Headache and Migraine News

25 September 2008

Misdiagnosis: Sinusitis and body pain

Researchers at the Georgetown University Medical Center made a surprising discovery about patients with sinusitis. It’s not just about headache, stuffy nose and tenderness in the face. There’s pain all over the body!

All right, this might not be so surprising to patients with sinusitis. But chronic sinusitis apparently does result in bodily pain – a symptom not usually listed. The researchers compared the pain with the chronic pain of the elderly, or those with arthritis.

Dr Alexander C. Chester, the study’s author, notes:

Bodily pain is not listed as a symptom of chronic sinusitis in general medical texts or journals and as a result, patients are sometimes diagnosed with unrelated conditions such as arthritis, depression, fibromyalgia or chronic fatigue syndrome. Unfortunately, this leaves too many people unaware of treatments for sinusitis that can improve their overall condition.

Speaking of misdiagnosis, it is believed to be extremely common that people with migraine are misdiagnosed with sinus headache. Many symptoms are common to both – tenderness, congestion, and headache, for example (read more about sinus headache here).

Before taking drastic steps (such as going for surgery), it helps to get a second opinion from a qualified specialist, and it also helps to do your own research. Looks like you already are! 🙂

22 September 2008

Demerol for Migraine in the Emergency room

James Discoveries & Stats, Medications, Tips 84

If you end up in the emergency room here in North America, and you’re diagnosed with migraine, there’s a very good chance you’ll end up with an injection. That injection is usually something called Demerol, or meperidine hydrochloride. But is that the best way to go?

Of course, Demerol for migraine is nothing new. Basically, it’s prescribed for the pain (usually headache pain). Meperidine is a powerful, fast-acting opiod (narcotic) drug.

Though Demerol may help with the pain, there are problems. It doesn’t tend to last as long as some drugs, there are issues with toxicity, and concerns about dependence. Is Demerol really the best drug to take in an emergency situation?

Though it’s being used less and less in many countries around the world, it’s still prescribed for migraine in the emergency room. A study over the summer set out to find out what other options might be better.

This was a meta-study – a review of information on the use of drugs for migraine in emergency (11 clinical trials were studied in all). The study found that many of the alternative drugs already used were more effective (or similarly effective) than Demerol at killing the headache pain itself (for example, a DHE (dihydroergotamine mesylate or Migranal) injection). (overview here)

Surely there are many options for dealing with advanced migraine symptoms, far beyond DHE and Meperidine. I hope more studies are done to find the best, fastest treatment for someone who so urgently needs it.

There may not be much we can do in the meantime. However, if you have ended up in emergency before, it would be a good idea to take a note of what worked for you (I remember being in emergency and going through a lot before finding real help!). You could make the information part of an emergency card or medicine log that you carry around and can pull out at the hospital (after all, you don’t want to try to explain it in the middle of an attack!). Remember, what worked well for someone else may not work well for you – these studies are simply looking for what is generally most effective.

19 September 2008

Do you REALLY have Ocular Migraine?

James Information 26

Ocular migraine seems to be an increasingly popular diagnosis these days. Unfortunately, the term is also causing a great deal of confusion. So let’s try to find our way to some clearer information.

The word ocular (sometimes spelt occular) relates to vision, or the eye itself. So we can at least tell that ocular migraine has to do with vision or eye problems. The problem is, the standard of headache classification from the International Headache Society doesn’t use this term.

So what we’ve ended up with are a number of different definitions. In other words, there is no one proper definition for ocular migraine. As a matter of fact, it would be helpful if the term was dropped altogether.

So what was your doctor talking about?

From what I’ve found, the most traditional use of the term is for a type of migraine that causes blindness. The blindness is in just one eye, and is either full or partial.

A better term for this type of migraine is retinal migraine. It’s very important to rule out other eye problems before you get a diagnosis of retinal migraine (for example optic neuropathy).

It’s possible your doctor is actually talking about migraine with aura (see this entry at the Mayo Clinic on ocular migraine). The aura would be the visual disturbances (read more about migraine and aura here). The visual disturbances may come before the headache, or there may be visual problems with no headache at all. These are much more common that retinal migraine. In migraine with aura, the visual symptoms are generally in both eyes.

There are other types of migraine that could involve visual disturbances, such as familial hemiplegic migraine. It is important to get a more specific diagnosis if you’ve been told you have ocular migraine. But it’s also important to make double sure you’ve ruled out other eye related problems, since of course the treatment would be quite different, and you don’t want to find you have something that’s getting quickly worse without treatment.

More about ocular migraine here.

17 September 2008

Headache and Migraine News Blog – new look!

James Website news 0

If you’re reading this through an RSS news feed, you may not have been over to visit the site lately. If not, you won’t know that the Headache and Migraine News Blog has a new look (and a new domain name – more on that later)! Here’s a recent snapshot:

This past January I decided to try moving Headache and Migraine News to the blogging software known as WordPress. The move was a success, so I’ve taken the time to more carefully design things (with a little help from Thesis) so that you have more resources at your fingertips, and are better able to interact with other visitors so that the community here can really work together.

You’ll see many of the features that were here before, plus some new ones – a list of recent article updates, an about page, and a sitemap. And there’s more to come! This is all part of a plan to revitalize things over the next few months, so that you can find more practical, clear information for fighting headache and migraine. Thanks for visiting!

Note: This blog also has a new domain name. Find it at headacheandmigrainenews.com

15 September 2008

Botox for chronic migraine?

James Treatments 7

The fight continues to get Botox officially recognized as a migraine treatment. On the 11th of September, the makers of Botox (Allergan) announced a new study that showed that patients using Botox had significantly fewer days with headaches (attacks?) than those who used a placebo.

The study, however, is being met with a great deal of suspicion. Why?

The problem is that an earlier study seemed to show that Botox didn’t make much of a difference. But the old study was calculating the number of migraine episodes, not the number of days. Is Allergan just tweaking the system to try to get numbers that work?

Well, obviously they have a vested interest. But don’t be quick to write off this study.

The truth is that the people “on the ground” – doctors and patients – have seen Botox work, and not just occasionally. Dr. Alexander Mauskop of the New York Headache Clinic is more optimistic. His clinic took part in the trial. He writes regarding the new Botox trial:

This report did not surprise us or our colleagues who routinely use Botox in treating patients with chronic migraines. The excitement we feel is due to the fact that many of our colleagues have been sceptical about the efficacy of Botox. Much more importantly, we hope that this definitive study will compel insurance companies to pay for this treatment.

This may simply be a matter of learning, little by little, exactly who Botox works for, and what its limitations are. Just because it doesn’t work for everyone, doesn’t mean it won’t help many.

The stakes are high as we continue to study Botox. If it really is effective for migraine, the cost is prohibitive for many people. But the company plans to file a license application with the American FDA in 2009, followed by applications in Canada and Europe, for use with chronic migraine.

Read more about Botox for migraine here.