chronic daily headache

8 January 2013

Zap the Brain? Electric Stimulation and Pain

James Discoveries & Stats, Information, Treatments 7

Ever since Dr. Frankenstein first saw his monster come to life, the world has been fascinated with the use of electricity in medicine.

Though crude methods have been made famous in the movies, in the last few years transcranial direct current stimulation (tDCS) has become a serious science that has helped people with migraine, chronic facial pain, depression, post-stroke rehabilitation, and more.

It could be argued that this form of treatment is still in its infancy. After all, we still know very little about how it works and how to best use it to treat specific patients.

However, it’s a lot less brutal than you might imagine if you’re thinking of a horror film.

Let’s take for example amperes, the measurement of electrical current. A toaster may have anywhere from 9-16 amps. Electroconvulsive therapy (ECT), on the other hand, which is used to treat issues such as severe depression, typically uses 200 to 1600 milliamperes, or .2 to 1.6 amps.

The current delivered for a lot of the pain treatment we’re talking about today is typically in the range of 1-2 milliamps, or about 0.0015 amps.

Amps comparison

Research by Dr. Alexandre DaSilva at the Headache & Orofacial Pain Effort (HOPE) Lab is giving us new insight into how tDCS may fight chronic pain issues such as migraine.

We do know that tDCS treatment can reduce migraine and headache pain. A recent study published in Frontiers In Psychiatry demonstrates how tDCS might work to reduce pain.

Researchers watched what happened during treatment using a specially designed radiotracer and a PET scan. The idea was to measure µ-opioid release.

Without getting into too much detail, you might already be able to guess how this works in the end. Opiates such as morphine impact the same system in the brain, and help fight pain. In short, the plan is to use tDCS to stimulate the natural systems of the body to alleviate pain.

Dr. DaSilva says (as quoted in ScienceDaily):

This is arguably the main resource in the brain to reduce pain. We’re stimulating the release of our (body’s) own resources to provide analgesia. Instead of giving more pharmaceutical opiates, we are directly targeting and activating the same areas in the brain on which they work. (Therefore), we can increase the power of this pain-killing effect and even decrease the use of opiates in general, and consequently avoid their side effects, including addiction.

Dr. James Fugedy has been using tDCS to treat pain for the past few years. He started with fibromyalgia, and has since helped patients with migraine, depression, and chronic daily headache. He writes:

Transcranial direct current stimulation (tDCS) is the most exciting innovation I’ve experienced in 30 years of practicing medicine. … The tDCS procedure itself is simple, but protocols have evolved and results have improved. The numerous but small studies done thus far indicate, but do not yet conclusively prove benefit. Large multi-center studies need to be done to verify outcomes. Still, there is enough evidence at this time to justify clinical use for the treatment-resistant patient, particularly when you consider that there are no negative side effects with tDCS.

Future studies will be designed to provide more solid evidence of benefit, and show us which type of treatment works the best for which type of patient.

We also need to know more about how to help patients long term. How frequent do treatments need to be for patients with chronic headache? For example, could a six-week treatment regime lead to permanent results?

Meanwhile, some doctors are increasingly using tDCS to treat chronic pain. So far, this treatment has an excellent track record. Patients need to start asking their doctors about it, and pushing for further research.

30 April 2012

Chronic Daily Headache vs. Chronic Tension-Type Headache

James Information 4

Confused about the difference between chronic daily headache and chronic tension type headache? Let’s talk about it.

This month a report came out about the use of Botox for various headache disorders. The meta-analysis (a study of earlier studies) concluded that Botox had been helpful for "chronic daily headache" and "chronic migraines", but had not yet been proven useful for "episodic migraine" or "chronic tension-type headache".

Now of course this doesn’t prove too much – just that the studies so far seem to show that Botox is more useful for people with some diagnoses and not for people with other diagnoses. It could mean some have been studied more than others, or that we have not yet found the right type of Botox treatment, or it could mean that Botox simply isn’t useful in some conditions. We don’t really know.

But what stood out to me was the use of the term chronic daily headache. What does that term actually mean? And why is it different from chronic migraine or chronic tension-type headache?

Having not read the full study, I’m not sure how the authors are using the term, but I suspect from the abstract that they’re taking it from the studies they’re using. Which makes things even more tricky.

Chronic Daily Headache (CDH) is not really a specific term for a headache disorder, but a general term. This means that chronic migraine and chronic tension-type headache could both be called chronic daily headache.

CDH could be:

chronic cluster headache
chronic migraine
chronic paroxysmal hemicrania
chronic tension type headache
hemicrania continua
new daily-persistent headache
short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

With all of these disorders, attacks come either constantly or at least 15 days a month. CDH are a huge problem. It has been estimated that up to 5% of the population have significant CDH symptoms. Most have chronic migraine.

Often CDH is related to the overuse of medication (such as triptans or acetaminophen / paracetamol, in which case you may be diagnosed with one of the above and medication-overuse headache, or it could be diagnosed as one or the other.

Because of the confusion over the terminology, or simply ignorance about the classifications, many patients are diagnosed with chronic tension type headache when they really have a different type of CDH.

Chronic Tension-Type Headache starts with episodic tension-type headache. In other words, first the patient has the occasional TTH, and later ends up with chronic TTH. Usually there’s pain on both sides of the head, feeling like a pressing or tightening. Physical activity probably won’t make it worse, but there is sometimes some mild sensitivity to light or noise, and possibly a little nausea (but not vomiting) – one, but not all three.

