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15 June 2009

Major shift in Migraine Thought? (part 2)

Last time we were talking about a major shift in migraine thought which may come as a surprise to many people. The shift is this – instead of thinking that most people get "normal" headaches, and a few get migraine attacks, a growing number of experts are suggesting that most headaches are actually from migraine, and that most people with chronic headaches in particular are actually migraineurs. (read Major shift in Migraine Thought? (part 1)

There are a number of reasons this shift has come about. First, new research has shown that your basic "tension headache" is not usually based on muscle tension at all, but is actually something much more complex. Next, a growing understanding of migraine and the mechanism of the migraine chain reaction. And, of course, recent studies have suggested that most people who think they have a sinus headache also have migraine.

Finally, simply a clinical discovery. Many people were walking into the doctor’s office because they were getting severe migraine attacks, but they also had nondescript, basic headaches. When they started being treated for the migraine attacks, they were surprised (and in many cases the doctor no doubt was too!) to discover that the other headaches vanished as well!

So many are coming to the conclusion that both are coming from the same source, and have the same cause.

Of course, you could still say that most headaches are tension-type headaches, but you need to realize that this is a description of what the headache is like, and perhaps how it’s generally treated. Once again, we don’t have a definitive answer when it comes to what actually causes these headaches any more than what causes migraine – and it may be the same thing in both cases.

Why does this shift matter?

So what does this mean to those of us here on the ground? Here are some thoughts, and maybe you’d like to add your own in the comments as well:

This is an important reminder not to ignore those "other" headaches. Many people are just concerned about that migraine attack, which may be rare, and so they just put up with more frequent headaches that are actually diminishing their quality of life quite a bit. They may seem insignificant next to a blazing migraine attack, but they do add up. You may be able to get treatment for them if you only pay attention and find a doctor that will pay attention as well.
Equally important, I think that this shift could really help many, many people who have been stuck with chronic headaches but have not been getting what could be successful treatment because they don’t have "typical" migraine symptoms. If you’ve spent any time reading this site, you know that migraine symptoms are not so typical. Even some doctors think you need to be screaming in agony before you’re really having a migraine attack. The truth is that many people suffer for years, lose jobs and have strained relationships due to so-called "lesser" headaches. Treatment is available! Maybe we just need to change the way we think about it.
On the research side, this could really open our eyes to new possibilities. It could give added momentum to migraine research as people begin to realize just how widespread the problem really is.
Finally, it could help in one specific area of research – the research that helps us understand why people’s symptoms are so different. If migraine really is so widespread, why is it that it leaves one person bedridden, unable even to drink a sip of water, while for another person there’s just a nagging headache? Why is one person dizzy, and another has stomach pain? Are there truly similar but distinct diseases here, or is it the same disease that shows itself in different ways? It’s very likely that migraine is something that almost everyone experiences as a "natural" response, but that it gets out of control with some people – but why? And could those differences lead to better treatment for certain types of migraine? I think this will be a key to solving the migraine problem.

What do you think? Is this a good development? How could it help, or what are the dangers? Share your thoughts!

2 June 2009

Major shift in Migraine Thought? (part 1)

James Discoveries & Stats, Information 4

There seems to be a major shift taking place in the medical world when it comes to migraine. It’s actually been going on for many years, and it will probably continue for many years to come, but many people are still unaware of it.

At the heart of the shift is the question of just how widespread migraine is. It’s not going to come as a shock that this is confusing to many people. Some people still think of migraine as a bad headache. Others don’t realize that it’s possible to have a mild migraine attack. Others are still confused about basic terms, like cluster headache, migraine, sinus headache, and so on.

The "Common" Headache?

Before we talk any more about migraine, probably the best thing to do is go back and talk about the common headache. Most people generally think of the most common type of headache as the tension headache (now more properly called the tension-type headache).

It might surprise you to know that we actually know very little about what a tension-type headache really is.

Wait a minute now – you just get tense, stressed, muscles get tense for one reason or another – you get a headache. What can be simpler than that?

It seemed that simple, until researchers actually started to investigate the actual muscle tension in the so-called tension headache. The surprise result was that a lot of people were getting the headache without any muscle tension at all!

Hence the name change.

