Related Conditions

by | Jul 11, 2021 | Comorbidity

Comorbid Conditions and Migraine

Related conditions are also known as comorbid conditions.  Sounds scary!  But what does it really mean?

The term comorbidity can be used in two ways.  The older and most proper definition is this:  a medical condition existing simultaneously with but independently from another condition, and in a higher rate than expected by coincidence.  Comorbidity can also be used to mean a situation in which one condition is caused by or closely related to another condition.  This is a newer and non-standard definition, and is sometimes used to describe situations in which we are learning more about a disease state such as migraine.

There are a number of conditions which are comorbid with migraine.  Some of them associate as true comorbidities in the first and more classic sense.  Others we are finding group together as “comorbidity clusters”, and this new information is leading us to further avenues of research.  Some comorbid conditions may exist because of shared genetic factors that increase the risk of both the comorbid condition and migraine.

Are Dietary Supplements Safe?

by | Jul 11, 2021 | Complementary & Alternative Medicine, Medication

Supplement Safety

How much do you know about supplement safety?  If you don’t know a lot, you are not alone.  A 2002 study of primary care physicians found that 42% were not aware of any drug-herb interactions that had appeared in the medical literature, nor had they treated a patient that had one.  A more recent study (2007) of internal medicine residents revealed that one-third did not know that supplements do not need to be approved by the FDA, or that safety and efficacy data are not required before supplements are put on the market.

This ignorance is not limited to physicians in training.  A survey of consumers has shown that 68% of consumers believed that supplements were regulated by the government, 59% believed dietary supplements were FDA-approved like medications, and 55% believed that manufacturers could not make claims of product efficacy without scientific evidence.

Regulation of Supplements

Here are the facts:  dietary supplements are currently regulated according to the Dietary Supplement Health and Education Act of 1994.  This permits the initial marketing of an herbal or other dietary supplement product without proof of safety, efficacy, bioavailability, or standardization.  The manufacturer is held responsible for ensuring a product’s safety.  The FDA is responsible for taking action against any product that is found to be unsafe after it is on the market, and for monitoring information on labeling and package inserts.  The Federal Trade Commission is responsible for any false advertising claims.  You can find more detailed information about supplements and how they are regulated from the government.

Use of Herbal Supplements is Common

Studies of surgical patients have shown that nearly one third take at least one herbal product on a regular basis.  The problem is that many patients don’t discuss this to the surgeon or to the anesthesiologist prior to surgery.  Without the bottle in hand, one in five patients were unable to identify what they were taking when asked.  A study of pregnant women in Australia revealed that 36% took an herbal product while pregnant.  A 2007 survey showed that 38% of American adults and 12% of children used dietary supplements.

What is the Best Way to Be Safe with Dietary Supplements?

You can be a responsible consumer of dietary and herbal supplements by reading labels carefully.

Look for certifications such as “USP Dietary Supplement Verified”, or certification by ConsumerLab, NSF International, or Good Housekeeping.  The certifications vary, but it’s a start, and they at least indicate evidence of laboratory testing.  USP stands for U.S. Pharmacopeia, and the standard include testing for uniformity, cleanliness, and freedom from environmental contaminants such as lead, mercury, or drugs.  It is safer to buy single-herb products that clearly show how much of the herb each dose contains than to buy a mixture of several herbals with unknown amounts of each herb.  And be very wary of buying any herbs that have not been manufactured in the U.S., EU, or Canada, as supplements from other countries have been found to contain contaminants.

Resource for learning more:

http://www.nlm.nih.gov/medlineplus/druginformation.html

http://www.naturalstandard.com/

References:

1. Ashar BH, Rice TN, Sisson SD. Physicians’ understanding of the regulation of dietary supplements. Arch. Intern. Med. 2007;167(9):966-969.
2. Ashar BH, Rice TN, Sisson SD. Medical residents’ knowledge of dietary supplements. South. Med. J. 2008;101(10):996-1000.
3. Kennedy J. Herb and supplement use in the US adult population. Clin Ther. 2005;27(11):1847-1858.
4. Timbo B, Ross M, Mccarthy P, Lin C. Dietary Supplements in a National Survey: Prevalence of Use and Reports of Adverse Events. Journal of the American Dietetic Association. 2006;106(12):1966-1974.
5. Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 10, 2008.

by Christina Peterson, M.D.

updated July 10 , 2021

Migraine prevention medications

by | Jul 11, 2021 | Medication

Preventive Medications for Headache

Not everyone with migraine headaches will require a preventive medication.  If you experience only a few headache days a month, and you are not disabled by your headaches, you may be able to treat your migraine headaches successfully with a migraine-specific medication alone.

Research has shown, however, that although about 40% of migraine sufferers are candidates for preventive medication, only one-fifth of those who would benefit from migraine prevention are receiving such medication therapy.

There are many, many medications used for the prevention of migraine, but only a few have been approved by regulatory agencies like the U.S. Food and Drug Administration, Health Canada, or the European Agency for the Evaluation of Medicines (EMEA)  Some of the newer medications approved for migraine prevention are expensive, and may not be approved by health insurance plans or national formularies until you have tried some of the older medications.

