MRI

13 July 2020

Can You Change Your Brain?

So if migraine is a symptom of having a brain that’s especially “sensitive” – can you change your brain? An interesting new study suggests that certain training can do that very thing.

The small study, published in the journal Headache in April, tested the idea with 18 adolescents. The adolescents with migraine took part in cognitive behavioral therapy (CBT-HA). Before the first session, and after the last session, patients underwent resting?state blood?oxygen?level?dependent contrast MRI scans. Arterial spin labeling was also used.

We won’t get into all the technicalities, but essentially brain measurements were taken before and after.

CBT-HA is basically training to learn how to cope with pain, how to think differently. It encourages changes in attitude and behaviour. Originally developed for depression, it’s now being used and studied for many disorders.

The results were very positive – fewer headaches per month, for one thing. But it also appears that there were actual measurable changes in parts of the brain that regulate pain. In other words, it’s a confirmation that we can actually change the way our brains work to fight pain.

This is not a new concept by any means – it’s widely known that we can affect physical changes by changing the way we think. But there’s a lot of study that needs to be done to see how to use this ability effectively to fight migraine and other conditions. And perhaps there is a stigma of this type of treatment – do people still prefer to “just take a pill”?

Meanwhile, positive studies continue to come out showing benefits from CBT. Thanks to the Cincinnati Children’s Hospital Medical Center and others who are doing significant research in this area.

Read the study abstract here: Alterations in Brain Function After Cognitive Behavioral Therapy for Migraine in Children and Adolescents

For another article discussing the study in more detail, visit 83% Of Patients Had Fewer Migraine Headaches After Doing Therapy

8 November 2018

Is Migraine and early Sign of MS?

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If you’re familiar at all with multiple sclerosis, you know that early diagnosis is considered to be very important to slow the progress of the disease and improve quality of life. We also know that migraine symptoms often accompany MS. So the obvious question is – could it be that my migraine attacks are actually an early sign of MS?

Researchers in Germany recently made that argument. But their study actually focused on the progression of headache attacks in the first few months of MS. And the results are not what you would expect.

We’ve noted before that migraine symptoms are actually especially common among women who have had MS for a long time. But according to the recent study, symptoms may actually improve over the first few months.

In the study, 50 patients were screened when symptoms of MS began, and then again 6 months later. Based on this small amount of information, headache symptoms did seem to decrease.

The authors of the study felt that the treatment of MS – specifically immunomodulatory therapy (therapy involving the immune system) may explain why headache symptoms decreased.

But of course, this means that early on in MS headache symptoms are worse. Cases have been reported of patients who have experienced migraine or cluster headache symptoms as their only or primary first warning of MS. We talked about a patient who had long lasting migraine symptoms who did indeed have MS.

An MRI for MS? These researchers recommended that young patients who have migraine-like symptoms should automatically be given an MRI, a test which helps rule out diseases other than MS and that may show signs of MS.

There are, however, good reasons why every headache patient should not be running to get their head scanned. But then again, patients already at risk for a certain disease who are experiencing new headache symptoms should take them seriously.

Who, then, is at risk for MS? MS most often is first diagnosed in young adults. But risk is a controversial subject. Some possible risk factors include:

type 1 diabetes
thyroid disease
inflammatory bowel disease
you smoke
you’re female
you’re related to someone with MS
you live far from the equator

So a patient with some of these risk factors, who is experiencing new headache symptoms, or especially symptoms which won’t go away and are getting worse, should see a doctor at the very least. Headaches can be a warning sign for many conditions, and MS is likely one of them.

This is not a reason to worry and panic. It is a reason to take headache symptoms seriously, early on, rather than to just consider it “normal” because you’re “stressed”.

Making Invisible Migraine Visible

James Discoveries & Stats 0

We usually talk about migraine as an “invisible illness”. It’s not always easy (for the layperson especially) to see that someone is having a migraine attack. And it’s even harder to see the burden of migraine that is still on the shoulders of someone who is not currently in the middle of a migraine attack.

Seeing Migraine in the Brain Researchers have been looking for ways to make migraine visible. That is, a way to test for migraine in a lab.

For example, we’re very interested to know if a reliable blood test could be developed for migraine – maybe even a test that tells us what type of migraine that person has, and therefore what the best treatment would be.

In June, a report in the journal Cephalalgia went a different direction. What about an MRI for migraine?

This MRI was actually a rs-fMRI – which stands for resting-state functional magnetic resonance neuroimaging (for all you health care geeks who want to impress your friends). The test was very simple. Could the MRI distinguish between a healthy individual and a migraine patient?

33 regions of the brain were studied, and the test turned out – not bad. It wasn’t 100% accurate (not many tests are!), but it managed to reach 86.1%. For those who had suffered from migraine for 14 years or more, the accuracy reached 96.7%.

Tests like this can give us an improving understanding of the progression and biology of migraine, and may in the future allow us to test for migraine in a non-invasive way, leading to faster and more accurate diagnosis.

