Migraines linked to carpal tunnel syndrome

An association was found showing that those who suffer from carpal tunnel syndrome more prevalently have migraine headaches.

Plastic surgeons at UT Southwestern Medical Center have demonstrated for the first time an association between migraines and carpal tunnel syndrome, with migraines more than twice as prevalent in those with carpal tunnel syndrome as those without, according to the study.

Researchers found that 34 percent of patients with carpal tunnel syndrome also reported migraines, compared to 16 percent of patients reporting migraines without carpal tunnel syndrome. Researchers also found the reverse: 8 percent of patients with migraines reported having carpal tunnel syndrome, compared to 3 percent of those with migraines but no carpal tunnel syndrome.

"Because carpal tunnel syndrome and migraine headache are so common, this association is relevant to the large number of people who suffer from these conditions. The association of these two distinct disease processes is a fascinating connection that needs to be explored further," said Dr. Douglas Sammer, Associate Professor of Plastic Surgery and Orthopaedic Surgery, and Chief of the Hand and Upper Extremities Division in Plastic Surgery. "Although we have theories, at this time we simply don't know why people with carpal tunnel syndrome are more likely to have migraines, and vice versa. A deeper understanding of how and why this connection exists may lead to earlier diagnosis or even the ability to implement preventive measures."

The findings suggest it may be worthwhile for physicians to perform peripheral nerve compression exams in the head and neck on patients with migraines, the researchers concluded.

Further studies are needed to determine whether migraines may be an early indicator for future nerve compression problems such as carpal tunnel syndrome, the researchers said, as well as whether there is a hereditary component to the diseases. Because migraines are more common in younger patients, and carpal tunnel syndrome is more prevalent in older patients, it could be that migraines sensitize the central nervous system to develop pain signals from later nerve compressions, according to the study.

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How do I get relief from a migraine?

This article talks about the difference between headaches and migraines and how to get relief from them.

Everyone gets a headache now and then, but migraine headaches are characterized by recurring attacks of moderate to severe headache pain. Often called migraines, these headaches are a common neurologic condition that can negatively affect an individual’s quality of life.

If you suffer from migraines, you are not alone. According to the National Headache Foundation and the American Migraine Study, more than 37 million individuals in the United States are affected by migraines, making them the second-most common type of headache. Migraines are most common among individuals ages 25 to 50, and migraines are three times more common in females than in males.

Migraines typically start in childhood and may get better or worse as an affected individual ages. Research from the National Headache Foundation suggests that migraines tend to run in some families and that 70 to 80 percent of migraine sufferers have a family history of migraines.

Signs and Symptoms

Migraines may last four to 72 hours and can disrupt your life. Some individuals who get migraines experience warning symptoms, known as an aura, before the onset of the migraine. An aura involves a group of symptoms including vision changes. The most common symptom associated with migraines is a throbbing pain on one side of the head.

The signs and symptoms vary among individuals and may include:

• Nausea
• Vomiting
• Blurred vision and/or a temporary blind spot
• A zigzagging or flashing light
• Sensitivity to light, smell and sound
• Dizziness
• Fatigue
• Difficulty concentrating

Cause and Common Triggers

While the exact cause of migraines is not known, genetics and environmental factors have been identified as possible causes. Several triggers include:

• Stress
• Fatigue
• Anxiety
• Caffeine withdrawal
• Changes in weather, altitude and/or air pressure
• Hormonal changes, like those that occur during a menstrual cycle or pregnancy
• Environmental factors, such as noise, bright lights or certain odors
• Consumption of vasoactive substances in certain foods, such as nitrates, tyramine (i.e. in aged cheese) red wine and monosodium glutamate
• Alcohol consumption
• Use of certain pharmacologic agents, such as nitrates, oral contraceptives, nifedipine and postmenopausal hormones
• Changes in sleep or eating patterns
• Smoking

Diagnosis

There is no single test for diagnosing migraines. If you suspect you are having a migraine, your doctor will review your medical history and symptoms as well as conduct complete physical and neurologic exams. Other medical tests, such as computed tomography or magnetic resonance imaging, may be ordered to rule out other medical conditions.

