Tips

21 July 2008

A reminder – share your medical history!

No, don’t share it with everyone, but do share it with your doctor, or those that might be treating you in the emergency room, for example! A recent story of a 38 year old who had some confusing symptoms reminded me of this.

I try to remind people that they need to talk to a doctor who knows their medical history. I can’t emphasize this enough. The more your doctor knows, the better she will be able to diagnose and treat you. If she is missing information, you could very easily end up with a wrong diagnosis, and treatment you don’t need (that could make things worse).

Or, you could end up with treatment that could harm you because, for example, it interacts with that natural remedy you’re taking, or that other drug, or that medical condition you failed to mention.

The story comes out of Toulouse, France. The 38 year old female patient came in with symptoms looking like serious cerebral stroke, and she was treated with this in mind. But it wasn’t stroke.

What she was experiencing was migraine aura – atypical aura. She hadn’t mentioned her history of migraine, and so she ended up being treated for the wrong thing. (see Migraine with atypical aura in the recovery room: a sometimes complicated diagnosis!)

Take the time to share your medical history. Have the pertinent information handy – maybe this means carrying around a sheet of paper, or having a medical USB drive. Keep it handy and get the treatment you need.

8 May 2008

Exercise and Migraine: 5 top tips for staying active

James Tips 3

Sure, everyone keeps telling us how important exercise is. It can be a great headache and migraine fighter – but it’s not that simple.

Many people with chronic headache or migraine think of exercise as the enemy. In many people, exercise can actually bring on the headache they were trying to avoid. Instead of imagining health and vitality, we think about throbbing temples and inflammation who knows where.

There’s no easy solution, but there are some ways to minimize the problem. The truth is, you’re almost certainly going to be better off if you can get some exercise into your routine (not convinced exercise will help you? Read about the benefits of exercise for headache here). Here are my top 5 tips to help you stay active in spite of the migraine monster looking over your shoulder:

Watch out for sudden changes: Headaches and migraine attacks thrive on sudden changes. This is a great rule of thumb to keep in mind. For example, don’t jump into a new, strenuous program – start slow. Make sure you warm up and cool down before and after exercise. And when choosing something to do, don’t pick something that involves long periods of stopping – do something with steady activity (even if it’s only short).
Sugar: The energy your brain uses comes mostly from blood sugar. Sudden rises and drops can cause problems. Some people find it helpful to eat easily digestible foods one hour or more before exercise (ie fruit, muffin). Some people also use glucose tablets before exercising, and find that they get fewer headaches. (Read more about athletes and sugar before exercise here)
Water: The other important factor is hydration – be sure to drink plenty of water. Many people have found that simply drinking more water fights their headaches quite a bit. It’s an old tip, but it’s a good one!
Exercise as a way of life: For someone with chronic headaches, this may be the most important tip of all. Many of us struggle with an exercise "program", or "going to the gym". It’s hard to be consistent when you many days you really can hardly get out of bed because of the pain. Instead, simply be more active on a regular basis. Learn to squat properly to get something out of the cupboard. Take the stairs when you can. Learn how to exercise your arms while sitting in the office chair. (An amazing source for tips is the book The Posture Prescription by Dr Arthur White and Kate Kelly) This is one tip that could truly transform your life.
Watch the pain: I know, no pain no gain, right? Well, when it comes to headache, that advice could be dangerous. If you get a headache when you exercise, it could be a sign of something serious. Listen to your pain. If it’s something new, see a doctor right away. Don’t keep exercising if you’re getting a worsening headache. Stop and try something less strenuous, or do things in smaller chunks.

What about medication? Well, our goal here really is to take less, not more. But there are times when it may be worth it to take some medication if it means you can exercise more. If you have chronic headache or migraine, it’s worth it to look at preventative medications. Your doctor may suggest you take a painkiller before you exercise. Common suggestions are Propranolol, Ergotamine tartrate, Indocin, or common anti-inflammatories (such as Advil). But try the above suggestions before you start popping more pills.

Want to read more? Click one of the links above, or read more about after exercise headaches, how to minimize the problem, and this post on Pilates and migraine.

17 April 2008

Headache or Migraine diary – by phone?

James Tips 1

It can be a pain to keep a headache diary. And yet, it is one of the most critical things that you need to do if you’re going to find solutions. What if, instead of searching for that paper or remembering until you got home (or got to a computer), you could just grab your cell phone and make a quick call?

Personally, I like paper, which is why I use the headache diary here. But I recently got an email from migraineur and web-smart guy Scott Clark, who suggested using the web transcription service known as Jott for keeping a headache diary.

