Emotions Enhance Pain

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.

Stroke

by admin | Jul 1, 2013 | Comorbidity

Stroke and Women

Women under the age of 45 who have migraine without aura may be at a slightly increased risk for stroke; women who have migraine with aura have more than twice the risk of heart attack or stroke than do women without aura or without migraine. This risk is further magnified if you smoke, have high blood pressure, or if you take oral contraceptives.

The relationship between migraine with aura and ischemic stroke before age 45 is well established, and there is also a relationship with TIA (transient ischemic attack) and subclinical lesions in the brain.  The authors of the GEM study (Genetic Epidemiology of Migraine Study) noted: “There has been substantial literature confirming an association between migraine with aura and ischemic stroke before the age of 45. The question of whether there is a similar association with CHD before the age of 45 has not yet been definitively answered.”

It has been speculated that cortical spreading depression (CSD), which is presumed to be the basis of aura, could also predispose the brain to lesions, and possibly even stroke. Some researchers in the field think it possible that repeated episodes of CSD resulting in aura could be responsible for an increased risk of stroke.

The Reykjavik Study found that stroke occurrence was increased in men and women with migraine with aura, but that death due to stroke was only increased for men with migraine.

Meta-analyses of of studies of stroke in women with aura have determined that migraine confers a higher overall risk of both ischemic and hemorrhagic stroke. Migraine with aura in women confers an overall stroke risk of 4.3/1000, higher than either diabetes or obesity, and contributes as much risk as smoking or hypertension.

The CAMERA II study has shown that infarct size in stroke is 3.24 times larger in women with migraine with aura.

This underscores the necessity for women who have migraine with aura to control stroke risk factors as much as possible.

References:

1. Scher AI, Terwindt GM, Picavet HSJ, et al. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology. 2005;64(4):614-620.

2. Schurks M, Rist PM, Bigal ME, et al. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009;339(oct27 1):b3914

3. Gudmundsson LS, Scher AI, Aspelund T, et al. Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study. BMJ. 2010;341(aug24 1):c3966

4. Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. Migraine and cardiovascular disease. Neurology. 2009;72(21):1864 -1871.

5. Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease. Neurology. 2010;74(8):628 -635.

6. Eikermann-Haerter K, Lee JH, Yuzawa I, et al. Migraine Mutations Increase Stroke Vulnerability by Facilitating Ischemic Depolarizations. Circulation. 2012;125(2):335–345.

7. Palm-Meinders IH, Koppen H, Terwindt GM, et al. Structural Brain Changes in Migraine. JAMA. 2012;308(18):1889–1897.

by Christina Peterson, M.D.

updated 7-1-13

Rosacea

by admin | May 10, 2013 | Comorbidity

What is Rosacea?

Rosacea is a skin disorder causing redness, irritation, and sometimes, bumpy skin and acne-like breakouts.

Rosacea usually shows up between the ages of 30 and 50 or so. It occurs more commonly in women than in men, although affected men are more likely to experience more severe rosacea. Rosacea is also more common in the fair-skinned, especially those with Celtic or Scandinavian heritage.

The cause of rosacea is not known, but it is suspected to be due to a combination of genetics and environmental factors. In one study, 52% of rosacea sufferers had a family history of at least one family member with rosacea. People with rosacea are more likely to be infected with H. pylori (the bacteria causing ulcers). Those with the acne rosacea form of the disorder have been found to be more likely to react to Bacillus oleronius, which in turn causes overreaction of the immune system.

The Migraine-Rosacea Connection

A connection between migraine and rosacea was noted in 1976 by Tan and Cunliffe. In their study of 137 patients and 161 controls, 44% of the rosacea patients had suffered from migraine, as compared to 13% of the control group. Another Swedish study in 1996 with 809 subjects with rosacea found an overall rate of migraine of 14% as compared to 13% in the control group. However, they found a 27% rate of migraine in rosacea patients between the ages of 50 and 60, and proposed the possibility that hormonal changes were affecting both conditions.

Types of Rosacea

According to the American Academy of Dermatology, there are four types of rosacea:

1. Erythematotelangiectatic rosacea – with symptoms of redness, flushing, and visible blood vessels
2. Papulopustular rosacea, or rosacea acne – with symptoms of redness, swelling, and acne-like breakouts.
3. Phymatous – with symptoms of skin thickness and a bumpy skin tecture.
4. Ocular rosacea – with symptoms of red and irritated eyes, swollen eyelids, redness at base of eyelashes.

About half of rosacea sufferers indicate that their symptoms come and go.

Rosacea Triggers

Like migraine, rosacea has a variety of triggers. Some of the triggers between the two conditions overlap, although they are not identical. And also like migraine, not everyone has the same triggers.