Treatment

The medications used for managing migraines are typically classified as preventive or pain-relieving medications. Treatment is determined by the frequency and severity of your migraines, the cause of your migraines, your other medical conditions, and your allergy history. Your pharmacist will explain how to take your medication. Some medications are taken daily, while others are taken at the onset of a migraine. In addition, several OTC products are marketed for the treatment of mild to moderate migraines. These products contain analgesics such as acetaminophen, ibuprofen and aspirin, as well as caffeine.

It is important to note that self-treatment of migraines is only recommended after a diagnosis has been confirmed. To prevent drug interactions, contraindications or adverse reactions, it is important to discuss the use of these products with your doctor or pharmacist beforehand.

Some patients with migraines may find relief by using alternative remedies such asbiofeedback, acupuncture, relaxation techniques and nutritional supplements.

Management and Prevention

The best way to prevent migraines is to take your medication at the first sign of a migraine or before being exposed to a known trigger. Keeping a headache diary may help you identify possible triggers. Lifestyle modifications may reduce the frequency and severity of migraines; modifications include avoiding known triggers, exercising regularly, taking medication as directed and not skipping meals.

You can ease the pain and discomfort associated with migraines by:

• Getting sufficient sleep

• Keeping a headache diary to determine your headache triggers

• Resting and relaxing when possible, and reducing stress

Conclusion

Migraine pain can be unbearable, so it is important for you to take your medication as directed and to seek immediate medical care if you do not obtain relief or if your migraine worsens. If you are taking any other medications, have other medical conditions, or are pregnant or breast-feeding, you should never take any medication until you have consulted your primary health care provider.

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Study: No link between migraines and breast cancer risk

A study found no association between migraine headaches and breast cancer risk in women.

A large, new study should reassure the millions of American women who have migraine: The debilitating headaches don't raise the risk for breast cancer.

"There is no association between migraine and breast cancer risk," said lead researcher Rulla Tamimi, an associate professor of medicine at Harvard Medical School. "There is no positive association, so there is no reason for concern, and there is no protective effect either."

About 18 percent of American women and 6 percent of men suffer from migraine, according to the Migraine Research Foundation. Migraine is a syndrome involving severe headaches that are often accompanied by visual disturbances, nausea, vomiting and sensitivity to sound and light. Attacks can last from four to 72 hours.

The idea that migraine and breast cancer might be connected arose because both involve sex hormone levels, Tamimi explained.

"We don't really understand the cause of migraines, but there has been a suggestion that they may be triggered by hormone levels," she said. "We know that hormone levels are also associated with breast cancer, so perhaps there could be a link between migraine and breast cancer."

But the report -- based on more than 100,000 women -- observed no association between migraine and breast cancer or migraine and female sex hormones, Tamimi said. The findings were published Dec. 12 in the Journal of the National Cancer Institute.

The research data, which included analysis of four other studies, hinted that migraine might even lower the risk for breast cancer, but that appeared to be a result of study design and not necessarily a real link, the researchers said.

Dr. Mark Green, a professor of neurology at Mount Sinai Hospital in New York City, said that the idea that migraines might be protective against breast cancer is intriguing.

"There is a suggestion that migraine is linked to a lower incidence of breast cancer. However, the numbers were small, and it's not appropriate to suggest that yet, but it's an interesting idea," said Green, who was not involved with the study.

Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, discussed the study's significance: "In the ongoing quest to find out what contributes to the causes of cancer, sometimes a negative association can also shed light on the subject," she said. "This study will give relief to many migraine sufferers, and give them one less thing to worry about."

The study relied on data on over 115,000 women who took part in the Nurses' Health Study II, about 18,000 of whom suffered from migraine. Over 20 years of follow-up, no association with breast cancer was observed.

Tamimi's team also looked at the levels of sex hormones of about 2,000 premenopausal women and found no link between hormone levels and migraines.

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Nasal spray to treat migraines

This article explains a nasal spray being developed to treat migraines.

Scientists from Nevada's Roseman University of Health Sciences presented their work on a nasal spray formulation of the antipsychotic prochlorperazine for the treatment of migraines at the American Association of Pharmaceutical Scientists annual meeting in San Diego.

