Obesity

by admin | Jun 1, 2011 | Comorbidity

Obesity and Headache

Obesity has been called the most common disease in America, although technically I believe dental decay holds that distinction.

A BMI (Body Mass Index) of 30 or more places an individual at risk for new onset of chronic daily headaches, which is a condition called New Daily Persistent Headache. A BMI of 25 to 30 is considered “overweight.” A BMI of 30 to 35 is called class I obesity, 35-40 is class II obesity, and BMI over 40 is class III obesity. Most of the studies that determined a correlation between obesity and migraine also did so at a BMI of 30 or greater, although the most risk was seen for class II obese women of reproductive age. Neither the prevalence of migraine nor the risk of severe headache were increased in older women or men with total obesity or abdominal obesity.

The Cause and Effect of Obesity—Are Chronic Headaches Included?

From the decade of the 1960s to the decade of the 1970s, medical epidemiologists, the folks who study statistics about diseases, found that the number of people with headaches, and especially migraines, was increasing.  But they didn’t know why. Now, it may partly be due to increased stress in our lives.  And it may partly be that migraines are being diagnosed more.  However, the increasing waistlines of the US may also be contributing to an increase in headache severity. There may a correlation between migraine and both total body obesity and abdominal obesity.

There is emerging evidence to suggest that there may be a correlation between metabolic syndrome and migraine as well. An increased waist-to-hip ratio is one of the diagnostic criteria for metabolic syndrome. Interestingly, there was also an increased rate of headache in the underweight. The best BMI in order to avoid headache is 20. What has not yet been determined is whether there are shared genetic factors that place a given individual at risk for both migraine and obesity, or whether something about migraine and the neurochemical changes that go on in the brain predispose toward obesity.

Studies on Obesity, Migraine, and Other Headaches

In 2002, Dr. Dawn Marcus noted that pro-inflammatory chemicals called cytokines had been discovered in migraine, and that they had been found to be elevated in obesity.  She conducted a small pilot study (61 headache patients) to look for a relationship between obesity and migraine.  She found that obesity was related to headache impact on a validated test of pain severity, psychological distress, and quality of life.  The test scores were significantly higher in obese patients. Medical geneticists are currently hard at work to see whether there is a genetic link between migraine, obesity, hyperlipidemia (elevated cholesterol and other blood fats), high blood pressure (hypertension), and other chronic conditions.

Research on obesity is moving forward to look at many complex biochemical relationships to learn more. In 2003, a large study was completed looking at the various risk factors for the development of chronic daily headache.  Some things we already knew about or suspected, like medication overuse, or not sleeping.  But an association with weight was a surprise to headache specialists. This study, conducted by Dr. Ann Scher and colleagues, involved just over 1,100 people who were followed for a year.  The obese people were far more likely to develop chronic daily headache (not acute migraine) than the normal group.  Chronic daily headache is defined as headaches which occur 15 days a month or more.

Who is Affected by Obesity and Headache?

In a more recent study, Dr. Marcelo Bigal, interviewed over 143,000 people in order to identify nearly 1,100 with chronic daily headache.  Sixty-four per cent of the study population was female.  Obese individuals, those with a body mass index (BMI) of 30 or more, were about twice as likely to develop chronic daily headache, 7% vs. 3.8% for the normal group.  The group who were just in the overweight range,  those with a BMI between 25 and 29.9, had a 5% risk of developing chronic daily headache.  Obese middle-aged women were at greatest risk. The obese group were also more likely to miss work due to their headaches.  When asked if they had missed more than four days of work, 33% of the obese group answered yes, as compared to 27% of the overweight group and 26% of the underweight group.

Can Weight Loss Help Chronic Headache?