The following are typical rosacea triggers:

• Hot beverages
• Alcohol
• Spicy foods
• A hot bath
• Stress
• Sun exposure – especially UVA
• Exposure to cold or humid weather
• Exposure to heat
• Exercise
• Topical creams or make-up

Treatment of Rosacea

The first step in the treatment of rosacea is trigger identification and lifestyle modification. In many cases, this is not sufficient, although it can be helpful. Skincare should include sunscreen, moisturizer, especially in cold weather, and avoidance of sunlight during midday. Many skin products or treatments can aggravate rosacea.

Medical treatment of rosacea can involve topical medications, short courses of antibiotics, and laser treatment.

It is important to see a dermatologist if you think you have rosacea, as the treatment will vary based on the rosacea type.

If you think you might have rosacea, here is a helpful rosacea quiz:

References:

1. Berg M, Liden S: Postmenopausal female rosacea patients are more disposed to react with migraine. Dermatology. 1996;193:73-74.

Hypothyroid

by admin | Jan 5, 2013 | Comorbidity

Hypothyroidism and Headache

Hypothyroidism has been found to be associated with chronic daily headache* in both the varieties of chronic migraine and new daily persistent headache. In one study, 30% of individuals with hypothyroidism had developed mild daily headache within 1-2 months of onset of the thyroid disorder. A history of migraine predisposed to the development of headache.

Hashimoto’s Disease, an autoimmune form of chronic thyroiditis, has also been associated with increased likelihood of headache.

A study of white matter hyperintensities seen on MRI in migraine found that either hypothyroidism or hyperthyroidism (too low or too high) was associated with these MRI abnormalities.

* This was chronic migraine without any evidence of medication overuse.

References:

by Christina Peterson, MD

updated January 5, 2013

Depression

by admin | Nov 14, 2012 | Comorbidity

Depression and Migraine

One of the most significant comorbid conditions associated with migraine is depression. This particular relationship is one that is considered bidirectional—it works both ways. What that means is that if you have a tendency toward depression, you are more likely to develop migraine headaches, but also if you are a migraine headache sufferer, you are more likely to become depressed. Careful population-based statistical studies have been done, and it does not look simply as if migraine headaches make you depressed, although that might seem a logical conclusion. It is not that simple.

Based on one of these large studies, a person is 2.9 times more likely to develop depression if they are a migraine sufferer, and a person is 3.8 times more likely to develop migraine if depressed.

Depression did not affect the frequency of migraine attacks, or the progression of migraine-related disability over time.

The situation is somewhat more significant for chronic daily headache, where the headache pain may have a more telling effect. Depression occurs in more than 80% of chronic daily headache sufferers. The comorbid depression often improves if the daily pain pattern can be broken, and an episodic pain pattern can be re-established.

If you suspect depression might be affecting you and your headache pain, discuss it with your physician. There are both medication and non-medication strategies available to help you cope.

references:

by Christina Peterson, MD

updated Feb 7, 2010

Irritable Bowel Syndrome and Diet Remedies

by admin | Nov 10, 2012 | Comorbidity

While many IBS patients know that there are certain trigger foods that bring on their symptoms, there has never been a specific IBS diet. However, recent research suggests that there may be foods to avoid that can decrease your symptoms. Certain complex sugars can be the culprit in IBS.

What About Hot Chocolate and IBS?

Well, you can have the chocolate. However, dairy products may be an issue. In a lecture titled Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms, Dr. Peter Gibson discussed his findings in the American Journal of Gastroenterology lecture. Dr. Gibson’s results indicate that following what is called the FODMAP diet can reduce symptoms within two days for some IBS sufferers.

FODMAP is short for “fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols.” It’s less important to remember these long chemical names than it is to know what foods they are in.

Oligosaccharides  

• wheat
• rye
• onions
• garlic
• leeks
• scallions
• shallots
• artichokes

Galacto-oligosaccharides

• beans
• chick peas
• lentils

Disaccharides

• milk products (except for hard cheese)

Monosaccharides

• excess fructose
• fruits that contain more fructose than glucose
• honey
• apples
• pears
• mangoes
• high frutose corn syrup
• agave nectar

Polyols

• sugar alcoholc
• sorbitol
• mannitol
• maltilol
• xylitol
• stone fruits: cherries, peaches, apricots, nectarines, plums/prunes
• watermelon
• apples
• pears
• mushrooms
• cauliflower
• snow peas

For those of you who are trying to lose weight, or are diabetic, you should know that sorbitol and xylitol are used as sweeteners in low-calorie sweets.

So what to do about the diet? It is recommended that you avoid all these foods for six to eight weeks, and then add back one food at a time to see if it causes you problems. Learn to read labels, because some of these complex sugars are contained in processed foods.

Small studies have shown that following this diet can significantly reduce symptoms in up to 75% of those who follow the diet.

Resources to read more:  The FODMAP Diet

When Everyday Foods Are Hard to Digest