"Prochlorperazine is a dopamine receptor antagonist that is widely used as an anti-nausea medication," said Venkata Yellepeddi, assistant professor of pharmaceutical sciences at Roseman University, in a statement. "Comparative clinical studies have shown that prochlorperazine provides better pain relief than other anti-migraine drugs such as sumatriptan, metoclopramide and ketorolac. Currently, there are no marketed nasal spray formulations of prochlorperazine available for the treatment of migraine. Prochlorperazine is only available in tablet form, which has delayed onset of action."

According to the FDA and the National Institutes of Health's medicine library, the generic drug prochlorperazine maleate is available in tablet form from Sandoz, the generics unit of Novartis, and Teva for the treatment of severe nausea and vomiting, schizophrenia and the short-term treatment of generalized nonpsychotic anxiety.

The Roseman University team hypothesizes that the reformulation will be effective, fast-acting and improve patient adherence, according to the release. It also avoids side effects associated with the use of preservatives.

Using high-performance liquid chromatography and microbiological assays, Yellepeddi showed that the nasal spray remained stable for up to 120 days, according to the release. Next, he will test the safety, efficacy and pharmacokinetics of the spray in rats. His research is being funded by a grant from the International Academy of Compounding Pharmacists Foundation.

While Yellepeddi's research is still in the early stages, in June, Avanir Pharmaceuticals touted positive results from a Phase III trial of its AVP-825 sumatriptan intranasal powder for migraines as compared with an oral formulation of the same treatment.

- read the release

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Migraines in children from toddlers to teens

This article discusses migraine headaches and how they present in children from toddlers to teenagers.

A toddler is having bouts of projectile vomiting, quite frequently but not every day. Fearing something is "terribly wrong" with her daughter's digestive system, her mother takes her to the doctor. Within 20 minutes, the pediatrician has traced the girl's symptoms to motion sickness – she gets sick every time she rides in the car, or shortly after. Although she's never had a headache, by age 3 the girl is diagnosed with the neurological disorder called migraine.

What Is Migraine?

A simple definition is a “recurrent, episodic headache, or head pain, that typically lasts between two and 72 hours untreated,” says Andrew Hershey, chair and a professor of neurology at Cincinnati Children's Hospital Medical Center​​​​. For some people,​ migraine comes with nausea or vomiting, while others experience light and sound sensitivity. Headaches are usually throbbing and partial​​ (involving one side of the head) and moderately or severely intense.​ Migraine has a strong genetic component.

Hershey, director of the CCHMC Headache Center, says while most migraine episodes come and go, they can evolve into chronic migraine: “About a third of our patients get to the point that the headache just never leaves them.”

At least 10 percent of kids have migraine, Hershey says.​ While the rate is about 4 percent in preschoolers, by late teens it affects up to 15 percent of boys and 20 to 25 percent of girls. The youngest patient Hershey ever treated started at 10 months old.

What Triggers Migraine​?

“Migraine is more than a headache. It’s a generalized disturbance of function that involves brain and body,” says Joel Saper,​ a neurologist and director of the Michigan Head Pain and Neurological Institute in Ann Arbor.

Although many people believe stress "causes" migraine, researchers are still working to determine the complex causes for the condition. What's known is that children have a variety of migraine triggers that can set off an episode, including food sensitivities, fatigue, bright lights, loud noises and sleep changes.​

In younger kids, non-headache signs or “migraine equivalents” can include stomach pain, episodes of dizziness, vertigo (spinning), visual disturbances and sudden mood changes, Saper says. Motion sickness is migraine equivalent, he notes, and it’s been recently established that colic in babies is a forerunner to migraine.

Before starting any kind of treatment, it’s crucial to pin down the diagnosis. Some 300 other medical conditions cause headache in kids, Saper says. Emotional causes also have to be ruled out – like school avoidance in a kid who’s anxious or being bullied.

For parents, Saper says it’s key to find a knowledgeable health care provider, whether it’s a specialist, family practice doctor, nurse practitioner or physician assistant.

Life With Migraine for Kids

Two decades ago, Cathy Glaser ​was concerned about her 3-year-old daughter Samantha, who was having cyclical bouts of vomiting and upset stomach. Through careful questioning, the pediatrician traced the episodes to motion sickness.

Glaser knows a lot about migraine. “We like to say my daughter was doomed since both parents have migraine. It runs through both of our families,” says Glaser, who eventually started the Migraine Research Foundation in New York.

