Please view this excellent Migraine Art Video, which was put together by James at Headache and Migraine News and Relieve-Migraine-Headache.com. I was struck by the statistic that over a billion people alive today will have a migraine attack in their lifetime. I am also impressed—as I have always been by exhibits of migraine art—by the creativity of migraineurs.
Excellent work, James.
Traveling this year? There are a lot of hidden pitfalls for migraine sufferers who travel. If you are traveling by air you are subject to multiple migraine triggers: pressure changes, dehydration, time zone changes, and skipping meals. Be certain to carry high protein snacks with you and drink water frequently. It’s also a good idea to pack your migraine medication in your carry-on luggage just in case you need it.
Make sure you have enough medication with you for the duration of your vacation. If you think this may be a problem because your insurance limits the number of pills you can get at one time, you may be able to ask for a “vacation override” at the pharmacy so that you can be certain to have enough to last. A good rule is to take twice as much migraine medication as you would normally need, and then you will be sure to have enough, even under the worst possible circumstances.
If your headaches are severe enough that you think you may require treatment while traveling, make certain you have a summary of your care with you. This allows a doctor who is unfamiliar with you to review your history. And don’t forget your health insurance card.
Of course, changes in environment can set off your headaches also. Traveling to a new location with a different climate can be a migraine trigger, especially if there is heat and humidity. Many migraine sufferers find that high altitude can trigger their headaches.
Eating different foods and a different schedule can even be enough to cause migraines in some people. It may be wise to plan on taking it easy the first day or two in order to get used to a new environment and not push yourself too hard. It’s better to do this so that you can avoid a headache and relax on vacation.
Watch out for trigger foods—watch for things like hot dogs, sausages, and other processed meats (pepperoni, salami, and similar) which contain nitrites. And need I mention alcohol? Just remember to keep things in moderation, and don’t forget what your trigger foods are.
Children with migraine can be particularly susceptible to motion sickness and carsickness. If you have a child with migraine headaches, it might be best to make frequent stops and take breaks on road trips. In fact, up to 60% of adults who have migraine had motion sickness as children. Sometimes, it doesn’t go away because you grew up.
Foreign travel can present extra challenges. Give yourself an extra day or two to cope with jet lag. Make certain medication is in its original labeled container when you clear customs, and carry a note from your doctor indicating which medications you are on, and that they are for personal use. Check to see if your medical insurance covers you internationally—some do. If not, you may wish to purchase travel insurance. The State Department has additional information about traveling abroad.
by Christina Peterson, M.D.
updated June 29, 2011
Is there a correlation between high blood pressure and migraine? Maybe. There have been studies to suggest that uncontrolled hypertension (high blood pressure) may result in an increase in migraine headache frequency or severity. However, it has also been argued that since both high blood pressure and migraine are commonly occurring conditions, any such relationship is mere coincidence.
Certainly, there can be transient increases in blood pressure during a headache of any type, simply because you are in pain, so it stands to reason that chronic headache sufferers might experience higher overall blood pressure.
Can high blood pressure cause a headache? Usually this is not the case unless blood pressure is extremely high.
A recent retrospective epidemiological study, which means it was looking back in time at previously collected data, actually proposed that maybe hypertension even protects against headache! Other studies, however, seem to suggest that there might be a correlation between hypertension and the transition from episodic to chronic migraine. It has even been suggested that there may be a protective effect for systolic blood pressure (the top number), but a negative effect for diastolic blood pressure (the bottom number).
The MIRACLES Study, also known as Hypertension and Migraine Comorbidity: Prevalence of Cerebrovascular Events, looked at 2973 patients with hypertension, migraine, or both. About 17% of the subjects had both hypertension and migraine, 40% had migraine only, and 43% had hypertension only. In the subjects with both conditions, migraine onset was older than in the migraine-only group, and onset of hypertension was earlier than in the hypertension-only group. Hypertension was harder to control, and there was often a family history of both migraine and hypertension.
The group with migraine-hypertension comorbidity had a 4.4% risk of stroke, as compared to 3.1% in the hypertension-only group, and 0.7% in those with migraine only. In the 40-49 year-old age group, the rate of previous stroke (or TIA) in the group with both conditions was five times higher than in the hypertension-only group.
