IBS

by | Feb 7, 2010 | Comorbidity

Irritable Bowel Syndrome and Migraine

In various studies of individuals with irritable bowel syndrome, 23-53% report migraine headaches. Symptoms include abdominal pain, bloating, cramping, constipation, diarrhea, and nausea. IBS affects about 20% of the general population in Western countries, and up to 7% in Asian countries.

In addition to migraine, individuals with IBS have been found to be more likely to suffer from depression, anxiety, and fibromyalgia. Although there were fewer individuals in Asian populations wtih IBS, the per cent who had generalized anxiety disorder was the same as in Western countries. There is growing evidence that an early history of childhood abuse or emotional neglect may place you at increased risk of developing irritable bowel syndrome.

The good news is that behavioral treatments such as relaxation therapy, hypnotherapy, or cognitive behavioral therapy may be effective for helping to control the symptoms of IBS. The depression-anxiety connection with IBS is not the only reason that people with irritable bowel syndrome are sometimes given medications used for depression, though. These medications affect a neurotransmitter called serotonin. Most of the body’s serotonin (over 90%) is found in the nerves that supply the bowel; a smaller amount is in the brain regions that control them. So, whether you work with medication or with behavioral means, there really is a mind-body connection here—and a brain-gut connection, too.

References:

1. Cole JA, Rothman K, Cabral H, Zhang Y, Farraye F. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterology. 2006;6(1):26. Available at: http://www.biomedcentral.com/1471-230X/6/26
2. Lee S, Wu J, Ma YL, et al. Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study. Aliment. Pharmacol. Ther. 2009;30(6):643-651. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19552631
3. Palsson OS, Turner MJ, Whitehead WE. Hypnosis home treatment for irritable bowel syndrome: a pilot study. Int J Clin Exp Hypn. 2006;54(1):85-99. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16316885
4. Toner BB. Cognitive-behavioral treatment of irritable bowel syndrome. CNS Spectr. 2005;10(11):883-890. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16273018
5. Beesley H, Rhodes J, Salmon P. Anger and childhood sexual abuse are independently associated with irritable bowel syndrome. Br J Health Psychol. 2009. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19691916
by Christina Peterson, MD
updated Feb 7, 2010

Restless Legs Syndrome

by | Jan 3, 2010 | Comorbidity, Restless Legs Syndrome

Restless legs syndrome, a movement disorder, is one of the many conditions that is more common in migraine sufferers. Although it may begin as a simple urge to move or an itchy, tingly feeling in the calves, it can become disabling. A higher than expected rate of RLS (34%) has been found in chronic headache sufferers.

What are RLS symptoms?

Restless legs syndrome is an unpleasant sensation that is often hard to describe. Words sometimes used are tingling, itching, creeping, crawling, jittery, burning, or grabbing. RLS affects calves more often than feet or thighs, and is usually bilateral. Being still for long periods brings it on, and moving around helps.

RLS symptoms are usually worse in early evening or later at night, and may cause insomnia.

RLS is present in about 10-15% of US, Canadian, and European populations, but is less common in Asia. RLS affects African-Americans less than white persons. RLS affects women about twice as often as men. Women who have not borne children have the same risk as men.

Restless leg syndrome is often reported during pregnancy. It most often occurs in the third trimester, and resolves with delivery. RLS affects 25-40% of pregnant women.

The Sleep Heart Health Study showed more stroke or heart disease occurring in those with RLS than those without. There was a correlation between greater frequency or severity of RLS symptoms and occurrence of cardiovascular disease. RLS itself most likely does not cause heart disease. We do know, however, that interrupted sleep can be a risk factor for heart problems.

RLS is more common in smokers.

Causes of RLS

Most cases of RLS are primary, which means that it runs in families, and is most likely genetic. RLS is familial in 25-75% of cases. Several genes have been identified, both dominant and recessive. There are also several causes of secondary RLS, one of the most common of which is peripheral neuropathy.

Secondary RLS can be caused by:

  • peripheral neuropathy
  • iron deficiency
  • folate deficiency
  • magnesium deficiency
  • diabetes mellitus
  • Lyme disease
  • lumbosacral radiculopathy (pinched nerve root)
  • rheumatoid arthritis
  • Vitamin B12 deficiency
  • Sjögren syndrome
  • uremia (kidney failure)
  • pregnancy
  • medications (these can cause or make worse existing symptoms of RLS) -diphenhydramine (present in many over-the-counter medications) SSRI antidepressants lithium beta blockers antidopamine medications (many antipsychotics, some nausea medications)
  • alcohol
  • caffeine

Restless Legs Syndrome and Advances In Treatment

Treatments for RLS start with self-help measures, such as hot or cold baths, whirlpool baths, exercise, limb massage, and avoidance of any triggers. There are also several medication treatments. It’s important to work with your doctor to make sure you don’t have one of the conditions that cause secondary RLS.

References:

1. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology. 2004;63(6):1065-1069.

2. Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology. 2008;70(1):35-42.

3. Walters AS, Hickey K, Maltzman J, et al. A questionnaire study of 138 patients with restless legs syndrome: The `Night-Walkers’ survey. Neurology. 1996;46(1):92-95.

4. Young, WB, Piovesan, EJ, Biglan, KM. Restless Legs Syndrome and Drug-Induced Akathisia in Headache Patients. CNS Spectrums. 2003; 8(6):450-456.

5. Hornyak M, Grossmann C, Kohnen R, et al. Cognitive behavioral group therapy to improve patients scoping strategies with restless legs syndrome: a proof-of-concept trial. J Neurol Neurosurg Psychiatry 2008;79:823–825.

Seizures and Epilepsy

by | Nov 14, 2009 | Comorbidity

Seizures, Epilepsy, and Migraine

Epilepsy affects 3% of the general population at any given time, but about 10% of us will have had a seizure at some point in our lives by the time we reach the age of 80. Epileptics are 2.4 times more likely to develop migraine than the general population. This increased risk is equal for men and women. No one type of seizure disorder is affected by this increased risk more than another.

The relationship between epilepsy and migraine is also bidirectional, that is, not only are you more likely to develop migraine if you have a seizure disorder; you are also more likely to develop a seizure disorder if you have migraine.

A recent study has discovered a familial occurrence of occipitotemporal epilepsy and visual aura, and linked it to a chromosome.

references:

1. Deprez L, Peeters K, Van Paesschen W, et al. Familial occipitotemporal lobe epilepsy and migraine with visual aura. Neurology. 2007;68(23):1995 -2002.
2. Winawer M. New evidence for a genetic link between epilepsy and migraine. Neurology. 2007;68(23):1969 -1970.
3. Bigal ME, Lipton RB, Cohen J, Silberstein SD. Epilepsy and migraine. Epilepsy Behav. 2003;4 Suppl 2:S13-24.

by Christina Peterson, MD

updated Nov 14, 2009