by admin | Jan 5, 2013 | Comorbidity
Hypothyroidism and Headache
Hypothyroidism has been found to be associated with chronic daily headache* in both the varieties of chronic migraine and new daily persistent headache. In one study, 30% of individuals with hypothyroidism had developed mild daily headache within 1-2 months of onset of the thyroid disorder. A history of migraine predisposed to the development of headache.
Hashimoto’s Disease, an autoimmune form of chronic thyroiditis, has also been associated with increased likelihood of headache.
A study of white matter hyperintensities seen on MRI in migraine found that either hypothyroidism or hyperthyroidism (too low or too high) was associated with these MRI abnormalities.
* This was chronic migraine without any evidence of medication overuse.
References:
1. Moreau T, Manceau E, Giroud‐Baleydier F, Dumas R, Giroud M. Headache in hypothyroidism. Prevalence and outcome under thyroid hormone therapy. Cephalalgia. 1998;18(10):687-689.
2. Trauninger A, Leél-Őssy E, Kamson DO, et al. Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients. J Headache Pain. 2011;12(1):97-103.
by Christina Peterson, MD
updated January 5, 2013
by admin | Nov 14, 2012 | Comorbidity
Depression and Migraine
One of the most significant comorbid conditions associated with migraine is depression. This particular relationship is one that is considered bidirectional—it works both ways. What that means is that if you have a tendency toward depression, you are more likely to develop migraine headaches, but also if you are a migraine headache sufferer, you are more likely to become depressed. Careful population-based statistical studies have been done, and it does not look simply as if migraine headaches make you depressed, although that might seem a logical conclusion. It is not that simple.
Based on one of these large studies, a person is 2.9 times more likely to develop depression if they are a migraine sufferer, and a person is 3.8 times more likely to develop migraine if depressed.
Depression did not affect the frequency of migraine attacks, or the progression of migraine-related disability over time.
The situation is somewhat more significant for chronic daily headache, where the headache pain may have a more telling effect. Depression occurs in more than 80% of chronic daily headache sufferers. The comorbid depression often improves if the daily pain pattern can be broken, and an episodic pain pattern can be re-established.
If you suspect depression might be affecting you and your headache pain, discuss it with your physician. There are both medication and non-medication strategies available to help you cope.
references:
1. Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders–a national population-based study. Headache. 2008;48(4):501-516.
2. Moschiano F, D’Amico D, Canavero I, et al. Migraine and depression: common pathogenetic and therapeutic ground? Neurol. Sci. 2011;32 Suppl 1:S85-88.
3. Tietjen GE, Herial NA, Hardgrove J, Utley C, White L. Migraine comorbidity constellations. Headache. 2007;47(6):857-865.
4. Hamelsky SW, Lipton RB. Psychiatric comorbidity of migraine. Headache. 2006;46(9):1327-1333.
5. Low NCP, Merikangas KR. The comorbidity of migraine. CNS Spectr. 2003;8(6):433-434, 437-444.
6. Moschiano F, D’Amico D, Canavero I, et al. Migraine and depression: common pathogenetic and therapeutic ground? Neurol. Sci. 2011;32 Suppl 1:S85-88.
7. Ligthart L, Nyholt DR, Penninx BWJH, Boomsma DI. The shared genetics of migraine and anxious depression. Headache. 2010;50(10):1549-1560.
by Christina Peterson, MD
updated Feb 7, 2010
by admin | Nov 10, 2012 | Comorbidity
While many IBS patients know that there are certain trigger foods that bring on their symptoms, there has never been a specific IBS diet. However, recent research suggests that there may be foods to avoid that can decrease your symptoms. Certain complex sugars can be the culprit in IBS.
What About Hot Chocolate and IBS?
Well, you can have the chocolate. However, dairy products may be an issue. In a lecture titled Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms, Dr. Peter Gibson discussed his findings in the American Journal of Gastroenterology lecture. Dr. Gibson’s results indicate that following what is called the FODMAP diet can reduce symptoms within two days for some IBS sufferers.
FODMAP is short for “fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols.” It’s less important to remember these long chemical names than it is to know what foods they are in.
