Migraine and Depression with Dr. Robert Shulman (audio)
This is an interview (audio only) from the National Headache Foundation featuring Dr. Robert Shulman. In the interview, Dr. Shulman gives an overview and also answers common questions.
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Highlights from the past 3 Months (April 2012 edition)
Which posts have been most popular with our visitors over the past 3 months. This is your chance to catch up on the conversation!
- Coming Migraine Treatment: Lasmiditan Lasmiditan is a new drug that is being investigated for the treatment of migraine attacks. It’s in a new class of drugs known as ditans, which are…
- Watch for it – Ketamine for Migraine and More Using ketamine for pain is not a new idea. But I think we’re going to see it get an increasing amount of attention in the months ahead…
- Botox for Migraine – how does it actually work? Botox, or onabotulinumtoxinA, is an emerging and at times controversial treatment for migraine. Many patients have found relief through Botox treatment, although others have found that it wasn’t very…
- Methods that are Really Fighting Neck Pain Killing migraine-triggering neck pain – what’s the best way? A recent study looked at a related question…
- Sinus Headache: Say NO to Antibiotics! There is increasing evidence that those who a diagnosis of sinus headache, or a self-diagnosis of sinus headache, should NOT be taking antibiotics. Why?
- Could we Stop Migraine – At the Start of Life? We know that people start having migraine attacks as very young children. It’s hard to say if there’s an age when migraine starts, because the younger we are the harder it is for us to recognize and express the symptoms…
- Spinal Cord Stimulation (video) It’s being used for migraine and other types of chronic pain when other treatments haven’t worked. Here’s an interview with one patient about his experiences with the treatment. In his case, the pain was back pain.
- Child with Migraine? The Migraine Trust Needs You! Are you a parent or a care-giver of a child (11 and under) with migraine? Live in the UK? Then The Migraine Trust is asking for your help!
- Botox and Magnesium for Cluster Headache? Yesterday Dr. Alexander Mauskop reported on a man who has been taking Botox and magnesium for cluster headaches for three years. He’s found it very helpful, although the treatment is not alone.
- Time to Vote – For a Christmas Card! You might remember from my post in January Fight Migraine by … designing a Christmas card? that the Migraine Trust was looking for Christmas card designs to sell for the 2012 season
Ice Cream Headache (Brain Freeze!): A New Study
Although the famous ice cream headache (also known as brain freeze, or more officially headache attributed to ingestion or inhalation of a cold stimulus) was first studied seriously almost 45 years ago, it’s still somewhat of a mystery. But a new study in the USA may be giving us clues not only about ice cream headache, but about other types of headaches as well.
British neurologist Dr. R. O. Smith, began studying brain freeze in 1968. Since then, there are several interesting facts that have come to light. For example:
- Brain freeze seems to be more of a problem in warmer climates
- It doesn’t seem that any permanent damage is done
- Nerves in the roof of your mouth seem to trigger changes in blood vessels, triggering the pain
- Migraine patients seem to be more susceptible
- An ice cream headache can trigger a migraine attack in migraine patients
 Photo courtesy of Tom Newby Photography |
The new study, entitled Cerebral Vascular Blood Flow Changes During ‘Brain Freeze’, confirms the blood vessel theory.
So what seems to be happening? First, typically, something cold comes into contact with the roof of your mouth. Quickly, blood vessels dilate (get bigger around), allowing for more blood flow. In particular, the anterior cerebral artery seemed to react. This may be a response to ensure that the brain stays warm.
Researchers believe that pain may occur at this point because of the sudden rise in pressure from the increased blood flow.
Soon after, the blood vessel constricts, presumably to keep the blood flow from getting to high. At this point, the patient’s pain recedes.
This type of headache is an interesting one to study – because it’s easier than most to study in the lab. You can’t usually sit around waiting for a migraine attack to start, but a brain freeze is easy to trigger. Because researchers believe that these types of headaches may have a lot in common with migraine headaches and post-traumatic headaches, for example, studies like this may provide clues to help us treat those as well.
For more, read this summary from the American Physiological Association: Changes in Brain’s Blood Flow Could Cause ‘Brain Freeze’. For more general information about the causes and treatments of brain freeze, see Stop the pain of ice cream headache!
Should I try a Multidisciplinary Pain clinic? (Guest Post)
I often encourage people to think about putting together a "team" of medical professionals as they seek proper treatment. This could mean simply working with a number of different doctors, complimentary health care providers, a dentist, etc – and making sure they all have the right information and are working toward the same goal.
(My thinking on this was really challenged by the useful book What’s Wrong With Me by Lynn M. Dannheisser and Dr. Jerry M. Rosenbaum, an excellent book now available in Kindle format).
Another way to find a team (or a part of your team) is to find one that already exists – in what we might call a multidisciplinary pain clinic.
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Today I would like to ask Dr. Michael Zitney to share his thoughts on these types of clinics from the inside. Dr. Zitney is the director of the Headache & Pain Relief Centre in Toronto, Canada. Let’s here what he has to say:
Many doctors can treat pain; an orthopaedic surgeon treats broken bones, neurologists treat migraines, anaesthesiologists block painful nerves, cardiologists treat chest pain caused by angina and family doctors treat all sources of pain every day. However, when an ongoing painful condition negatively impacts the way you function on a daily basis, there are tremendous advantages to attending a Multidisciplinary Chronic Pain clinic.
There is no specific definition of the words "pain clinic". The clinician in charge can be a physician, chiropractor, osteopath, physiotherapist or dentist. There may be only one clinician or they may have a team working with them.
The term "multidisciplinary" describes a team composed of various clinicians. This usually suggests doctors (medical, chiropractic or osteopathic), nurses, physical therapists and often, psychologists. If the clinic is located in a hospital there may be diagnostic services, research facilities, social workers and occupational therapists associated. Clinics may have all the clinicians on-site or may be associated with other practices in the area. Physicians may be neurologists, anaesthesiologists, family physicians or certified pain specialists. There may be inpatient and outpatient facilities; there may be a training program for medical students or others.
Chronic pain (especially if it includes chronic headaches and migraines) is a complex problem. There are many changes that occur in the brain and body. These changes progress over time. Numerous systems are involved; typically the changes are neurological, musculoskeletal, myofascial, vascular, immunological, psychological, emotional, nutritional, pharmacological and more. Entire families are affected and coping strategies are taxed. No one person, doctor or therapist can be an expert in all the changes that occur. It helps to have a well functioning team working together.
The human brain is an amazingly adaptable organ. Once these chronic pain changes occur, the brain resets to maintain the status quo, even in the face of pain and impairment. Trying one treatment or medication is often useless. The brain needs to be "rewired". This usually involves some combination of removing the pain/headache triggers, boosting the natural pain fighting and trigger blocking ability of the brain, improving the nutrition and sleep patterns and (temporarily) breaking the "pain cycle". These must be done all at the same time for a chance of success. It takes a well-crafted treatment plan utilizing various specialties to rewire the brain.
If you are having success at your currant clinic, continue with treatment. If you are not making progress after a reasonable effort, ask for a referral to a Multidisciplinary pain clinic.
Coming Up: NYC Marathon and the Migraine Research Foundation
This just in from the Migraine Research Foundation:
