Journal of Headache and Pain

11 May 2020

Women, Migraine, and Serious Disease

A study published this year in the Journal of Headache and Pain confirms our previous concerns about migraine and heart disease – but also gives us surprising clues about cancer risk.

It was hard to come up with a title for this post, and in fact this is a complex study with no easy answers. But let’s start with an overview.

This research comes from the Women’s Health Study, a study of 27,844 women. They were 45 and older at the start of the study, which followed the women over the next two decades or so.

The study was looking for some big clues or general trends when it comes to headache and migraine and death rates. Simply put, do we see women with migraine dying at a higher rate than the general population? If so, what are they more likely to die of?

The perhaps comforting short answer is – no, women with migraine are not more likely to die sooner than women in general. But there’s more to it than that. (And in some ways, we would like to start seeing women with migraine dying later than the general population – because often times they are more aware of their health and may start taking better care of themselves!)

But there was one cause of death that was higher among women with migraine with aura specifically – that was cardiovascular disease. As we’ve noticed in other studies, migraine, and especially migraine with aura (as in this case) does seem to increase risk of cardiovascular disease.

Although some have questioned the role of migraine medication in this link, it’s interesting that, in this study, it was only migraine with aura that increased risk.

The moral of the story is the same as what we’ve been saying for years – if you have migraine, treat it. And be aware of other risk factors you may have for stroke and heart attack et cetera.

Now, for those of you who are mathematically minded, you may be asking – if there is an increased risk for cardiovascular disease, why weren’t women with migraine in general more likely to die earlier? The surprising answer – those with migraine with aura were also at a slightly decreased risk for cancer – especially female-specific cancers. So that balanced out the numbers.

Why would this be? Remember, this study was just looking for some overall clues, it doesn’t give us a lot of specific information. But researchers believe the answer could be related to hormones, which do affect both migraine and cancers.

For more on this study, see Women With Migraine, Aura Have Increased Risk of Cardiovascular Death. For all the details of the study, go to Migraine, headache, and mortality in women: a cohort study.

16 September 2019

Just how “different” is Migraine with Aura?

James Information 0

Migraine with aura actually refers to a whole set of clinically different types of migraine. It’s characterized by temporary symptoms such as seeing flashing lights or patterns (visual aura), or a feeling of “pins and needles”, numbness, or problems with speech. (Read more here – Migraine with aura)

migraine visual aura simulation — Visual migraine aura simulation, by Kronos

So obviously experiencing or not experiencing aura means that the symptoms are somewhat different. But is migraine with aura actually a different disease? Should it be treated differently? Is it doing something different to your body than migraine without aura?

These are questions that doctors and researchers have been struggling with for many years. A new report in The Journal of Headache and Pain is helping to direct the discussion toward future research.

If you really want to delve into the details, you can read the report (and use all the footnotes!) here: Differences in treatment response between migraine with aura and migraine without aura: lessons from clinical practice and RCTs. But here are a few brief thoughts, based on the article, about migraine with aura.

Is Migraine with Aura a “different disease”?

There is a lot of discussion about whether or not we should call migraine a “disease”, but researchers use the word “etiology”. That means, does migraine with aura have a different basis, a different cause. We don’t know what causes migraine, but we have clues.

There are hints that migraine with aura may have a different etiology, but we don’t know for sure. As we’ll see below, it does sometimes respond differently to treatment, and it can affect the body in different ways. Is it just a variation of migraine? Or is it really different?

And this is complicated by the fact that many people experience both migraine with and without aura.

Should treatment be different for Migraine with Aura?

Generally speaking, there has not been a different treatment regimen for migraine with aura. And with good reason – most studies show similar results for both. However, there are some exceptions.

For example, magnesium may work better for those who have aura. Botox may be another example.

A rather interesting example was tonabersat. Don’t feel bad if you haven’t heard of it. It’s a “gap-junction modulator” that actually inhibits the cortical spreading depression in the brain which happens during a migraine attack – and which seems to directly influence aura. In trials, tonabersat at first didn’t seem very effective – until patients with migraine with aura were separated out. Then it was shown that it seems to help only patients with aura.

So if we target the cortical spreading depression (CSD), would that stop the attack in patients with this type of migraine? Well, the jury is still out. We often talk about migraine as a “chain reaction” here, but we’re still not sure if the CSD is just a link in the chain, or if it’s more part of a “web” of biological changes.