Although Samantha was stoic, Glaser could always tell when she had a migraine coming on. “I could look into my daughter’s eyes and see she was getting a headache,” she says. “I could look at her face – she was ashen. All of a sudden those sparkly child’s eyes were absolutely dead. And her whole affect changed.”

Migraine invaded every aspect of Samantha’s childhood, and she visited the emergency room several times a year. It hijacked family trips. On their way to a family reunion at Hersheypark in Pennsylvania, they were forced to pull off the New Jersey Turnpike, because Samantha was green with motion sickness.

School presents many challenges for kids with migraine. Glaser says that as a parent, you need to be your child’s advocate. And you have to be proactive.

“I used to go to school every year at the beginning, or before, with a doctor’s note about migraine and my own daughter’s treatment explain when she raises her hand and says, ‘I need to take my medication now,’ they need to let her go,” she recalls.

Samantha “didn’t want to miss her life,” Glaser says. Even as an 8-year-old, she would say “Mom, I can be alone and feeling horrible, or I can be at school with my friends feeling horrible. I choose school.”

Every summer Samantha's parents sent her off to sleep-away camps, ​and every time they got calls in the middle of the night to come get her – the camp couldn’t handle it. “This is the life of a child who has regular headaches who insists on living the life of a kid,” Glaser says.

Sameness Helps

Boys and girls get headaches equally until age 12 or 13 – but when girls start their periods, the picture changes. Migraine is an “estrogen-vulnerable” disorder, Saper explains. Hormone cycling in girls and later women – from menstruation, oral contraceptives and menopause – can make migraines worse. Boys are more likely to grow out of migraines than girls.

As she entered her teens, Samantha developed menstrual migraine. (She also gets weather headaches, when there’s a change in barometric pressure or a storm’s coming on.)

With migraine, “Sameness helps,” Saper says. Sleep is a big issue, and regular bedtimes and waking times are important. If kids have trouble sleeping, he says melatonin “is a particularly good medicine” to help.

Some children with migraine are food sensitive. “What they eat may make a difference, whether it be the gluten, cheese or dairy products – there’s a long list,” Saper says. Kids shouldn’t miss meals or skip breakfast.

Dehydration can also trigger migraines, and healthy habits include drinking plenty of water or other non-caffeine drinks. Exercise also helps, and so do relaxation and stress-management techniques. 

Not Your Parents’ Headache

For migraine that goes beyond a headache or two a month, research suggests the best approach combines medication and cognitive behavioral therapy. The two main drug categories are medications for treatment and for prevention.

NSAIDs such as Aleve and Ibuprofen are used to break acute headaches in kids, Hersey says ­– aspirin should be avoided because of the risk of liver problems. And parents and patients should be alert to overuse. For prevention, the drugs amitriptyline and topiramate are most commonly prescribed.

At Cincinnati Children’s Headache Center, after kids undergo a neurological and headache exam, the team comes up with a multipronged treatment plan, including medication choices and learning healthy habits. Kids with chronic headaches return for cognitive behavioral therapy, which takes about six weeks to absorb.

Part of the goal is getting kids to accept that they have a chronic illness and teaching them to manage their own care, Hershey says: “We often say to the kids, ‘It’s your headache – it’s not your mom and dad’s.”

Scott Powers, a pediatric psychologist at the center, is working with his team to fine-tune a migraine app that kids can use to track their episodes and symptoms electronically. The app also allows researchers to better connect the dots between triggers and headache timing.

College and Migraines

With the importance of regular sleep, healthy eating habits and keeping stress on an even keel – what could possibly go wrong when kids with migraine leave for college?

But when the time came, Samantha insisted on going away to a big school, Glaser says. After much discussion they agreed that Samantha would go to a school within driving distance, near a hospital and with a well-staffed campus health center.

“Her view about college was ‘I want to stop being 'Migraine Girl,'" Glaser recalls her daughter saying. “’I want to stop being defined by my disease.’” 

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Link found between migraines and seizures

This article explains a link found in the brain between migraine headaches and seizures.

Seizures and migraines have always been considered separate physiological events in the brain, but now a team of engineers and neuroscientists looking at the brain from a physics viewpoint discovered a link between these and related phenomena.