Is it psychological? Well, some psychological factors seem to influence some headaches, but there have been no consistent findings that show that the common headache is due to psychological factors. In other words, people with fewer anxiety or mood problems do not get fewer headaches.

So in the end, we know even less about tension-type headache (TTH) than migraine! And just like migraine, we don’t know what causes TTH.

So, could TTH be connected somehow to migraine? Currently we’re usually looking at symptoms and ruling out other causes before we put a headache and other symptoms into a category of migraine or TTH. But what if many of the migraine attacks and TTH attacks actually had the same root cause?

What if the common headache was actually migraine?

A shift of thought

Many specialists are becoming convinced that most of the headaches out there are actually coming from migraine. And this changing opinion is showing up in popular literature about migraine. Take for example:

I was taught – as most doctors were taught, and still believe – that tension headache accounts for the vast majority of chronic headaches … Migraine, not muscle contraction, is what causes headache ascribed to tension. These mild-to-moderate, nonspecific headaches stem from low-level activation of the mechanism of migraine … it arises from a single mechanism, but since the degree of activation fluctuates, it is expressed to varying extents and in many different ways.

Dr. David Buchholz, Heal Your Headache

While it is true that an unlucky few have common migraine as well as hypnic headache, or both hemicrania continua and cluster headaches, such cases are extremely rare. What most of us construe as "different headaches" are actually different presentations of one headache type, and that is usually migraine … The overwhelming majority of headache patients have one kind of headache and, usually, that is migraine. Migraine is by far the most common kind of headache.

Dr. Robert Cowan, The Keeler Migraine Method

This shift in thought has huge implications for research, treatment … and for you. And we’ll talk more about that in part 2.

15 May 2009

Migraine without Headache: More common than we think?

James Information 8

In the past, migraine without headache has been considered pretty rare. But it may be more common than we think. Part of the reason is that many people experience migraine attacks with and without headache at different times. I know – I’ve had migraine without headache, and migraine with headache both.

Regardless, the statistics we usually see put the number at about 3% of migraineurs, or about 0.5% to 1% of the general population. (More on migraine statistics)

The International Headache Society lists migraine without headache as typical aura without headache, under the subset of Migraine with aura. Previously this was typically called "silent migraine", but been confused with a host of other names like occular migraine, visual migraine, eye migraine, and so on.

But the typical aura without headache covers more than just visual aura. Visual auras might include seeing flashing lights, or zigzags, or partial blindness, for example. But there could be other symptoms instead, such as numbness, or feeling pins and needles. These can be particularly tricky to diagnose.

Diagnosing migraine without headache

Often migraine without headache occurs later in life. Part of the reason is that some people who get migraine attacks with aura and headache lose the headache over time, or start getting headaches that aren’t so "migraine-like".

Sometimes these symptoms look a lot like other issues, such as transient ischaemic attack (a "mini-stroke"). It’s important to rule out other causes (especially if you’re over 40) before you get a diagnosis of "migraine".

Doctors will want to know what type of aura you’re experiencing, and they’ll be especially interested in how long the aura lasts. If it’s lasting less than 5 minutes, or more than an hour, that could be an extra indication of another problem.

If you suspect that you may have migraine without headache, pay special attention to the aura symptoms so you can give your doctor accurate information.

7 May 2009

Have a slight headache? Might be migraine

James Information 1

One of the common myths I hear about migraine is that an attack is always something incredibly painful. Well, maybe a lot more people know today that a migraine does not always mean a headache. But if there is a headache, people think it has to be a severe one.

We have to be careful of our terminology. "Migraine is not just a bad headache" is true – but sometimes it’s not a headache, and sometimes it’s a mild headache. "Migraine is more than a bad headache" may be less accurate … sometimes there’s no bad headache at all.

Don’t get me wrong – migraine headache pain can be VERY severe. I’ve had attacks when I’ve been writhing on the floor with groans of agony. So let’s in no way minimize how bad a migraine attack can be.

But when I hear "I’ve got a headache… not as bad as a migraine though…" I get a little concerned.

Yes, your slight headache could be migraine.

Now occasional slight pain is no reason to panic, spend thousands on brain scans and go through the rounds of risky medication. Oh, you should mention it to your doctor if it’s something new. But just calling something "migraine" doesn’t mean you need to take drastic measures. Some people simply do not have severe symptoms.

