by admin | Feb 9, 2018 | Comorbidity
Mental Health and Headaches
Depression, anxiety and panic disorder, and bipolar disorder all occur more commonly in migraine sufferers than in the general population. In fact, a constellation of depression, anxiety and migraine has been found in a subset of migraineurs. Some studies suggest that bipolar disorder may be even more strongly associated with migraine than with depression.
There is emerging evidence that early childhood abuse or neglect can affect migraine sufferers as well, and there may be an association between PTSD and migraine or chronic headache. In women with chronic migraine, 42% were found to have had some form of childhood abuse, neglect, or abandonment.
Correlations have also been found between PTSD and migraine in returning Iraq and Afghanistan Veterans, even in the absence of head injury. (Naturally PTSD and blast injury only further compound the resultant headaches.)
References:
5. Ruff RL, Ruff SS, Wang X. Headaches among Operation Iraqi Freedom/Operation Enduring Freedom veterans with mild traumatic brain injury associated with exposures to explosions. J Rehabil Res Dev. 2008;45(7):941-952. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/19165684by Christina Peterson, MD
updated Feb 7, 2010
by admin | Sep 6, 2017 | Complementary & Alternative Medicine, Medication
The Risk for Drug-Herb Interactions is Not Trivial
Herbal supplements, vitamins, and dietary supplements are widely used. Depending on the study you look at, 25-85% of people who see doctors at a given time are using herbal supplements. About 15 million adult Americans are at risk for possible adverse interactions between prescription drugs and herbs or high dose vitamins, according to the Journal of the American Medical Association. A British study (2003) found that of the 62% who took herbal preparations. 1 in 20 were taking a potentially dangerous combination. How can you make sure you’re not at risk?
The 20,000 or so herbal supplements that are on the market in the US alone only come under the direct scrutiny of the FDA if there is a problem, or when a product is selected for spot-checking. While information about interactions is increasing rapidly, it is still quite limited. The best sources of information are your pharmacist or your physician, although be aware that for many of these products, the information is simply not yet known.
Twenty Herbs and Five Classes of Medications that can Interact
This is not an exhaustive analysis of herbal supplements, but an overview of some of the more common herb and drug combinations that can affect the headache sufferer.
Barbiturates
“Well, I don’t take barbiturates!” you might to yourself indignantly. Except that you do if you take Fioricet* or anything else with butalbital in it. Combining this with kava kava can cause undue sedation. It should also be noted that there have been reports of liver failure from kava kava alone, and taking it in conjunction with acetaminophen (or paracetamol) is not wise, as this enhances risk to the liver.
Calcium channel blockers
Calcium channel blockers taken in combination with dong quai can drop blood pressure significantly. So can taking hawthorn leaf. The combination of verpamail and guarana can cause hyperstimulation of the nervous system. Gingko can inhibit the metabolism of diltiazem.
SSRI anti-depressants
SSRI antidepressants such as Prozac, Paxil, and Lexapro should not be taken in conjunction with St. John’s wort as this can result in serious side effects. St. John’s wort acts on the same brain receptors as these medications.
Tricyclic antidepressants
St, John’s wort should also not be taken with tricyclic antidepressants (amitriptyline, doxepin, imipramine, desipramine, protriptyline) as it can reduce the effective level of drug in your system. With high enough doses, serious side effects can occur.
ACE-Inhibitors
Lisinopril, enalapril, ramipril, and other ACE-inhibitors are sometimes used off-label as migraine preventive medications. Combining them with cayenne, used internally, can increase the risk of cough sometimes seen as an adverse effect of the ACE-inhibitors.
Aspirin and anti-inflammatories
There is a wide range of herbs that interact with the coagulation process. Most of these cause bleeding by interfering with the platelets (clotting cells). In small doses, this effect can be desirable. It’s why a baby aspirin is recommended in older individuals for cardiovascular protection. However, if you use these herbals in combination with one another or with pharmaceuticals that have a similar effect, you may discover—the hard way—that you have gone far beyond any desirable goal.
The four most commonly used herbs that interact with blood clotting are known as the four G’s: Ginger (also called sheng jiang, shen jing, shokyo, or shoga), Garlic, Gingko biloba (also called maidenhair or kew tree), and Ginseng (sometimes called Panax; Siberian ginseng is also known as Eleutherococcus). Many headache sufferers take aspirin-containing analgesics or other nonsteroidal anti-inflammatory medications (especially indomethacin) and should know of the potential for interactions that can result in bleeding. In the case of migraine, it should be the Four G’s and an F, because feverfew falls into this category as well.
Other herbs with anti-coagulant properties are chamomile, dong quai (or tang kuei), and horse chestnut. Other anti-platelet herbs are: bilberry, bromelain, cayenne, flaxseed oil, green tea, meadowsweet, motherwort, turmeric, and willow.
