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6 August 2015

The Ophthalmic Migraine Kaleidoscope

Some people report a certain visual hallucination due to migraine – seeing kaleidoscopes. What exactly does this mean?

Some people talk about the ophthalmic migraine kaleidoscope. “Ophthalmic Migraine” is actually not a specific kind of migraine, but it’s a term that’s sometimes used to refer to migraine with visual disturbances or “aura”. Sometimes ophthalmic migraine refers specifically to a migraine attack in which there are visual symptoms but no headache. The diagnosis either way would be a type of migraine with aura.

But what is this ophthalmic migraine kaleidoscope?

As most people know, a kaleidoscope is made from a tube that has loose pebbles or beads or other colourful things that are reflected inside by mirrors. The when you look in the tube and turn it, the light shines in the other end and you see moving, colourful shapes, such as in the picture to the left.

Patients occasionally describe these migraine auras as kaleidoscopes. Podoll and Robinson’s Migraine Art describes the experiences of some patients as recorded in medical literature:

octagonal kaleidoscopic geometric figures fitted together in ten colors

kaleidoscopic images

a crimson area with an ever-moving pattern like a kaleidoscope

flower kaleidoscope Even though these auras are not always specifically described as kaleidoscopes, there are a number of similar descriptions. Flower patterns, for example. Webs, spirals and lattices. Very specific mosaic patterns are also described. Take for example this description from a patient:

It was an irregular shape composed of five-and-six-sided units, which were largest in the center of the shape and smaller at the edges. Clusters of units were revolving and each individual unit was revolving; it was all swirling and moving all the time. In the middle, the units tended to be blue and orange, those around them were red and green, but there was no very clear demarcation into zones. Colors were intense and brilliant like stained glass windows full of light…

Sounds like a kaleidoscope to me!

Of course not all auras are like an ophthalmic migraine kaleidoscope. But why patterns at all?

The aura images, such as the ones described above, are a result of activity in the brain. The cortical spreading depression is a kind of “brain storm” that spreads across the brain, bringing strange symptoms with it.

It has been hypothesized that the shapes some people see are actually a representation of how parts of the brain work. It’s like you’re seeing a “reflection” of the setup of part of your brain. (Read more in Why Migraine Auras are the way the are)

The visual disturbances are usually treated with ordinary migraine treatments, such as magnesium, triptan medications, lifestyle changes, and so on.

If you have experienced kaleidoscope auras, tell us about it – or better yet, draw a picture and submit your artwork here.

I’ll close with the words of someone else who took the time to represent their migraine aura in art:

I felt separate from the real world, and when I closed my eyes I could see flashes of color and light. . . . I became almost mesmerized by what I was seeing behind my eyelids.”

All quotes taken from Migraine Art: The Experience from Within.

Migraine Fractal

27 July 2015

Are Sex Headaches Dangerous?

James Information 1

Before we get into the details, here’s the bottom line. If you are experiencing sex induced headache, and you haven’t seen a doctor, you need to do so right away.

Now that that’s clear, let’s go into more depth. Are sex headaches dangerous?

In some cases, sex headaches can be dangerous. But if we’re talking about a headache that is a sign of something life-threatening, most sex headaches are not putting you in immediate danger.

If you have ever experienced a massive headache upon climaxing, you know that life-threatening or not, a sex headache can be quite a serious interruption to life and intimacy.

The headaches most commonly related to intercourse are classified as primary headache associated with sexual activity. Why “primary”? A primary headache is diagnosed when the headache (and/or related symptoms) are primary – that is, there is no apparent underlying disorder that is causing the headache. For example, if you are hit in the head, the headache is secondary. If you have a blood clot leading to headache symptoms, the headache is secondary. This is not always a clear and easy differentiation.

These sex headaches are also commonly called orgasm headaches. You may experience a massive headache upon climaxing, or a headache that increases along with sexual excitement, or an abrupt headache that “explodes” just before orgasm.

These headaches are probably not life-threatening, but again, you need to see a doctor right away.

What causes sex headaches? If it’s a primary headache, there are several theories. The headaches may be a response to pressure in the head or problems with the circulation system. There may also be biological problems in the body’s neurological system, leading to hypersensitivity and wrong signals being sent chemically.

However, there is a much more serious cause of sex headaches. Many people ask about headaches during sex and exercise, or they ask – are exertion headaches dangerous?