Oligosaccharides
- wheat
- rye
- onions
- garlic
- leeks
- scallions
- shallots
- artichokes
Galacto-oligosaccharides
Disaccharides
- milk products (except for hard cheese)
Monosaccharides
- excess fructose
- fruits that contain more fructose than glucose
- honey
- apples
- pears
- mangoes
- high frutose corn syrup
- agave nectar
Polyols
- sugar alcoholc
- sorbitol
- mannitol
- maltilol
- xylitol
- stone fruits: cherries, peaches, apricots, nectarines, plums/prunes
- watermelon
- apples
- pears
- mushrooms
- cauliflower
- snow peas
For those of you who are trying to lose weight, or are diabetic, you should know that sorbitol and xylitol are used as sweeteners in low-calorie sweets.
So what to do about the diet? It is recommended that you avoid all these foods for six to eight weeks, and then add back one food at a time to see if it causes you problems. Learn to read labels, because some of these complex sugars are contained in processed foods.
Small studies have shown that following this diet can significantly reduce symptoms in up to 75% of those who follow the diet.
Resources to read more: The FODMAP Diet
When Everyday Foods Are Hard to Digest
by admin | Nov 8, 2012 | Stress Management
Life Out of Control? Learn Stress Management & Anxiety Reduction
Managing stress is important in controlling headache frequency. But managing headaches is also essential. Headaches can exert a significant toll on everyday life.
Relationships can suffer—one study found that in 30% of cases, migraine sufferers reported tension with a spouse due to their migraine headaches, and 24% reported that sexual relations were impaired.
In a 1999 UK survey, 58% of migraine sufferers reported that migraines prevented them from maintaining a sexual relationship—this survey was of both sexes, not just women, it is important to stress. In a 1998 study, it was found that 10% of migraine sufferers who are parents reported losing patience with a child during a migraine attack, 22% felt that their children sought more attention because of their headaches, and 94% reported that their migraines interfered with parent/child activities.
So don’t let your headaches run your life—and don’t let your stress ramp your headaches up and out of control.
Do You Have Good Ways To Manage Stress?
We all have stress in our lives. It is not possible to do away with it. We can’t even really control it all. We can learn to manage stress, though. Here are some ways to cope:
- Learn better time-management skills.
- Become more organized.
- Learn to delegate.
- Practice yoga.
- Regular massages.
- Relaxation therapy.
- Biofeedback.
- Meditation.
- Have more fun.
Stress Management Techniques
The following are strategies that have been found in studies to work effectively for migraine management.
Biofeedback is a way of using your body’s own information – heart rate,blood pressure, skin temperature, or muscle tension to retrain your system and reduce headache frequency. It is noninvasive.
Relaxation training focuses on methods of instruction in relaxing specific muscle groups systematically. This helps you relax in general, as well as targeting muscles which may be tightening up and acting as headache triggers. The goal is to achieve a general feeling of calmness. It is considered both a physical and a psychological form of treatment.
Cognitive behavioral therapy is a form of psychotherapy that addresses unhelpful thoughts and beliefs, misperceptions, and faulty learning that can result in anxiety, depression, low self-esteem, and being “stuck” in one’s pain. It focuses on behavioral strategies to enhance coping skills, alleviate emotional distress, and promote positive change.
There is also a difference between regular everyday stress and the kind that is unusual and unhealthy. Sometimes this comes from problems you are having in your life, sometimes it comes from things in your past that are affecting your health now, and sometimes it just comes from coping with chronic headache pain.
There are specialized techniques for dealing with this kind of psychological stress in addition to the above:
- Cognitive therapy
- When appropriate, marital or family counseling
- Hypnotherapy
- Psychotherapy
by admin | Oct 1, 2012 | Women & Headaches
This article addresses questions most frequently asked by women with migraine who are planning a pregnancy. Please consult your own physician if you are pregnant or are planning a pregnancy.
I’m pregnant…but what’s going to happen to my migraine?
Results from studies suggest that at least 70% of women who have migraine without aura experience improvement in migraine during pregnancy, particularly during the second and third trimesters.1-4 Since migraine without aura is often associated with falling levels of oestrogen, the reason for improvement in pregnancy is often considered to be the more stable levels of oestrogen. However, there are many physical, biochemical, and emotional changes in pregnancy that could also account for improvement, including increased production of natural painkillers known as endorphins, muscle relaxation, and changes in sugar balance. In contrast to migraine without aura, attacks of migraine with aura follow a different pattern during pregnancy as attacks are more likely to continue and aura may develop for the first time.5-7
I’m pregnant…but is migraine going to harm my baby?
