by admin | Aug 19, 2021 | Children & Headaches
If you have a child with migraine headaches, you know how alarming it can be to have a child with aura symptoms. These symptoms can be helpful, though, as they do indicate when to treat the migraine attack. Early treatment can get a headache under control more easily.
But what about the child who has migraine without aura? Do you know what warning signs to look for to tell that an attack is on its way?
Warning signs of impending migraine
Many migraine sufferers experience vague warning symptoms before the headache pain of a migraine begins. In fact, in adults, this type of warning occurs in more cases than auras do. A French study (Cuvellier, Mars, & Vallée; Cephalalgia, 2009) of children with migraine found that two-thirds of the children who had migraine with or without aura had at least one early warning sign, and over half had two signs. These early warning signs are called a prodrome.
The three most common warning signs were irritablilty, fatigue, and face changes. Face changes meant shadows under the eyes or pallor (paleness). The next three most common early warning signs were sensitivity to sound, anxiety or feeling stressed, and yawning. Sensitivity to light, nausea, and food cravings were also reported. Because this was a study asking about symptoms previously occurring, the length of time the warning signs lasted was not measured.
If you have a child with migraines, paying attention to these early symptoms that occur before the head pain does can pay off. Treating early can bring migraine relief and keep your child happy and active.
by admin | Aug 5, 2021 | Migraine Survival
The Oregon Headache Clinic
15259 SE 82nd Drive, #201B
Clackamas, OR 97015
503-656-9844 | fax 503-656-3120
noheadaches@migrainesurvival.com
The Oregon Headache Clinic, located at 15259 SE 82nd Dr, #201B, Clackamas, OR 97015, and founded by Christina Peterson M.D., was established to help patients identify and treat headache disorders, including migraine and chronic head pain.
The Oregon Headache Clinic will be closing at the end of September, 2021.
If you have been a patient of the Oregon Headache Clinic, please contact us to discuss a referral and transfer of care and records. Dr. K.W. David Ho has agreed to accept our patients in transfer. Dr. Ho is a neurologist with additional training in pain medicine. He can be reached at 503-987-3707 or at www.nerveandpain.com.
It has been a privilege and an honor to be a partner in your headache care.
![About Our Experts]()
by admin | Aug 1, 2021 | Migraine Survival
Migraine Survival
Migraine Survival was started by Dr. Christina Peterson to bring about more awareness of migraine and other headache types, including awareness about all the associated health conditions that exist for headache sufferers. The purpose of this site is for both headache patients and the health professionals who care for them to learn more about headaches in order to achieve better control of their headaches, so that they can live their lives with less pain and with better quality of life. All content is written by experts, and is verified by one of our Board of Experts before publication. Revised content will be periodically updated. Need to contact Migraine Survival? Write to us at noheadaches@migrainesurival.com
Our Board of Experts
Medical Director of the Oregon Headache Clinic, and owner of Migraine Survival, focusing on a wellness-based approach to headache.
read more about Dr. Peterson…
read more about Dr. Spies…
Director of the São Paulo Headache Center, and Professor of Neurology at ABC Medical School. He also serves on the Board of Trustees of the International Headache Society.
Director of Clinical Research, Harley Street consultant, Honorary Senior Clinical Lecturer at the Research Centre for Neuroscience within the Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, University of London. She is also an Instructing Doctor and examiner for the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists. Dr. MacGregor was previously Research Director at The City of London Migraine Clinic. She has served as Treasurer of the International Headache Society (IHS) and was General Secretary 1999 to 2005, and has served as a Trustee of the Migraine Trust and member of the Medical Advisory Board of Migraine Action Association, both lay organizations. Dr MacGregor has served as an ad hoc reviewer for the British Medical Journal, The Lancet, The Lancet Neurology, Neurology, Drugs and Therapeutics Bulletin, Headache, Cephalalgia, Climacteric and Maturitas. Dr. MacGregor has over 150 publications and 5 single-author books to her credit. She lectures extensively.
Dr. Ingo Anderle is an Optometrist with over 20 years private practice experience. He practiced in Germany and New Zealand, before relocating 10 years ago to work in Spain and Gibraltar. He speaks Spanish, English and German fluently and has run his own practice in La Linea, Spain.
Dr. Anderle is passionate about exceeding patient expectations. He has broad experience in working with children, people with disabilities, low vision patients, headache and migraine sufferers, and those with cataracts.
by admin | Jul 31, 2021 | Triggers
Is chocolate a major migraine trigger?
Chocolate gets a lot of bad press as a headache trigger. Is it really as bad as it’s made out to be? Actually, it’s not.
A 1995 study found that 22% of chronic headache sufferers reported chocolate to be a headache trigger. In an interview, one of the researchers, Dr. Lisa Scharff, indicated that many of the women who responded positively on a trigger questionnaire to chocolate did so because they had heard about other people getting headaches from chocolate, or discovered that their personal experience with chocolate as a headache trigger occurred premenstrually, casting some doubt on whether the chocolate was the actual trigger.
