The great name “Operation Brainstorm” refers to a program from the National Headache Foundation in the USA. If you’re a veteran or on active duty, you may want to check it out.
The goal of Operation Brainstorm is to actually visit various locations throughout the country to host forums, provide education, and even provide “migraine survival toolkits”. For example, the program will make a visit to the American Legion Post 0346 in Farmington on the 11th of October 2023.
There has been a growing understanding of traumatic brain injury and of course post-traumatic stress disorder, which are often associated with headache and migraine symptoms. The National Headache Foundation is able to bring its expertise to good use in these areas.
For more information, check out the poster (click the poster to go the the official site) and the video below.
You’re more likely to associate altered consciousness with conditions like epilepsy, or something sudden like a stroke. But sometimes the diagnosis should be migraine.
Migraine certainly can feature some unusual symptoms, and different levels of consciousness is one of them. This is most often associated with a type of migraine called migraine with brainstem aura. But because it’s unusual, it can lead to misdiagnosis, as happened recently.
A 16-year-old was experiencing attacks where she would get a severe, throbbing headache with vertigo. She would fall down, and even temporarily lose the ability to speak. Then the episode would pass.
Not surprisingly, an EEG was ordered, and she was diagnosed with a kind of epilepsy. But the medications for epilepsy didn’t work – and the attacks continued, 2-5 times a month.
Finally, the diagnosis was changed to migraine – and migraine treatments did work.
There is a lot of discussion about the relationship of migraine with epilepsy. And sometimes the differentiation isn’t as clear as we would like. Research certainly needs to continue, so that we can understand both conditions better.
But in the meantime, the important thing for patients is finding a treatment that works. If the common treatments for something aren’t working, it would be a good time to rewind and take another look at the symptoms, and also the medical history of the family (in this case, the patient’s mother did suffer from headaches).
Headache specialists and researchers may be interested in looking at more of the technical details of this particular case. It was published this month in Acta Epileptologica: A case of migraine misdiagnosed as epilepsy.
In its clinical description, there’s no doubt that the symptoms of cluster headache are quite different from migraine. There has been some confusion in the past (such as the unfortunate term “cluster migraine“), but we’ve talked more than once about the differences.
All that being said, “migraine” is not one thing either. There are many different types of migraine with different symptoms, and in some cases with different treatments. Since we’re still learning about what causes the migraine chain reaction, and what really causes cluster headache, the question arises – is there actually a similar cause? Is this one disease that manifests itself in different ways? If so, although treatment options are quite different now, might there be some future treatments that address both?
The article discusses some of the challenges when it comes to making a hard-and-fast decision. There are certainly a lot of similarities, but also a lot of differences. There is no symptom that only appears in migraine and cluster and nothing else (it would be easier if you knew that, as soon as your nose turns purple, it’s either cluster or migraine). Should we look more at treatments – diagnosing based on which treatments work? This is fraught with complications as well.
The authors give us a helpful summary, so here’s a summary of the summary. Yes, cluster and migraine share not only some symptoms during the attack, but also symptoms in-between attacks (such as visual hypersensitivity – being sensitive to bright light between attacks, for example). There are also genetic similarities, similarities in demographics (what “kinds” of people get migraine or cluster), and similarities in certain triggers (they’re basically talking about triggers in a lab – give Joe this drug, it will trigger a cluster attack. Give JoAnn the same drug, it will also trigger an attack).
But these are overlapping similarities. There are some genetic features the same, and some different. There are some symptoms the same, and some different. Cluster is also triggered “more quickly” – telling us that perhaps the “chain reaction” that leads to the symptoms is different for each.
So basically, we need to know more about each. For the time being, we still look at what has “worked best”, we still recognize that everyone is an individual and so needs individual treatment. But we do encourage further discussion and research, because the more we understand, the better treatments can become.
If you’d like to get deeper into the topic, check out this actual video debate between Dr. Anja S. Petersen and Dr. Kuan-Po Peng. They talk not only about the scientific evidence, but also the practical implications of a more or less marked divide between the two.
It’s no surprise that cluster headache has a major impact on life, leading to significant disability, sick days, loss of productivity and family time. But what is less known is that cluster is also connected to other diseases that can make life challenges even greater.
