James

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Posts by James Cottrill:

23 October 2013

Medication-Overuse Headache and the Brain (new study)

James Discoveries & Stats, Medications 11

It has been estimated that half of the patients with chronic headache types have medication-overuse headache. If you’re taking abortive medication for more than 10 days each month, you may have medication-overuse headache (commonly called rebound headache).

Medication-overuse Headache - what are the dangers?

MOH could be a result of abortive medications such as triptans, paracetamol / acetaminophen, ibuprofen, and many others. The good news is that most patients seem to improve once they stop taking the medication. They also tend to respond better to preventative medications.

The bad news is that some patients do not improve – a significant number. Has the medication overuse done permanent damage to the brain?

A study in Switzerland, published last month, investigated grey matter changes in the brain to see if there was a difference among patients who did improve and who didn’t.

Changes in grey matter related to chronic pain are well known. But could these changes predict how well a patient will respond to treatment?

These researchers believe so. The evidence demonstrated that there were indeed differences between patients who improved and patients who did not. A lot of the difference could be seen in the orbitofrontal cortex area of the brain.

The orbitofrontal cortex is one of the least-understood areas of the brain, but it does seem to relate to decision-making, mood, and social interactions.

This study is another reminder of how important it is to get proper ongoing treatment. It also shows again that every patient is different. It may give us clues about how well certain patients will respond to certain treatments, and how headache conditions and other chronic pain conditions impact the brain physically.

References:

The study: Decrease of Gray Matter Volume in the Midbrain is Associated with Treatment Response in Medication-Overuse Headache: Possible Influence of Orbitofrontal Cortex.
The International Classification of Headache Disorders, 3rd edition (beta version)
The Mysterious Orbitofrontal Cortex.
Neuroscientific Foundations of Anesthesiology

21 October 2013

Migrainous Infarction – A Stroke from Migraine?

James Information 8

Migrainous Infarction - Stroke from Migraine?

She has migraine with aura. But this time, aura symptoms last more than an hour. Tests (neuroimaging) show that she has had “cerebral infarction”. This is a disturbance of blood vessels supplying the brain. This causes a type of stroke.

The result may be a variety of stroke symptoms.

Although migraine with aura may increase your risk of stroke, migrainous infarction is much more rare, because it occurs during the aura phase of migraine.

Migrainous infarction is VERY rare.

If your aura symptoms unusually last over an hour, get to a doctor immediately!

Additional notes: In answer to the question above – is this a stroke from migraine? We actually don’t fully understand the connection. Migrainous infarction is not a stroke which happens to occur during a migraine attack, or the migraine-like symptoms that may accompany a stroke. In migrainous infarction, the aura symptom or symptoms are actually related to the infarction. In other words, the blood vessels and part of the brain which is affected is related to the type of aura symptoms you have.

Again, it is extremely rare, and people have been mistakenly diagnosed when they actually have a different condition.

For more information: Migrainous infarction from the International Headache Society; Clinical and MRI characteristics of acute migrainous infarction.

19 October 2013

Vagus Nerve Stimulation For Cluster Headache and Migraine – without surgery?

James Information, Treatments 5

Vagus nerve stimulation is not new in cluster headache treatment, or even in migraine treatment. But it has commonly been accomplished through surgery. Is there a better way?

The vagus nerve is a very important nerve that extends from the head through the neck all the way down to the abdomen, connecting to important systems along the way. It runs down each side of the body. When there’s a disfunction in this nerve, common symptoms could include pain, muscle cramps, and even problems with various key organs.

Though we’re not sure why stimulation of this nerve can fight cluster headache and migraine, we do know that it sometimes works – even in chronic cases.

Commonly a device is implanted through surgery. But today, there is increased interest in non-invasive vagus nerve stimulation.

One device being studied is known as gammaCore, developed by the neuroscience company electroCore.

The gammaCore device is a small hand-held unit, about the size of an electric razor. It’s placed on the neck and turned on for about 90 seconds.

So far, the results have been positive. Patients have found pain to decrease with a minimum of side effects.

As with any treatment, it doesn’t work for everyone. But since it involves no surgery and no medications, it’s worth further study.

And further study is what it’s going to get. Patients with chronic or episodic cluster headache may be eligible for a study in the UK and Ireland. Researchers want to complete the study early next year.

You can read more about gammaCore here. Read more about traditional vagus nerve stimulation here.

16 October 2013

Child with Sinus Headache?

James Discoveries & Stats 0

My child has a horrible sinus headache – they’re flushed and sweating, they’re congested … their eyes are watering … and they have a runny nose. What should I do? Antibiotics? Nasal spray?

Not so fast. There is increasing evidence that your child may actually have migraine. And if you’re getting these symptoms, you may too.

One of the most common and notorious misdiagnosis is mistaking migraine for sinusitis. A study completed this year further confirms that – even in children – these symptoms could be tricking doctors into giving the wrong treatment. And the wrong treatment could do more harm than good.

This study out of the University of California was recently published in the journal Neurology. It included paediatric and adolescent patients who had actually been diagnosed with migraine. Most of them had more than one “cranial autonomic symptom”. It didn’t matter if migraine was chronic, if there was aura or not, or what age the patient was.

What are cranial autonomic symptoms? These are symptoms of the head that are not controlled by the patient. They could include things like:

Congestion
Runny nose
Watery eye
Flushing/sweating
Puffy eyelid, or droopy eyelid
A sensation of fullness in the ear

This study suggests that these may not be unusual migraine symptoms – but very common ones.

Now the symptoms tended to be one-sided, but that’s not enough to help doctors correctly diagnose migraine. Patients and doctors need to be more careful about tracking symptoms, being aware of the patient’s medical history, and asking more questions – maybe even doing more tests.

In addition, these symptoms could indicate other headache disorders, such as short-lasting unilateral neuralgiform headache attacks.

The wrong treatment could have a lasting impact – a longer period of time without improvement, and even harm from medications and antibiotics that was unnecessary. Because migraine attacks tend to go away in three days or less, many parents think that the nasal spray or antibiotic “worked”. In reality, the attack went away on its own (and probably could have gone away sooner with the proper treatment).

Headache is much more common in migraine than in sinusitis. Think twice before giving your child medications and especially antibiotics (which likely aren’t needed in sinusitis either). Get a second opinion, and watch symptoms carefully.

14 October 2013

Rhizotomy for Migraine?

James Treatments 7

Rhizotomy is a surgical procedure which severs nerve roots, often in the spinal cord, in an attempt to relieve pain.

Has rhizotomy been used to fight migraine? Yes, but rarely.

Why rarely?

Surgical procedures are not recommended until many other treatments have been tried.
Rhizotomy is not always considered reliable for certain types of pain. It is much more common for back pain, cancer pain, and trigeminal neuralgia.
Rhizotomy is temporary, and usually not complete relief, and will need to be repeated every few months.
There are other types of surgery and treatment that can “block nerves” which can be tried in serious, previously untreatable cases of migraine.