by admin | May 14, 2012 | Complementary & Alternative Medicine
What is the definition of alternative medicine?
What is complementary and alternative medicine (CAM), and how does it differ from “conventional” medicine? At the present time, conventional medicine is considered to be that delivered by MDs, DOs, and the allied health professionals they have customarily worked with in the past, such as psychologists, RNs, MSWs, registered dietitians, and physical and occupational therapists. CAM practitioners, however, work with conventional medical practitioners on an increasingly common basis. Therefore, the term “integrative medicine” is becoming favored over the term “complementary and alternative” medicine.
Complementary medicine has meant those forms of non-conventional medicine used in conjunction with conventional treatment; alternative medicine has meant those used instead of conventional medicine.
CAM includes chiropractic doctors, naturopathic doctors, acupuncture, homeopathic medicine, Ayurvedic medicine, mind-body techniques, bioelectromagnetic therapies, aromatherapy, Reiki, Qi gong, T’ai Chi, therapeutic touch, and herbal remedies. As some treatment modalities previously considered to be “CAM” have become more mainstream, and have received more scrutiny and research evidence, they have achieved “conventional” status, such as massage, biofeedback, and cognitive behavioral therapy.
Integrative Medicine and CAM for Migraine
Biofeedback, cognitive behavioral therapy, and other types of counseling or psychotherapy have been studied for headache sufferers, and can be effective. There have also been positive studies of acupuncture for migraine.
Formal studies of aromatherapy suggest benefit from lavender and peppermint oil for the treatment of headaches.
by admin | May 9, 2012 | Medication
Treating Migraine with Medication
Mild Analgesics in the Treatment of Migraine
If you have mild migraine attacks, your migraine headaches may respond to over-the-counter medications. However, these should be taken in moderation as excess doses can increase headache frequency and severity. International Headache Society recommendations are to limit the use of over-the-counter medications to no more than 15 days a month, which averages out to three days a week.
The frequent use of over-the-counter medications can also result in other problems if used year over year. Acetaminophen (paracetamol) can cause liver damage if overused. Non-steroidal anti-inflammatories such as ibuprofen can result in stomach irritation, and can contribute to risk of heart disease. Long term excessive use of either type of over-the-counter medication can result in kidney damage.
Migraine Prescription Medications
Most migraine sufferers have attacks that are moderate or severe. These usually do not fully respond to over-the-counter medications. Fortunately, there are a variety of migraine-specfic medications designed to abort an acute migraine attack. If you have tried one or two, there may still be others that would work. Sometimes, pills do not work fast enough, as it takes at least 30 minutes for a pill to get from your stomach to your bloodstream. If this has happened to you, be aware that there are migraine-specific medications in both injectable and nasal spray forms.
Migraine and Medication: Prevention
Until we learn more about the primary prevention of headache disorders, medications remain the mainstay of treatment. Learn how to most effectively manage your headaches with medication when trigger management and lifestyle management are not adequate to keep your headaches at bay. At present, preventative medication therapy is under-utilized in the management of migraine headache. If you have three or more days of disabling headache per month, migraine prevention may be helpful for you, and you should discuss this with your physician. Even if you have as few as two disabling headache days a month, but cannot use triptan medications to abort them because of other medical conditions, you may be a candidate for migraine prevention medication.
There are many preventive medications. Even if you have tried three or four, there are likely to be other medication options available.
by admin | Apr 11, 2012 | Migraine
The question of whether a headache is a migraine may seem obvious if you are an experienced migraine sufferer, but not everyone knows this stuff inside out. There is still confusion out there, and it’s always worth reviewing. Some people, for example, think that a migraine is defined by how bad the headache is. While a migraine is defined by moderate or severe pain, among other things, it does require other features to be a migraine headache and is not just a severe headache. And there are other types of severe headache that are not migraines.
Eight Ways to Tell if a Headache is a Migraine
- If your headache is one-sided, it is more likely to be a migraine.
- Migraine pain is generally moderate or severe.
- Most migraine pain is pounding or a throbbing sensation in head.
- Migraine pain is often made worse by routine physical activity.
- If you have nausea or vomiting with your headache, it is more likely to be a migraine.
- If bright light or noises bother you during a headache or make your pain worse, it is likely that your headache is a migraine.
- If your headache is preceded by an aura—a warning phase with flashing lights, colored shapes, lines, blind spots or any other kind of neurologic symptom like numbness, your headache is a migraine.
- If you have headache at the back of the neck, it can still be a migraine, as long as you have other migraine symptoms. Neck pain associated with migraine is actually more common than nausea in migraine attacks.
What is harder for people is how to tell headache types apart when you happen to suffer from more than one kind of headache. It’s important to know which one is a migraine so you can take the right medication. If you only get so many migraine medications a month, you don’t want to “waste” one on a headache that isn’t a migraine. Plus, taking these too often can lead to more headaches.
It’s not always easy to tell various headaches apart, as they may start out the same. Remember, too, that not every migraine attack is going to be exactly the same. But keeping a headache diary can help you begin to sort your own headaches out, and this can help you and your physician figure out what is going on.
by admin | Jan 14, 2012 | Triggers
Can Licorice Cause a Headache?
Apparently, it can, although that headache may not necessarily be a garden variety migraine.
