by admin | May 11, 2014 | Comorbidity
Vitamin D, Pain, and Migraine
Do you think you have normal Vitamin D levels? The answer might surprise you. Up to 36% of otherwise healthy adults aged 18-29 have a vitamin D deficiency, and 41% of outpatients age 49 and over. In hospitalized patients, the numbers are even higher: 56% of inpatients in the US, and 70-100% of hospital patients in Europe. Women are more likely than men to be deficient in vitamin D. Low vitamin D levels were first associated with pain some years ago, when rheumatologists made an association with joint pain and low vitamin D in arthritis patients. Since then, further study of vitamin D levels has led to an association with a number of other conditions, one of which is migraine.
Sources of Vitamin D
The primary source of vitamin D is synthesis in the skin after sun exposure. Darkly pigmented skin acts as a natural sunblock to this process, and can place an individual at increased risk of vitamin D deficiency. Risk groups for vitamin D deficiency include breastfed infants, older adults (50 and older), individuals with limited sun exposure, people with dark skin, people with fat malabsorption, such as Crohn’s disease or celiac disease, and people who are obese. Obesity constitutes a risk factor because it is thought that vitamin D is pooled in body fat. (Vitamin D is a fat-soluble vitamin.) When it is pooled in fat, it is less available to the bloodstream and the other places in your body that it needs to be active. Dietary sources of vitamin D are somewhat limited, and include fatty fish, such as salmon, tuna, mackerel, and sardines. Other food sources of vitamin D are egg yolks, fortified milk, beef liver, cod liver oil, fortified margarine, and swiss cheese. Some medications can interfere with vitamin D absorption, such as anticonvulsants, steroids, and non-statin cholesterol-reducing medications. Vitamin D is necessary for the proper absorption of calcium, and is important for proper bone metabolism and muscle function.
Vitamin D Deficiency and Pain
Vitamin D deficiency can cause nonspecific muscle weakness and widespread pain. This can result in chronic widespread pain and fatigue, and may result in a misdiagnosis of either fibromyalgia or chronic fatigue syndrome. If you have been diagnosed with either of these, and have not had a vitamin D level checked, talk to your doctor. Although preliminary, there is also some evidence to suggest that adequate vitamin D levels may also be protective against certain cancers and possibly, multiple sclerosis. But don’t just start taking supplements without knowing what you’re doing—get your level checked. It is possible to get too much vitamin D. All fat-soluble vitamins can cause toxicity if taken in excess.
references
- Gloth FM, Lindsay JM, Zelesnick LB, Greenough WB. Can Vitamin D Deficiency Produce an Unusual Pain Syndrome? [Internet]. Arch Intern Med. 1991 Aug 1;151(8):1662-1664.[cited 2009 Apr 21] Available from: http://archinte.ama-assn.org/cgi/content/abstract/151/8/1662
- Atherton K, Berry DJ, Parsons T, Macfarlane GJ, Power C, Hypponen E. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey [Internet]. Ann Rheum Dis. 2008 Aug 12;ard.2008.090456.[cited 2009 Apr 21]
- Holick, MH. High Prevalence of Vitamin D Inadequacy and Implications for Health. Mayo Clinic Proceedings [Internet]. 2006 Mar 1; 81(3):353-373.[cited 2009 Apr 21]
- Yetley EA. Assessing the vitamin D status of the US population [Internet]. Am J Clin Nutr. 2008 Aug 1;88(2):558S-564.[cited 2009 May 11] Available from: http://www.ajcn.org/cgi/content/abstract/88/2/558S
by admin | Mar 13, 2014 | Triggers
Trigger Avoidance to Control MIgraines
One of the simplest but most important things to do in the management of migraines is to manage your migraine triggers. While it seems an obvious thing to do, it may not always be easy. Some things are obvious: eat regular meals, maintain good hydration, get enough sleep. Things that are not as easy to accomplish, although we “know we should,” are keeping a regular schedule and a regular bedtime, exercising regularly, and maintaining a moderate caffeine intake.