Scientists believed these two brain events were separate phenomena because they outwardly affect people very differently. Seizures are marked by electrical hyperactivity, but migraine auras -- based on an underlying process called spreading depression -- are marked by a silencing of electrical activity in part of the brain. Also, seizures spread rapidly, while migraines propagate slowly.

"We wanted to make a more realistic model of what underlies migraines, which we were working on controlling," said Steven J. Schiff, Brush Chair Professor of Engineering and director of the Penn State Center for Neural Engineering. "We realized that no one had ever kept proper track of the neuronal energy being used and all of the ions, the charged atoms, going into and out of brain cells."

Potassium and sodium contribute the ions that control electricity in the brain. The Penn State researchers added fundamental physics principles of conservation of energy, charge and mass to an older theory of this electricity. They kept track of the energy required to run a nerve cell, and kept count of the ions passing into and out of the cells.

The brain needs a constant supply of oxygen to keep everything running because it has to keep pumping the ions back across cell membranes after each electrical spike. The energy supply is directly linked to oxygen concentrations around the cell and the energy required to restore the ions to their proper places is much greater after seizures or migraines.

"We know that some people get both seizures and migraines," said Schiff. "Certainly, the same brain cells produce these different events and we now have increasing numbers of examples of where single gene mutations can produce the presence of both seizure and migraines in the same patients and families. So, in retrospect, the link was obvious -- but we did not understand it."

The researchers, who also included Yina Wei, recent Penn State Ph.D. in engineering science and mechanics, currently a postdoctoral fellow at University of California-Riverside, and Ghanim Ullah, former Penn State postdoctoral fellow, now a professor of physics at University of South Florida, explored extending older models of brain cell activity with basic conservation principles. They were motivated by previous Penn State experiments that showed the very sensitive link between oxygen concentration with reliable and rapid changes in nerve cell behavior.

What they found was completely unexpected. Adding basic conservation principles to the older models immediately demonstrated that spikes, seizures and spreading depression were all part of a spectrum of nerve cell behavior. It appeared that decades of observations of different phenomena in the brain could share a common underlying link.

"We have found within a single model of the biophysics of neuronal membranes that we can account for a broad range of experimental observations, from spikes to seizures and spreading depression," the researchers report in a recent issue of the Journal of Neuroscience. "We are particularly struck by the apparent unification possible between the dynamics of seizures and spreading depression."

While the initial intent was to better model the biophysics of the brain, the connection and unification of seizures and spreading depression was an emergent property of that model, according to Schiff.

"No one, neither us nor our colleagues anticipated such a finding or we would have done this years ago," said Schiff. "But we immediately recognized what the results were showing and we worked intensively to test the integrity of this result in many ways and we found out how robust it was. Although the mathematics are complex, the linking of these phenomena seems rock solid."

The ability to better understand the difference between normal and pathological activity within the brain may lead to the ability to predict when a seizure might occur.

"We are not only interested in controlling seizures or migraines after they begin, but we are keen to seek ways to stabilize the brain in normal operating regimes and prevent such phenomena from occurring in the first place," said Schiff. "This type of unification framework demonstrates that we can now begin to have a much more fundamental understanding of how normal and pathological brain activities relate to each other. We and our colleagues have a lot on our plate to start exploring over the coming years as we build on this finding."

The National Institutes of Health and the Mathematical Biosciences Institute of the National Science Foundation supported this work.

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Weight loss surgery and severe headaches

A study claims that weight loss surgery can increase a person's likelihood of having severe headaches.

After weight-loss surgery, some patients may be at risk for developing severe headaches, a new study suggests.

In a small number of people, the surgery was associated with a condition known as spontaneous intracranial hypotension -- or low blood pressure in the brain. The condition can trigger headaches while standing that disappear when lying down. These headaches can be accompanied by nausea, vomiting, neck stiffness and difficulty concentrating, the researchers added.

But Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City, said the study is too small to be able to draw any firm conclusions.

"You're talking about 11 people out of more than 300, and that's a low number," said Roslin, who had no part in the study. "The other thing that's strange is that these headaches showed up an average of 56.5 months after surgery, which is a long time.

"This would not be my concern if I was contemplating bariatric surgery," Roslin said.

The report was published online Oct. 22 in the journal Neurology.