However, the study of tonabersat may give us new insights into how migraine should be treated.

Does Migraine with Aura affect the Body differently?

Yes, it seems to. Although other types of migraine may raise your risk of cardiovascular problems (think heart attack, stroke, etc), migraine with aura does seem to uniquely increase your risk of ischemic stroke in particular. There may also be differences in blood flow and the effect on the brain itself.

In many trials, migraine with aura was also more difficult to treat – it simply didn’t respond as well to typical treatments.

Interestingly, one study showed that women with migraine with aura are more likely to suffer from anxiety and depression, compared to those with other types of migraine.

Conclusion

Researchers want to see more studies on targeting migraine aura itself. They also feel that it would be worth it to differentiate more between the two major types of migraine in studies, so that more information can be gathered.

At this point, very little is understood about the difference between types of migraine, other than the differing symptoms. However, it is clear that there are differences beyond symptoms – migraine with aura may be harder to treat, may respond better (or worse) to individual treatments, and does seem to change the brain and body in some different ways.

5 January 2019

MSG and Headache – A Myth?

James Discoveries & Stats, Information, News 1

Late last year, an article in Lifehacker caught my attention – Stop Being Afraid of MSG. People with headaches and migraine may either be relieved or shocked by the claims that follow:

If you’re still afraid of the seasoning MSG giving you headaches, you should know you’ve bought into a decades-old myth.

Words like “afraid”, “bought into” and “myth” certainly make one feel like they should change their opinion immediately, and order a bottle of MSG (affiliate link conveniently provided in the above article).

But on the other hand, many headache sufferers swear that, every time they eat MSG, they get a headache.

So what’s the truth? First, in spite of the fact that MSG has sometimes pretty much been blamed for the imminent fall of civilization, it doesn’t seem to have an obvious, immediate effect on most people. And long term effects of that kind are extremely difficult to measure.

So the real question is, does it bother some people, perhaps those predisposed to migraine?

Almost anything bothers somebody, so we’re actually looking for something more widespread than 6 people in Berlin who get sick if they eat MSG.

So here’s what many of you really want to know. Yes, there are many people who feel that MSG gives them headaches. You will hear lots of stories. That doesn’t make it a fact, but it’s widespread enough that it seems to be more than a coincidence.

However, the clinical trials have not been conclusive. So why is that? Are the “right” people simply not in the trial?

Part of the challenge is that MSG is noticeable. That means placebo effect. So a well designed study is difficult to do with MSG, and trials in the past have often been poorly designed from a scientific point of view.

In 2016, a useful review of the studies of MSG was published in the Journal of Headache and Pain (Does monosodium glutamate really cause headache? : a systematic review of human studies). The study pointed out some of the problems with previous studies.

Falling short of claiming that MSG headaches are “myth”, the researchers concluded that the evidence was not strong enough from clinical trials to prove a direct causal relationship:

Because of the absence of proper blinding, and the inconsistency of the findings, we conclude that further studies are required to evaluate whether or not a causal relationship exists between MSG ingestion and headache.

Interestingly, the study actually interacted with the beta edition of the International Classification of Headache Disorders 3rd edition (ICHD-3 beta), which listed monosodium glutamate (MSG)-induced headache as one type of “Headache attributed to a substance or its withdrawal”. The cited studies were investigated more closely, and again, the studies did not seem robust enough to prove the relationship between MSG and headache.

The editors of ICHD-3 seemed to agree, dropping the mention of MSG altogether when the document came out of beta.

If someone gets a headache after eating foods with MSG, what does that mean? Is it possible that other issues (such as high salt content in general) could be causing the headache? In some cases, yet. It is easy for individuals to assume that one thing is causing their headache, when it’s something else altogether – and that’s something that happens frequently.

On the other hand, it would seem difficult to use these studies to “prove” that there is no causal relationship. So that leaves us with two practical issues.

First, you are the only one who is going to “test” the relationship on yourself. Keep an open mind, and if you’re convinced that MSG is a problem for you, stay away from it. If you’ve read the evidence and would like to give it another try, go ahead.

We should probably be a little cautious before we start labelling the MSG headache as a con or myth. And laughing at the silly woman who still lives in the bronze age and thinks that MSG causes her headache would seem to be counter-productive. We really don’t have the evidence to know if MSG bothers her or not. And when new research comes out, who knows if our minds will change.