Dr. Scharff, Dr. Dawn Marcus, and others studied sixty women with chronic headache in 1997. The women were asked to follow a restricted diet, and were then tested with four candy bars, two of which were chocolate, and two of which were carob. All four bars were flavored with mint to prevent identification. Even the women who believed their headaches were triggered by chocolate did not develop headaches, regardless of whether they had eaten the carob or the chocolate.
Wöber and colleagues at the Medical University of Vienna recently reported similar findings—that headache sufferers theoretical understanding of headache triggers differed from their actual experience.
Chocolate has been blamed as a migraine trigger in the past because it was thought to contain tyramine, but more recent chemical analyses have found it to contain minimal levels of tyramine. It does, however, contain things that are good for you: flavonoids and stearic acid. The stearic acid is part of the fat in chocolate, and most of the studies done to date suggest that it is “cholesterol-neutral.” In other words, it doesn’t affect your cholesterol in a negative way. And the flavonoids act as anti-oxidants, and may have anti-platelet (anti-clotting) effects.
Studies of cocoa and dark chocolate found evidence that chemicals in cocoa reduced inflammation, and that chemicals in chocolate lowered blood pressure, increased HDL (good cholesterol), lowered LDL (bad cholesterol), prevented platelets from clumping together (like aspirin does, only not as strongly as aspiring does), improved endothelial function (the inside of blood vessels), and improved insulin sensitivity.
Dark chocolate has five times the amount for flavonoids of blueberries. Finally, chocolate is high in magnesium. And there is some evidence that chocolate results in a release of serotonin and endorphins.
I’d say chocolate is your friend. Unless, of course, it really is one of your migraine triggers. It is for some people.
References:
- Marcus, DA, Scharff, L, Turk, L, Gourley, M. A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997 Dec; 17(8):855-62, discussion 800.
- Lippi, G, Mattiuzzi, C, Cervellin, G. Chocolate and migraine: the history of an ambiguous association. Acta Biomed. 2014 Dec 17; 85(3):216-21.
- Moffet, AM, Swash, M, Scott, DF. Effects of chocolate in migraine: A double-blind study. Journal of Neurology, Neurosurgery, and Psychiatry. 1974, 37, 445-448.
by admin | Jul 11, 2021 | Medication
CGRP (Calcitonin Gene-Related Peptide) and Migraine
CGRP (calcitonin gene-related peptide) has been found to play a role in causing migraine. CGRP is released from cells in the trigeminal ganglia, and migraineurs have an increased level of CGRP in blood serum. In the brain, CGRP levels are increased in inflammatory conditions. There is some evidence that at least some migraine sufferers may have inflammatory markers (such as TNF-α) present in their nervous systems during migraine attacks. CGRP is thought to increase the sensitivity of migraine pain receptors (trigeminal nociceptors). There is also some evidence that CGRP is implicated in paroxysmal hemicranias. CGRP may even play a role in hypertension.
Drug development for CGRP blockers has been a long road. Telcagepant was found to be effective in Phase III trials, but was abandoned after the discovery of concerns about liver toxicity. Olcegepant, which had undergone Phase II trials, is intravenous, and was not developed further due to adverse effects as well as an intravenous therapy for an acute medication not being the most practical option for many. Other CGRP antagonist drugs in the gepant class have emerged and more are in development (rimegepant, ubrogepant, atogepant, and vazegepant). Some gepants are used as acute medications, while others have utility for prevention of migraine.
Another form of CGRP blockade is in the form of monoclonal antibody drugs that either block the CGRP receptor or the CGRP ligand. There are currently four injectable monoclonal antibody CGRP blockers for migraine prevention: erenumab, galcanezumab, fremenezumab, and eptinezumab.
References:
1. Durham PL. Calcitonin Gene-Related Peptide (CGRP) and Migraine. Headache. 2006;46(Suppl 1):S3–S8.
2. Hoffmann J, Goadsby PJ. New Agents for Acute Treatment of Migraine: CGRP Receptor Antagonists, iNOS Inhibitors. Curr Treat Options Neurol. 2012;14(1):50–59. doi:10.1007/s11940-011-0155-4.
3. Durham PL, Vause CV. CGRP Receptor Antagonists in the Treatment of Migraine. CNS Drugs. 2010;24(7):539–548. doi:10.2165/11534920-000000000-00000.
4. Goadsby PJ, Edvinsson L. Neuropeptide changes in a case of chronic paroxysmal hemicrania-evidence for trigemino-parasympathetic activation. Cephalalgia. 1996;16:448-450.
5. Tepper, S. J. and Stillman, M. J. (2008), Clinical and Preclinical Rationale for CGRP-Receptor Antagonists in the Treatment of Migraine. Headache: The Journal of Head and Face Pain, 48: 1259–1268. doi: 10.1111/j.1526-4610.2008.01214.
6. Rafaelli, B. Neeb, L. Reuter, U. Monoclonal Antibodies for the Prevention of Migraine. Expert Opin. Biol. Ther. 2019 Dec; 19(12):1307-1317.
by admin | 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.
While most of the associated comorbid conditions listed here relate to migraine, there are also some comorbidities that are emerging that pertain to chronic daily headache.
by admin | 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
by admin | 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.
by admin | 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.
by admin | 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
Recent Comments