Although it is not clear why this condition might develop after weight-loss surgery, the researchers speculated that significant weight loss alters pressure in the brain, which might uncover a pre-existing condition that causes fluid to leak from the spine and trigger severe headaches.

While the study showed an association between weight-loss surgery and an increased risk of severe headaches, it did not prove a cause-and-effect link.

For the study, a team led by Dr. Wouter Schievink, of Cedars-Sinai Medical Center in Los Angeles, studied 338 people with spontaneous intracranial hypotension. They compared these people with 245 people with unruptured intracranial aneurysms -- a weak spot in a blood vessel in the brain that can break and cause bleeding, another condition that can cause headaches.

The researchers found that 11 of those with spontaneous intracranial hypotension had weight-loss surgery, compared with two of those with intracranial aneurysms (3.3 percent versus 0.8 percent).

Among those who had weight-loss surgery, headaches started within three months to 20 years after the procedure.

Of the 11 people who had weight-loss surgery and spontaneous intracranial hypotension, treatment relieved the headaches in nine cases. Two patients continued to have headaches after treatment, the researchers found.

"It's important for people who have had bariatric surgery and their doctors to be aware of this possible link, which has not been reported before," Schievink said in a statement. "This could be the cause of sudden, severe headaches that can be treated effectively, but there can be serious consequences if misdiagnosed."

Dr. John Morton, chief of bariatric and minimally invasive surgery at Stanford University School of Medicine, noted that obesity increases pressure in the brain and is a more common cause of headaches.

"When you carry excess weight, you have increased pressure in the brain," Morton explained.

In some patients, that increased pressure leads to headaches and even blindness, which are actually relieved by weight-loss surgery, he noted.

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Your sinusitis may be a migraine

This article explains that many sinusitis diagnoses may actually be misdiagnosed migraine headaches.

Many people with migraine headaches are first misdiagnosed with, and treated for, sinusitis problems leading to an impaired quality of life, according to migraine expert and surgeon Elliot Shevel from the Headache Clinic, a group of private treatment facilities across the country.

New research has been published in recent years confirming the trend, said Shevel, and showing “the importance of clinicians making a proper and correct diagnosis”.

Painful effects
According to United States-based medical research organisation Mayo Clinic, migraines are chronic headaches commonly accompanied by symptoms such as nausea and sensitivity to light and sound. They are caused by the “activation of a mechanism deep in the brain that leads to the release of pain-producing inflammatory substances around the nerves and blood vessels of the head”, according to the World Health Organisation’s website. 

Sinusitis is inflammation of the cavities around the nasal passages and can be caused by having a cold, allergies and bacterial or fungal infections, according to Mayo Clinic. 

In a 2013 study published in the Journal of Headache and Pain, 130 migraine patients in Kuwait were asked about their headache history. More than 80% had been initially misdiagnosed as having sinusitis, with the correct migraine diagnosis taking anywhere from one to 38 years of seeking treatment.

Most of the 80% of patients who had been misdiagnosed previously were treated with medication, but 12% underwent surgery to help alleviate sinusitis.

The reason for the high rate of misdiagnosis, according to the researchers, is that “symptoms suggestive of sinusitis are frequently seen in migraine patients”, including congestion in the nasal passageways prompting them to call for general practitioners to be more aware of the diagnostic criteria for migraine.  

Medication overuse
An inaccurate migraine diagnosis can lead to further problems such as medication overuse headaches, said Headache Clinic managing director Daniel Shevel.

Medication overuse headaches occur when chronic use of painkillers begins to cause head pain. Migraine sufferers who receive little relief from sinusitis medication may begin to self-medicate in this way, according to Shevel. 

“Sufferers are between a rock and a hard place – if they resist the pain medication they suffer the pain, but if they take it they make future pain more likely.”

Migraines can be debilitating and some last for up to 72 hours, but there are effective treatments available, said Shevel. “The first step, however, is being accurately diagnosed.”

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The impact of migraines on the whole family

This article discusses the impact that migraine headaches have on the entire family.

Most Migraine sufferers will tell you that their migraines are worsened by stress. Stress can come from a number of sources, but the ones that seem to be on the top of the list are school, or work, and family. Though all three are tremendously significant, it is infinitely easier to change a classroom, school or even job than it is to change one’s family.

