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14 January 2009

Blog Carnival: What Keeps You Going? (and more)

This month’s Headache and Migraine Disease Blog Carnival has been posted over at Somebody Heal Me. You can head on over there and check out all the links for yourself, but here are just a few that I found particularly interesting. The first two are "on topic", the last two have some interesting scientific information.

The Pursuit of Painlessness
Fly With Hope
Why Do We Yawn? Many of you know yawning often comes before a migraine attack. But yawning isn’t as well understood scientifically as you might think. Maybe some clues about what yawning is will help break another part of the migraine code.
Sleeping off my headacheâ€¦ I actually heard of this unusual treatment many, many years ago. I won’t comment too much now, and I’ll let the article link you to more information. I think the proponents of this treatment (if you can call it that) tend to be overly optimistic, but there’s no doubt that sleep position (that’s what it’s all about) is very important to your health, and can impact the frequency and intensity of your attacks. Check it out!

There are many more articles to read (including my submission on the new drug Telcagepant). Read the full set right here.

13 January 2009

Sorry about that… Should Your Doctor Apologize?

James News 4

I just couldn’t resist sharing this story out of Canada. The Canadian Medical Association Journal made a bold move with its editorial, suggesting that doctors – *gasp* – apologize to patients when they make a mistake!

All right, I admit one of my first reactions was – they shouldn’t have made the mistake in the first place! Admittedly, there are mistakes that are inexcusable. Mistakes that come from being irresponsible, which should have serious consequences for the doctor.

That being said, doctors are – *gasp* – human. And there are times when they’re simply going to be wrong. Just like the rest of us.

The journal suggests:

Offering an apology with disclosure is an important component of addressing medical errors. An apology includes an acknowledgement of the event and one’s role in the event, as well as a genuine expression of regret for the patient’s predicament. An apology can have profound healing effects for all parties. For the physician, an apology can help diminish feelings of guilt and shame. For the patient, it can facilitate forgiveness and provide the basis for reconciliation.

So what are they saying? Doctors should admit they’re wrong and apologize. Now that I think about it, that sounds like good advice for all of us. Don’t doctors do that already? Shouldn’t they do it? Why even bring it up?

What do you think – has your doctor apologized to you? Would it have been a good thing?

via the Dallas Morning News: Canadians are *nice* — the Canadian medical journal argues for apologies

9 January 2009

5 Signs You have Retinal Migraine

James Information 94

A diagnosis of retinal migraine may be more and more common, but there’s still confusion over what exactly it is. There are five signs that you can use to tell if you have retinal migraine, but don’t miss the important warning at the end…

One eye: First, the eye symptoms tend to be monocular, meaning they’re only in one eye.
Visual disturbances: So what’s going on in this one eye? There are a variety of disturbances which other migraine sufferers may be familiar with. This might include flashing lights, or patterns in your visual field. There may be an area where your vision is impaired (ie dark spots), or even loss. Even blindness in one eye is possible with retinal migraine.
Temporary: Permanent vision loss is another matter. With retinal migraine the symptoms are reversible.
Headache: A headache typically starts during the visual disturbances, or within an hour after they stop. The headache typically lasts between 4 hours and 3 days, is often one-sided and pulsating, and usually either includes sensitivity to light and/or sound, nausea, or both. There is an increasing body of evidence showing cases of retinal migraine without headache as well. There is an argument that the "headache" not be necessary for a diagnosis of retinal migraine, but usually it’s still included.
Repeated: In order to actually be diagnosed with retinal migraine, you need to have had at least 2 attacks.

Now that you’ve got the 5 signs, it’s time for the warning. It’s very important that other causes have been ruled out. It’s easy to get a misdiagnoses here, so some things are very important:

It’s helpful to see your doctor during an attack, so she can ask the appropriate questions to diagnose you.
You need to have a normal eye exam in between attacks. Remember, this is temporary. There are a number of things that can cause similar visual disturbances, such as brain damage, tumours, ischemic optic neuropathy (damage to the optic nerve) and other optic disorders. Even if the symptoms are coming and going, it’s very important to rule out other causes.
Make sure your doctor has your medical history, and family medical history as much as possible. This will help her narrow down the possibilities to the most likely.
If your symptoms don’t quite fit the above criteria, you may have another type of migraine. Migraine aura without headache is a typical suspect if you have no headache, especially if you’re having symptoms in both eyes. Migraine with aura is another possibility if you have the headache but your visual symptoms are more varied. If you’re not sure about what your doctor is telling you, get a second opinion.