For more, see the study abstract here: Migraine classification using magnetic resonance imaging resting-state functional connectivity data

4 July 2016

Stabbing Pain In Head: What’s the diagnosis?

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You’d think that a patient complaining of stabbing pain in head would be fairly easy to diagnose. Wouldn’t there be some problem right where the stabbing occurs?

Unfortunately, it’s not that simple. There are many causes for stabbing pain in the head, but there are some good ways to narrow down the causes.

Common: An Outside Cause

If there were an obvious outside cause to the pain, such as a knife in the head, you wouldn’t be taking the time to read this article. However, the outside cause is not always completely obvious. The pain may last longer than you expect, or may spread to a part of the head that you don’t expect.

For example, cold weather, or even cold water, could cause stabbing pain. Exposure to cold may not cause an instant headache, and the headache may not go away immediately. Usually, however, it should be gone within half an hour.

Another common cause is an airplane headache. The stabbing pain is usually connected to take-off or descent. Read more about this type of headache: Are You Experiencing Airplane Headache?

It’s actually common for migraine patients in particular to be more sensitive to outside stimuli. Sometimes you’ll find the stabbing pain hitting on the same side where you commonly experience migraine pain.

Stabbing Pain in Head: Nerves/Structural Problems

Stabbing pain in head When there isn’t an outside cause, the pain may be coming directly from certain nerves.

There are various stabbing headaches that are highly related to certain nerves, such as occipital neuralgia (related to the occipital nerves, with pain in the back of the head) and classical trigeminal neuralgia (related to the trigeminal nerve, closely connected in location to parts of the nerve distribution).

In many cases certain nerves become compressed, and/or irritated. This is a common cause of stabbing pain in the head, or other parts of the body.

Irritation of nerves come from many causes – an infection or previous infection, poor posture or a previous injury. There may not even be an apparent cause.

Diagnosing Stabbing Head Pain

If there is no apparent cause, you can help your doctor to diagnose the problem by sharing the following information:

When did the pain start? Was there anything unusual happening at the time when you started to experience this pain?
Is the pain ever triggered by something specific? For example, does touching your face, or chewing, or turning your head sometimes or always trigger the pain? (In some cases, pain may be triggered at times but not at other times by the same thing. This will help your doctor rule out possible causes.)
How frequent is the pain, and how long does it last? Stabbing pain usually only lasts a few seconds, but you may have repeated “stabs”. Does it come in cycles? How long has this been happening for?
Exactly where is the pain, and does it move? This is very helpful in diagnosing nerve-related pain. Does the pain follow a path, like a streak of lightning? Is it always on the same side? Does it radiate out from a certain location? Does it come from the ear? Back of the scalp? Can you point to a specific location on your face?

If your doctor cannot find a probable cause, she may need to order a scan (such as an MRI). This will help find damage in certain locations.

Many types of stabbing head pain can be treated effectively with medication. Of course, treatment will depend very much on the type of pain you have and what your medical history is. In unusual cases when medication doesn’t work and the pain is very disabling, surgery may be an option.

Stabbing pain in the head can be difficult to diagnose, but there are good treatments available if you and your doctor can work together to get the right diagnosis.

22 February 2016

A Better Way To Evaluate Concussions?

James Discoveries & Stats, News 0

A concussion is a form of brain damage. And the brain, as we all know, is a very complex piece of equipment. It’s not easy to tell how bad the damage is.

Some patients may seem fine to start with, but within weeks they may develop serious symptoms that could be with them for years to come.

Sometimes migraine symptoms will develop. But sometimes they won’t. Sometimes recovery will be fairly quick, sometimes not.

Typically, your doctor will give you a neurological examination, checking for vision problems, hearing problems, changed in your coordination or balance. If your doctor is concerned about some serious symptoms, either from the exam or from diagnosis of headaches or nausea, he may request some type of scan, such as a CT or MRI.

The MRI can assess white matter injury in the brain. A mean fractional anisotropy (FA) is one way to assess how much damage has been done. But because everyone’s brain is different to start with, the FA measure doesn’t always give reliable results.

Dr. Joseph Delic at the University of Pittsburgh Medical Center and his team investigated the value of another technique, known as Shannon entropy (SE) analysis, to see if it would give more accurate results. And in the opinion of the study authors, it does.

In fact, someone with a SE below a certain level were 16 times more likely to develop migraine from concussion. Also, the lower the SE the longer the recovery.

If doctors have access to a better way to assess patients with concussion, they will be better able to provide treatment over the long term, and avoid treatment that isn’t needed.

For more, read the information on the study from the Radiological Society of North America: Technique Helps Predict Likelihood of Migraines in Concussion Patients, and this article in ScienceDaily: Technique helps predict likelihood of migraines in concussion patients.

Also see: Is it Concussion or Migraine? and Concussion: Tests and diagnosis