Medications that have not yet been approved for a specific condition by a regulatory agency, but are prescribed for you by your doctor anyway are used in what is called “off-label” use.  It does not mean that it is unsafe to do so; it just means that the drug has not been tested for that condition.  This is why you might go to pick up your prescription, and be told by the pharmacist that you have been given a blood pressure medication, or an antidepressant, or a seizure medication.  Your doctor knows you don’t have these conditions, but we have found that some of these medications are useful for the prevention of migraine.  Many of them have been tested in a formal fashion for migraine, but simply have not been subjected to the very expensive and rigorous testing necessary to obtain approval of the appropriate regulatory agency for a secondary condition (migraine), since it is already known that they are safe and effective for their primary use.

Should you be taking preventive medications?  This depends on how many disabling migraine days a month you experience, and can also depend on how well acute medications work to abort your attacks.  This is a decision to make with your physician.

Tension type headache

by | Jul 10, 2021 | Types of Headaches

What Does a Tension-Type Headache Feel Like?

Tension-type headaches, the official name for tension or stress headaches, are a non-throbbing, pressure pain in part or all of the head, and may be associated with neck pain or tightness  A tension headache is often described as a “tight band” around the head, or feeling like the head is “in a vise”.  A stress headache or tension-type headache is usually not associated with nausea, or with avoidance of light or sound.  It is not made worse by routine physical activity, and is of mild or moderate pain intensity.

Tension-type headache is the most commonly occurring headache type of headache worldwide.  Tension-type headaches used to be called muscle contraction headaches, but not everyone who gets these headaches has tight muscles or has sore muscles in the scalp when they are touched or pressed.

Tension-type headache is usually what is called episodic, meaning that is comes and goes.  In most cases, it occurs occasionally, although it can be more frequent.  Rarely, tension-type headache occurs as a chronic headache, affecting you more days than not.  Tension-type headache is the most commonly-occurring headache worldwide, affecting up to 70% of some populations.

Are Tension Headaches Due to Stress?

While stress can increase the frequency of this headache type, just like it can increase the frequency of migraines, it is not felt to the cause of this type of headache.  Stress management can help with management of tension-type headaches; it also helps with the management of migraine.

The majority of people with tension-type headaches have episodic headaches, which means that you have less than 15 days of headache a month.  This can often be managed with over-the-counter medication or non-medication strategies such as massage.  (The International Headache Society makes a distinction between “infrequent” tension-type headaches at less than ten headaches a month, and “frequent” tension-type headaches, between 10 and 15 days a month.)  Chronic tension-type headaches, defined as more than 15 headache days a month, is more likely to require medical attention.

Natural Remedies for Tension Headaches

The natural remedies used most frequently for tension-type headaches are massage therapy, acupuncture, chiropractic treatment, aromatherapy, and biofeedback.

Caffeine

by | Jul 10, 2021 | Triggers

Is Caffeine Your Trigger?

Caffeine, which has been called the most commonly used drug in the world, deserve special consideration.  It is estimated that 90% of Americans consume some form of caffeine daily, and more than half in excess of 300 mg a day.  Caffeine, in moderation, is not a problem.  What determines moderation, however, is a matter of both opinion and individual variability.  Many people consider 200-300 mg/day to be moderate use, however, this may be more than can be tolerated without difficulty if you are a migraine sufferer, and if this proves to be a migraine trigger for you.  Also, bear in mind that the DSM-IV defines caffeine intoxication syndrome as symptoms arising from ingestion of more than 250 mg of caffeine.

The US Food and Drug Administration limits caffeine content to 6mg/fluid ounce in soft drinks and energy drinks.  There is not a similar limit in beverages that are brewed at or after point of sale.  The average cup of coffee contains at least 100 mg of caffeine.  (How big is your cup?)

Another important consideration is caffeine-containing medications.  Many headache sufferers take caffeine-containing over-the-counter medications, and are not aware of the amount of caffeine in these preparations, or that they may be getting more caffeine in their pills than in their coffee.

Commonly taken caffeine-containing over-the-counter medications

Excedrin® Migraine 65 mg
Excedrin® Tension Headache 65 mg
Extra-Strength Excedrin® 65 mg
Anacin® 32 mg
NoDoz® 100 mg & 200 mg
Goody’s® powder for headaches 32.5 mg
Goody’s® powder for pain relief 16.25 mg
Vivarin® 200 mg
Dexatrim® 200 mg
Midol® 32.4 mg
Vanquish® 33 mg

Caffeine-containing prescription pain medications

Darvon® compound 32.4 mg
Esgic® 40 mg
Wigraine® 100 mg
Cafergot® 100 mg
Fioricet® 40 mg
butalbital, aspirin, caffeine 40 mg
Norgesic® 30 mg
Norgesic® Forte 60 mg

Caffeine is in a lot of products, including beverages