Discoveries & Stats

2 June 2014

Are Migraine Patients “Visually Impaired”?

Do you ever feel like your senses are just overloaded? This is actually a common complaint when someone is in the middle of a migraine attack – there’s too much noise, too much light, too many smells.

But it has been suggested that people with migraine are more sensitive all the time. There is a growing body of evidence which suggests that migraine impacts us even when we’re not having a migraine attack.

A study published this spring, An inability to exclude visual noise in migraine, is adding to our understanding of just what migraine does to some patients all the time.

The study, published in the US journal Investigative Ophthalmology & Visual Science, built on earlier studies to look into how migraine patients process visual information. The researchers used two tasks – a motion coherence task and a motion equivalent noise task. These are common scientific tests which check patient’s ability to interpret moving dots on a screen.

The study determined that migraine patients had trouble filtering out visual noise. That is, they couldn’t focus in on certain visual information the way the non-migraine patients could.

An earlier study in the UK had the same results, and in that case the researchers found an even worse problem in patients with aura (see Visual Noise Selectively Degrades Vision in Migraine).

This type of impairment has been studied in other conditions such as schizophrenia and autism. But there are also concerns that this trouble with visual noise may cause problems with reading comprehension. If this is a serious problem in migraine, it could be even worse in patients who experience “visual snow” and other ongoing auras.

If further studies continue to demonstrate this impairment, it could tell us a number of things. First, it could clarify which parts of the brain and neurological systems are impacted by migraine. But it could also show how migraine impacts all of life. There may be symptoms of migraine that doctors could watch for, or test for.

If you have migraine, do you have trouble with “cluttered environments”? What types of background “noise” in life bother you the most (ie visual, light, sounds, etc)?

For some thoughts on one of the earlier studies on migraine and visual noise, see Visual ‘Noise’ May Overexcite Those With Migraine

14 May 2014

Supplements as Preventatives for Children – what works?

James Discoveries & Stats, Treatments 2

We know that many supplements have been used to prevent migraine in adults, but what about children? A recent review published in the journal Cephalalgia asked the question – and you may not like the answer.

The authors of the study reviewed research that’s been done into complimentary and alternative preventative treatments for children – specifically, various supplements used for migraine prevention. Based on the research, they made some recommendations, but their conclusion may be the biggest issue.

So what did they recommend? For one, butterbur – but only Petadolex. Also recommended was magnesium, but only certain formulations (read more here). Finally, coenzyme Q10.

Supplements that were not recommended included riboflavin, ginkgolide (from Ginkgo biloba) (at least not in isolation), and polyunsaturated fatty acids.

Now why would those three not be recommended? Aside from the polyunsaturated fatty acids (which researchers felt did not work), the problem was not that they don’t work, but simply that there’s no good evidence that they do.

In this case, it doesn’t mean there’s no studies. But the studies were small or poorly designed.

How far behind is migraine treatment for children?

Now we understand that, with so many options, it’s not wise to try a bunch of treatments that have no evidence behind them before we try the many treatments that are much more likely to work. Far too much time and money is wasted on treatments that may be well marketed but are actually of little benefit.

But in the world of paediatric migraine treatment, the problem is that there are simply not enough good studies.

Now we know that migraine research in general is woefully under-funded. But if you’re a child with migraine, you’re at an even higher risk, because there are even fewer studies.

Although the recommendations of the researchers for supplements are helpful, they themselves do not emphasize the benefits of COQ10, magnesium, and butterbur. Instead, in their abstract (Nutraceuticals in the prophylaxis of pediatric migraine: Evidence-based review and recommendations.), they conclude simply:

Overall, the quality of the evidence for the use of nutraceuticals in pediatric migraine prophylaxis is poor. Further research needs to be done in order to study the efficacy of nutraceuticals for the prophylaxis of pediatric migraine.

This review should be helpful to parents and guardians who are looking for effective treatments for children. But we could help them even more by promoting further research into alternative and complimentary paediatric treatments.

10 April 2014

Under-30 with Migraine – Special Risk?

James Discoveries & Stats 0

A study among Canadian migraine patients says that the under-30 crowd may be at special risk. You might be surprised to know why.

It’s not news that depression and migraine often go together. The reasons are not so simple. Many migraineurs are not depressed, and many with depression don’t have migraine. But there does seem to be a link, possibly related to the body’s neurological system and genetics.

But a study that came out of Canada late last year sounded the alert for a specific group of people. These people are young, unmarried, and had migraine. And that migraine was significantly limiting their activities.

This group was more likely to be depressed, and more likely to have thoughts of suicide.

Although the reasons were not clear from the study, some reasons may be obvious. Many of these people have been recently diagnosed. When the world was supposed to be opening up to them, careers starting, and opportunities for new relationships appearing – they suddenly encountered a major roadblock. Migraine.

Being unmarried, some of these may also have less support when they need it.

Depression and suicide are all-too common. The answer is not “get a grip”. When related to migraine, there are often physical problems that need to be – and can be – treated.

If you’re under 30 with migraine, there are excellent treatments available. But you need to know that finding those treatments may take time.

If you had migraine when you were under 30 and you’re now older, what helped you? If you’re under 30 now, and have migraine, what can we do to help?

For more, you can find the study here: Migraine and Despair: Factors Associated with Depression and Suicidal Ideation among Canadian Migraineurs in a Population-Based Study

7 April 2014

Subcutaneous Sumatriptan for Cluster Headache

James Discoveries & Stats, Medications 0

An recently updated survey of triptan for cluster studies came up with a winner: subcutaneous sumatriptan.

Of course, there weren’t a lot of competitors. Cluster headache is rare and therefore the studies are few.

Other contestants included the placebo (the clear loser), oral zolmitriptan and intranasal zolmitriptan.

Because cluster symptoms are so fast and furious, oral medications generall do poorly. That leaves us with the intranasal zolmitriptan and subcutaneous sumatriptan.

Intranasal medications are taken, as you may guess, through the nose. It’s a fast way to get medications into the body without the needle factor.

Only about 28% of patients were left with no pain or mild pain after taking the intranasal zolmitriptan.

Finally, subcutaneous sumatriptan. Subcutaneous is a fancy word that usually refers to an injection. However, medications such as Sumavel DosePro are needle-free.

Patients who took the subcutaneous sumatriptan did the best. Three quarters had little or no pain within 15 minutes.

Learn more about subcutaneous sumatriptan here. This article is more focused on migraine, and does warn about using sumatriptan before talking to your doctor, which is always important.

Study abstract: Triptans for acute cluster headache.

21 March 2014

Headache Patients: Stop getting your Head Scanned!

James Discoveries & Stats, Tips 5

You have a horrible headache. Maybe it’s the worst ever. Or maybe it’s accompanied by strange symptoms. Is it serious? Deadly? Better get a scan to check it out…

Wait! Not so fast. Getting a CT scan (computed tomography scan) or an MRI (magnetic resonance imaging scan) might sound like a good idea – “better safe than sorry” – but it could do more harm than good.

Thankfully, doctors are being educated about when to use and not use scans. But there are still doctors who are quick to use them – and even patients that demand a scan when it’s really not needed.

The guideline is simple, really. Scans should only be done when there is a good reason to suspect that something will show up – something related to the headache symptoms the patient is experiencing. That includes very few headache patients.

So what’s the problem? Here are some reasons why scans should usually not be done.

CT Scans: Radiation. This is the easy one. Recent studies have once again raised concerns about the link between CT scans and cancer. Don’t expose your body to radiation unless you’re sure it’s necessary, and the benefits outweigh the risks.
CT/MRI: There’s often a better way. The doctor can often use a better, more accurate method to find out what’s wrong. Just because these are well known methods, doesn’t mean they’re the best. And just because they find nothing doesn’t mean there’s no physical problem.
CT/MRI: Time and expense. Admittedly, the expense is often what drives concerns here. As patients, we’re in favour of methods that accurately diagnose the problem – no matter what the expense. On the other hand, when time and money is being wasted on a method that won’t help, there’s a problem. Yes, it is an issue for all of us when money is being wasted on unnecessary scans. Besides, your time is valuable, right?
CT/MRI: The last issue is the danger of unnecessary treatment. Here’s how it works. You have one of these amazingly accurate scans, and your doctor finds “something wrong”. We all have “something wrong” with us, but many of those things never lead to any symptoms. This “something wrong” your doctor finds leads to treatments, maybe even surgery. All of this does harm to your body. But does it solve the problem?
This is a huge issue right now, because so many tests are available. Statistically, many people are receiving unnecessary treatments and surgery, leading to more complications – when the “something wrong” wasn’t the thing causing the symptoms in the first place.

In short, even “safe” scans like MRIs (although even there accidents happen), and other tests such as EEGs, can lead to more problems for you when they’re used “just because”.

What should I do?

If your doctor recommends a scan, ask why. If she can’t give you a very specific answer, but just wants to “cover all the bases”, get a second opinion.

If a friend or family member is pressuring you to have a scan, send them to this post. 🙂

I’ve been there – it’s tempting to get every test possible, especially when you’ve spent months or years trying to find a solution. But for most of us, these types of scans just mean spending more time on the wrong thing.

MRI and CT scans are wonderful tools that have saved many lives. And yes, in a few headache cases they are a big help. We should be very thankful that they’re available. But let’s use the tools wisely.