 2017

Migraine and Epilepsy: A Common Target?

James Discoveries & Stats 0

Migraine and epilepsy have a lot in common. For example, there are genetic connections. Epilepsy drugs are often used to treat migraine. And patients with one disease are likely to have the other as well.

Migraine and Epilepsy: A Common Target One interesting connection between migraine and epilepsy is the “cortical spreading depression” (CSD). CSD is a kind of electrical storm that passes through the brain of a migraine patient. It’s also been observed after a traumatic brain injury, and in patients with malignant strokes.

As you may have guessed, CSD has also been observed in patients with seizures. So – could we just target the CSD, and get rid of both the seizures (in some patients) and migraine attacks (in others)?

One of the tricks is that the CSD is not nearly as predictable in patients with epilepsy as it is in patients with migraine (although we still have a lot to learn about its role in both diseases). Does the CSD occur before the seizure, during, or after? Well – yes, it could be any of those three. So – is it a cause, or is it actually a protective measure? Sometimes it does seem that the CSD can put up a wall to stop the seizure in the brain. Other times, it seems to prepare the brain for the next seizure.

The brain seems to use the CSD in some interesting ways that we’re just beginning to understand. But some researchers of both migraine and epilepsy are hopeful that we may be able to use our growing knowledge of this “brain storm” to help the brain heal and avoid future attacks, whether they be migraine attacks or seizures. One treatment that is being studied and used today is vagus nerve stimulation, which may actually inhibit the CSD. It’s hopeful that more treatments will be developed for both diseases, and maybe the cortical spreading depression will be the common target.

For a more in-depth discussion, see Interplay between Cortical Spreading Depolarization and Seizures

9 February 2017

Women, Migraine, and Stroke

James Discoveries & Stats, Information 1

The link between migraine and stroke is nothing new, but recent research is making it a hot topic once again. In particular, there are increased concerns about the risk of stroke in women with migraine.

RISK For example, a study published last month in the American Journal of Medicine researched data on women who were evaluated for ischemic heart disease (“hardening of the arteries”). Of those women, anyone who had reported a history of migraine was at a higher risk of a “cardiovascular event” such as stroke or heart failure. (Study abstract: Migraine Headache and Long Term Cardiovascular Outcomes: An extended follow-up of the Women’s Ischemia Syndrome Evaluation.)

A study in Turkey (Istanbul University) focused on patients with their first stroke, between the ages of 15 and 50, compared to gender and age matched healthy patients. Frequency of migraine was almost double in the stroke patients. But when different types of migraine were compared, the results were much more specific. The only ones with an increased risk were women with migraine with aura. Another study in the American Journal of Obstetrics and Gynecology suggested that women with migraine with aura who also used hormonal contraceptives were at a significantly higher risk.

(See Migraine as a risk factor for young patients with ischemic stroke: a case-control study. and Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke.)

Another study out of Harvard University and Massachusetts General Hospital in Boston focused on those who experienced stroke after surgery – again, patients with migraine – especially migraine with aura – were at an increased risk in the first 30 days after surgery. (Migraines tied to increased stroke risk after surgery)

Each of these studies has its strengths and weaknesses, but the research continues to suggest that people with migraine, especially women with migraine with aura, have an increased risk of stroke.

It’s important to remember that this is not a high risk, in the sense that you’re just guaranteed to have a stroke. If you have migraine, chances are you won’t have a stroke any time soon. But, like smoking or a poor diet, migraine does increase your risk. It increases your chances.

So its all the more important to treat your migraine, and minimize other risk factors that you can control.

Finding good treatment for migraine may do more than just alleviate pain – it may decrease your risk of stroke. And some migraine-fighters, such as magnesium, may also fight stroke.

For more on migraine and heart disease, see Migraine and Heart Disease: 7 Critical Things to Know Now

2 February 2017

The Early Stages of a new Hemiplegic Migraine Treatment

James Discoveries & Stats 1

Recent genetic research has identified some possible new treatments for hemiplegic migraine – treatments which may also work for other types of migraine in the future.

It may be much more exciting when a new treatment is just about to hit the market, but it’s worth noting the steps that many of these treatments have had to go through in order to get to your medicine cabinet. So this is one of those treatments that is still in the very early stages.

This study, based in Spain, received a research grant from the Migraine Research Foundation. The study was based around certain genetic mutations, in this case in the P/Q-type calcium channel (CaV2.1). These types of mutations have been linked to a number of disorders, including hemiplegic migraine. It is believed that the functional changes caused by these mutations may lead to the cortical spreading depression – a kind of brain storm that occurs in other types of migraine as well (a storm of activity that sometimes leads to the visual auras many migraine patients have experienced).