Whether it be marital discord, money concerns, or parent – teen conflict, families issues have a tremendous impact on the migraineur and ignoring this is likely to result in less than successful migraine therapy.

On the flip side, having a supportive, understanding family can be an enormous help to the migraine sufferer…to an extent. Unfortunately, we find that very often with our adolescent patients, the parents are too focused on the migraine; so called “helicopter parents” who are hovering over their teen with repeated inquiries about their pain. In my clinic I had one parent ask her 16 year old son how he was feeling 4 times in a 15 minute visit. This kind of attention only serves to increase the focus on a problem that we are trying to minimize.

Often, having the whole family involved in the therapeutic process is the answer. It may mean scheduling visits at a time that spouses or parents are available, and it may involve family counseling. People often find the prospect of family counseling threatening. It really should not be viewed as such. Seldom do people take classes on being a spouse or a parent before having to be one. Processes that seem right and become family habit sometimes are detrimental in ways not obvious to those involved.

Making the effort to work on sources of family stress and how the family responds to them; learning to be supportive without being overbearing can be the key to improving the life not only of the migraineur, but the whole family.

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When to go to the hospital for a migraine

This article explains when it is appropriate to go to the hospital for a migraine headache.

Headache is one of the most common reasons for an emergency room visit. Some people go due chronic headache or Migraine problems that do not go away with treatment, and in other cases, headache is a symptom of another medical problem.

The best reason for an ER visit is for unusual symptoms that are new to you. You may seek attention to make sure there is no chance of another problem such as aneurysm or meningitis. A severe headache that starts very suddenly (within a second or two) can mean another disorder such as stroke. New symptoms such as a fever, weakness, vision loss or double vision, or confusion are some of most concerning symptoms. If you have a new symptom and serious, life-threatening medical problems such as liver, heart or kidney disease, are pregnant, or have a disorder which affects your immune system such as HIV infection, an ER visit may be more essential.

For many patients, an ER visit for headache or Migraine happens after a long period of severe headache lasting days or weeks. After long time of experiencing severe headache, you may reach the "last straw" and no longer be able to deal with the problem. ER doctors are not specialists in headache and Migraine, and their goals are to make sure there is no serious life-threatening problem and help reduce suffering. Different ER doctors have different ways to treat acute headache and Migraine: there is no universal protocol for emergency treatment of headache disorders.

When going to the ER, be sure to mention:

• your symptoms, including any that are new or unusual for you;
• any medications you have taken, especially in the last few days; and
• if you have had good results from a particular medication regimen, that can be helpful to the ER.

Often ER doctors will want to order tests such as a CT scan of the head or spinal tap to make sure there is no bleeding in the brain, large stroke or meningitis. If you are having your typical severe headache or Migraine, and no new symptoms, the chance these tests will be helpful are extremely low and you have the right to refuse them. (See 5 Things Migraine and Headache Patients and Doctors Should Question.)

The majority of persons coming to an ER for severe headache or Migraine do not get lasting results from the medications given in the ER, so having a good long-term plan and relationship with an outpatient doctor who treats your headache disorder is very important. If you have even occasional long-lasting headaches or Migraines, a good preventive plan is very important, and you should have at least one rescue medication to prevent future ER visits.

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New noninvasive device for migraines - Using Cefaly in The Office to Treat Headaches.

A new noninvasive device has been developed to treat migraine headaches.

I have been very impressed so far. - JR

Two new prescription devices approved by the U.S. Food and Drug Administration (FDA) may provide some relief for people with migraine headaches who don't tolerate migraine medications well, according to a new study.

One device -- the Cefaly -- is designed to prevent migraines, while the other device -- the Cerena -- is meant to be used when migraines first start, according to an FDA news release.

"Patients have been looking for alternative migraine treatments. Because these devices aren't ingested or metabolized like drug therapies, they don't necessarily have the same types of side effects," Michael Hoffmann, a biomedical engineer with the FDA, said in the news release.

Migraines involve severe pulsing or throbbing pain in one part of the head. These intense headaches can also cause people to develop nausea and vomiting as well as sensitivity to light and sound. About one-third of people with migraines experience an aura, or visual effects such as flashing lights, dots or a blind spot, which marks the onset of the headache, said the FDA.

