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21 September 2015

Is this Study a Step Closer to Migraine Blood Tests?

A new study has led to a flurry of media interest in blood tests for migraine. But what is the study really telling us?

The study was published online this month in the journal Neurology. 52 women with episodic migraine were in the study, along with 36 controls. Each woman had a blood test, which was checked for a group of lipids (molecules including oils, fats, and waxes) which regulate inflammation in the brain.

Migraine checklist The results were actually quite remarkable. Certain lipids, known as a ceramides (waxy lipids), were low in women with episodic migraine. Women with migraine tended to have less than 60% the ceramides of the controls. The more ceramides, the lower the risk of migraine.

Two other lipids were the reverse – higher levels meant an increased risk of migraine.

So would it be possible to tell who has migraine just from a blood test? Well, the researchers tried it, taking 14 of the participants at random and doing a blood test – and yes, they were able to tell who had migraine and who did not.

The immediate question is – of what use is that?

Frankly, these women already knew they had migraine – the symptoms are a dead give-away.

This study raises some of the same benefits and challenges as other research already has.

First, is a blood test really going to be more useful in diagnosing migraine than a few specific questions? Probably not in the near future. But what if the test could differentiate types of migraine, or differentiate between migraine and other headache disorders? Now we may have something useful.

Another question is – why these differences in lipid levels (or whatever the difference may be in a given study)? Is this being caused by migraine? Or migraine medication? Or is it part of the biology that leads to migraine in the first place? Could migraine be predicted – even prevented?

Back in 2011 we discussed another type of blood test for migraine. This test seemed to show a possible trigger, related to high levels of an amino acid known as homocysteine. In this case, people with certain levels may benefit from a specific treatment (for example, taking certain B vitamin supplements).

That’s not an overall test for migraine, but it’s useful for some people.

This most recent study was very small, and is not going to lead to immediate changes in treatment or testing. More studies need to be done to confirm the results, and perhaps most importantly to compare different types of migraine and other headache disorders such as cluster headache.

But this line of research could lead to more easy ways to customize treatment in the future.

Read more about the study in this press release from the American Academy of Neurology: A new marker for migraine?

17 September 2015

Headache Waking You Up? Could Be Hypnic Headache.

James Discoveries & Stats, Medications, Treatments 0

You’ve noticed it’s starting to happen on a regular basis. All of a sudden, you wake up with a headache.

You didn’t have the headache when you went to sleep. Where did it come from? It may just be mild, but it could be severe – you might even feel sick.

Hypnic Headache - waking you up? Now that you’re awake, the headache lasts for a few minutes – but could even last up to four hours.

And it’s happening several times a week now – twice a week, maybe four times, or even every night.

It’s possible that you have a rare kind of primary headache known as hypnic headache.

But don’t jump to conclusions too quickly. This headache, sometimes known as the “alarm clock headache”, really is quite rare. It tends to happen in people over the age of 50, and it can easily be misdiagnosed.

The reason is that there are many other reasons why you may wake up with a headache. Sleep apnea is a common trigger of certain headaches, for example.

If you wake up feeling restless, it probably isn’t hypnic headache. A hypnic headache generally won’t last for more than 4 hours. And it will wake you up quite often – more than twice a week, often every day.

If you suspect you have hypnic headache, your doctor will want to ask some questions to try to find an underlying cause. Chances are she will give you a different diagnosis. Like I said, it’s rare.

However, if you are diagnosed with hypnic headache, there are some excellent treatments.

A recent study suggested that lithium is the best treatment for these types of headaches. Oddly enough, caffeine consumption upon waking is the second-best treatment. Melatonin or indomethacin may also be tried if these are not effective.

For more information about hypnic headache, check the links below:

Lithium, caffeine effective for hypnic headache treatment
Hypnic Headache (The Migraine Trust)
Hypnic headache (International Headache Society)

14 September 2015

Warning Flag: Do you have non-headache pain?

James Discoveries & Stats 2

It’s actually very common for migraine patients to suffer from non-headche pain – that is, back pain or leg pain or face pain or neck pain – and so on. But could this kind of pain be warning us that things are going to get worse?

Dr. Ann Scher and her team studied the symptoms of nearly 13,000 migraine patients to see how non-headache pain – that is, non-cephalic pain, related to the progression of migraine disease. The researchers then compared non-cephalic pain with migraine frequency.

