This week: Take the time to learn about a different type of headache.
I’m blessed with a very unusual point of view. Because of this site, I don’t just focus on my own symptoms, and my own condition, but a wide variety of conditions and diseases that are related to headache.
A few weeks ago, I was researching a rare type of migraine. I was reading through some technical medical information that one would never choose to read on a rainy night with a hot cup of cocoa, unless you had a very good reason.
Suddenly, I noticed something – a connection with a disorder that another member of my family has – this disorder possibly connected with my migraine disease.
It’s a long shot, but that little bit of information in a rare medical text might just tell me something about my disease that will bring me a whole lot closer to understanding what’s going on.
So for the sake of finding those connections, and for the sake of looking outward and discovering the struggles of other people – I challenge you to learn about another type of headache or migraine today. Here are some possible places to start:
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!
In the last post we introduced two concepts – visual snow (VS) and persistent migraine aura (PMA). The first is a specific symptom which can have a number of causes; the second a diagnosis which can include the first.
First, persistent migraine aura (PMA) is diagnosed when other causes are ruled out. But as we’ve said there are a number of things that can cause visual snow (VS).
Doctors will take a careful drug history for patients with VS, because one cause is hallucinogenic drugs. The drug may only have been taken once, and time may have passed since it was taken, but it can have permanent effects.
Optic neuritis, an inflammation of the optic nerve, can also be a cause. Optic neuritis usually develops from an autoimmune disorder. Read more about optic neuritis here.
There are many other things that can be involved – even vitamin deficiencies.
Dr. Klaus Podoll, Dr. Markus Dahlem and Sofia Greene list common tests that are done for persistent aura symptoms here. These include:
Ophthalmologic examination
Neurological examination
Psychiatric examination
Thorough headache history and family history
Thorough drug history (including illegal drugs, especially hallucinogens: LSD, Ecstasy, mushrooms, other?)
CAT or MRI of head (the MRI is important to rule out what is called a migrainous infarction)
Other examinations may follow, including an EEG, evoked potentials (a testing of the functioning of the nervous system), blood work, and a lumbar puncture.
Obviously, if anything shows up on these tests, you’ll be following that up.
Assuming these treatments are out of the way, there are some treatments that have been tried, with some success. There is no tried-and-true established treatment, but some options include:
valproic acid
acetazolamide
lamotrigine (particularly for VS not classified as PMA)
topiramate (Topamax)
Sometimes injections of furosemide (frusemide) are used, if other treatments fail. Clonazepam is also used for patients who have symptoms from hallucinogenic drugs.
Do you have experience with ongoing migraine aura, or visual snow? Have you found anything that has helped? How did the symptoms start?
We’ve talked a lot about migraine aura – especially visual aura – here in the past. Typically, visual aura hits before an attack of pain in migraine, although sometimes it hits all by itself, and can be quite debilitating in its own right.
But what if that visual aura never went away?
That’s what does happen to some people. I’ll get more specific in a moment, but first a couple of important notes…
Is this migraine?
There is some debate over whether these visual symptoms should come under the classification of migraine at all. Now of course, there are many things that can cause aura-like symptoms, shall we say. So of course those other issues need to be ruled out before you can even consider whether or not this is migraine-related.
Next, we have to ask if the visual symptoms are the same as migraine aura, or if they have unique properties. This could mean there is a different cause, though it still could be that there is a root cause involved in the migraine attacks and the visual symptoms.
Finally, even if the symptoms are the same, there is still debate over how closely they are related to migraine. Does the patient have individual migraine attacks? Could there be a common cause of both? Could it be a similar symptom from another cause? These are difficult questions to answer, though we certainly seem to be getting closer to answers as our understanding of the brain increases.
What is Persistent Migraine Aura and Visual Snow?
Last year I was corresponding with someone about persistent migraine aura, and visual snow, and they pointed me to some helpful information. I would give them credit, but for some reason I can’t find the correspondence at the moment (what? James isn’t perfectly organized? I’m so disillusioned!)! But I appreciate the nudge to post on this topic.
Persistent Migraine Aura (PMA), also known as persistent aura without infarction, is diagnosed when there are aura symptoms lasting more than a week without evidence of infarction (which refers to the death of brain cells). This is in a patient that already has migraine with aura, and then has symptoms that are typical of their migraine attacks but lasting longer.