Make Sure You are not at Risk for Interactions
Be safe, not sorry. If you are taking more than one medication, the possibility for interactions increases greatly. Drug-drug interactions are already an issue for many people, especially for those who have more than one prescribing provider. If you are also taking herbal supplements, it increases the potential for further drug-herb interactions. Talk to your pharmacist if you have any concerns about this; they are far more qualified to answer your questions than the clerk at the health food store.
What Should I Do If I’m Worried About Drug-Herb Interactions?
If you are concerned that you might be experiencing an adverse reaction to a vitamin, mineral, or herbal supplement, talk to your health care provider. Some of these reactions are predictable symptoms related to taking too much. Others may be due to contaminants in a product, or due to a drug-herb interaction. If your doctor or health care provider is not certain, a call to your pharmacist may be helpful. Databases listing this information are being updated frequently. It’s important to let someone know if you think your are having a reaction. Adverse reactions to supplements are supposed to be reported to MedWatch which is a reporting program of the FDA. That way, accurate information can be collected. This can be helpful to someone else in the future.
by Christina Peterson, M.D.
by admin | Jun 24, 2017 | Types of Headaches
Medication overuse headache occurs when the underlying headache disorder becomes worse because of the frequency of pain medication taken for the headache. Medication overuse headache, or MOH, occurs most frequently in migraine and posttraumatic headache. This problem has recently received attention in the news, triggered by the release of new guidelines for the treatment of headache in the UK by The National Institute for Clinical Excellence.
Learn more about medication overuse headache at these links:
Painkillers ‘are the cause’ of millions of headaches
Painkillers ’cause’ of millions of headaches (video)
Painkillers “can cause’ headaches
Diagnosing Medication Overuse Headache
Resource for Medication Overuse Headache
Another concern recently reported regarding the regular use of pain relief medications is discussed here:
Popular Pain Relievers Linked to Hearing Loss
Whether you are concerned about medication overuse headache, hearing loss, or any other consequence of frequent use of pain medications, reducing their use becomes important. The best way to do this is to prevent headaches such as by controlling migraine triggers, or by using a preventive medication.
by admin | Apr 13, 2017 | Types of Headaches
What Are Trigeminal Autonomic Cephalgias?
The various autonomic cephalgias differ in definition by the duration and frequency of the headache attacks, as well as by some of the symptoms. Most of them respond to a medication called indomethacin.
The main types of trigeminal autonomic cephalgias are cluster headache, paroxysmal headache, and SUNCT, an acronym for Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing.
Details of the TACs can be found at ichd-3.org.
by admin | Nov 15, 2016 | Comorbidity
Gluten Intolerance and Migraine
Did you know that gluten intolerance, also known as celiac disease, is more common in migraine sufferers? Celiac disease was once thought to be due to an allergy to the gluten protein found in wheat and other grains. It is now known to be an autoimmune disorder, with an inherited tendency.
Symptoms of Celiac Disease
These are the symptoms of full-blown celiac disease, but you could experience only some, or even almost none except migraine. (Almost no one has all of them.)
- Abdominal pain or bloating
- Gas
- Diarrhea
- Constipation
- Joint pains
- Fatigue
- Mood change or depression
- Weight loss or weight gain
- Muscle cramps
- Anemia
- Osteoporosis
- Tingling due to neuropathy (nerve damage)
- Missed menstrual periods
- Infertility or miscarriages
- Behavioral changes
- Delayed growth in children and failure to thrive in infants
- Itchy skin rash
- Tooth discoloration and loss of enamel
As if that list wasn’t scary enough, researchers are finding that untreated celiac disease is found more commonly in conjunction with other autoimmune disorders such as Hashimoto’s thyroiditis, type I diabetes, and Addison’s disease.
Lactose intolerance is also more common in people who have gluten intolerance or sensitivity.
Gluten Intolerance and Gluten Sensitivity
There is a difference between being gluten intolerant and being gluten sensitive. Gluten intolerant individuals have had an autoimmune process triggered early in life, and over time, the continued exposure to the gluten protein results in flattening of the normal hills and valleys in the intestine (villi) . The symptoms are due, in part, to a degree of malnutrition due to malabsorption of nutrients.
Gluten intolerance affects between 1 in 133 and 1 in 250 individuals, depending on which study one wishes to read. Gluten sensitivity affects about 5% of the population. Why might this be? There are some interesting theories about the probable origins of gluten intolerance historically.
Gluten sensitivity is less severe, and results in fewer symptoms. There is some evidence to suggest that the symptoms that have been attributed to gluten sensitivity might not be due to gluten at all, but may be due to fructan exposure, and may actually be better approached via the FODMAP diet than a gluten-free diet.
