It’s that time of year again! Time to look back to see what articles and news stories were most popular with all of you. Here are the top 10 posts of 2022, most popular first…
Thanks for reading, commenting, and sharing in 2022! But most of all, thanks for taking responsibility for your own health research. May 2023 be your healthiest year yet, as we continue to fight back against headache and migraine of all kinds!
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.
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.
Last month a meta-study was published in the Journal of Oral & Facial Pain and Headache, focusing on the use of melatonin supplements for migraine. The results are pretty encouraging for a supplement that is generally considered safe in small doses.
The helpful thing about this new study is that it didn’t just evaluate if melatonin “helped”, but it got specific into the “how”. Researchers found the following benefits:
Less frequent migraine attacks
Shorter migraine attacks
Less severe migraine attacks
Less use of “painkillers”
Why exactly melatonin works so well is not entirely understood. Obviously, if melatonin helps you sleep, improved sleep will certainly help fight migraine. But there may be more to it than that.
Melatonin is also an antioxidant, which may provide a number of benefits. Headache researchers have especially honed in on the anti-inflammatory powers of melatonin. More recently, melatonin gained traction as part of the COVID-19 fighting toolbox (see for example this study).
Melatonin is, of course, produced naturally in your body. At a 2019 Migraine World Summit event, migraine expert Dr. Christine Lay provided some very helpful advice for migraine patients:
I think there are ways to promote your own melatonin. When we come home after a busy day, I encourage patients to keep their room dim. And so not to have every single light on in the house, every, you know, television going, but rather to keep the room fairly dim and to use lamp lighting, perhaps, rather than overhead lighting so our own natural melatonin will kick in. But for some patients supplements can be very effective. I think we have to be mindful as migraine patients that you’re not spending all of your money on the most expensive one but you’re not buying the cheapest one because we know these things are not really mandated. We don’t know about quality control, necessarily. So you want to make sure you’re buying a good product.
The other thing I think is important: there are sometimes what we call sublingual, or melt-in-your-mouth, melatonin. I tend to tell patients to avoid those because they usually have additives in them or they may have an artificial sweetener which could then provoke a migraine attack. So they need to stick, primarily, with tablets or pills. In terms of amounts, it’s quite variable. There’s a lot of research showing that melatonin can help patients with chronic migraine, even chronic migraine people who feel like they don’t have a sleep problem. There’s something positive about melatonin. It may actually have even an antiinflammatory benefit to some degree. So melatonin can be very effective. I usually have patients start at a lower dose, perhaps three milligrams, and then work slowly to build up depending on how they tolerate it. I don’t think patients, without discussing with their doctor, should go beyond 10 milligrams because you have to be mindful of how much you’re taking. And most experts will say you need a melatonin break. It’s something that’s naturally produced in our brains by the pineal gland, and so, if you’re continually supplementing the melatonin, your brain might get used to not making its own. So you do need to take periodic breaks every few weeks or couple of months.
Dr. Christine Lay
Dr. Lay also recommends foods with melatonin, such as walnuts. (Make yourself some Morning Glory Muffins. Seriously.)
For a highly-rated melatonin without a lot of the additives that Dr. Lay talks about, try Natrol Melatonin. It’s very inexpensive right now, and has even bigger savings with Subscribe & Save. Be sure to get this particular version – Natrol has various others, such as the fast dissolve version that has additives that you’ll want to avoid.
A new study is once again linking migraine and sugar – and yes, there’s something you can do about it.
We’ve talked a lot about the link between migraine and eating, in particular, sugar and refined grains. But how your body responds to foods is actually very complex, so there’s a lot more to say.
A diet that gives you a lot of spikes in sugar certainly seems to trigger more migraine attacks. For example, liquid sugar – drinking a lot of juice or carbonated sugary beverages, for example.
The study talked a lot about “insulin resistance”. Imagine it this way. There’s a lumber mill out in the forest, and trees are being cut down and made into planks for building houses, and so on. I might add that this is a very sustainable operation, and trees are being replanted and habitats protected. 🙂
The lumber mill salesman goes into the city with his planks and sells them to all the people, and the people go into action, building houses using wood for fuel and making little toys and whatever else they do with the wood. Wood is amazing.
But after a while, the lumberjack starts getting a little greedy and starts cutting down more and more trees. The lumber mill is having trouble keeping up, but it’s giving a lot of work to the salesman. The salesman, also getting greedy, is in the city constantly, shouting to all his clients about what they could do with more and more and more wood! More salesmen are trained for the “growing market”.
After buying the wood for a while, and storing the extra in the garage, the people in the city get fed up. They have too much wood, the salesman is simply annoying – they’re done. They get so fed up, they call the police on the salesman, put out a restraining order, and start putting up posters warning everyone to stop buying from this guy.