Researchers suspect decreased blood flow to the eye or optic nerve may be to blame for the unique symptoms of retinal migraine. However, like other types of migraine, the overall cause is still a mystery.

The good news is that retinal migraine often decreases or disappears with typical migraine treatment. Be sure to see a specialist and discuss your options.

7 January 2009

Little Known Ways to Get to Sleep (even with a Headache)

James Tips 15

Getting a good night’s rest is key to minimizing migraine attacks, cluster headache and many other types of headache as well. In fact, working at improving sleep may be one of the best ways you can fight migraine and headache.

Get to sleep - fighting insomnia with headache

Our first Community Question had to do with getting to sleep, and your excellent advice can be found here. But I was recently tipped off by Lifehacker that there are some great new articles out there with more quick tips.

First, 10 reader tips from the UK to relieve insomnia. From the more obscure (read a book of legal case studies? Yeah, that would do it…) to the very practical (write down everything on your mind, and get it out of your mind!), there are some good ideas here.

Next, some all-natural herbs to help you sleep (wait – which are the unnatural herbs?). You may have heard of these before, but one we haven’t talked a lot about is valerian root.

Valerian has been used for hundreds of years for sleep and relaxation. Some people find it helps right away, though often it needs to be taken over several weeks to be effective.

Valerian still needs to be studied more. We know it is a powerful herb, and though it usually seems to be safe it can cause side effects (ie headache and agitation). It’s wise to talk to your doctor before taking it.

Valerian has even been studied specifically for use in migraine and epilepsy, though so far the studies have not been conclusive. Some people take it during the day, but for sleep it’s often taken an hour before bedtime in a time-release capsule (such as these 600mg capsules).

Other surprises from these articles include lettuce and celery – a great whole food option that will do you good whether it helps you sleep or not!

What helps you get to sleep? Leave a comment and share your ideas with us!

5 January 2009

Anti-seizure meds and Suicide

James Discoveries & Stats, Medications 10

Anti seizure meds are back in the news after the The US Food and Drug Administration (FDA) reported on its analysis of almost 200 studies on various drugs. The question was – are people on antiseizure medication at more risk of suicidal thoughts?

This is an important question particularly for migraine sufferers, for a couple of reasons. First, many migraineurs are on these drugs as a treatment for migraine. They include drugs like Depakote (divalproex sodium), Neurontin (gabapentin), Lamictal (lamotrigine), Keppra (levetiracetam), and of course Topamax (topiramate).

To add to the issue, depression is comorbid with migraine, meaning that people often have both issues at the same time.

Suicide warnings on antiseizure medication

The FDA finally concluded that there was a risk of increased suicidal thoughts for people taking these and related medications (21 medications in all). They decided that a new warning label will be required for these medications. That decision was followed in Europe, and the data is currently under review in Canada.

The decision to change warning labels has been controversial. It’s natural that there would be controversy where money is involved. Seizure medication sold to the tune of $10 billion in the United States alone in 2007.

But money isn’t the only issue. Doctors are concerned that the news is confusing patients, and they’re afraid some patients will stop taking their medication.

The risk for suicide is really very small, they say, compared to the risks of not having the medication at all.

These labels are often so arbitrary. For example, in 2007 psychiatrists convinced the FDA to scale back language on labels of antidepressants, because some patients got worried and stopped taking the medication.

What’s the answer? What you’re doing right now – we as patients need to be educated on the issues.

There’s almost no chance that taking antiseizure medication alone will cause you to commit suicide. The warning in the US will be that "about 1 in 500 patients face an increased risk of suicidal thoughts and behavior".

However, if you do suffer from depression, be aware that the drug could, in rare cases, make it worse. Discuss this with your doctor, and be sure she knows your medical history.

Do not just stop taking your medication without talking it over with your doctor.

Medications have helped many with migraine. But we need to use them knowledgeably, with caution, and with the counsel of a doctor.

For more, read U.S. orders suicidal action warning on epilepsy drugs from the UK, and FDA adds suicide warning to epilepsy drugs