It is impossible, of course, to control the amount of stress that we are exposed to on a day-to-day basis, but stress management techniques are available to help with managing the toll it takes.
Lifestyle Migraine Triggers
There are many things that count as lifestyle triggers, but if you follow a generally healthy lifestyle, it covers most of them.
- Get enough sleep. Although many people try to skimp on sleep, most adults need 7 to 8 hours of sleep a night.
- Follow a regular bedtime. Did you know that sleeping in more than an hour past your normal awakening time can trigger a migraine for some people?
- Drink enough water – dehydration causes headaches.
- Eat regular meals – skipping meals can trigger a migraine.
- Exercise regularly.
- Use caffeine moderately.
- Use alcohol moderately.
- Take breaks.
- Take vacations.
Sleep disorders deserve special attention. There have been two studies which have identified sleep disorders as a risk factor for the development of chronic daily headache, and improving sleep can help with the control of migraine. If getting on a good sleep schedule does not help, and you are still having trouble sleeping, discuss this with your doctor. A sleep study may be helpful in making a proper diagnosis, as the problem may be more complex than simple insomnia.
Maintaining a healthy weight can also be important in controlling headaches. There have been several studies that have identified obesity as a risk factor for the development of chronic daily headache, as well as several studies linking obesity to the increased frequency and severity of migraine.
If you can maintain a regular schedule, you will be one step ahead of the game in keeping your headaches at bay.
Managing lifestyle triggers can go a long way toward reducing migraine headache frequency and severity, and decreasing the amount of medication you might need.
by admin | Mar 5, 2014 | Triggers
What are migraine triggers?
Triggers are not the cause of a migraine, as they would not cause migraine headaches in people without a migraine tendency. But they are the things that trigger an attack in those who do have migraines. It is felt that migraines are an inherited condition in most people. If a careful three-generation family history is taken, a history of migraine can be found in at least one extended family member in 90% of migraine sufferers. The underlying inherited susceptibility to migraine, most likely genetic in basis, is felt to be the cause of migraine.
Triggers are physiological or environmental stressors which serve to further lower the threshold of those already susceptible to migraine, making a headache happen more easily.
It is commonly known that foods can trigger migraine headaches. But did you know that there are many non-food triggers? A poll conducted by the World Headache Alliance asked “What is the most significant factor preventing you from effectively managing your headaches?” Most people indicated that it was the inability to manage stress and other lifestyle factors.
Many migraine specialists consider the “migraine brain” to be more sensitive, in a way, although probably a better way to think of it would be more sensitized. But whichever word you use, it means that if you have migraines, your brain doesn’t do well with changes, like changing hormonal levels. It also means you are more susceptible to changes in your schedule, and can’t get away with things like skipping meals, skipping sleep, or not drinking enough water.
Explore the content on various trigger types in this section to learn how you can decrease the number of migraines you experience.
by Christina Peterson, MD
updated Mar 5, 2014
by admin | Feb 20, 2014 | Comorbidity
The co-occurrence of depression and chronic migraine is well known. And, after all, it would not be unusual to be depressed if you had a headache more days than not.
However, a study performed by Dr. Sait Ashina and colleagues at Albert Einstein College of Medicine in Bronx, New York, has found that in people with episodic migraine (meaning fewer than 15 headache days a month), the presence of depression had a higher risk of developing chronic migraine. The risk of doing so also correlated with the severity of depression. Migraine sufferers with moderate or severe depression were more likely to transition to chronic migraine than those with mild or no depression. The reason for this association is not yet clear.
It is unclear whether treatment of depression can prevent this transformation to chronic migraine.
by admin | Jan 31, 2014 | Comorbidity
Anxiety, Panic and Migraine
Anxiety disorder has been reported as being twice as prevalent in migraine sufferers, while panic disorder has been reported as occurring six times as often. Like depression, these are also bidirectional relationships. If you have panic disorder first, you are twice as likely to develop migraine. You are also twice as likely to develop severe headache that does not meet migraine diagnostic criteria.