Some headaches may be cause by fluids leaking from around the brain and spinal cord (a CSF leak). In this case, the headache may increase with a change of posture. With proper tests and treatment, a CSF leak will usually go away in time. Without proper treatment, there can be serious complications, such as swelling of the brain.

There are other headaches which can be brought on by exertion, which have an underlying cause. Aneurysm, stroke, and brain tumour are examples. Other danger signals are headaches that get worse over time, that come with other symptoms (for example dizziness, visual problems, a change in behaviour, seizure, or nausea), and headaches that start abruptly.

But remember, these things can be very difficult to diagnose. Some serious conditions can show no symptoms at all, while some very severe symptoms may be a sign of a disease that isn’t life threatening and can be easily treated.

Either way, a new headache or a change in symptoms should be warning enough to get to a doctor and spend some time investigating.

Is there a cure for sex headache? That will all depend on the cause or diagnosis. There are excellent treatments for most kinds of sex headaches, but as with any headache disorder it can take time to find what works for you.

If you’re struggling with sex headaches, you can be hopeful that you can find good treatment and leave them behind. But they are never something to be ignored.

For more information:

16 July 2015

Botox and CGRP – and the Future of Migraine Treatment

James Discoveries & Stats, Information, Medications, News 0

A new study about Botox and CGRP confirms some of our suspicions, and may point the way to future migraine research and treatment.

Although it’s really started making headlines over the past year or two, the study of CGRP in migraine has been heating up over the past 20 years. CGRP stands for calcitonin gene-related peptide neurotransmitter. These neurotransmitters are especially involved in the communication of pain messages in the body (see The Secret of CGRP).

Early on, researchers began to suspect that CGRP levels rose during a migraine attack – so far nothing surprising.

However, researchers next began to discover that CGRP levels tended to be higher in migraine patients all the time, although levels seemed to drop with triptan treatments.

Test tube A study in 2013 showed that women with various types of migraine and cluster had elevated levels of CGRP in their blood (between attacks). Among those with migraine, those with chronic migraine had the highest levels – and among those with chronic migraine, migraine with aura showed the highest levels of all.

That finally brings us to the research related to Botox. As many of you know, Botox treatment works well for some people, and not for others. Why?

Last year we talked about a study which showed that people with high levels of CGRP were far more likely to benefit from Botox (onabotulinumtoxin type A) treatments.

Last month, another study confirmed the same thing. Once again, patients with higher levels of CGRP were more likely to respond well to treatment.

But a month after the Botox treatment, levels of responders dropped – although the levels in nonresponders did not.

We are left with a lot of unanswered questions – but those questions could drive migraine research in the direction it needs to go.

Why the different levels of CGRP? Exactly what role do CGRP levels play in migraine? Could this point us to an underlying cause or disorder?

Perhaps more importantly – why the differences?

Over the past few years, research has shown us again and again and again – not all migraine disease is the same. There are “different migraines”, with different treatments, different symptoms, and different neurological manifestations.

And yet we still so often talk about “migraine” as if it’s one thing and one thing only.

Those in cancer research and treatment are learning this the hard way as well – not all cancer is the same, not all cancer is equally dangerous, and not all cancer should be treated in the same way.

Migraine research is going – and must go – the same direction.

Imagine going to the lab for tests – and then being diagnosed with a specific type of migraine – and then getting treatment for that type specifically. Your chances of excellent treatment will go way up.

For now, we have an important way forward for research into CGRP levels, and for Botox treatment. In the future – something much bigger and better.

Solar Flares, Migraine and Cluster Headache

13 July 2015

Are Solar Flares Giving Me A Headache?

James Discoveries & Stats, Information 19

Many people suggest that solar activity has an impact on their migraine attacks or cluster headache cycles. But could there really be a connection?

The short answer is – yes, there could be a connection. But understanding, confirming and explaining it is very difficult.

So how exactly does activity on the sun affect the earth?

Solar Flares, Migraine and Cluster Headache To explain briefly, solar activity can send a geomagnetic storm toward the earth. For the most part, we are well protected from these storms, which is why they don’t generally make headline news. The biggest concern is usually satellites and electrical grids and equipment (including implants for heart patients).

We do know that magnetic fields are especially important to certain animals, such as those who use the earth’s magnetic field to find direction.

It seems reasonable that changes in the magnetic field could impact human biology. In fact, there have been some studies done that suggest a connection between geomagnetic storms and lifespan (see here also), depression, and other diseases.

