Neurologic Disorders

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.

Can bariatric surgery help migraine?

by admin | Oct 2, 2014 | Comorbidity

Migraine and Obesity Related

It has been well-established that there is a connection between obesity and migraine headaches. The number of headaches a month is higher in the overweight, and even higher in the obese population. The reasons for this are complex, and are still being studied by scientists to figure it all out—but it looks like at least part of the reasons have to do with creating an environment of increased inflammation.

So, we know that, basically, the fatter you get, the more migraine headaches you are likely to have. What has been less clear is whether weight loss can reverse this trend.

A small study was done of severely morbidly obese patients who underwent bariatric surgery.  Twenty-four patients with a BMI of 35 or greater were identified with migraine headache by using the ID-Migraine Screener. Migraine severity was measured with the Migraine Disability Assessment Scale (MIDAS). A 50% reduction in the number of headache days was seen after surgery. Prior to surgery, half the patients reported moderate or severe disability from their migraines; this number dropped to 3 patients after surgery. Headache improvement occurred with weight loss even though, during the time of the study, many participants were still in the obese range of weight.

Postoperative complications after bariatric surgery can be significant, and living after bariatric surgery can be challenging as the rate of vitamin deficiencies is high, and can result in neuropathies and other neurologic problems. While weight loss may be beneficial for the prevention of medical conditions related to obesity, it is premature to recommend it solely for migraine.

References:

Vitamin D and Pain

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

1. 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
2. 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]
3. 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]
4. 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

Depression Increases Risk of Episodic Migraine Progression to Chronic Migraine

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.

Anxiety and Panic Disorders

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:

1. 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.
2. Avoiding:  You might try to avoid places, things, or people that remind you of the original event.
3. 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