Anxiety and depression often go hand-in-hand. This is especially true in the migraine sufferer. Both anxiety and depression are more common.
Post-traumatic stress disorder is common in women with migraine. About 42% of women with migraine have post-traumatic stress disorder.
We all know what being nervous feels like, but how do you know if you have an anxiety disorder or a panic disorder? There is no blood test, x-ray, or MRI that can prove you have anxiety. A diagnosis of anxiety is based on your symptoms. There are paper question and answer tests that help to confirm the diagnosis. Anxiety differs from fear because there is no obvious cause for the feeling of fear, such as someone breaking into your house or threatening you. We all experience some anxiety when under stress. It’s when it becomes frequent or severe that it becomes an anxiety disorder.
Anxiety disorders are considered mental disorders. There are several different types, and it is possible to have more than one kind. Anxiety can begin at any age, including childhood or adolescence. Anxiety can lead to other problems as well. For example, irritable bowel syndrome can also occur in migraine patients, and most people with IBS also have an anxiety disorder.
Generalized Anxiety Disorder and Other Types of Anxiety Disorders
- Generalized Anxiety Disorder—this means you worry all the time about everyday life events. You can’t stop worrying about your family, your health, your relationships, money, school, and everything else.
- Panic Disorder—this means you have panic attacks. This is when you have sudden attacks of panic or feel as if you might be dying. A panic attack can come out of nowhere, and feels like things are out of control. Your heart beats fast, you feel short of breath, you feel dizzy or faint, and you might feel shaky. You may even tremble. You may feel a sense of detachment, and you may have hot or cold flashes.
- Obsessive-Compulsive Disorder—Some people with this anxiety disorder have more obsessions, and some have more compulsions. This is not very common in migraine sufferers. It involves things like fear of dirt or germs, or fear of thinking evil or sinful thoughts. If you have this, you might wash your hands repeatedly or do laundry several times a day. You might count things all the time or eat foods in a certain order every time. People who hoard things until there is no room left in their homes have a form of obsessive-compulsive disorder.
- Social Anxiety Disorder—If you have this, you are so afraid of making mistakes or embarrassing yourself in front of others that you avoid social situations. You may be afraid of eating, drinking, or working in front of others. You may avoid talking on the telephone to people you don’t know.
- Posttraumatic Stress Disorder (PTSD)—PTSD occurs in response to a highly stressful traumatic event, like witnessing war. It can also result from going through sexual assault or natural disaster. There are three kinds of symptoms in PTSD. If you have this type of anxiety disorder, you might notice these:
- Re-living: Anything that makes you live through the initial event or triggers memories is a problem. This might include the anniversary date of the event. Symptoms include nightmares, hallucinations, and flashbacks.
- Avoiding: You might try to avoid places, things, or people that remind you of the original event.
- Increased Arousal: This means you might react too much to trigger events, memories, flashbacks, and nightmares. You might react to little things as if they were life-threatening. This could make you irritable or have outbursts of anger. It can make your blood pressure too high. It can cause trouble sleeping. It can also make it hard for you to express your feelings to other people.
- Phobias—Phobias are excessive fears of specific things, like fear of flying or fear of spiders. We all feel a little creepy about spiders. But someone with a phobia will be so afraid they can’t live their life normally.
What Does an Anxiety Attack Feel Like?
Trouble sleeping, nightmares, and insomnia from anxiety are also common.
Anxiety can cause weird symptoms, though, too. It can make you feel restless. It can make your hands or face tingle. You can develop chest pain, stomach pain, nausea, irritability, and dizziness. You may have difficulty thinking or concentrating. Anxiety can make you urinate more frequently. And yes, it can give you a headache.
How do you treat an anxiety attack?
Relaxation techniques can help. You can learn to slow your breathing and deeply relax your muscles. (There are tapes that can help to teach you these things.) You can also picture yourself being successful and overcoming your anxious feelings. Many people have found meditation to be helpful. Then when an anxiety attack hits, you have the tools you need to fight those anxious feelings.