Some licorice, especially many varieties manufactured in the US, is flavored primarily with anise seed, and carries little risk to your blood pressure. But true licorice comes from the root of the herb Glycyrrhyza gabra, and contains glycyrrhizin. Glycyrrhizin has many effects on the neuro-endocrine system, and increases blood pressure. Authentic licorice made with licorice root should be eaten in moderation to avoid elevations in blood pressure and other health issues.
There was a report made recently of a single case of licorice-associated thunderclap headache due to reversible cerebral vasoconstriction syndrome with PRES (posterior reversible encephalopathy syndrome). What does all that mean?
Reversible cerebral vasoconstriction syndrome (RCVS) is a cause of thunderclap headache–a type of suddenly occurring severe headache–that headache experts are working to understand better. It likely has multiple causes, and most likely affects susceptible individuals. We need to better understand what causes someone to be susceptible to suddenly and unpredictably having segments of their brain blood vessels constrict and then dilate.
PRES is a condition in which the posterior (back part) of the brain is affected by swelling, and the affected person suffers from headache, seizures, visual problems, and alterations in mental status. In this particular case, these two conditions were brought on by eating one pound of licorice a day over a four-month period. Thankfully, it was all reversible.
Should you avoid licorice? Probably not, but I wouldn’t advise eating a pound a day, especially if you have migraines, and definitely not if you have high blood pressure. Moderation is still a good thing.
by admin | Jan 10, 2012 | Comorbidity
TMJ Symptoms and Headache
While there has been a recognized association between bruxism (grinding) and temporomandibular disorders, this has not been well-studied with respect to headache disorders. One study found that 40% of patients presenting with TMD also had migraine. The authors of the study note that further research is necessary.
Clenching has been associated with anxiety disorders, and may be highly comorbid with migraine as well. Although formal studies of temporomandibular dysfunction in migraine are lacking, many headache experts note a correlation between TMD symptoms in their migraine patients.
Types of Temporomandibular Dysfunction
The American Academy of Orofacial Pain recognizes two types of temporomandibular dysfunction. These are called myogenous (related to muscles) and arthrogenous (related to joints). Myogenous TMD is due to bruxism, clenching, or both, and has no evidence of joint issues. Arthrogenous TMD is due to problems with the jaw joint itself, and may include degeneration of the disc in the jaw joint. Many people with TMD will have both types.
TMD occurs more frequently in women, with a 4:1 ratio reported. Not everyone with TMD is depressed. Some people with TMD have abnormalities in a gene called serotonin transporter gene, which has also been found in association with depression. Serotonin transporter gene changes have also been associated with the emotional processing of pain, and may cause an increase in migraine attacks as well as TMD pain.
Symptoms of arthrogenous TMD are popping or clicking of the jaw, inability to fully open the jaw, ear pain or a sense of fullness in the ear, ringing of the ear, dizziness, and hyperacusis (hypersensitivity to normal sound levels). Myogenous TMD causes pain in the jaw and muscles of the face.
Treatment of Tempormandibular Dysfunction
The TMJ Association recommends the following self-management measures for TMD: moist heat, cold packs, at least temporary avoidance of hard or chewy foods, or foods that make you open your jaw wide, like apples or corn on the cob, and good general dental care. In addition to maintaining a good posture in general, you should avoid sitting with your chin in your hand, and you should not sleep on your stomach. Also keep in mind the saying, “lips together, teeth apart.”
These measures are not a substitute for medical or dental evaluation. If they are minimally helpful, you may require physical therapy or dental treatment, which can include an oral device.Your physician or dentist will be able to determine whether you need referral to an oral surgeon or craniofacial specialist.
There is little evidence that either orthodontia or occlusal adjustment can prevent or treat temporomandibular dysfunction, according to the Cochrane Summaries.
References:
1. Palit S, Sheaff RJ, France CR, et al. Serotonin transporter gene (5-HTTLPR) polymorphisms are associated with emotional modulation of pain but not emotional modulation of spinal nociception. Biol Psychol. 2011;86(3):360-369.
2. Kotani K, Shimomura T, Shimomura F, Ikawa S, Nanba E. A Polymorphism in the Serotonin Transporter Gene Regulatory Region and Frequency of Migraine Attacks. Headache: The Journal of Head and Face Pain. 2002;42(9):893-895.
3. Esposito, CJ, Fanucci, PJ, Farman, AG. Associations in 425 patients having temporomandibular disorders. J Ky Med Assoc. 2000;98(5):213-215.
4. Gatchel, RJ, Stowell, AW, Buschang, P. The relationship among depression, pain, masticatory functioning in temporomandibular disorder patients. J Orofacial Pain. 2006;20(4):288-296.
5. Ojima, K, Watanabe, N, Narita, N, Narita, M. Temporomandibular disorder is associated with a serotonin transporter gene polymorphism in the Japanese population. Biopsychosoc Med. 2007;1:3. pub online 2007, Jan 10, doi: 10.1186/1751-0759-1-3.
6. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. In: The Cochrane Collaboration, McDonald F, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010. Available at: http://summaries.cochrane.org/CD006541/orthodontics-for-treating-temporomandibular-joint-tmj-disorders. Accessed January 10, 2012.
7. Koh H, Robinson P. Occlusal adjustment for treating and preventing temporomandibular joint disorders. In: The Cochrane Collaboration, Koh H, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2003. Available at: http://summaries.cochrane.org/CD003812/occlusal-adjustment-for-treating-and-preventing-temporomandibular-joint-disorders. Accessed January 10, 2012.
by Christina Peterson, M.D.
updated January 10, 2012
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