9 January 2017

Cluster Headaches Causes

James Information, Uncategorized 1

As with any type of pain, the agony of this super-intense headache raises the question – what exactly are cluster headaches causes? In other words, why am I in such incredible pain?

There are actually two questions to ask. First, what may actually trigger a cluster headache attack at a certain time? But the other question is – why is it that a certain trigger results in a headache for one person, but not another? In other words, what is the cause of the disease in the first place?

But before we get into cluster headaches causes, make sure you understand what cluster is. Here is a handy infographic contrasting migraine with cluster: cluster headache vs migraine

So why does one person get cluster headache attacks, while another person doesn’t?

There has been some research done into the possibility of a genetic cause, or at least genetic factors that contribute. For many years now, researchers have recognized that family members of a cluster patient are more likely to have cluster themselves. In late 2016, a study from Italy was published in the Journal of Headache and Pain, indicating some possible genetic variants that seem to increase a patient’s risk (A genome-wide analysis in cluster headache points to neprilysin and PACAP receptor gene variants.).

Most often when we talk about cluster headaches causes, we end up discussing the brain and nervous system. We know, through modern imagine techniques, that the hypothalamus is involved, as has long been suspected. The trigeminal nerve in the head seems to be important, especially in the process that causes symptoms such as eye pain, tears and congestion. Other possible indirect cluster headache causes are related to a nerve cluster behind the nose (the sphenopalatine ganglion), histamine, and the blood vessels themselves. Read more about these factors here: What is behind the dreaded Cluster Headache?

All that being said, there is still nothing we can point to with certainty. Cluster may indeed be caused by a number of factors working together – for example, even someone who is predisposed genetically may not get cluster because other physical factors are lacking. There are other behavioural factors, such as a history of smoking, which seem to play a role.

But what actually kicks off a cluster headache attack (or, what triggers a cluster period)?

Cluster isn’t as closely connected to “triggers”, such as food or hormonal changes, as migraine is. There are some factors which have been related to periods of cluster headache attacks, including smoking, sleep apnea, and the season of the year (autumn being the highest risk time of year).

Once the cycle has started, there may be other individual cluster headache causes. Alcohol is commonly reported, as well as strong chemical fumes. A hot day, or getting “overheated” during exercise seems to trigger attacks for some. However, when you’re not in a “cluster period”, these things will not trigger attacks at all.

Cluster is hard to research because it is so rare. However, we are learning more and more about the brain, and the last 30 years has brought us incredible advances in understanding. Many of these new revelations about cluster headache causes have brought new treatments to the forefront, such as deep brain stimulation for chronic cluster headache patients.

Further reading: Cluster headaches causes and treatments (Medical News Today)

6 June 2016

Sore Muscles? The Migraine, Headache and Depression Connection

James Discoveries & Stats 1

A recent study published in the Journal of Headache and Pain should remind doctors and patients that that we need to pay attention to related symptoms in patients with headache.

When we say that “migraine isn’t just headache”, it’s hard to know how to say simply just what it is. After all, some migraine patients never have a headache. But most have headache plus many other symptoms. And those symptoms are different with every patient.

Major depression, also known as clinical depression or major depressive disorder, has a complex connection to migraine. It is likely that there are underlying biological and genetic factors that are behind both in some people (although some people with migraine are not depressed).

Muscle soreness and migraine A recent study investigated a third symptom that tends to go along with both major depression and migraine – muscle soreness or pain.

Patients with major depression and anxiety were followed up after two years, and their symptoms were evaluated, including headache, migraine, and muscle pain.

Headache and migraine were strongly associated with pain in the muscles of the neck, shoulder, back, upper limbs, and lower limbs. The researchers suggested that treatment of headache, as well as depression, could help alleviate muscle soreness as well in these patients.

Other studies have suggested that when migraine patients have pain other than headache, they are at further risk to end up with chronic migraine (see Warning Flag: Do you have non-headache pain?).

When patients deal with major issues such as intense migraine attacks and uncontrolled waves of depression, they often don’t even think about the fact that their shoulders are sore. Many symptoms are missed because we are trying to deal with the big ones. But the more symptoms we can get rid of, the better quality of life will be overall.

Do you suffer from muscle soreness or pain, as well as a headache disorder? Have you ever discussed it with your doctor?

Also see: