by admin | Mar 14, 2011 | Comorbidity
What Is Essential Tremor?
Essential tremor is the most common neurologic movement disorder, affecting 10 million people in the US . It is a slowly progressive neurologic disorder that causes shaking of the hands, and sometimes also the head and voice. Although it can occur at any age, essential tremor (or ET) more commonly occurs in those 40 and over. At age 40, ET affects about 4% of the population. It becomes more prevalent in older people.
Essential tremor can run in families—about half the time it is due to a genetic mutation. ET occurs in men and women equally, although head tremor is more likely to occur in women.
The tremor that occurs in ET occurs with use and is not present at rest or while you are asleep. Stress will make the tremor worse. The tremor can also be worsened by fatigue, cold, strong emotions, caffeine, low blood sugar, and some antidepressants.
Essential Tremor and Migraine
in a small study of patients with ET, 36.5% also had migraine. In a group of migraine patients, 17% had ET as compared to 1.2% of the control group. Another small study did not find an association between the two. Yet another opinion has been advanced based on a small study that the tremor present in migraine patients is, in fact, due to small strokes and not due to the progressive neurologic disorder that is essential tremor.
Case reports have also been made of a familial disorder with migraine headaches, episodic vertigo, and essential tremor in affected family members.
This is a good resource about essential tremor
references:
1. Biary N, Koller W, Langenberg P. Correlation between essential tremor and migraine headache. J Neurol Neurosurg Psychiatry. 1990;53(12):1060-1062.
2. Barbanti P, Fabbrini G, Aurilia C, et al. No association between essential tremor and migraine: A case-control study. Cephalalgia. 2010;30(6):686 -689.
3. Baloh RW, Foster CA, Yue Q, Nelson SF. Familial migraine with vertigo and essential tremor. Neurology. 1996;46(2):458-460.
4. Duval C, Norton L. Tremor in patients with migraine. Headache. 2006;46(6):1005-1010.
by Christina Peterson, MD
updated March 14, 2011
by admin | Feb 25, 2011 | Types of Headaches
Coital Headache Treatment
There are two types of sexually-associated headaches: pre-orgasmic headache, and orgasmic headache, or post-coital headaches. Other names sometimes used for sex headaches are orgasmic cephalgia, coital headache, or orgasmic migraine. (Not everyone with this type of headache has migraines.)
Orgasmic headaches have been thought to be a variant of exercise-induced headache, at least in some cases. However, any type of sexual activity that leads to orgasm, including oral sex and masturbation, has been associated with headaches.
Sex headaches occur in 3% to 4% of sexually active men, and a slightly lower number of women. A small survey (176 people) done by the National Headache Foundation found that 46% of those surveyed reported having had sex headaches, however over 1/3 had only had six such headaches. Having another type of headache (migraine, tension-type headache, and exertional headache) increases the risk of developing sex headaches. It should be noted that medications used to treat erectile dysfunction (Viagra®, Cialis®, and Levitra®) can also cause headache as a side-effect.
Pre-orgasmic headaches are a dull ache in the head and neck, associated with awareness of tight neck and jaw muscles during sexual activity, that increases during increasing sexual excitement. This bilateral headache builds slowly and can become more intense a few minutes before orgasm.
Post-coital headache is a sudden, severe, explosive headache occurring at orgasm. Understandably, this can be quite alarming the first time it occurs. Although it is probably not a sign of something serious, it is best to see your doctor to make certain. Occasionally, this type of headache does herald a potentially serious problem. About 78% of sex headaches are post-coital headaches—the abruptly occurring kind. The co-occurrence of migraine is more common with this type of sex headache. There are both episodic and chronic forms of sex headaches. About 75% are the episodic kind, and 25% are the chronic kind. Prognosis is best if you only have a few attacks.
Sex headaches—should I be worried?
What’s going on with your head, anyway? In most cases, the pain is caused by blood pressure changes or changes in blood vessel diameter. In rare situations, though, this headache is caused by blood leaking out of a blood vessel and into your brain at the time of this headache. This can be due to weakness in the blood vessel wall. This is why anytime you experience the worst headache of your life, or if you have had the first sex headache or “thunderclap headache,” you should be evaluated to rule out a serious condition.
Once you have seen a doctor to rule out a potentially serious problem, treatment may be offered. If orgasmic headache happens infrequently, it can often be prevented with prescription-strength nonsteroidal anti-inflammatories. If you are in an episode with frequent occurrences, or if you experience the chronic form of sex headache, preventive medications can reduce the severity of your symptoms. Beta blockers and calcium channel blockers have been found to be effective.
References:
by admin | Feb 11, 2011 | Comorbidity
Is there a connection between high cholesterol and migraine? While there is no 100% agreement on this correlation, there are some studies that suggest there might be some connection. Since elevated cholesterol and dyslipidemia (improper levels and relationships of several blood fats) are often part of more complex disorders, like metabolic syndrome, it can be difficult to isolate out cholesterol levels as an association with migraine.
In one study, the highest association found between elevated cholesterol and migraine was in women with a history of migraine, but not with active headaches. This is possibly due to advancing age. In another study of migraine sufferers who were age 50 and older, an association was found between LDL-C (“bad cholesterol”) and triglycerides. Triglycerides continued to rise with advancing age in men with migraine.
1. Monastero R, Pipia C, Cefalù AB, et al. Association between plasma lipid levels and migraine in subjects aged ≥50 years: preliminary data from the Zabùt Aging Project. Neurol Sci. 2008;29(S1):179-181
2. Kurth, T, et al. American Academy of Neurology 59th Annual Meeting: Session S05.001. Presesnted May 1, 2007.
by admin | Dec 3, 2010 | Types of Headaches
Ice Pick headaches
Ice pick headaches are sharp, stabbing pains occurring as a single stab or as a series of stabs, occurring mostly in the eye and orbit, temple, or parietal regions. Stabs last a few seconds, and may recur throughout the day, usually at irregular intervals. This headache type is not well understood, even though it occurs more commonly in migraine sufferers. Although this is often referred to as ice pick headache, the official term according to the International Headache Society is Primary Stabbing Headache. It has also been referred to as “jabs and jolts.”
Treatment of icepick headaches is difficult, because the pain comes and goes too quickly to take anything. These stabbing head pains tend to be a little more common if you also have migraines or cluster headaches, but ice pick headaches can occur independently. Some studies indicate a female predominance for icepick headaches.
Although this headache type is sometimes listed as one of the less frequently occurring headaches, some version of the phrase “ice pick headache” remains in the top search terms for this website month after month. So, either it occurs more frequently than previously appreciated, or the symptoms are so terribly bothersome that it drives sufferers to seek information. Perhaps both. Some estimates have indicated that as many as 40% of migraine sufferers may also have had ice pick headaches at some time in their lives, but there is no good epidemiologic data available to confirm this.
What are Ice Pick Headaches?
Ice pick headaches (called primary stabbing headache now in the International Headache Diagnostic Criteria) are defined as either a single stab or a series of stabs felt in the orbital region (around or behind your eye), temporal area, or parietal area of the head. (The parietal area is behind the temporal area.) Stabs occur with irregular frequency. On days that they occur, they may occur only once, or may occur many times per day, but with no regularity. Duration of stabs is short, usually a few seconds.
So, what does an ice pick headache feel like? Well, pretty much like it sounds—like an ice pick suddenly jabbing into your head without warning. The pain is often sharp and severe, and most people who have had these headaches are glad they don’t last very long.
Stabbing headache or ice pick headaches can occur as an isolated headache type, but occur more commonly in migraine or cluster headache sufferers. The pain experienced can be very intense, and tends to hit without warning. If you experience tears, redness of the eye, and nasal stuffiness in conjunction with stabbing pains in the temporal region or the orbital region, it is likely that you have a rare headache type known as SUNCT (Short-lasting Unilateral Neuralgiform headache attacks with Conjuctival injection and Tearing), which is one of the Trigeminal Autonomic Cephalgias. Another condition that needs to be ruled out is trigeminal neuralgia, which causes facial pain and can sometimes feel like a jolt in the face.
Headache textbooks tend to be somewhat dismissive of stabbing headache, indicating that reassurance should be offered, since this headache type does not indicate underlying pathology such as a tumor or aneurysm. This, however, is not terribly helpful to the sufferer who is experiencing the sensation of needles, ice picks, spikes, or tiny knives being jabbed into their head on a recurring but unpredictable basis.
Some sufferers of stabbing headaches indicate that they started to experience them in childhood. Most attacks of ice pick headache occur randomly and without warning, although some sufferers have identified emotional or other stressors as triggers. Other than stress, triggers of ice pick headache have not been clearly identified.