It is thus likely that there is a migraine-hypertension link in some migraine patients that may be genetically based. Clearly, more studies are required so that we can understand this connection better.
References:
1. Hagen K, Strovmer LJ, Vatten L, et al. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway. J Neurol Neurosurg Psychiatry 2002;72:463–6.
2. Friedman, D. Headache and hypertension: refuting the myth. J Neurol Neurosurg Psychiatry 2002;72:431.
3. Bigal ME, Sheftell FD, Rapoport AM, Tepper SJ, Lipton RB. Chronic Daily Headache: Identification of Factors Associated With Induction and Transformation. Headache: The Journal of Head and Face Pain. 2002;42(7):575-581.
5. Mancia G, Agabiti-Rosei E, Ambrosioni E, et al. Hypertension and migraine comorbidity: Prevalence and risk of cerebrovascular events. Evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study). J Hypertens 2011; 29:309–318.
by Christina Peterson
updated June 26, 2011
Asthma has been found to be comorbid with chronic daily headache. (This was chronic migraine without any evidence of medication overuse.) A Norwegian study of over 50,000 people found that headache (both migraine and non-migraine headache) was 1.5 times more likely to occur in asthma sufferers, as well as chronic bronchitis and hay fever. In this study, more women than men had asthma (although more men had chronic bronchitis).
A British study of similar size found that the risk of developing asthma in a migraineur was 1.3 times higher than in a non-migraine sufferer.
Asthma can also serve as a migraine trigger, although asthma does not cause migraine. (Migraine does not cause asthma, either.) The association of asthma and migraine is well established, but the cause of that association is not known.
Just as in migraine, it’s important to identify what your asthma triggers are, and avoid them when possible. Obviously, it is not possible to avoid all pollen exposure. However, you can minimize exposure to dust (and dust mites), and to cigarette smoke.
References:
by Christina Peterson, M.D.
updated June 20, 2011
A recent large study has confirmed findings of previous studies that migraine headaches are more common in people who suffer from allergic rhinitis, and that immunotherapy can decrease the frequency of headache in those patients. Data from the Migraine, Allergy and Rhinitis Study (MARS) was analyzed. Allergy patients with headache received formal headache diagnoses, and received allergy testing with either skin tests, or blood tests of IgE antibodies. Of the 536 allergy patients in the study (60% women), 32.5% had migraine.
The most common allergens found were weeds, trees, grasses, and indoor insects. Patients were divided into those with high atopy and low atopy. (People who have allergies suffer from atopy, the genetic predisposition to develop IgE antibodies to allergens.) The average was 3.39 migraine days per month, and each attack lasted an average of 1.5 days.
What the study found was that the number of people with migraine was not altered by treatment with immunotherapy, but that the frequency and disability from migraine was reduced, but only in migraine sufferers under age 45. The study showed a predicted 52% reduction in the frequency of migraine headache and a 45% reduction of the number of days with migraine-related disability in migraineurs ≤45 years of age that received immunotherapy. The study also found that in the younger group, 45 or younger, low degrees of allergic sensitization were correlated with migraines that were less frequent and less disabling, and that migraines were more frequent in those with high degrees of allergic sensitization.
Allergies are comorbid with chronic daily headache, which means that they occur more commonly in those with chronic headache. This is true of both chronic migraine, and of new daily persistent headache. (New daily persistent headache is a chronic headache that starts off right from the very beginning as a daily or near-daily headache.) It is not yet clear whether controlling allergies can reverse chronic headaches.
References:
1. Ku M, Silverman B, Prifti N, et al. Prevalence of migraine headaches in patients with allergic rhinitis. Annals of Allergy, Asthma & Immunology. 2006;97(2):226-230.
2. Mortimer MJ, Kay J, Gawkrodger DJ, Jaron A, Barker DC. The prevalence of headache and migraine in atopic children: An epidemiological study in general practice. Headache. 1993;33:427–431.
3. Martin VT, Taylor F, Gebhardt B, et al. Allergy and immunotherapy: are they related to migraine headache? Headache. 2011;51(1):8-20.
4. Eross E, Dodick D, Eross M. The Sinus, Allergy and Migraine Study (SAMS). Headache. 2007;47(2):213-224.
by Christina Peterson, M.D.
updated June 20, 2011
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