Migraines can last as long as 72 hours if left untreated. These headaches affect 37 million people in the United States. Although anyone -- even children -- can get migraines, women are affected more often than men, the FDA reported.

"There are many drugs to reduce migraine pain and symptoms," said Dr. Eric Bastings, a neurologist with the FDA, in the news release. "Although these drugs are quite effective, they are not for everyone. Some can make you tired, drowsy or dizzy. Some can affect your thinking. And some migraine drugs can cause birth defects; so pregnant women can't use them," he said.

The Cerena Transcranial Magnetic Stimulator can be used as soon as patients feel a migraine coming on. It's held against the back of the head. After pressing a button, a very short magnetic pulse stimulates the area of the brain that processes visual information, the FDA said.

The Cefaly transcutaneous electrical nerve stimulation device is also FDA-approved as a preventative treatment for migraine. Patients can use this device daily before a migraine develops. This portable, battery-powered device involves an electrode patch that is placed on patients' foreheads. The patch is connected to a headband. The device sets off an electrical current to stimulate a large nerve in the head that has been linked to migraines, the agency said.

"It's a set-time therapy -- running for 20 minutes and stopping automatically," Hoffmann noted.

Reported side effects for both devices were minor and resolved quickly, including:

• Skin irritation
• Discomfort
• Sleepiness
• Dizziness
• Pain at site of application

The FDA researchers noted the safety and effectiveness of the Cerena and Cefaly have not been evaluated in use by children, pregnant women and those with pacemakers.

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Screening tool available for chronic migraines

This article describes a new screening questionnaire for chronic migraines.

Researchers have developed a new tool that can accurately identify patients with chronic migraine (CM).

The screening questionnaire — called the ID-CM — can potentially be used by physicians or by patients themselves.

"The way we imagine it in clinical practice is that someone completes this questionnaire in a physician's office and it provides a suggestion that the patient may have chronic migraine," said researcher Dawn Buse, PhD, director of Behavioral Medicine, Montefiore Headache Center, Bronx, New York. "The physician would still go through a careful history and physical and complete the diagnostic criteria."

"It may be helpful for people living with chronic migraine who don't realize there's a term for what they're living with," she said. "It might help connect them with specialist health care professionals who can treat them well, and it may help connect them with the right treatment."

The only treatment approved by the US Food and Drug Administration for chronic migraine, defined as having 15 or more migraine days a month, is onabotulinum toxin A (Botox, Allergan Inc), although patients do use other migraine therapies, including triptans.

Dr. Buse presented the research, funded by Allergan, here during PAINWeek.

Rigorous Process

Developing the tool took almost 3 years and involved a rigorous multi-step process. The research team reviewed existing instruments, sought input and consensus from headache physicians and research scientists from around the world, and had a group of people with CM assess the relevance of the questions being developed.

Another important step in the development process was psychometric validation. "This is where we look at someone with chronic migraine, someone with episodic migraine, and someone with no headache and see how well a particular item (for example, whether the pain is pulsating or how often the pain is severe) identifies or separates the different groups," explained Dr. Buse.

As well, headache experts used a semi-structured clinical interview to provide their own diagnosis, which was used as the gold standard. Compared to this gold standard, the screening tool had a sensitivity of 82%, a specificity of 87%, a negative predictive value of 77%, and a positive predictive value of 90%.

Among other things, the final 12-item screening tool asks respondents how often their pain is moderate or severe, how often they're unusually sensitive to light and sound, how often they feel nauseated or sick to their stomach, and how often they worry about missing work, school, or social events because of headaches.

Despite its substantial economic and quality-of-life burden, chronic migraine remains underdiagnosed and undertreated.

Dr. Buse and her colleagues hope to have the screening tool available in the next month or 2 and are working on a manuscript for possible publication.

Findings Relevant

Asked to comment, pain expert Lynn Webster, MD, vice president, scientific affairs, PRA Health Sciences, Salt Lake City, Utah, said he thought Dr. Buse's presentation was "very interesting" and relevant to the average physician who sees many patients with headaches in his or her daily practice.

"An accurate diagnosis is challenging for many physicians and a tool to help make that diagnosis would be welcomed," said Dr. Webster.

The tool appears to be reasonably accurate and sensitive, "which is always a challenge in developing such tools," added Dr. Webster.

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