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.
by admin | Jun 25, 2010 | Miscellaneous
Pirates wore eyepatches not because they had all lost an eye. They did so as a defensive mechanism. When you are in a bright environment and go suddenly into the dark, it takes a while to be able to see. Pirates would patch one eye so that when they were relaxing in the ship’s hold by candlelight or lamplight and suddenly were called up to the decks to fight off intruders, they would be able to see well enough to fight their intended targets. By keeping one eye “in the dark” with a patch, they were always at the ready. (This historical myth has been deemed “plausible” by Mythbusters.)
So what does this have to do with migraine? Migraine sufferers experience photophobia, or the avoidance of light. Specifically, however, most migraine sufferers avoid bright light when they have a migraine headache because exposure to light makes the headache worse.
Why might this be? Dr. Rami Burstein has presented his recent research into this today at the American Headache Society 52nd Annual Scientific Meeting. To really track down this phenomenon, Dr. Burstein studied blind migraine sufferers. The first group studied were migraine sufferers who were totally blind, with no perception of light. Some of these people will still develop migraine aura, and “see” visual images, because these come from the brain. It is, in fact, the only time they are able to see anything. When observed during a migraine aura, their pupils were noted to constrict in response. The second group studied was a group of migraine sufferers who were unable to see visual images but who could still see light. This group included both migraine with aura and migraine without aura, and who had blindness due to a variety of conditions affecting the retina or other parts of the eye. In this group, the effects of light were either unpleasant, or had no effect—unless they were in the midst of a migraine. There was intensification of migraine pain in all with exposure to light. But what was most interesting—and most “pirate-like”—was that there was a long-lasting effect of light exposure. Exposure to light worsened migraine headache pain within 1 to 5 minutes. Retreating to a dark environment to obtain relief took from 5 minutes to an hour. This occurs in sighted persons as well; it was studied in the blind to exclude interference of other visual input.
Dr. Burstein reported a newly identified visual processing pathway from the retina to the thalamus that accounts for this phenomenon. Blogging live from Los Angeles at the American Headache Society meeting.
by admin | May 13, 2010 | Medication
Common side-effects of opiate analgesics
Opioid analgesics, which are also commonly called narcotics or opiates, are derived from the medicinal poppy and have been with us for centuries as a means of relieving pain. Only recently have we begun to unravel some of the deeper secrets of exactly how these medications may affect us at a cellular level.
The more common side effects of these painkillers are probably pretty well-known to most who have taken these medications: constipation, sedation, itchiness, urinary retention, nausea, and respiratory depression. What you may not know about is some of the less commonly discussed side effects of these commonly used pain medications.
One of the problems associated with opioid medications is suppression of the immune system. A variety of studies have found that chronic use of these medications is strongly associated with increased risk of infection or worsening or existing infection. This has been found to be true for both bacterial infections and for HIV/AIDS.
Another problem that can occur is called opioid-induced hyperalgesia. When this happens, pain increases despite increasing doses of opiate painkillers. This occurs because of chronic narcotic medication use, and occurs independently of allodynia. (Allodynia means you feel pain from touch or other stimulus which would not be painful normally.)
Less usual side-effects of painkillers
Chronic use of opioids can also result in hormonal imbalance, known in technical terms as hypogonadal hypogonadism. In men, this results in fatigue, depression, anemia, decreased libido, erectile dysfunction, and bone loss (osteopenia). This affects most men who are on a chronic opioid regimen or on methadone maintenance. This hormonal imbalance can also affect women, and results in fatigue, depression, anemia, decreased libido, menstrual and ovulatory difficulties, and bone loss.
In a few alarming studies, there is some evidence to suggest that there may be some effect of opioids to accelerate growth of some tumor types. Further follow-up studies are underway to confirm this possibility.
A new class of medications has been developed to combat some of the side-effects of opioids. These peripherally-acting mu-opioid receptor antagonists (PAMORAs for short) work outside the brain to block many of the more common side effects of opioids—and a few of the less common ones. The PAMORAs were developed to combat opioid-related constipation. Recent research suggests that they might have some ability to suppress viral activity in HIV and Hepatitis C, and to prevent the development of certain bacterial infections in ICU patients, although this very preliminary. Further studies are needed.
PAMORAs may also have the ability to block the tendency of opioids to promote the spread of tumor cells. Again, further research into this is in process. Will PAMORAs have a role beyond treating opioid-induced constipation? It’s far too early to tell. For now, though, you are more informed about opioids.
references
1. Portenoy RK, Forbes K, Lussier D, Hanks, G. Difficult pain problems: an integrated approach. In Oxford Textbook of Palliative Medicine 3rd edn. (ed. Doyle D, Hanks G, Cherny N, Calman K). 2004. p. 439. Oxford: Oxford University Press.