There is no evidence that migraine, either with or without aura, affects the risk of miscarriage, stillbirth or congenital abnormalities over and above the expected outcome for pregnancy in women without migraine.5,8
I’m pregnant…but what can I take to treat my migraine?
Drugs tend to exert their greatest effects on the developing baby during the first month of pregnancy, often before the woman knows she is pregnant. Hence take as few drugs as possible, in the lowest effective dose. Although many of the drugs taken by unsuspecting women rarely cause harm, there is a difference between reassuring the pregnant woman that what she has taken is unlikely to have affected the pregnancy and advising her what she should take for future attacks. Most evidence of safety is circumstantial; few drugs have been tested during pregnancy and breastfeeding because of the obvious ethical limitations of such trials. Hence drugs are only recommended if the potential benefits to the woman and baby outweigh the potential risks.
Non-drug treatment
Many pregnant women favour non-drug methods of management during pregnancy, particularly once they are aware that migraine is likely to improve with time. Early pregnancy symptoms such as sickness, particularly if severe, can reduce food and fluid intake resulting in low blood sugar and dehydration, aggravating migraine. Simple advice to eat small, frequent carbohydrate snacks and drink plenty of fluids may help both problems. Adequate rest is necessary to counter overtiredness, particularly in the first and last trimesters. Other safe preventative measures that can be tried include biofeedback, yoga, massage, and relaxation techniques. The benefits of these methods can last longer than the pregnancy!
Drugs to treat the symptoms of migraine
Pain killers
Most painkillers are safe to use in pregnancy. However, check with your doctor, particularly if you are getting headaches more often than a couple of days a week. Paracetamol (acetaminophen) is the drug of choice in pregnancy, having been used extensively without apparent harm to the developing baby.9 Aspirin has been taken by many pregnant women in the first and second terms of pregnancy.9, 10 However, it should be avoided near the expected time of delivery since it can increase bleeding. Codeine: Codeine is not generally recommended for the management of migraine in the UK.11 However, occasional use in doses found in combined analgesics is unlikely to cause harm. Ibuprofen: can be taken in doses not exceeding 600 mg daily.9
Antisickness drugs
Buclizine, chlorpromazine, domperidone (not available in the U.S), metoclopramide and prochlorperazine have all been used widely in pregnancy without apparent harm.
Triptans
Data from the large sumatriptan safety database, where inadvertent exposure to sumatriptan during pregnancy has occurred, are reassuring.12 However, continuing triptans during pregnancy is not recommended.
Ergots
Ergotamine should not be used during pregnancy as it can increase the risk of miscarriage and perinatal death.
Drugs to prevent migraine
If daily medication is considered necessary to prevent migraine during pregnancy, the lowest effective dose of propranolol is the drug of choice.9 Amitriptyline is a safe alternative.9 There are no reports of adverse outcomes from pizotifen (not available in the U.S.) used during pregnancy or lactation, although it is less often used than the drugs above. In contrast, sodium valproate, increasingly used for migraine prophylaxis, should not be taken during pregnancy in the absence of epilepsy as there is a high risk of fetal abnormalities.13 Indeed, women prescribed sodium valproate for migraine must use effective contraception. In general, other anti-epileptic agents prescribed for migraine prophylaxis cannot justifiably be recommended during pregnancy on the basis of currently available evidence.
I’m pregnant…but I got these funny blind spots with my migraine – should I see my doctor?
It is not uncommon for a woman to have her first attack of migraine aura during pregnancy. Symptoms are typically bright visual zig-zags growing in size from a small bright spot and moving across the field of vision over 20-30 minutes before disappearing. A sensation of ‘pins and needles’ moving up an arm into the mouth may accompany this. If you experience these typical symptoms and your doctor confirms that this is migraine, there is no need to be concerned and no tests are necessary. However, if the symptoms are not typical for migraine aura, it is important to exclude other disorders, such as blood clotting disorders or high blood pressure, which may occasionally produce symptoms not dissimilar from migraine.
What’s going to happen to my migraine after I have the baby?