So if there is a dysfunction in this calcium channel, the question is – could we find a medication that could fix it? And, importantly, a targeted tool – a medication that won’t cause a bunch of other problems and make other unwanted changes at the same time.

In other words, we want laser surgery, not a dynamite blast.

Computer research The researchers started with a database of millions of compounds that interact with this calcium channel. Then they started narrowing things down. Would this compound do what we want? Would it likely cause major side effects? Is it even available? If available, is it too expensive to manufacture? And so on, and so on.

After this extensive research, the millions were narrowed down to 6 – yes, just six – six possible compounds that have a good chance to be treatments.

At this point, animal studies often follow to test general safety before a possible drug for humans is developed.

This is an amazing process that would not be available without our knowledge of genetics, international cooperation, and modern computers. And one more thing – funding. Thanks to those of you who have given to the Migraine Research Foundation, research like this is possible.

If a medication could be developed to stop the hyper-sensitivity of migraine, stopping the cortical spreading depression, it could drastically improve the lives of millions.

To donate to the Migraine Research Foundation, just visit this page.

30 January 2017

Chemotherapy Headache

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Chemotherapy headache is very common in cancer patients, although the chemo itself is not always the cause, or only cause, of the pain. Today we’re going to take a look at what may cause the headaches, and what you can do to fight them.

Chemotherapy and headaches If you’re experiencing headaches during or after chemotherapy, you probably don’t need to be told that your body is already going through a lot of unwelcome changes. There are a huge number of things that can lead to head pain – the chemotherapy itself, other medications (including “painkillers”!) that you take along with the chemo, the cancer itself, changes in schedule and eating habits, and the many other changes that are happening in your body that are directly or indirectly related to your treatment.

In light of this reality of chemotherapy headaches, here are some important things to remember:

Always mention headaches, related symptoms, and especially any changes in your headache symptoms, to your doctor. Do not assume that this is just another symptom you just have to “live with”. Even if the headaches are temporary (and will go away after the treatment is over), there are may be things you and your doctor can do to alleviate the pain. And alleviating the pain may help your overall treatment be more effective. But some headaches can be signs of ongoing and serious problems that need more attention.
Pay attention to the timing and intensity of the pain, and any related symptoms. It can be hard to keep track when you already feel so tired and sick, but if you notice anything it can help your doctor diagnose your pain. For example, are headaches waking you up in the night? Are they worse in the morning? Is nausea worse when the headache is present? Any clues might help you find a good treatment.
Make sure your doctor knows your headache history. Have you been prone to migraine attacks in past years? Or regular, mild tension-type headaches?

Chemotherapy headache, and this includes chemotherapy and migraine headaches (and other migraine symptoms) can be difficult to treat. You may or may not be able to conquer all the pain, but there are some things that you and your doctor might want to consider:

Stay Hydrated. If you’ve been told to drink more water and you’re having trouble getting it down, you’re not alone. But drinking lots of water has helped some people lessen their headaches. If you can’t drink much water, but find other liquids more appealing, talk to your doctor. She can help you choose something that will be easier for you to drink. Another option is to drink one thing, and then something else, rather than sticking to one thing all the time.
Adjusting medications. Medications may trigger headaches during chemo treatment. This may be nausea medication (such as ondansetron (Zofran)), or the chemo drugs themselves. Your doctor might be able to adjust the level of your chemo drugs, or give you a different medication for nausea, for example. Even “painkillers” may lead to more headaches. If the dosis isn’t right for you, for example, a drug treating the pain may start “rebound headaches” – as if your body is starting to ask for more and more of the drug. Adjusting the dose, changing the medication, or even alternating meds, may help.
Fighting chemo headache with medication. Taking any extra medication during chemo is common, but as you probably know, it’s a tricky balance. Your doctor will want to avoid NSAIDs (like ibuprofen or aspirin), but might want to try paracetamol/acetaminophen, or a prescription medication.
Keep a regular “schedule” as much as you can. Those with migraine often find changes to schedule and meals especially difficult, and there’s only so much you can do about it. But if you can try to eat/sleep/wake up/take a short walk at a more regular time, it might help lessen the headache pain.
Complimentary treatment. As with medications, complimentary treatments will vary depending on the patient. A cold compress or ice pack in a towel may help some people, but it may or may not help you. But it’s worth a try. Two options that may be helpful include the ICEKAP and the ThermaZone Continuous Thermal Therapy Device. Massage can also help. A warm foot bath, or foot massage, may also help alleviate headache symptoms.

It can be overwhelming juggling many symptoms and treatments at the same time. But if you can lessen your chemotherapy headache, it can help your overall treatment. If you’ve experienced chemotherapy headache and have found something that helped, leave a comment!

More about chemotherapy headache and cancer related headache from the American Society of Clinical Oncology here.