A connection – but why? Are solar storms affecting the earth in some way that in turn affects our environments and in turn affects our bodies? Or is there a more direct connection? What exactly are the storms doing? Changing brain activity? Changing our cells? Confusing neurological signals?

The questions about these global storms is as complex as the environment in which we live.

Yes, there have been connections suggested to the severity of migraine attacks (see Geomagnetic Activity and the Severity of the Migraine Attack) and cluster headache cycles (Cluster headaches and solar activity?).

If you would like the check for yourself if there is any connection, the information is a bit complicated but there are resources. The NASA website has a question and answer about migraine and solar activities here. The links are out of date, but you can still find the information on solar activity at the Space Weather Prediction Center. Check also NASA’s Solar Dynamics Observatory.

At spaceweather.com you can actually sign up for alerts if there is solar flare activity.

If you’ve seen a connection between your health and geomagnetic storms, leave a comment! We would love to hear from you.

6 July 2015

Do I need an MRI to diagnose my Headache?

James Information, Resources, Tips 0

Over the past few years, the number of CT and MRI scans for headache symptoms have been increasing. The increase has concerned experts, and has led to campaigns to stop scans that aren’t needed.

Unneccessary scans can lead to direct health risks (particularly in the case of CT scans), they can lead to more unnecessary tests, wasted money and time, and in almost every case they will not lead to any new treatment.

MRI for Headache? But there are times when MRIs (magnetic resonance imaging) should be requested. Along with concerns that too many MRIs are being done is the concern that doctors aren’t asking for them at the right time. A recent study in the USA indicated that many doctors may not recognize the “red flags” that warn doctor and patient that more investigation is needed.

So – the big question – should I as a patient be asking for an MRI? Or, as a doctor, should I refer a patient to have an MRI?

The answer is complicated. And the decision needs to be made with a lot of knowledge of the context of each patient.

Before a decision is made…

What needs to be done before a final decision is made? First, a proper and complete neurological examination. This means a lot of questions from the doctor to the patient. When did the pain start? What other symptoms are you experiencing? Are the symptoms temporary, or permanent? Are they getting worse?

This will also include medical history questions, and possibly (ideally) family history questions. Do you have family members who suffer from migraine? What other conditions have you been diagnosed with? Any childhood diseases?

One great example is visiting the doctor with a new headache. A new headache is often a good reason for an MRI. However, with a family history of migraine, and a history with related disorders, and symptoms consistent with migraine, an MRI won’t be necessary. But if there is reason to suspect another cause for the headache, or certain symptoms are present – an MRI will be called for.

Other important factors are gender and age. For example, getting headaches for the first time when you’re over 50 is a good reason to consider an MRI.

So even before we look at the warning signs, we have to assume you have a qualified doctor who is asking the right questions.”Red Flags”So what are some of the danger signs that may mean you should be getting an MRI? Here are a few examples.

As mentioned above, a new headache (a new type of headache in someone who doesn’t generally get headaches), especially if symptoms have appeared suddenly, is a good reason to call for an MRI.
A progressive headache. When symptoms get continually worse, an MRI may be required.
Exertion headache. Any headache that seems to come with exertion, such as straining to use the toilet, a sex headache, a headache you get when exercising. This is specifically a headache that appears directly because of exertion – most “exercise headaches” that come from moderate to intense exercise are not the same thing, and will probably not need an MRI for diagnosis.
Headaches that change with head position, or that show signs of raised or lowered intracranial pressure. This can be tricky, because a feeling of “pressure” or “fullness” is common in migraine. But hearing sounds, a change with head position, a worsening feeling of pressure – these things may indicate another problem, and an MRI may help with diagnosis.
Certain other symptoms, such as neuralgic pain. There are too many other possibilities to list, but one example is shooting, sudden pain along certain paths, certain vision or hearing problems, changes in behaviour and weakness.

And then what?

Even if an MRI is called for at the right time, it’s very likely that it will not show anything and simply confirm that you have a headache condition such as migraine. However, more tests may be called for if something shows up.

Many symptoms that look like something else are actually migraine. Migraine can look like stroke, or brain tumour, or sinusitis. But in certain cases it is worth it to investigate further.

If you are a doctor, this is worth taking at least a few minutes to study further. An excellent place to start is the MedScape article MRI in Headache by Dr. Michael Eller and Dr. Peter J Goadsby.

For more information, check out the links above, and also Most headache-related brain scans aren’t needed from Harvard Medical School and Imaging: Do I need an imaging study for my headache? from the American Headache Society Committee on Headache Education (ACHE).