If migraine has improved, this will usually continue until periods return. However, a bad attack of migraine can occur within a couple of days of delivery. This may be because of the sudden drop in oestrogen that occurs.14 Exhaustion, dehydration and low-blood sugar are other possible causes.
What can I take to treat my migraine if I’m breastfeeding?
The same drugs used in pregnancy can be taken while breastfeeding, with the following exceptions; aspirin is excreted in breast milk, so should be avoided during breastfeeding because of the theoretical risk of Reye’s syndrome and impaired blood clotting in susceptible infants; metoclopramide is not generally recommended during lactation since small amounts are excreted into breast milk. The triptans almotriptan, eletriptan, frovatriptan, rizatriptan and sumatriptan are licensed for use in breastfeeding provided that you do not breastfeed within 24 hours of the last dose. I would recommend similar advice for naratriptan and zolmitriptan.
Planning a pregnancy
If you are planning a pregnancy, now is the time to discuss with your doctor about any medication you are taking. If you are taking preventative treatments that are not recommended in pregnancy, consider stopping them and/or switching to a safer alternative. For drugs used to treat the symptoms of migraine, try to limit triptans to the first two weeks of the menstrual cycle, when you are unlikely to be pregnant. Now is also the time to get in shape for pregnancy, which will also help migraine – avoid skipping meals, take regular exercise, drink plenty of fluids and start taking a multivitamin supplement for use in pregnancy.
Migraine and Pregnancy Summary Points
- Migraine may worsen in the first few weeks of pregnancy but usually improves by 16 weeks of pregnancy.
- Migraine does not harm the baby.
- Paracetamol/acetaminophen is safe throughout pregnancy and lactation. Aspirin is also safe, but may cause bleeding problems if taken near term.
- Prochlorperazine has been used for pregnancy-related nausea for many years.
- Metoclopramide and domperidone are safe, but are probably best avoided during the first trimester.
- For continuing frequent attacks, which warrant daily preventative treatment, propranolol has best evidence of safety during pregnancy and lactation.
- If you have taken triptans and then find you are pregnant, do not worry. However, continued use during pregnancy is not recommended.
Rapid advances in medicine may cause information contained here to become outdated, invalid or subject to debate.
References
1. Maggioni F, Alessi C, Maggino T, Zanchin G. Headache during pregnancy. Cephalalgia1997;17(7):765-9.
2. Sances G, Granella F, Nappi R, et al. Course of migraine during pregnancy and postpartum: a prospective study.Cephalalgia 2003;23(3):197-205.
3. Chen T-C, Leviton A. Headache recurrence in pregnant women with migraine. Headache 1994;34:107-110.
4. Granella F, Sances G, Pucci E, Nappi R, Ghiotto N, Nappi G. Migraine with aura and reproductive life events: a case control study. Cephalalgia2000;20:701-7.
5. Wright G, Patel M. Focal migraine and pregnancy. BMJ 1986;293:1557-8.
6. Chancellor A, Wroe S, Cull R. Migraine occurring for the first time in pregnancy. Headache1990;30:224-7.
7. Cupini L, Matteis M, Troisi E, Calabresi P, Bernardi G, Silvestrini M. Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia 1995;15:140-4.
8. Wainscott G, Sullivan M, Volans G, Wilkinson M. The outcome of pregnancy in women suffering from migraine. Postgrad Med1978;54:98-102.
9. Rubin P, ed. Prescribing in Pregnancy. 3rd ed. London: BMJ Books, 2000.
10.Slone D, Siskind V, Heinonen O. Aspirin and congenital malformation. Lancet 1976;i:1373-5.
11.Steiner T, MacGregor E, Davies P. British Association for the Study of Headache. Guidelines for all doctors in the diagnosis and management of migraine and tension-type headache. Management Guidelines 2004 available at www.bash.org.uk
12.Loder E. Safety of sumatriptan in pregnancy: a review of the data so far. CNS Drugs 2003;17(1):1-7.
13.Lindout D, Schmidt D. In utero exposure to valproate and neural tube defects. Lancet 1986;ii:1142.
14.Stein G. Headaches in the first post partum week and their relationship to migraine. Headache1981;21:201-5.
written by E. Anne MacGregor, MD
MigraineSurvival is not responsible for the results of your decisions resulting from the use of this information.
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