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Posts by James Cottrill:

7 April 2010

Gluten-free, Casein-free Diet – for Migraine?

Would you believe – a gluten-free, casein-free diet for migraine? And … um … just what is that, anyway?

First, let’s back up a step. There are a host of diets for migraine. Actually, I’d like to talk more about that in a future post. But let’s start by saying many are sceptical about these diets.

For one thing, it’s hard to get long term, scientific data about these diets. For another – they simply don’t work for everyone, no matter what some people claim.

On the other hand – diets do work for some. From my research, I remain strongly convinced that diet should be one of the key factors in your migraine treatment.

The other day I got an email from Carolyn. She says she has been migraine-free for 6 years, and healthy overall, due to a gluten-free, casein-free diet (otherwise known as the GFCF diet).

This diet is often talked about when it comes to autism and even schizophrenia. But migraine also comes up occasionally as a "symptom" in people who could benefit from the diet.

Gluten-Free Casein-Free Diet - Whooooo, Me?!

GFCF – Whooo, ME?!

If you break it down into two diets, you have two that are more commonly recommended for migraine. First, the gluten-free diet, which we’ve talked about before.

Casein is found in milk and cheese. And yes, I’ve heard people recommend cutting out dairy to stop migraine attacks as well (our friend Carolyn cut out beef as well, but that’s not standard for the GFCF diet).

It’s even harder than you think – many "dairy-free" diets still contain casein, including soy products.

The Theory Behind it All

Why this combination of gluten and casein? It’s a tricky question. If the diet does work, why?

The theory is that the GFCF diet limits opiate peptides in the body, which may be interfering with certain neurological functions of the body.

However, at this point we need more information before we can confirm exactly what is happening.

When it comes to autism, some researchers believe that this indicates a gut-to-brain connection, something that is very probable in migraine, as we’ve discussed before.

Giving it a Try?

First, if you’ve tried a GFCF diet for migraine, please let us know how long you have been/were on it, and the results.

If you’re thinking of giving it a try, you already know it will be a challenge. You’ll need to do research before-hand, get products and recipes together that will make things easier, and try to find people who can support you.

You might want to try things one step at a time. Carolyn said that she started with a gluten-free diet, and found that her migraine attacks diminished. Then she moved on to the gluten-free casein-free diet ("everything from a cow", in her case).

When used for children with autism, the diet is often started the other way around (or, all at once) – casein-free first, then gluten free.

You may or may not see a change right away, and as with many things you may feel worse before feeling better. Carolyn gave a good suggestion – commit to 6 months and see how it goes.

Planning is crucial. Talk to your doctor. While she may not understand, she at least needs to know you’re going to try this.

Do your research. Just cutting out milk and bread is not enough – gluten and casein are in a great many products – but that’s far beyond the scope of this post.

Again, if you’ve tried this diet, especially if you’ve tried it for migraine, we want to hear your experiences! Please, leave a comment, or contact me here.

To start more research on your own, read WebMD’s Gluten-Free/Casein-Free Diets for Autism, and check out The Big GFCF "FAQ’s" (hey, migraine is even mentioned there once!)

5 April 2010

Top 7 ways to stop Weekend Headache

James Tips 12

Are those all-too-common weekend headaches holding you back, just when you’re ready to cut loose and enjoy yourself? It’s time to fight back!

Weekend headaches destroying your relax time?

If you’re prone to tension-type headaches, or migraine attacks, it’s likely that your weekend headache is simply another attack. But then again, it can be an attack that’s more powerful than normal – some people’s weekend headaches are more painful than the ones they "normally" get. Or, some people may only get weekend headaches.

In order to fight them, a good strategy is to look for changes. People with headache or migraine seem to be especially sensitive to changes – diet, schedule, environment – even changes within the body.

Some people believe that their weekend headaches are "stress let-down" headaches. This could be explained by changes in the body after a busy week, when you’re finally relaxing.