On the other hand, a lot of people suffer through years of headaches that could be treated, all because they think they’re "just headaches", and don’t recognize them as migraine attacks.

If you’ve been visiting for a while, you should realize that our knowledge of migraine has gone far beyond the "take two aspirin" phase. Migraine is still wrapped in mystery, to be sure, and we have a long way to go. But there are treatments available now that we had no concept of 20 years ago.

I should note there is some disagreement over just how many headaches out there should be attributed to migraine. Some suggest most are actually migraine. Others say that migraine is something more specific. Regardless, my point here is that all migraine attacks are not severe.

If headache pain is disrupting your life, don’t just put up with it. Don’t assume it’s "just a headache". It may be migraine, and there may be good treatments that you haven’t even considered that could greatly improve your quality of life.

That’s right, your "slight headache" could be migraine.

15 April 2009

Cluster or Migraine: What’s the Difference?

James Information 13

Spending a bit of time on Twitter lately, I’ve noticed that there still seems to be quite a bit of confusion over what migraine is, as opposed to what cluster is.

Sometimes in the past the two have been used interchangeably. Or sometimes, just based on imprecise information. For example, sometimes people think of any bad headache as a "migraine headache", or think of certain types of pain as a "cluster headache".

In reality, these two are very different, and require different types of treatment. Let’s take a quick look at cluster and migraine, and see if we can clear up a few misconceptions.

Migraine vs Cluster

Migraine

Cluster

Similar

Typically one-sided pain
Congestion a common symptom

Different

Pain usually moderate to severe
Usually a throbbing pain (if headache is present)
Often accompanied by headache
Common (about 16% have at least one migraine attack)

Very Different

Lasts 4 hours to 3 days
Symptoms may come on suddenly or gradually, and usually decrease gradually.
Aggravated by activity (patients prefer to lie down in a dark room)
More common in women, but men get it too
Attacks may or may not have a predictable pattern. (ie patients may get one attack in a lifetime, or attacks on a monthly cycle, etc)
Other typical symptoms: Auras (visual and otherwise), nausea, sensitive to light and/or sound

Similar

Usually one-sided pain
Congestion a common symptom

Different

Pain usually severe to very severe
Usually a sharp, burning pain
Almost always accompanied by headache
Rare (present in about 0.3%)

Very Different

Lasts 15 min to 3 hours
Headache usually comes suddenly – may reach peak intensity in 5-10 min, and decreases rapidly
Patients restless and agitated during and attack (prefer to pace or rock back and forth)
More common in men, but women get it too
Attacks come in a pattern or cycle: headache every other day up to 8 times a day (often the same time every day). Attacks occur in a series (cluster period) lasting for weeks or months, then a remission of months or years (some chronic sufferers have no remission periods)
Other typical symptoms: watery and/or red eyes, sweat, swollen or drooping eyelid, congestion, small pupil

You’ll see right away that I used terms like "usually" and "typically" a lot, and I probably could have used them more. There is a lot of variation from person to person, so we’re just hitting on some of the more common, typical traits of each. But just a reminder – either of these can include pain that’s not just on one side, sometimes there is no pain in migraine, sometimes it’s not throbbing pain, etc.

Key differences

You can see highlighted some of the key differences between migraine and cluster. Cluster headaches come on faster and leave quicker than migraine attacks. It’s unusual for a migraine attack to last less than 4 hours, and unusual for a cluster attack to last more than 3 hours.

Another key difference – migraine patients tend to avoid light and movement. They’ll often go lie down in a dark room.

That’s the last thing a cluster patient wants to do – good luck getting them to lie down! They become restless and may rock or pace.

But the last highlighted item is especially key. Clusters get their name not from where the pain is or what it feels like, but from the cycles of pain.

You’re not going to get just one cluster headache. You’ll get several in a series – maybe one a day, or several a day, regularly. This can go on for weeks and even months, but then completely disappear for months or years.

Sad to say, there are also chronic cluster headache sufferers who have no periods of remission (as this recent news story on cluster headache illustrates).

Hopefully that clears up some misconceptions, especially regarding cluster. Cluster is an incredibly painful condition. There is treatment for cluster, but the treatment has had limited success in many people. Much more research needs to be done to fight what has been rightly called the suicide headache.