If you suspect you might have gluten intolerance, there are blood tests to look for antibodies. If present, these are pretty reliable. But it doesn’t mean nothing is wrong if the blood test is negative. Sometimes, it’s necessary to get a biopsy of the small bowel. If you are concerned about possible gluten sensitivity, see a gastroenterologist, who can help pin down the nature of your problem.
While avoiding wheat, barley, and rye is an obvious strategy, it may be more difficult to avoid gluten when it hides in unusual places like vitamins, medications, communion wafers, cosmetics, and the glue on older envelopes. Be aware that beer contains gluten as well.
If you are concerned that you might have a gluten sensitivity or intolerance, talk to your doctor about getting tested or referred to a gastroenterologist.
Concerned About Gluten in Medications?
How can you know if your medication contains gluten or not? Here are some phone numbers for pharmaceutical companies:
Abbott products – 1-800-441-4987, option 1
GlaxoSmithKline products – 1-888-825-5249
Pfizer products- 1-800-438-1985
Teva generic drug products 1-800-545-8800
Or ask your pharmacist.
Nutritional supplements should list the company phone number and/or website on the label-contact them and ask. Since gluten is not an active ingredient, it is not required to be listed on the label, and may simply be referred to as an “inert ingredient”, or the technical term for this is, which is “excipient.”
Irritable Bowel Syndrome
Irritable Bowel Syndrome is also comorbid with migraine, and affects about 15% of the general population. The symptoms of IBS can be very similar to the GI tract symptoms of gluten sensitivity and intolerance—the two disorders can be confused. And for those sensitive to fructans, avoiding them with the FODMAP diet may alleviate symptoms. A gastroenterologist can help.
Resources for gluten sensitivity and celiac disease:
http://celiac.nih.gov/
http://www.celiac.com/
http://www.glutenfreely.com/glutenfreely/nonceliacglutenintolerance.aspx
http://well.blogs.nytimes.com/2014/10/06/when-gluten-sensitivity-isnt-celiac-disease/
by Christina Peterson, M.D.
updated 11/15/2016
by admin | Nov 9, 2016 | Comorbidity
Endocrine and Metabolic Disorders and Headache
What are metabolic disorders? A metabolic disorder occurs when there is any disruption in the normal chemical processes of one or more organs in your body. Most metabolic disorders are inherited, but not all are. There are also metabolic conditions that affect the functioning of the body that are not a permanent condition, such as vitamin D deficiency or alcohol overuse, which is self-inflicted, but which does adversely affect the functioning of your body’s organs.
While the list of endocrine and metabolic disorders is quite long, there are a few that can affect the risk of headache or migraine, such as thyroid disorders or Ehlers-Danlos syndrome.
This raises the issue of whether or not obesity should be included here, or whether it is a genetic issue. Obesity does involve metabolic processes. Whether or not it is genetic, and to what extent, remains controversial. It is increasingly clear, however, that increasing obesity is correlated with an increased risk of chronic daily headache and with increased migraine frequency and severity.
by Christina Peterson, MD
updated Nov 9, 2016
by admin | Oct 13, 2016 | Triggers
Food Triggers in Migraine
Food triggers are those most commonly talked about – everyone has heard about them. But in truth, only about 25% or so of migraine sufferers have any food triggers, perhaps a bit higher for alcohol as a trigger. For most people, migraine food triggers are not food allergies. Migraine sufferers with various food triggers have been tested for allergies to their offending foods, and no markers of allergy (IgE) have been found.
If you do think you have a food trigger, avoiding that food can reduce the number of headaches you have.
Triggers are additive, so food triggers in addition to other triggers, like sleep deprivation or hormonal changes, can more easily bring on a migraine attack. It is not usually necessary to go on a special migraine trigger elimination diet to discover what your food triggers are. It is usually sufficient to keep a food diary in conjunction with a headache diary.
These are common food triggers:
Aged Cheese, Sour cream, Yogurt, Buttermilk
Citrus
Nuts
Legumes:
Peas
Beans
Soy:
Soy sauce
Tofu
Edamame
Soy “Nutraceuticals” used instead of estrogen HRT
Soy may hide in ingredients as texturized vegetable protein
Onions
Garlic
Pickled foods, Vinegar: Salad dressings, Ketchup, Relish
These are moderately common triggers:
Aspartame (Nutrasweet®)
Chocolate
Wine, Beer, Other alcoholic beverages
Wheat/gluten*
Caffeine
*This pertains largely to those who have a comorbid condition called gluten insensitivity, or celiac disease. This condition is a little more common in migraine sufferers than it is in the general population.