Chronic migraine, in contrast, usually starts with migraine attacks which eventually become chronic. The symptoms are migraine-like.

Now with both chronic migraine and chronic tension-type headache, your doctor will want to rule out other conditions. It is possible to have the symptoms of chronic TTH, and yet actually have a different diagnosis.

If you have been diagnosed with CDH, try to get a more specific diagnosis. Why? Because as research continues, there are treatments that will be more likely to help you depending on which type of chronic condition you have. The more you can narrow it down, the quicker you can get treatment that works.

For more of a breakdown of CDH types, see the National Headache Foundation’s topic sheet on Chronic Daily Headache.

30 March 2012

Watch for it – Ketamine for Migraine and More

James Discoveries & Stats, Medications, Treatments 6

Using ketamine for pain is not a new idea. But I think we’re going to see it get an increasing amount of attention in the months ahead.

A few weeks ago, NPR featured a news story on the use of ketamine for depression. Ketamine, originally developed as a human anaesthetic, has since been used for various applications in medicine.

Ketamine for depression, migraine, and more?

It’s also used as an illegal drug, gaining fame as "K", "Vitamin K" or "Special K".

In recent years there has been sporadic interest in using ketamine for pain. It’s a difficult drug to study, because it tends to be rather obvious that you’ve taken it.

But it has been suggested as a treatment for cluster headache, familial hemiplegic migraine, chronic daily headache, and migraine, as well as other types of pain.

Ketamine is a neurological drug, classed as a NMDA (N-methyl-D-aspartate) receptor antagonist. It is believed to work in a number of different ways in the brain – relating to calcium channels, serotonin, and glutamate – terms that will be familiar with migraine researchers in particular. In fact, ketamine has been especially useful in the treatment of headache or migraine that just won’t go away and isn’t responding to other kinds of treatment (refractory). It’s given as an IV or intranasal treatment. Of course, this means it’s way down on the list of treatments that will be given – it’s rare and even when it’s tried it’s often not successful.

However, with the growing interest in ketamine for depression, the game changes. You can bet that there will be increased interest in ketamine for chronic pain conditions, which often come hand in hand with depression.

Although increased interest doesn’t mean this should be the drug of choice for most people, it does mean that more research will be done. It may be a treatment that will help a few patients whose pain is seemingly unstoppable.

For more on the background of ketamine, read Ketamine and MDARs in the treatment of neuropathic pain from Dr. Jan M. Keppel Hesselink. For a review of the studies on ketamine for other types of pain aside from headache, read Ketamine in Chronic Pain Management: An Evidence-Based Review

12 February 2011

Managing Your Migraine – Lincoln, England

James News, Resources 0

Also coming three weeks from today – an event in Lincoln, England, UK for migraineurs. The theme is Managing Your Migraine. The event goes from 9:30am to 1pm on the 5th of March 2011.

Here’s what the Migraine Trust has to say about the event: The Migraine Trust is organising a public information event for people living with migraine and for those who would like to find out more about managing the condition. The programme includes presentations by local migraine experts, an opportunity to ask questions and meet other migraine sufferers.

The program will also include discussion about Chronic Daily Headache, and a question and answer time.

Once again, you need to register in advance. There is a fee, but you can register online. You must register and pay in advance, because space is limited.

Go now and register for the Managing Your Migraine event.

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6 December 2010

Migraine, Headache, and Obesity – What’s the Link?

James Information 2

There doesn’t seem to be much doubt that there’s a connection between obesity and migraine. Various studies suggest that weight gain, obesity, eating patterns, and so on, are risk factors for migraine and chronic daily headache.

Now once again, we do have the chicken-and-the-egg question. Could the migraine or CDH actually be causing the weight gain?

It’s probably a factor, but it’s probably not that simple. Certainly, chronic illness can make it difficult to exercise. But we’re likely looking at a more complex web of cause and effect here. That means that if you want to lose weight and get rid of migraine, you should be working on both issues together.

How is obesity linked to migraine and headache?

Several neurotransmitters and proteins have been associated with migraine or headache and body fat or eating habits. Take, for example, serotonin, ghrelin, orexin, and adiponectin.

You also need to throw anxiety and depression into the mix – again, depression not necessarily caused by chronic illness, but connected. The chemicals in your body related to weight gain can be involved in mood issues as well.

What kinds of connections have researchers suggested? In 2007, a study connected Body mass index to an increased number of migraine attacks (2006). Dr. Ann Scher and her team, in 2003, followed over 1100 people and discovered that obese people were more likely to develop chronic daily headache (in other words, in this case the obesity was not brought on because people already had CDH and so were less active).

A study this past August suggested that overweight adolescents were also at higher risk for recurring headaches. But other studies have not had such firm findings.

It’s been suggested that certain types of body fat, such as abdominal fat, are stronger risk factors than general body fat.

We’re left strongly suspecting a connection between migraine, chronic daily headache, depression, and obesity. But we’re still not sure exactly what that connection is. Larger, better designed studies are needed to give us more clues.

For the time being, we know that overall health is important for those with migraine or chronic daily headache. You don’t need to become a super-athlete in a day – simply start slowly and think about how you can slightly improve your diet, get a little more active, and if possible find a better treatment for your headaches and/or migraine.

Thanks to the book Menstrual Migraine