Simply put, Jott takes your voice and turns it into text, allowing you to update agendas, email, and send text messages by phone. (Note: Jott is currently only available in Canada and the USA)

Ok, sure, so what do I do – call Jott whenever I have a migraine attack? Well, relax. Scott has written a whole article about using Jott for your headache diary. Lots of great tips – and a simple breakdown of how it works and how to make it work for you. Check out the article right here: Migraine Diary with Jott.

If you find the idea useful, leave a comment here and let me know. Maybe there’s something to all this computer stuff after all!

8 April 2008

Is a Deviated Septum giving you a headache?

James Tips, Treatments 46

Recently I got an email from Scott, who had just been diagnosed with a "deviated septum". He has daily headaches, and was wondering if a deviated septum could be responsible.

First, a little background. What is a deviated septum?

Your nasal septum is the partition between the right and left parts of your nose. When a person has a deviated septum, it’s pulled over to one side or the other (the one in the illustration is deviated to your left).

There can be a number of causes, and sometimes we can’t be sure why one particular person has a deviation. Sometimes surgery can cause this, or an injury, or perhaps a traumatic birth, or it may even occur during the baby’s development in the womb.

Question #1 – can a deviated septum trigger headache symptoms? Yes, in some people it can.

Question #2 – how likely is it that a deviated septum is the primary trigger or cause? In other words, what are the chances that surgery will solve the headache problem in any given person? In most cases, it’s not very likely that surgery will solve your headache problem.

A deviated septum is actually very common – 4 in 5 people have it. One way to see if you might have a deviation is to try breathing through either nostril while blocking the other. If there’s a significant difference in air flow, you may have a deviation.

There are at least two reasons this may cause headaches. Most commonly, the septum may block mucus, causing frequent recurring sinus infection. That’s a major recipe for a headache!

Drs Young and Silberstein have also noticed a different kind of "deviated septum headache", which they write about in their book Migraine and Other Headaches:
Rarely, a deviated septum may cause a one-sided headache on the side toward which the septum deviates. If the septum deviation is causing the headache, placing a small piece of paper soaked in an anesthetic (lidocaine or Novocaine®) will relieve the headache. The treatment is surgical straightening of the deviated sinus.

Note that this is rare – it’s more likely that, if you have problems, it will be with a sinus infection.

If neither of these situations seem to fit you, chances are surgery will not help.

If you do opt for surgery, it’s called a septoplasty, and it’s done in a day. It usually won’t change the look of your nose. It is a fairly safe surgery, though with all surgery there are risks. It won’t instantly cure sinus infections, but it can make you less susceptible. The more deviated the septum was, the greater the improvement usually is. Read more about surgery for a deviated septum here.

Have you had experience with surgery for a deviated septum? Did it help you with your headaches? Leave a comment and tell us about it.

12 March 2008

Rationing drugs due to insurance concerns

James Discoveries & Stats, Medications, Tips 2

Let’s face it. Stocking up on drugs is not an idea that makes your insurance company happy. But the challenge of having the right drugs on hand at the right time is adding to worldwide migraine pain.

This is actually a study from June 2007, but it’s worth looking at. Dr. Robert A. Nicholson, assistant professor at Saint Louis University School of Medicine and School of Public Health headed up a study of 233 migraine sufferers who took triptan drugs. Here’s what he found…

42% of patients said that their insurance plan restricted the number of triptan doses covered each month. 37% said they had a prescription for triptan drugs, but hadn’t filled it because of the cost.

Of those with no limitations, 79% took a triptan at first sign of a migraine attack (as most doctors recommend). Of those with prescriptions, only 49% took a triptan at the first sign of an attack. Of those who took a triptan right away, 51% said that migraine had a severe negative impact on their lives. But of those who hesitated to take the drug, 79% said that migraine had a severe negative impact on their lives. In fact, one in three of these people ended up in the emergency room at least once in the previous 12 months.

In summary – if someone’s insurance company is limiting their triptans per month, or if cost is keeping people from using them, they have more severe attacks and more frequent visits to the hospital. Not only does this seem bad for health, it doesn’t seem very cost effective for the insurance company.

The good news is that triptans, when used right away, are working.

One more interesting note. Dr Nicholson notes that many people delay in taking migraine medication because they want to be sure it’s really a migraine. Don’t worry, he says. Statistics show that your first guess is almost always right.

What can we do about this? Look for another insurance company? Find other alternative treatments (for when your pills run out)? What’s your strategy?