Information

8 November 2018

Is Migraine and early Sign of MS?

If you’re familiar at all with multiple sclerosis, you know that early diagnosis is considered to be very important to slow the progress of the disease and improve quality of life. We also know that migraine symptoms often accompany MS. So the obvious question is – could it be that my migraine attacks are actually an early sign of MS?

Researchers in Germany recently made that argument. But their study actually focused on the progression of headache attacks in the first few months of MS. And the results are not what you would expect.

We’ve noted before that migraine symptoms are actually especially common among women who have had MS for a long time. But according to the recent study, symptoms may actually improve over the first few months.

In the study, 50 patients were screened when symptoms of MS began, and then again 6 months later. Based on this small amount of information, headache symptoms did seem to decrease.

The authors of the study felt that the treatment of MS – specifically immunomodulatory therapy (therapy involving the immune system) may explain why headache symptoms decreased.

But of course, this means that early on in MS headache symptoms are worse. Cases have been reported of patients who have experienced migraine or cluster headache symptoms as their only or primary first warning of MS. We talked about a patient who had long lasting migraine symptoms who did indeed have MS.

An MRI for MS? These researchers recommended that young patients who have migraine-like symptoms should automatically be given an MRI, a test which helps rule out diseases other than MS and that may show signs of MS.

There are, however, good reasons why every headache patient should not be running to get their head scanned. But then again, patients already at risk for a certain disease who are experiencing new headache symptoms should take them seriously.

Who, then, is at risk for MS? MS most often is first diagnosed in young adults. But risk is a controversial subject. Some possible risk factors include:

type 1 diabetes
thyroid disease
inflammatory bowel disease
you smoke
you’re female
you’re related to someone with MS
you live far from the equator

So a patient with some of these risk factors, who is experiencing new headache symptoms, or especially symptoms which won’t go away and are getting worse, should see a doctor at the very least. Headaches can be a warning sign for many conditions, and MS is likely one of them.

This is not a reason to worry and panic. It is a reason to take headache symptoms seriously, early on, rather than to just consider it “normal” because you’re “stressed”.

Snopes takes on Cream of Tartar for Migraine

James Information, News 0

It’s not often that a Snopes article makes the rounds that is specifically focused on a migraine remedy, but the popular anti-myth site got some attention last month with a discussion of cream of tartar as a migraine remedy.

Admittedly, the article is bound to offend a wide crowd, discussing “the dubious malady of ‘MSG poisoning,'”, acid levels in the body, and even taking a jab at a popular health news site. But let’s take a look at the core issue – is cream of tartar a good migraine remedy?

What is cream of tartar? You may be familiar with cream of tartar as the white powdery substance used in baking. Baking soda actually contains cream of tartar. By itself, it’s often used to improve the look of things you’re cooking – this isn’t a cooking blog, so for a few tips, check out Cream of Tartar: What It Is and How to Use It.

But what is it? Joe Schwarcz PhD explains:

[Cream of tartar] is a byproduct of winemaking and remains behind as a sediment after fermentation. In chemical terms, it is potassium hydrogen tartrate which is basically partially neutralized tartaric acid.
[Cream of Tartar]

In everyday terms, let’s say this – cream of tartar is a mild acid in dry powdery form.

A search engine exploration will confirm that this is a “recommended” natural remedy (although now the Snopes article is pretty popular). And perhaps the last line in the Snopes article is key: “If the anecdotal reports of cream of tartar’s efficacy against headaches are real, it apparently works via a different mechanism than the ones proposed on the websites suggesting it to be a remedy.”

So what would that mechanism be?

As you might have guessed, cream of tartar is very high in potassium (of course, since it’s potassium hydrogen tartrate!). Potassium is very important in the body, regulating hydration and blood pressure, for example. In fact, in her popular book Fighting the Migraine Epidemic, Angela A. Stanton PhD advocates a system of hydrating the body with a balance of potassium and salt to fight migraine attacks.