For example, if you have episodic migraine (fewer than 15 attacks per month), chronic migraine (more than 15 attacks but not daily) or daily chronic migraine, how many other “pains” do you have? That is, how many other locations are manifesting pain? This chart shows the differences:

Non-headache pain So the more chronic the disease, the more pain locations (see study at Pain Comorbidities of Episodic and Chronic Migraine).

In fact, nearly half of those with chronic daily migraine had severe pain in another location, whereas less than 20% with episodic migraine did.

But what if you have episodic or chronic (non-daily) migraine? Do these other pains increase your chances to progress to a worse version of the disease?

The answer seems to be yes.

Back pain For each non-cephalic pain location, patients with episodic migraine were 30% more likely to progress to chronic. For patients who were already chronic, each pain location increased their odds by 6% to stay chronic. Read more at Noncephalic pain sites shed light on progression from episodic to chronic migraine.

One theory is that there is an underlying genetic condition that is triggering both pains. It’s certainly not unusual for migraine patients to be more sensitive to pain. There also could be something else that is worsening pain symptoms and worsening the migraine disease, such as the type of medication a patient is taking.

This is another study which helps us understand the progression of the disease. It is, at the very least, another warning flag for patients and their doctors. If there is pain in more than one location, the migraine attack should be taken all the more seriously before they have a chance to get worse.

As a side note, although this study was supported by Allergan, Dr. Ann Scher is also supported by the Migraine Research Foundation. To support further research, click here if you’re in the United States, here if you’re elsewhere.

10 September 2015

Drugs For Headache: Infertility?

James Medications 0

A report at the European League Against Rheumatism Congress 2015 is raising concerns about the use of certain anti-inflammatory drugs (NSAIDs). The study clearly showed the link between the medications and infertility.

cradle In this case, the connection was quite clear. While taking the medication (participants took it over a period of 10 days), the patients were much likely to ovulate – much less likely.

The drugs in the study were diclofenac, etoricoxib and naproxen. Of the control subjects (those taking none of the above), 100% ovulated. Of those taking etoricoxib, only 27.3%. Of those taking naproxen, 25%, and of those taking diclofenac, only 6.3%.

The good news is that the effect seems to be temporary – that is, only when the women were actually taking the medication (yes, they checked back a month later). But this and other previous studies do raise a number of questions. What about a lower dosage? What about one dose every couple of days? Is there a cumulative effect for someone frequently taking a NSAID? What about other NSAIDs, like ibuprofen?

This study is yet another reminder that we need to get away from “take two and call me in the morning” – no discussion of the alternatives or the risks. And headache/migraine treatment needs to be a lot more than masking pain.

For more information, see:

7 September 2015

Severe Headache in Pregnancy – What’s the Answer?

James Discoveries & Stats, Medications 1

There are quite a few excellent treatments for headache in pregnancy. The situation does get a little more difficult, however, when an unexplained headache lands you in emergency, and you want to take something that will help break the pain cycle.

Emergency Headache Treatment in Pregnancy Acetaminophen / paracetamol is a common drug to try first. In the case of migraine, intravenous magnesium may be tried as well.

But after that, the possibilities are a little more controversial. There are narcotic treatments, for example, which are being used less and less because they seem to be less helpful overall and may cause problems in pregnancy. NSAIDs and triptans are sometimes avoided in pregnancy, although it’s a matter of risk, and triptans are being more often accepted today. In that case, a medication such as sumatriptan may be given by injection.

Dr. Katherine Scolari-Childress wanted to know if there was a better option, so she tested a combination treatment against an older standard, codeine.

The women were first treated with 650-1000 mg of paracetamol/acetaminophen, but this treatment did not do enough to relieve the pain.

The combination that was being tested is intravenous metoclopramide (often given for nausea) and diphenhydramine (an antihistamine). Out of 46 pregnant women with normal blood pressure, 100% responded to just one dose (only about 2/3 responded to the codeine). 65% had full headache relief. Women taking the combination also spent slightly less time in the unit.

Almost every woman said she would use the medication combination again.

Doctors in emergency need to take notice of new treatments that may work better for pregnant women. As less effective drugs are phased out, and others are in some cases too high a risk, there are still excellent treatments which can provide relief in a way that is safe for mother and baby.

For more information: IV regimen safely resolved acute headache in pregnant women