A study out of Sweden, published this month in Neurology, looked at the common types of diseases and conditions that tended to go along with cluster headache.
What we’re talking about here are “comorbidities”, that is, diseases and conditions that tend to go together. The term makes no comment on what caused what – did one cause the other? Are they the result of a common root? Is the treatment for one triggering the other? Or were more issues diagnosed because the patient was already seeing a specialist (e.g. a neurologist)? Those are separate questions.
For cluster patients, the most common comorbidities were neurological. In fact, they were diagnosed with far more neurological conditions than the reference group. That would include things like migraine, and depression.
Other types of conditions that tend to be more common in cluster headache patients include:
Eye diseases
Respiratory
Gastrointestinal
Musculoskeletal systems and connective tissue
On the positive side, there are some areas of disease that are less likely in cluster patients, such as:
Blood and immune system
Endocrine and metabolic
Pregnancy/childbirth related
Cardiovascular (from previous studies)
Diabetes (previous studies)
However, when cardiovascular conditions do go along with cluster, they tend to significantly increase disability.
Also, the study gives an important reminder. Although cluster is much more common in men, it does attack women, and can lead to even more disability and comorbid conditions in them.
So what is the value of knowing this information? Is there anything you can do about it?
First of all, because one may cause or trigger the other, it is important to be aware of and treat both (or all) conditions. Because resolving one may help resolve the other.
Second, sometimes other conditions can be ignored because of the incredible pain of cluster headache. The patient may not be thinking about other conditions, or the doctor may not think to ask (especially if it is outside their area of specialty).
Third, some treatments may be preferred, or avoided, once a diagnosis of comorbid conditions is made. Maybe there is a treatment that could make the other condition(s) worse, or a treatment that could help both.
So if you are suffering from cluster, do be aware of some of the most common other conditions to look for. A more in-depth eye check-up, a closer look at stomach problems, and so on, could resolve a lot of symptoms.
It won’t surprise most people that there’s a link between migraine and poor sleep. A new study confirms this once again, and also highlights a tool that is used in evaluating sleep.
Does poor sleep lead to migraine, or is it the other way around? Could sleep patterns actually lead a person to develop migraine? Or does a bad night simply trigger an attack in someone who is already susceptible?
Probably the most certain is that a bad night or change in sleep schedule (e.g. sleeping in) may trigger an attack (although it may not be the next day), and that poor sleep patterns can worsen migraine patterns.
But here’s the other challenge – migraine attacks themselves may make sleep difficult, even though it would seem to be what you need the most! (We’ve talked a lot about how to get better sleep – here are some sleep tips from our community.)
Studying the Migraine Sleep Link
The study we’re looking at today was published in the journal Frontiers in Neurology in August. Researchers used a questionnaire to evaluate sleep patterns in migraine patients, as well as patients without migraine, for comparison.
The bottom-line result: poor sleep quality increased the risk of migraine 3.981 times compared with good sleep quality.
Looking at age, those over 35 were more likely to see this connection. Women also were more likely to see the link, although the researchers admitted they would have liked to have had more men in the study.
The study also confirmed that “migraine burden” was higher with sleep problems. Patients with migraine and sleep issues are more disabled, have more severe pain, more depression. So whatever causes whatever, it’s very important to improve sleep if you already have migraine.
The weakness of this study is, in a way, its strength. The study used a questionnaire, which means that patients were evaluating their sleep for themselves. Might they minimize certain things, or exaggerate others? It is somewhat subjective.
Another method would be to actually do sleep tests in a lab, but that’s time-consuming and has its own limitations because it’s not a “real-life” situation. It’s great for diagnosing some things, but it’s much more challenging to evaluate overall sleep patterns and habits.
The benefit of filling out a two-page questionnaire is that it’s easy. You could probably do it right now without being very inconvenienced. You could even fill it out twice a year, and look for patterns. A doctor could use it as a part of the toolbox in your diagnosis and treatment.
There simply is no doubt that there’s a connection between sleep and migraine. There are many options when it comes to medications. But some simple lifestyle changes are often far more powerful, more permanent, and have other health benefits as well. If you’re dealing with migraine or headache, sleep should be a major area of investigation.