But hold on – it’s not that simple. Although a daily recommended amount of potassium is by no means agreed upon, here’s an example – 4700mg/day (see High Potassium Eating). Now, a teaspoon of cream of tarter will give you 495mg of potassium – over 10% of your daily amount, and not far off from a cup of milk.

But taking that much potassium in powder form – or in a supplement – can be dangerous, and even trigger headaches and other symptoms. Why? because it messes with blood pressure.

Incidentally, a quick browse of popular potassium supplements show typical doses of far less than what a single teaspoon of cream of tartar would contain.

In spite of the fact that she advocates paying attention to potassium to fight migraine, Dr. Stanton warns against taking a potassium supplement:

I often receive the question if potassium should/could be supplemented in a pill form. The answer is no, you should not. Potassium is a dangerous mineral if too much is consumed (hyperkalemia) and if too little is consumed (hypokalemia). In both cases, if dietary changes don’t improve the condition, hospitalization is necessary. The harm in taking potassium as a supplement comes from the fact that it all absorbs at once. … Taken as a supplement by a migraineur, who normally has low blood pressure, it can cause fainting, palpitations, and potential heart damage, and may cause seizures. You are also likely to end up with a migraine.

She footnotes this discussion with various studies and discussions of how potassium actually works in the body.

So here’s the short answer: If your potassium is so low that you need such a high instant infusion of potassium, you have problems much more serious than slightly low potassium levels. You need to get to a doctor.

On the other hand, yes, potassium is important for migraine patients – but it should be taken the normal way, in normal foods, such as milk, spinach, avocado, and salmon. That way, the potassium absorbs normally.

By the way, don’t worry about the small amounts of cream of tartar that you typically use in cooking and baking. We’re talking here about taking it directly as a supplement.

Although the Snopes article was specifically responding to a discussion of MSG, migraine, and cream of tartar, the bottom line still seems to be that there are great sources of potassium you can make use of right now – but a teaspoon of cream of tartar isn’t one of them.

20 October 2018

More on “Midface Migraine” – and Tooth Aches.

James Discoveries & Stats, Information 0

“Midface migraine” is not a type of migraine, but a description of a migraine attack with pain in the face. It’s not unusual for patients to experience pain in various areas at various times.

Pain in the face could be a sign of a related condition, but on the other hand, it could lead to misdiagnosis. Recently we talked about the too common misdiagnosis of sinusitis. Toothache and Migraine

But a case study pointed out that two conditions can affect each other. In this case (actually two cases), it was dental issues (see: Midface migraine with concomitant dental disease: A report of two cases.)

Now, the report does point out that migraine is actually sometimes misdiagnosed as a dental issue, such as a tooth infection. But these cases there was an actual dental issue.

Both patients had midface migraine-type pain and symptoms. The first patient found that the tooth pain and migraine pain were lessened by a root canal, and then went on to find more relief with sumatriptan (a common migraine abortive).

The second patient tried sumatriptan first, and it didn’t help much. However, a root canal provided significant relief.

If you’re experiencing facial pain, or tooth pain, that is accompanied by migraine symptoms, it may be wise to see a dentist. And if you’re a dentist, remember that migraine and tooth decay or infection may actually go together. A careful diagnosis can help alleviate pain and additional symptoms.

16 October 2018

Can we Avoid Pointless Procedures for Sinus Congestion?

James Information 0

Researchers continue to express concern about incorrect diagnosing of sinus congestion. And the situation is more serious than you may think, because patients continue to take medications and undergo tests that may not be necessary.

A recent article in The American Journal of Otolaryngology again points out some of these issues. (By the way, otolaryngology, believe it or not, is an abbreviation of otorhinolaryngology, which refers to treatment related to the ears, nose, throat, head and neck.)

Sinus pain? Migraine? The article is about the treatment of rhinosinusitis, also known as sinusitis. The authors state: “Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief.” (see abstract: Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine)

Our modern concerns about the use of antibiotics aside, we should already know that something is wrong when they often don’t even alleviate the symptoms.