But there could be triggers you can do something about…

Caffeine? Caffeine is often blamed for weekend headache. Whether you’re taking in more or less caffeine on the weekend, either way, it could be triggering an attack. If you aren’t about to cut out all caffeine, at least try to keep it steady, and low. Same amount of caffeine, same time of day.
Sleeping late? Same time? But – I sleep in! Well, that could be the problem. For many, sleeping late is a sure-fire way to a powerful migraine attack. You might not like getting up at the same time every day, but it sure beats that headache.
Not enough sleep? Actually, any change in sleep schedule could mean a weekend headache. However, some people find they can get away with staying up late sometimes, as long as they still get up at the same time.
Eat breakfast. A good, healthy, breakfast – at the same time! Some people even find they get rid of symptoms by getting up and having breakfast, even if they go back to bed afterwards!
Change of diet? Are you eating differently on the weekend? Or, worse – drinking differently? Could the wine you enjoy on the weekend be triggering headaches? Cut it out for a while and see.
Environment check. There are many things in the environment that could be triggering a weekend headache. Ask yourself, how is my environment different on the weekend? Is there anything that could be triggering a headache or migraine attack?
Look at the BIG PICTURE. Weekend headaches aren’t currently considered a disease of their own. They’re a part of something bigger, whether you get headaches other times or not. If you have a diagnosis (ie migraine), killing those weekend headaches is probably a part of your overall treatment. If you haven’t been diagnosed – talk to your doctor about the headaches right away. They should not be ignored.

There are other ways to stop weekend headaches, but I’ll turn it over to you now. What have you found that helps? Leave your comments!

Check here for more about the dreaded weekend headache.

1 April 2010

1% Thursday: Warning Signs

James Tips 0

Make it a habit to watch for warning signs.

Even for those of us that try to keep track of migraine, cluster headache or whatever-kind-of-headache symptoms from day to day still miss these. It’s usually not hard to miss the main symptoms – headache, dizziness, nausea – whatever it is for you. And quite often we can point to one or two possible triggers in each attack (oh, it was that glass of wine – or I skipped breakfast).

Learning to recognize the warning signs are a little trickier, especially when they’re quickly overshadowed by a wave of incredible pain. But it’s worth paying attention.

In migraine, we call these premonitory symptoms (formerly prodrome). They can arrive right before the major part of the attack, or even a day or more earlier. Some common symptoms? You feel unusually tired. Your neck feels stiff. You have trouble focusing, even trouble speaking. You look pale. Or you start yawning a lot.

What’s the use of noticing these symptoms? First, it may help you correctly recognize your triggers, if you know when the migraine chain-of-events started. Second, it often helps to take medication earlier in the attack. The premonitory phase may be too early, but it will put you on the alert. Talk to your doctor about when to take your medication.

And we’re not just talking about medication – avoiding further triggers, perhaps getting hydrated, or going for a walk, or getting some rest – there may be things you can do to minimize your coming attack.

If you don’t have a migraine or headache diary, print one out and start watching for those early symptoms.

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!

31 March 2010

Familial Hemiplegic Migraine 1 – Not Always the Same

James Discoveries & Stats 2

Familial Hemiplegic Migraine 1 (FHM1) is a rare type of migraine related to the gene locus CACNA1A. Common to FHM1 are speech, visual and sensory disturbances, headache, and loss of coordination (read more about Familial Hemiplegic Migraine here).

DNA display at
Oxford University Natural History Museum
Photo courtesy of net efekt

The fascinating thing about migraine that is familial – that clearly runs in families (although most migraine may be genetically based) is that it’s possible to study genetic connections.

Using these connections,researchers have classified different types of FHM – numbering them 1, 2 and so on (more on types of FHM).

But even within these sub-groups of a specific type of migraine, there are differences. A recent study (published in January) focused on two different CACNA1A mutations – S218L and R192Q. The former, S218L, is associated with more severe versions of FHM.

To understand the study, you need to understand that cortical spreading depression (CSD), a type of "storm" that sweeps across the brain, seems to be key to the progression of migraine symptoms. Not just in FHM, but probably in all types. (more on the science of migraine here)

The finding, in mice, was that those with the S218L mutation were far more susceptible to CSD. It took less stimuli to get one started, and often one "push" would cause multiple CSD events.

For those with the R192Q mutation, just one event was harder to start.

What does this matter? Well, obviously for those with familial hemiplegic migraine this may lead to better diagnosis and treatment.

However, it’s also doing two things for all migraine patients. First, it’s helping us understand more about how cortical spreading depression works. Second, there may be a much wider group of migraineurs that have a similar or identical mutation. Many with more common types of migraine have mutations in the gene locus CACNA1A.

In fact, it’s not only migrainuers we’re talking about. Other disorders may be involved, including those with nystagmus (involuntary movement of the eyeballs) and ataxia (unsteadiness, loss of muscle coordination), and seizures. Head trauma has also been related to this gene mutation. The connection between S218L and the calcium channels are also of interest as the study of calcium channels and migraine is of great interest in current research.