Some people with anxiety disorders require medications. Many people with anxiety do just as well with non-medication psychological treatment. These treatments may involve counseling, or may involve biofeedback, hypnotherapy, or relaxation training.
Avoiding anxiety is also important. Caffeine, alcohol, and nicotine can make anxiety worse. Don’t drink too much, smoke too much, or drink lots of coffee if nervousness and anxiety bother you. Remember that some over-the-counter medications contain caffeine–especially headache medications.
You may feel better if you exercise regularly. This can help regulate anxious feelings.
References:
1. Afari N, Harder LH, Madra NJ, et al. PTSD, combat injury, and headache in Veterans Returning from Iraq/Afghanistan. Headache. 2009;49(9):1267-1276. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19788469
2. Peterlin BL, Tietjen GE, Brandes JL, et al. Posttraumatic stress disorder in migraine. Headache. 2009;49(4):541-551. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19245387
3. Peterlin BL. Post-traumatic stress disorder in migraine: further comments. Headache. 2009;49(5):787. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19456892
4. Peterlin BL, Tietjen G, Meng S, Lidicker J, Bigal M. Post-traumatic stress disorder in episodic and chronic migraine. Headache. 2008;48(4):517-522. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18377377
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/19165684
6.Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders–a national population-based study. Headache. 2008;48(4):501-516.
7. Low NCP, Merikangas KR. The comorbidity of migraine. CNS Spectr. 2003;8(6):433-434, 437-444.
8. Ligthart L, Nyholt DR, Penninx BWJH, Boomsma DI. The shared genetics of migraine and anxious depression. Headache. 2010;50(10):1549-1560.
by Christina Peterson, MD
updated Jan 31, 2014
by admin | Jan 22, 2014 | Men & Headaches
MEN GET MIGRAINE TOO
Although migraine headaches are more common in women, who account for 75% of migraine sufferers, men do experience migraine headaches.You just don’t seem to hear about it as much—until it affects your favorite football or hockey player.
Men’s symptoms are no different from women’s symptoms, although men are not affected by hormonal fluctuations like women are. What is different, though, is that men are somewhat less likely to seek medical care for their migraines—and when they do, they are less likely to receive a migraine diagnosis.
Middle-aged men with migraine are 42% more likely to suffer a heart attack than are non-migraineurs.
What are some unique facts about men and migraine?
Men are somewhat less likely to seek medical care for their headaches than women are, and are also a little less likely to receive an appropriate migraine diagnosis. This is unfortunate, since having migraine increases a man’s risk of having a heart attack. We do not yet know whether controlling migraines prevents this risk, but being under the care of a physician helps to monitor the risk—and take action if necessary.
Other Headaches in Men
Tension-Type Headache
Tension-type headache, the most commonly occurring headache, occurs almost equally in men and women.
Chronic Daily Headache
This headache type occurs in both men and women, and is somewhat more prevalent in women. However, a study of chronic daily headache found that men were more likely to report disability than were women.
Cluster Headache
Cluster headaches occur far more prevalently in men than in women. In the past, an 8:1 male to female ratio had been reported. More recently, a 5.4:1 male to female ratio had been reported, and now, the ratio has dropped to 2.1:1, suggesting lifestyle changes for women have increased their risk and reduced the difference in the ratio. Cluster headache is defined as severe or very severe unilateral pain occurring around, behind, or above the eye/orbit or in the temporal area, and occurring anywhere from once every other day to 8 times a day, lasting 15 minutes to 3 hours.
The headache pain must be accompanied by at least one of the following:
- Tears
- Red eye
- Nasal congestion
- Runny nose
- Forehead or facial sweating
- Pupil constriction or droopy eyelid (ptosis is the technical term)
- A sense of restlessness or agitation
Sex Headaches
Contrary to popular belief, sexually-induced orgasmic headaches occur more commonly in men. There are two types. 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. Orgasmic headache is a sudden, severe, explosive headache occurring at orgasm. Understandably, this can be quite alarming the first time it occurs. It would be best to see your doctor for evaluation to make certain it is not a sign of something more serious.