Previous research has suggested that most of the time the diagnosis of sinusitis is wrong, and that the culprit is actually migraine. The report clarifies this in further technical detail:

One explanation is that … Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant.

Notice the symptoms that could be from a migraine attack:

midfacial pain (sometimes referred to as “midface migraine”)
midfacial pressure
rhinorrhea (nasal cavities full of mucus, aka runny nose)
nasal congestion

These are not uncommon migraine symptoms.

To make matters worse, many patients who do not find relief with antibiotics also submit to a CT scan – radiation which increases their risk of cancer.

To add to the challenge yet again, patients often come to doctors insisting that they have sinusitis. As the researchers affirm in this report, doctors should seriously consider asking more questions before prescribing drugs that won’t help (this includes not only antibiotics but also nasal sprays) or scans that aren’t necessary.

If you’re feeling congested and have a headache, take a closer look at your symptoms.

For quick information to share with a friend, see Sinus Headache – Probably Migraine.

11 October 2018

Diagnosing Migraine with Aura – New Criteria

James Information 0

Following up on the report about the new International Classification of Headache Disorders 3rd edition (ICHD-3), one of the most interesting changes, though a little technical, was the change in the diagnostic criteria for migraine with aura. This is to say, new more precise ways of diagnosing migraine with aura (MA).

There are many types of migraine, of course, and also many types of migraine with aura. When the beta edition of ICHD-3 came out several years ago, there was concern that MA could be confused with transient ischaemic attacks, or mini-strokes. This is one reason why more specific details were added to the definition.

Migraine aura So let’s take a quick look.

First, in order to actually be diagnosed with MA, you need to have more than one attack. That hasn’t changed. Also, it’s still possible that you could fit the criteria below, but you better fit a different diagnosis.

Next, you obviously need to experience an “aura”. In migraine, aura is something temporary, or “reversible”. Possible aura types include:

visual (such as seeing flashing lights or patterns)
sensory (often a “tingling” sensation)
speech and/or language (such as slurred speech)
motor (weakness)
brainstem (various specific auras, including vertigo or impaired hearing)
retinal (for example, vision loss in one eye)

We won’t get into the details of all of these. Some of these will help doctors diagnose what type of MA you have – remember, there are several sub-types. All you need is one of these symptoms to receive the MA diagnosis.

It’s interesting that these symptoms usually come in a predictable order, as the migraine chain-reaction spreads.

Finally, to be diagnosed with MA you must have at least three of the following six characteristics:

At least one aura symptom spreads gradually over 5 minutes or more.
Two or more aura symptoms occur in succession (has this ever happened to you? It’s probably more common than you think. This was added for clarification since the beta version.)
Each individual aura symptom lasts 5-60 minutes (so, yes, auras could last several hours if there are several auras. Note that motor symptoms are an exception – they could last for 2-3 days.)
At least one aura symptom is unilateral – on only one side.
At least one aura symptom is positive (for example, seeing flashing lights is positive, partial blindness is negative.)
The aura is accompanied, or followed within 60 minutes, by headache (presumably the aura ends, and then within 60 minutes there’s a headache. Or they overlap.

Note that these are aura symptoms, not prodrome symptoms. The difference is that the prodrome may start hours or even a day or two before the attack. It’s often less defined, but may include feeling tired or “heavy”, or having neck stiffness, or having unusual trouble concentrating.

Many of the above symptoms are shared with transient ischaemic attack (TIA), but it’s hoped that the specific details will help rule out TIA. The key symptom of TIA is one-sided weakness or numbness, although other symptoms such as vertigo or vision loss are not uncommon. Learn more about transient ischaemic attack here.

Of course, in either case, it’s best to see a neurologist who can confirm a diagnosis for you, and help you avoid even more serious problems down the road.

For details about various types of migraine with aura, click through the list here.