daily headache

1 March 2022

Childhood Headache Increasing?

Last year, Dr. Marc DiSabella of Children’s National Hospital shared a report at the American Headache Society Virtual Annual Scientific Meeting regarding headache in children between the summer of 2020 and the winter of 2021. Although the report as seen online may raise more questions than it answers, it does give us a lot of food for thought.

Regarding headaches, researchers found that episodic headaches tended to decrease over this time, but that chronic and daily headaches increased. Nearly half of the patients said that their headache symptoms worsened. 12% said that their stress levels went down, whereas about half experienced worse stress and anxiety.

A further breakdown of information would be interesting. For example, most children reported that they ate and drank more over that time. Don’t you want to know – did they drink more water? Milk? Soft drinks? That question could make a drastic difference.

When did they eat? Snacks? Meals? And what was the difference between those who ate more, and those who ate less? For example, for some poorer children, the only half-decent meal they had many days was at school. So many children home from school due to COVID-19 restrictions found their nutrition decrease, not increase.

A CDC reported on weight gain:

…the rate of body mass index (BMI) increase approximately doubled during the pandemic compared to a prepandemic period. Persons with prepandemic overweight or obesity and younger school-aged children experienced the largest increases.
Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020

Doubled! And this study once again confirms that problems we had in 2019 tended to get worse by 2021.

More than half of children reported less physical activity, and 62% said that added screen time contributed to their headaches.

This report does tell us some things. Yes, many chronic headaches did get worse, and this certainly may relate to a lack of exercise. But every situation was different. And some differences could be the involvement of parents, opportunities in the community, economic levels, and so on.

A recent article at Akeso Health Sciences reported on this study and others. Like anything else, the changes and instability that children have been experiencing over the past 2 years bring risks. In other words, some children may have thrived, others not so much. But it helps when parents are aware of the risks and finding ways to mitigate them.

Are children eating nutritious meals? Getting exercise out of doors? Do you notice changes in symptoms (headaches, stomach problems, paleness, irritability)? How about mental health? Are families finding creative, fun, and educational things to do together?

2 March 2021

Chronic Migraine + Daily Headache?

James Discoveries & Stats 2

A recent review of migraine studies may have uncovered a hole in the research. Are people with chronic migraine and daily headache being overlooked?

Admittedly, it may be hard to exactly tell what’s going on when a patient simply has constant headache pain. Once you have chronic migraine, that’s an attack at least every other day. Who is to say that the headaches “in between” aren’t just migraine attacks “coming or going”?

But researchers for the Revista de Neurología (Neurology Magazine), a journal in Spain, discovered what may actually be a big problem with the research.

When a clinical trial starts for migraine, researchers are looking to be as precise and clear-cut as possible. They want people with migraine, or without it. And they want to know if it’s episodic or chronic. They don’t want people in mysterious in-between land. Which means that you’re not likely to even get into the study if you have migraine as well as some unspecified daily headache.

The researchers from Revista de Neurología 1.7 – 3.3% of migraine patients may fall into this category (in case you’re wondering, that’s a lot of people!). So, although current studies may benefit them, essentially these people are hardly being studied at all.

OK, maybe they simply have a slightly different manifestation of chronic migraine. But what if there are actual biological differences in these patients? That could mean that treatment that work might be quite different for them.

As the researchers write in their abstract:

They may have a longer lasting migraine and different response to treatment. Patients with chronic migraine and daily headache may have complex pathophysiological mechanisms that favor the daily manifestation of migraine
Chronic migraine with daily headache. Literature review

The only bit of treatment wisdom that they pulled out for the abstract was that OnabotulinumtoxinA (Botox) may be useful for these patients. But they admit simply that “management of these patients is a therapeutic challenge”. Indeed!

We need to find a way to better help these patients, and part of that is actually taking the time to study which treatments work best for them, even if they represent a smaller percentage of migraine patients.

Do you suffer from chronic migraine as well as daily headaches? Have you been shut out of a trial or treatment or service because of it? What treatments have you found helpful?

20 August 2010

What is Transformed Migraine?

James Information 0

Transformed Migraine is another older term that isn’t used as often anymore. What used to be called transformed migraine or evolutive migraine can now actually be called several different things, depending on the diagnosis.

The most basic diagnosis is chronic migraine. Transformed migraine (TM) referred to patients who had migraine symptoms very frequently or even every day. That’s what chronic migraine is.

In chronic migraine, the patient has migraine symptoms at least 15 days per month for at least 3 months.

Cases of chronic migraine often start out as something else – simple migraine without aura most often. (Hence the term "transformed")

Now, the diagnosis does get a little tricky here. First of all, you could also have chronic tension-type headache if your symptoms more closely mirror the technical description of tension-type headache. However, you could even have both at the same time. And just how different tension-type headache and migraine are biologically is a matter of debate.

If your doctor thinks you may have transformed migraine or chronic migraine, there are certain things she’ll want to check out. First, she’ll want to do a work-up to make sure there isn’t another cause for your symptoms. This includes other diseases, or a recent trauma to the head, for example.

She’ll also want to see what medication you’re taking – how much, and how often. She may diagnose you with medication-overuse headache if she feels cutting back on medication will help you.

You may also be diagnosed with probably chronic migraine if there’s a chance that medication overuse has played a role in the past couple of months.

She’ll also want to check and see what may be aggregating your condition – migraine triggers, biological factors, and so on. She’ll also want to check for related conditions, such as depression.

Treatment for chronic migraine can be challenging, but many people have found relief. Your doctor will probably focus more on preventative strategies, such as supplements, preventative medications, and lifestyle changes. These things can improve your quality of life over the long term.

More on transformed migraine from the National Headache Foundation.

31 March 2009

More on the NTI-tss device (with video)

James Treatments 0

The NTI-tss device continues to be a valuable tool in the fight against migraine. It doesn’t involve any drugs – just a custom made device that you wear in your mouth through the night. For many people, the results have been very good.

Migraine attacks are often triggered by excessive clenching and/or grinding of your jaw at night. Not only can this increase migraine attacks, it also lowers quality of life by adding often daily dull headaches. The NTI-tss device is designed to help people in this category, as Dr. Andrew Blumenfeld explains in this video:

The information on migraine may be nothing new to you, but the video is a good reminder that often migraine patients have constant pain that is ignored because of the more obvious flashes of migraine pain.

How the NTI-tss device works

The idea behind the NTI-tss device is this. By keeping the teeth slightly apart, particularly the molar and canine teeth, the device makes it physically impossible for you to clench as intensely. The muscle activity (hyper-activity) is drastically reduced.

For many people, this eliminates a major migraine trigger, and also reduces or eliminates the daily, dull headache that they wake up with.

The research around the NTI-tss device has gone forward quite a bit since we last talked about it. Depending on your response to an initial fitting, or depending on your particular issues, you may be fitted with slightly different devices in different ways.

Talk to your dentist and find out if they are using the NTI-tss device, and if they have used it to treat migraine patients. If you’re in Canada, there’s a directory of dentists here.

Let me leave you with a video of someone being fitted with the device. It’s a very easy process (I’ve had it done myself).