Posttraumatic Headaches and Traumatic Brain Injury
Men and women both experience head trauma, and are thus both affected by posttraumatic headaches. However, recent emphasis on post-traumatic headache due to traumatic brain injury in football and other sports, as well as in returning Iraq and Afghanistan War soldiers, suggests that there may be a male predominance.
If you are a man with persistent headaches, seek medical help. It might prevent more than just headache pain.
by admin | Jan 6, 2014 | Triggers
Cocoa and Blood Pressure?
Ten blood pressure studies were compared; five of tea intake and five of cocoa intake. In the cocoa studies, 64% of the subjects were men and 36% women; 34% of all subjects had high blood pressure. In the tea studies, 71% were men, 29% were women, and 49% had high blood pressure. (Four studies used black tea, and one used green tea.) None of the tea studies reported any significant alterations in blood pressure. In the cocoa studies, four of five reported a reduction of both systolic (top number) and diastolic (bottom number) blood pressure after cocoa consumption. The study reporting no change utilized the lowest dose of cocoa. Blood pressure was most likely to be reduced in young individuals with mild essential hypertension.
The authors concluded that “the magnitude of the hypotensive effects of cocoa is clinically noteworthy; it is in the range that is usually achieved with monotherapy of beta-blockers or angiotensin- converting enzyme inhibitors.” They also emphasized the importance of dark chocolate, noting that milk products inhibit the absorption of the polyphenols.
Cocoa for Migraine
A study presented at the 2009 International Headache Congress provided evidence that a cocoa-enriched diet (in rats) suppressed proteins associated with inflammation in the trigeminal ganglia. This suggested that a cocoa-enriched diet in migraine sufferers might help to suppress migraine headaches. Obviously, more research will be necessary.
Volunteers? I know it’s time for my next dose of chocolate.
by admin | Nov 13, 2013 | Types of Headaches
Posttraumatic Headaches
Posttraumatic headaches are headaches that occur following a head or neck injury. This type of headache is often associated with dizziness, fatigue, or memory problems, especially in the early phase of symptoms. In the majority of cases, posttraumatic headaches will resolve within a few months. However, sometimes, posttraumatic headaches can be chronic.
There is no specific headache type which characterizes the posttraumatic headache. The headache symptoms may mimic either tension-type headache or migraine headache, and is actually most commonly a hybrid mixture of the two.
Treatment is symptomatic. Surprisingly, as common as this headache type is, there have been no controlled trials of medications for the treatment of posttraumatic headache.
by admin | Oct 10, 2013 | Comorbidity
Chronic Headache and Migraine – What’s your childhood got to do with it?
One of the common myths about migraine is that it is more common in women because women are more emotional. This is not the case. However, we are finding that there is a subset of migraine sufferers for whom past negative experiences that contain emotional links may make pain worse.
This is particularly true in the case of repressed emotions, such as those that occur because of adverse childhood experiences. A history of adverse childhood experiences has been shown to be associated with an increased incidence of depression and anxiety as well as an increase in migraines.
The types of adverse childhood experiences that have been studied include emotional abuse, physical abuse, sexual abuse, witnessing domestic violence, exposure to household substance abuse, exposure to household mental illness, parental separation or divorce, and imprisonment of a household member. A scale of Adverse Childhood Experiences has been developed for study, and it has been found that the higher the score, the higher the prevalence of headaches. It is of note that this affected both women and men.
And it makes sense, when you think about it. A child’s brain is still developing, and is more likely to be affected by things they need help making sense of, things that are scary or traumatic. Occurrences of revictimization in adulthood were high, and were associated with depression and anxiety as well as increased pain. These studies suggest that adverse childhood experiences may serve as risk factors for chronic headache, including transformed migraine. Not everyone who developed chronic headache disorders also experienced depression or anxiety; these occurred more commonly but independently of one another.