2. Wang J, Barke RA, Ma J, Charboneau R, Roy S. Opiate abuse, innate immunity, and bacterial infectious diseases Arch. Immunol. Ther. Exp. (Warsz.). 2008 Oct ;56(5):299-309.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18836861
3. Sacerdote P. Opioid-induced immunosuppression. Curr Opin Support Palliat Care. 2008 Mar ;2(1):14-18.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18685388
4. Wei G, Moss J, Yuan CS. Opioid-induced immunosuppression: is it centrally mediated or peripherally mediated? . Biochem. Pharmacol. 2003 Jun 1;65(11):1761-1766.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12781327
5. Peterson PK, Molitor TW, Chao CC. The opioid-cytokine connection. J. Neuroimmunol. 1998 Mar 15;83(1-2):63-69.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9610674
6. Weber RJ, Pert A. The periaqueductal gray matter mediates opiate-induced immunosuppression. Science. 1989 Jul 14;245(4914):188-190.[cited 2009 May 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/2749256
7. Moss J, Rosow CE. Development of peripheral opioid antagonists’ new insights into opioid effects. Mayo Clin. Proc. 2008 Oct ;83(10):1116-1130.[cited 2009 May 12] Available from: http://www.mayoclinicproceedings.com/content/83/10/1116.long
by admin | Feb 9, 2010 | Types of Headaches
Chronic Daily Headache
About 3% of the adult population suffers from chronic daily headache; it may be slightly more prevalent in the adolescent population. This condition is not well-understood, although research into this type of headache is ongoing.
Sometimes chronic headache starts up as daily headaches from day 1, and is called new daily persistent headache. In other cases, other headache types such as migraine or tension type headache occur more and more frequently, becoming chronic until they finally become daily or near-daily. Sometimes, chronic daily headache occurs because of medication overuse.
Recent studies have shown that risk factors for the development of chronic daily headache include sleep apnea and other sleep disorders, snoring, and obesity in addition to medication use.
by Christina Peterson, MD
updated Feb 9, 2010
by admin | Feb 8, 2010 | Comorbidity
Can Allergy, Hay Fever, or Asthma Increase the Risk of Migraine?
Immune disorders, such as asthma and seasonal allergies, are more prevalent in those who suffer from migraine and other headache types, including chronic headaches. Those who have allergic rhinitis may be as much as 14 times more likely to suffer from migraine headaches than those who do not. One large study found that the likelihood of either migraine or other types of headache was 1.5 times higher in those who had asthma, hay fever, or chronic bronchitis.
Looking at it a little differently, migraine sufferers have a 1.3 times higher risk of developing asthma than non-migraineurs. So, if you have headaches, and you think you have allergies, there could very well be a connection. It might be a good idea to get it checked out. If you have allergic rhinitis and you think it is causing sinus headaches, seek treatment. Make sure it really is a sinus infection, though, before asking for an antibiotic, as migraines can mimic sinus area pain.
References:
1. Becker C, Brobert GP, Almqvist PM, et al. The risk of newly diagnosed asthma in migraineurs with or without previous triptan prescriptions. Headache. 2008;48(4):606-610. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/181943004. Aamodt AH, Stovner LJ, Langhammer A, Hagen K, Zwart J. Is headache related to asthma, hay fever, and chronic bronchitis? The Head-HUNT Study. Headache. 2007;47(2):204-212. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/173003605. Davey G, Sedgwick P, Maier W, et al. Association between migraine and asthma: matched case-control study. Br J Gen Pract. 2002;52(482):723-727.
by Christina Peterson
updated May 22, 2013
by admin | Feb 7, 2010 | Comorbidity
Irritable Bowel Syndrome and Migraine
In various studies of individuals with irritable bowel syndrome, 23-53% report migraine headaches. Symptoms include abdominal pain, bloating, cramping, constipation, diarrhea, and nausea. IBS affects about 20% of the general population in Western countries, and up to 7% in Asian countries.
In addition to migraine, individuals with IBS have been found to be more likely to suffer from depression, anxiety, and fibromyalgia. Although there were fewer individuals in Asian populations wtih IBS, the per cent who had generalized anxiety disorder was the same as in Western countries. There is growing evidence that an early history of childhood abuse or emotional neglect may place you at increased risk of developing irritable bowel syndrome.
The good news is that behavioral treatments such as relaxation therapy, hypnotherapy, or cognitive behavioral therapy may be effective for helping to control the symptoms of IBS. The depression-anxiety connection with IBS is not the only reason that people with irritable bowel syndrome are sometimes given medications used for depression, though. These medications affect a neurotransmitter called serotonin. Most of the body’s serotonin (over 90%) is found in the nerves that supply the bowel; a smaller amount is in the brain regions that control them. So, whether you work with medication or with behavioral means, there really is a mind-body connection here—and a brain-gut connection, too.
References:
1. Cole JA, Rothman K, Cabral H, Zhang Y, Farraye F. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterology. 2006;6(1):26. Available at:
http://www.biomedcentral.com/1471-230X/6/262. Lee S, Wu J, Ma YL, et al. Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study. Aliment. Pharmacol. Ther. 2009;30(6):643-651. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/19552631
by Christina Peterson, MD
updated Feb 7, 2010
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