Sulfites
The following foods contain sulfites:
Wine, especially red
Dried apricots, apples
Dehydrated potatoes
Shrimp, lobster
Used as a dough conditioner
Used to bleach food starch
Glacéed fruit
Jams
Prepared gravies
Molasses
Soup mixes
Vegetable juices
Fruit juices
Hard cider
Nitrates/Nitrites
The following foods contain nitrates or nitrites:
Smoked fish
Corned beef
Bologna
Pastrami
Pepperoni
Canned ham
Bacon
Sausages
Frankfurters/ Hot dogs
Beef jerky
These are less common triggers:
Bananas
Papayas
Pineapples
Figs
Avocados
Olives
Yeasty foods, like freshly baked bread
Intensely sweet foods
Intensely salty foods
MSG – this may hide as the following:
Hydrolyzed vegetable protein
Hydrolyzed plant protein
Natural flavoring
Kombu extract
MSG has been debated as a trigger. Many people are convinced it is their trigger, even though the scientific basis for this has been questioned, as glutamate is widely distributed throughout the brain as a neurotransmitter. It may, in fact, be the sodium or impurities in MSG to which migraineurs are reacting.
Here are some links for further information about MSG:
http://www.guardian.co.uk/lifeandstyle/2005/jul/10/foodanddrink.features3
http://www.truthinlabeling.org/manufac.html
by admin | Apr 12, 2016 | Types of Headaches
Cluster Headache
Cluster headache involves severe pain which is one-sided, occurring in the eye or orbital region, or in the temporal region of the head. The pain is associated with redness of the eye, tears, nasal stuffiness, facial sweating, pupil constriction, a droopy eyelid (called ptosis), and often with a sense of restlessness. The headache pain occurs anywhere from once every other day to 8 times a day, and lasts 15 minutes to 3 hours.
Pain appears in regularly occurring episodes one or more times a day for several weeks, then symptoms disappear between “clusters.” Cluster attacks may not recur for months or years. In some cluster headache sufferers, there is a seasonal pattern to their occurrence, with attacks occurring in spring and fall, or in winter and summer.
Although cluster headaches are fairly well-known, they are actually not that common. Cluster headache affects less than 1% of the general population.
Cluster headache was once far more prevalent in men, with an 8:1 male:female predominance. More recently, that ratio has dropped. At present, the ratio has dropped to a 2.1:1 male:female predominance. The reason for this change is not clear, but may reflect changes in women’s lifestyles.
Cluster headache can be severe, and has been called the “suicide headache.”
A recent study has found a correlation between cluster headache and exposure to passive smoke in childhood.
by Christina Peterson, MD
updated April 12, 2016
by admin | Nov 17, 2015 | Comorbidity
There are several other neurologic disorders that are more common in migraine sufferers. Why “other?” Because migraine itself is a neurological disorder, since it originates within the brain. The three most commonly occurring neurological disorders among the non-elderly are migraine, epilepsy, and head injury. (Amongst the elderly, Alzheimer’s disease and Parkinson’s become more prominent. For most migraine sufferers, headaches either disappear or become less prominent around age 60.)
Epilepsy occurs more commonly in migraine sufferers. A genetic link has been discovered between the two.
There is also a relationship between mild traumatic brain injury and headache, of course, as it can result in posttraumatic headache. They may have migraine-like features. And head injury represents a risk factor for the development of chronic daily headache.
Other less commonly occurring neurological conditions that occur more frequently in migraine sufferers are restless legs syndrome, essential tremor, and multiple sclerosis.
The correlation with multiple sclerosis is not well understood, and further research has been suggested.
by admin | Nov 5, 2015 | Comorbidity, Women & Headaches
Endometriosis and migraine
Endometriosis is more common in women who have migraine headaches, and migraine is more common in women with endometriosis.
An Italian study found that 1/3 of women who had endometriosis also suffered from migraine headaches. About 5% of women of reproductive age have endometriosis. Another study found that of women with pelvic pain, 2/3 experience migraine – about three times the rate of the general population. Not all the women with pelvic pain had biopsy-proven endometriosis.
Several studies have now also shown an increased incidence of endometriosis in migraine sufferers, and this is felt to be most likely due to common genetic factors. Migraine attacks were more frequent in women with endometriosis than in women with migraine and no endometriosis, and migraines began at a younger age.
References:
3. Tietjen GE, Bushnell CD, Herial NA, et al. Endometriosis is associated with prevalence of comorbid conditions in migraine. Headache. 2007;47(7):1069-1078. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/176355994. Nyholt DR, Gillespie NG, Merikangas KR, et al. Common genetic influences underlie comorbidity of migraine and endometriosis. Genet. Epidemiol. 2009;33(2):105-113. Available at:
http://www.ncbi.nlm.nih.gov/pubmed/18636479by Christina Peterson, M.D.
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