Treatment for Icepick Headaches
Treatment is problematic, since the attacks are so short. In some cases, indomethacin taken preventatively will be helpful, but this is by no means universally so. Some migraine sufferers who also experience ice pick headaches report that the stabbing headaches improve with better control of their migraines. A small case series (three patients) reported benefit for ice pick headache from melatonin. As with many headache types, more information is needed before we more fully understand the underlying causes and can offer a meaningful solution.
References
1. Rozen, TD. Melatonin as treatment for idiopathic stabbing headache. Neurology. 2003; 61:865-866.
2. Raskin, NH, Schwartz, RK. Icepick-like pain. Neurology. 1980 Feb;30(2):203-5.
by admin | Aug 11, 2010 | Miscellaneous
What Are Symptoms of a Migraine Headache?
The pain of a migraine can be unilateral or bilateral, and is most often pulsating, pounding, or throbbing in quality. Fifty per cent of migraine sufferers report the onset of migraine pain in the occipital region (back of the head), or even neck pain. Up to 80% of migraineurs may experience posterior pain (back of the head, or even neck pain) before or during an attack. Regardless of where pain begins, it often settles into a one-sided headache. Often, migraine pain is made worse by routine physical activity, such as climbing stairs. The vast majority of migraine attacks have moderate to severe pain intensity.
How long do migraines last?
The vast majority of migraines last between 4 hours and 72 hours. Rarely, a migraine attack will last longer than three days. This can be an indicator of a more serious problem, and should lead you to seek medical attention. If not treated early, up to 80% of migraine sufferers can develop a highly sensitized pain called allodynia, in which a usually normal level of touch is perceived as painful. While this usually affects the face and head, it can on occasion spread to the upper torso and extremities as well, and migraine sufferers will find it uncomfortable to put up with usual things, like jewelry, eyeglasses, neckties, clothing, hats and similar things.
What are other symptoms of a migraine attack?
There is usually associated avoidance of light (photophobia), sound, or even smell. There is often nausea or loss of appetite. Many migraine sufferers have difficulty thinking or concentrating during an attack. Some experience dizziness, lightheadedness or vertigo. Recent information regarding migraine sufferers indicate that neck pain is present in many migraine attacks, and may be even more common than nausea.
The Warning Phase: Migraine aura and prodrome
About 20% of migraine sufferers report a prodrome, or warning phase, preceding their headaches, consisting of vague symptoms like mood changes, yawning, food cravings, thirst, or excessive urination. This can be brief, lasting a few minutes, or can be prolonged, lasting hours, a day, or longer.
Fifteen to twenty per cent of migraine sufferers sometimes or always have an aura preceding their headaches. Auras are neurologic symptoms, most often affecting vision with spots, colors, sparkles, or vision loss. An aura can also cause stroke-like symptoms like tingling, numbness, or weakness in the face, an arm, or sometimes an entire side. Most migraine auras last 15-30 minutes; some will last up to an hour. If an aura lasts longer than an hour, and this is not your characteristic aura pattern, it would be prudent to seek medical evaluation. It is also possible to experience the aura phase of the migraine without any headache pain. When this happens, it is still considered a migraine, and is sometimes called acephalgic migraine, which just means migraine without pain.
Other Phases of Migraine
The prodrome phase and the aura phase of migraine are the first two of four possible phases of migraine. In some migraines, the prodrome phase may be brief or subtle, and not everyone realizes they are experiencing a prodrome. Symptoms you’ve always just thought were “part of the migraine” may be prodromal symptoms. The headache phase of the migraine is the obvious phase in which the headache pain and associated symptoms develop. This typically lasts from 4 to 72 hours. Finally, there is the postdrome phase. In the postdrome, you may feel drained, empty, or tired. Some people refer to this as a “migraine hangover.”
Migraine Treatment
You should treat your migraine headache as soon as you begin to feel headache pain. While early treatment of acute migraine attacks is important, trying to treat in the prodrome phase is too early, and there is not yet sufficient study data to recommend treating during the aura phase, although it may help in some people. Treatment of migraine can be abortive, which means taking medication intended to stop the migraine attack, or preventive, in which medication intended to prevent migraine attacks is taken on a daily basis. If abortive treatment has not worked, or not worked well enough, rescue medication can also be used later in the attack.
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