We are not yet certain to what extent weight management might reduce the frequency and severity of headaches.   Some headache specialists feel that this may be so, while others simply suspect that the same risk factors that contribute to obesity also contribute to headache. Further, if you have chronic headaches, you are less likely to be active or to exercise. A recent study of severely morbidly obese patients who underwent bariatric surgery revealed a 50% reduction in the number of headache days after surgery. Reduction of migraine severity was also seen. However, this was a small study, and given the significant risks associated with bariatric surgery, it cannot be recommended for migraine management alone.

The positive finding Dr. Bigal’s study is that obese chronic daily headache sufferers were just as responsive to treatment as were other patients.  In a second study, Dr. Bigal and his colleagues compared the treatment outcomes of 170 migraine patients.  They found that after three months of treatment, response rates were about the same in all weight classes. So, the good news is that whether obesity is the chicken or the egg in chronic daily headache, treatment strategies are still effective.

References:

Sleep Disorders

by admin | Apr 14, 2011 | Comorbidity

Sleep Disorders and Headache

Sleep disturbances have been found to be comorbid with chronic daily headache. Sleep disturbances are common in migraine sufferers as well, but have not been studied adequately in large population-based studies. Thus no comment can be made as yet about whether any particular kind of sleep disorder formally relates to migraines, although many migraine sufferers know they can’t skimp on sleep without getting a migraine attack.

It is known that morning headaches can arise from sleep apnea, although morning headaches can certainly have other causes, such as bruxism—the clenching or grinding of teeth. There are many types of sleep disorders in addition to sleep apnea, including simple insomnia, sleep interruption due to depression or anxiety, and others. Deterioration in the quality of sleep can be caused by nocturnal movement disorders, such as periodic limb movements and restless leg syndrome, which is more common in migraine.

Here are four key questions you can ask yourself about the quality of your sleep:

1. Is your sleep Restorative?
2. Do you have Excessive daytime sleepiness, tiredness or fatigue?
3. Do you habitually Snore?
4. Is your Total sleep Time sufficient?

(notice how these spell R-E-S-T?)

Why Sleep is Important

Adequate sleep is an important factor in controlling all types of pain, including your headaches. Sleep deprivation is a migraine trigger for many people. If you are concerned about the quality of your sleep, it is a good idea to either keep a sleep diary, or to add space to your headache diary to track your sleep.

References:

1. Rains JC, Poceta JS. Sleep and Headache Disorders: Clinical Recommendations for Headache Management. Headache: The Journal of Head and Face Pain. 2006;46(s3):S147-S148.

2. Rains JC, Poceta JS. Sleep-related headache syndromes. Semin Neurol. 2005;25(1):69-80.

3. Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5(5):385-396. 4. Rains JC. Chronic Headache and Potentially Modifiable Risk Factors: Screening and Behavioral Management of Sleep Disorders. Headache: The Journal of Head and Face Pain. 2008;48(1):32-39.

by Christina Peterson, MD

updated April 14, 2011

Essential Tremor

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

High Cholesterol

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.

Immune Disorders

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:

Bipolar Disorder

by admin | Feb 7, 2010 | Comorbidity

Bipolar Disorder and Migraine

There has a long been a well-known association between bipolar disorder and migraine headaches, but until recently, this had not been formally studied. Several recent studies have remedied this.

In one small series of psychiatric patients (62) admitted to the hospital, and assessed for migraine, 48% of the women and 39% of the men had migraine. The prevalence was highest in those individuals who had bipolar disorder type II at 77%, and those had more migraine attacks as well.

A study of Latino adults of Mexican-American origin found a stronger correlation between migraine and bipolar disorder than between migraine and depression. A Canadian study found that depression, anxiety, and bipolar disorder were all about twice as prevalent in migraine sufferers as in the general population.

Bipolar disorder has been assessed in large population-based studies, and the risk of developing bipolar disorder if you have migraine is between 3 and 7 times higher than if you do not have migraine.

These associations have led to a search for a common genetic marker for migraine and bipolar disorder.

References:

by Christina Peterson, MD

updated Feb 7, 2010