Abuse and Comorbidity
In this population, there was also an association found with comorbid disorders. Emotional abuse was found to correlate with an increased prevalence of IBS, chronic fatigue syndrome, and arthritis. Physical neglect was also associated with arthritis, and with uterine fibroids in women. Physical abuse was associated with endometriosis. In general, those who had multiple types of adverse childhood experiences were more likely to have more comorbid conditions, and more types of painful conditions.
Pain and Emotions
A very interesting study of fibromyalgia patients compared them to other pain patients in their pain response to sadness and anger. Both groups showed a decreased pain threshold and pain tolerance as a consequence of these emotions. The women with fibromyalgia were not more emotional than the other women, but they did report experiencing more pain, even though when measured formally, the levels of pain threshold and pain tolerance decrease were similar. In other words, they had a differing emotional experience to the pain. This suggests that migraine, headache, and fibromyalgia sufferers who have a history of adverse childhood experiences might benefit from cognitive behavioral therapy, which can help you reframe the meaning of emotional experiences.
References:
1. Tietjen GE, Brandes JL, Digre KB, et al. History of childhood maltreatment is associated with comorbid depression in women with migraine. Neurology. 2007;69:959-968.
2. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part III). Association with comorbid pain conditions. Headache. 2010;50:42-51.
3. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part II). Emotional abuse as a risk factor for headache chronification. Headache. 2010;50:32-41.
4. Tietjen GE, Brandes JL, Peterlin BL, et al. Childhood maltreatment and migraine (Part I). Prevalence and adult revictimization: A multicenter headache clinic survey. Headache. 2009;50:20-31.
5. Anda, R, Tietjen, GE, Schulman, E, Felitti, V, Croft, J. Adverse Childhood Experiences and Frequent Headaches in Adults. Headache. 2010;50:1473–1481.
6. van Middendorp, H, Lumley, MA, Jacobs, JWG, Bijlsma, JWJ, Geenen, R. The effects of anger and sadness on clinical pain reports and experimentally-induced pain thresholds in women with and without fibromyalgia. Arthritis Care & Research. 2010;62:1370–1376.
by Christina Peterson, M.D.
by admin | Jul 17, 2013 | Migraine
What is Chronic Migraine?
What is chronic migraine? The International Headache Society’s International Classification of Headache Disorders, 3rd edition, has defined chronic migraine as 15 or more headache days a month that has lasted for three months or more, and that on eight or more days a month has the features of a migraine headache.
What Causes Chronic Migraine?
Why some people get chronic migraine and some people don’t is not always entirely clear. There is some evidence that chronic migraine may be on a spectrum of headache frequency between episodic migraine (less than 15 days a month) and transformed migraine, which is migraine occurring very frequently, similar to chronic daily headache, but with clear migraine features to the headaches. Research into why headaches become chronic has shown the following risk factors for headache chronicization. This research did not focus on chronic migraine specifically, but looked at chronic daily headache.
Risk factors for chronic migrane are:
- History of head or neck trauma
- Female
- Habitual snoring
- Sleep apnea and other sleep disorders
- Obesity
- High caffeine intake
- Smoking
- Coexisting pain disorders
- Overuse of pain medications
- Major life changes (moving, getting married, etc.) were associated with the onset of chronic headache
1. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Chronic migraine is an earlier stage of transformed migraine in adults. Neurology. 2005; 65(10): 1556-1561.
http://cep.sagepub.com/content/26/6/742.abstract [Accessed July 17, 2010].
3. Bigal M, Sheftell F, Rapoport A, Lipton R, Tepper S. Chronic Daily Headache in A Tertiary Care Population: Correlation Between the International Headache Society Diagnostic Criteria and Proposed Revisions of Criteria for Chronic Daily Headache. Cephalalgia. 2002:432 -438. Available at:
http://cep.sagepub.com/content/22/6/432.abstract [Accessed July 17, 2010].
by Christina Peterson, M.D.
updated July 17, 2013
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