You can understand their concerns – but now a system that was working well is completely broken. A very useful system is ending up with unused wood gathering dust in the garage, and at the same time a supply-chain problem. But now the salesmen have too much wood – so the storehouses are getting full of wood, that’s simply not being used for anything.
Now, imagine that the wood is food you eat with sugar. It’s processed by the body, and a salesman – let’s call him Mr. Insulin – gets the sugar to the city (or perhaps stores some of the wood properly in the lumber storehouse – like the liver, for example). The city (cities) is like your cells.
Sometimes, for various reasons, the cells can become “resistant” to the salesman, Mr. Insulin. The salesman gets more aggressive – in fact, more salesmen are trained at the Pancreas School of Insulin, because obviously, something isn’t working. But more salesmen aren’t helping.
For a while, the sales trucks are full of wood, but eventually there’s too much wood (sugar) for the insulin. The body is simply getting overwhelmed.
The excess sugar is stored in the storehouses – we call it “fat”, and you might see this right around your waist.
Insulin Resistance and Migraine
With the system broken, you end up with all kinds of problems. Diabetes…. it may cause problems in the brain – dementia – and … migraine?
This particular study, as you may guess, did find a link between insulin resistance and migraine, as well as metabolic syndrome and migraine. Metabolic syndrome is defined by the Mayo Clinic as “a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.”
Researchers looked at various indications of metabolic syndrome and insulin resistance. For example, fat around the waist. Yes, more likely in the migraine group. Insulin resistance? More likely in a migraine patient. Higher levels of insulin? Yes. Metabolic syndrome? Same thing.
And looking at the situation in reverse, migraine patients with insulin resistance were more likely to have worse migraine disease – more disability, worse attacks, and so on. Metabolic syndrome, in this case, was not as closely related to worse attacks.
Now we need to remember that there are a number of things that can cause “supply chain” issues in the body. Think of our lumber mill. Maybe one city just tends to build houses more slowly and carefully. Maybe the lumberjack gets a more efficient chainsaw. Maybe the weather is bad for a season.
In the same way, problems people with certain genetics or medical histories – or family medical histories – may be more susceptible to “supply chain” problems.
This study doesn’t show that insulin resistance causes migraine, but it is another clue (along with many other studies) that general health should help fight against migraine.
If you’re tempted to go and spend a fortune on that new exercise equipment, or that pill promising to “melt” fat around your waistline, think twice. Before getting to “next level” options, you have the power to make a huge difference in your own health.
That’s right – we’re back to exercise and diet.
Consider “quitting sugar” (that is, drastically reducing the added sugars and refined grains in your diet). For tips, see How To Quit Sugar (1) and How To Quit Sugar (2). If you spend most of your time in a chair, start by adding some movement to your day. In other words, take small steps to get your body moving. This does not mean going from the armchair to 6 hours at the gym tomorrow. Small steps, but consistent, regular steps.
The story of acetaminophen/paracetamol, commonly associated with the brand name Tylenol, is a strange one. A researcher studying treatments for worms requested one chemical and received the wrong one. The worms didn’t mind it, but it did seem to fight fever.
It was in the late 1800s that acetaminophen was first used to fight fever and pain in Germany. But it was never widely used until it came to market in the USA and the United Kingdom in the 1950s.
As might be expected, a drug to treat pain and/or fever quickly became popular. Not only by itself, but in combination with other medications under numerous brand names. Few medications are taken with as much frequency as this one.
As is the case with many drugs, we’re not really sure how it works. The most common theory today is that it blocks COX (cyclooxygenase) enzymes in the brain, thus keeping pain signals from being transmitted. Read more from Tufts University School of Medicine: How Does Acetaminophen Work?
Being so common, problems started to arise with overdoses. It’s easy to take too much, or to take two products that contain paracetamol without carefully checking the labels. (By the way, unlike some “painkillers”, taking more of this one doesn’t increase its power – so never take more than the recommended amount thinking it will help you more.)
The “good” news may be that this may not be your best choice for headaches after all. Sure, if it works for the occasional tension-type headache, there may be no reason to change. But if you’re popping a pill every month, or every week, it’s time to talk to your doctor. But when it comes to other headache conditions such as migraine, there are so many better options that you may want to avoid acetaminophen altogether. SeeIs Acetaminophen/Paracetamol Really “Ineffective”?
Recent studies remind us of some key issues that we’ve talked about before:
Even “safe” medications should be used rarely, if possible. They all have risks.
You are an individual, and you need to find what works for you.
Lifestyle, such as regular movement and what you eat, are still king, and can never be replaced by a pill.
Read labels.
Getting headaches on a regular basis? Talk to a specialist. There are probably better treatments than over-the-counter painkillers.
Paracetamol is a unique drug with a strange history. It has helped many, but as our knowledge continues to expand, we may find that it has had its day. This will be an interesting story to keep watching.