Often these symptoms are only on one side, though not always. They can continue for weeks, even years.
Visual snow (VS) is a more specific symptom, which could be a part of PMA or not, or even a symptom that is a part of a totally different diagnosis.
As you might guess from the name, VS is when the person sees "snow", like static on an old TV, all the time. This may be a temporary condition, or pretty much permanent. VS is often accompanied by other symptoms, and other types of visual disturbances, as the video below illustrates:
What’s causing it?
That question doesn’t always have an answer. As mentioned above, often it’s related to migraine and considered a part of migraine disease.
Sometimes there are other causes – at least suspected causes. Research on VS is extremely limited, and though the visual symptoms do have some patterns and relate to other symptoms, it’s sometimes hard to know if there’s a solid related cause, or just two things that are comorbid (that tend to go together, though we may not know why), or if there’s just a coincidental relation.
In our next post on the topic, we’ll talk a little more about possible causes, and what treatments have been suggested.
For now, remember that this is a condition/symptom that is known by (some in) the medical community, and if you’re suffering from it you are by no means alone.
Of course you know that the question isn’t fair – a concussion is a brain injury. And it can be a pretty serious one.
Debates and discussions are heating up when it comes to concussions – especially concussions among children (remember the Sports Head Injury Controversy). In a study to be published next month in the journal Pediatrics, the shocking find was that just calling the brain injury "concussion" meant that people didn’t take it as seriously. If children were diagnosed with "concussion" as opposed to something else (ie "aquired brain injury"), they spent less time in the hospital and returned to school sooner. In spite of the fact that their injury may be as serious or more serious than others.
And that could be a serious mistake.
Carol DeMatteo, associate clinical professor at the School of Rehabilitation Science at McMaster University in Hamilton, suggests that it’s time to drop the term concussion and start using mild traumatic brain injury.
DeMatteo says,"Even children with quite serious injuries can be labelled as having a concussion. Concussion seems to be less alarming than ‘mild brain injury’ so it may be used to convey an injury that should have a good outcome, does not have structural brain damage and symptoms that will pass."
For more about concussion, various types of sports related head injuries and post-traumatic headache or migraine, try:
… and wait, men, don’t tune me out on this one. This is for you too.
There’s more than one reason why flowers can be therapeutic for someone prone to headaches or migraine attacks. For example, there’s the scent of flowers. Good old fashioned nice smelling 100% natural flowers, whether fresh cut or potted or growing outdoors. We’ve talked a lot about aromatherapy, and I believe you can get a lot of the same benefit from flowers.
Also, as we talked about in The Forgotten Therapy, natural beauty itself has an incredible power that is little appreciated. Sometimes we put beauty in the category of "things we don’t need". That’s a serious mistake – we all need beauty, maybe more than we need some of the pills we take.
This is actually a coincidence, but this post comes at an interesting time – when there’s some debate going on in the UK regarding whether or not to allow flowers in hospital wards. Some of the concerns may be valid (for example flowers in an emergency ward that are just getting in the way), but some seem to be based on bad "science" – the belief that flowers are depleting the room of oxygen, or adding dangerous gases or bacteria. And yet no one can seem to produce any evidence that flowers (or the water they’re in) pose any real risk to the patient.
I’d have to suggest that the real benefits far far outweigh any imagined problems.
But here are a couple tips to help you get the most out of the flowers you’re going to buy this week (you are going to do it, right?):
First, avoid "grocery store" flowers (including potted plants). I know they seem like a great deal, and they’re oh-so-convenient. But in my experience they don’t last nearly as long and don’t compare to the quality of those found in the market or flower shop.
Second, here’s what I do with fresh cut flowers. This will keep the water fresher, and the flowers will last longer. First, re-cut the flower stems at an angle under water. If your flowers came with special "food" from the florist, use that in the water as per instructions. Otherwise, try a vinegar/sugar mix – 3 tablespoons of sugar and 2 tablespoons of white vinegar per quart (about 1 litre) of water. I’ve found it makes a big difference.
Now go buy a bouquet of your favourites! (And please, don’t ban flowers from the hospital rooms!)
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!