More on this study: High cortical spreading depression susceptibility and migraine-associated symptoms in Ca(v)2.1 S218L mice.
More on FHM1, seizures and head trauma
Electroencephalographic changes and seizures in familial hemiplegic migraine patients with the CACNA1A gene S218L mutation

29 March 2010

The Language of Pain: A Review

James News, Resources 2

I just finished reading the brand new (2010) book, The Language of Pain: Finding Words, Compassion, and Relief by David Biro, MD. So – let’s talk about it!

Today I was standing in line at the bank. On the back of someone’s t-shirt I read,”Pain is weakness leaving the body.” The quote has been made famous by the US Marines.

All right, I know what they’re trying to say. But if pain is weakness leaving the body – why do I feel so much weaker today (post migraine attack) than I did Saturday (pre-migraine attack)?

You might actually be surprised how much debate there is over how to define pain. What is pain? Is it a warning – something that keeps us from harm? Yes, sometimes. But sometimes pain causes the harm, it seems. Or even takes on a life of its own.

The Language of Pain: Finding Words, Compassion, and Relief

Pain, whatever it is, drives us inside ourselves. No one understands, and words seem to go from a stream to a trickle until they finally dry up.

Perhaps a good introduction to the book is in the author’s postscript:

… At its most intense, there is no time to think, let alone try to represent how one feels. … So why bother trying to speak? Why not just close one’s eyes, as I did many years ago in my hospital room, and wait for it to pass? And for those who witness pain, why bother trying to break down the wall of private experience and attempt to share what cannot be shared?
The simple answer is that we must. We must because the consequences of not trying are too great…

We must… but — how?

The goal of the book, if I could summarize it, is to free our tongues so that we can talk about pain (or draw, pain, sing, – most forms of expression fit in this case). Not only talk about it, but talk in ways that help us to understand it better. To deal with it better. And to share in ways that help others understand a little better – doctors, friends, family – the world.

It’s amazing that such a big topic hasn’t been discussed more. Don’t get me wrong – art, visualization, conversations of all kinds have been going on throughout history, and are strongly in the mainstream of medicine today. But the how – how to express pain – it’s a topic we don’t talk about enough.

Dr. Biro has done an excellent job tackling a very difficult topic. He’s done his research – everything from the literature of Charles Dickens and and James Joyce to the paintings of Frida Kahlo to the expressions of cancer and migraine patients.

He’s also navigated the very tricky waters of philosophy. It’s easy to get lost in the never-ending mazes of philosophy, and perhaps he does get a little off-course when he touches on ultimate questions, such as God and pain. But over all, he does a remarkable job sifting through philosophy and coming up with something very practical.

That practical thing is a box of tools that you or I can use to express – and understand – our pain better. He introduces us to different types of metaphor – different ways to approach the topic.

I’m more convinced than ever, after reading The Language of Pain
, that being able to express our pain is key. Key to survival, key to understanding, key to treatment – yes, even key to finding cures. As the author writes:

Physicians like me are often humbled by the uncanny sense that some patients have about what goes on inside their bodies. Deciding that something is wrong with them, or, less commonly, that nothing is wrong, patients will blatently contradict the assessment of their doctors and the “objective” data gleaned from sophisticated medical tests. Often they turn out to be right.

But many of us have only experienced the opposite side of communication. The vacant look when you try to explain. That look that says,”I won’t say you’re lying, but I know it can’t be that bad.”

The doctor that brushes you off. The employer that thinks you just want to take a day off.

But as powerful as misunderstanding can be, real communication can be just as powerful when it comes to solutions.

Dr. Biro isn’t exaggerating. If we want to move forward – and fight things like migraine – we must communicate. And it’s a skill we can learn.

It’s taken me a long time to get to this review. Not because I wasn’t interested in the topic, but because this isn’t the kind of book you can scan. It’s not a long book, but it’s not a book to rush through. You need to take the time to understand what is being said, and hopefully let it become a part of you, so that your creative expression starts to show it.

Though it’s not an easy read, it’s certainly not just a book for “artsy” people or clever writers. It’s for every patient in pain – and that’s the point.

I have a feeling this book won’t be read as much as it should be. Then again, more and more people, both patients and professionals in the health care field, do seem to be more and more aware of the necessity of clear communication. If that’s you, this is a great place to start.

You can also find The Language of Pain: Finding Words, Compassion, and Relief at Amazon UK.