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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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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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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Headaches in children

This article discusses headaches in children, which is becoming more prevalent as the school year begins.

As the school year approaches and begins, many parents may start to hear their children complain about headaches.

According to Nick DeBlasio, MD, a pediatrician in Cincinnati Children's Hospital Medical Center's Pediatric Primary Care Clinic, about 10% of school-aged children and 15-27% of teens experience them from time to time.

Headaches can be triggered by a number of different things. Here are the most common causes of occasional headaches in children:

Inadequate hydration. Not drinking enough fluids is one of the biggest causes of headaches. This is especially true when the weather gets warmer and kids become more active outside and lose fluid through sweating. If this is the case, the cure might be as simple as having your child drink more water.

Diet. Does your child eat regular meals? Skipping one meal, like breakfast, can trigger a headache. It's also important to make sure that your child is eating a well-balanced diet with lots of fruits and vegetables. Too much caffeine and certain foods can cause a headache as well.

Sleep. Kids in middle and high school typically need at least 10-12 hours of sleep a night. Not sleeping enough at night can cause a headache. And getting less than 10 hours isn't enough to feel well-rested.

Stress. We all experience stress from time to time, and children and teens are no exception. If your child is under a lot of pressure from school, or experiencing big changes at home like a divorce or a big move, a headache can result.

Vision problems. If your child is unable to see what's happening at the front of the classroom, he might be straining his eyes to see far away, which can result in a headache. A vision test can give you a better understanding of whether or not your child's headaches are being caused by vision problems.

Family history. Your child is more likely to have headaches if a parent gets them as well.

If your child has a headache, try giving her water and over-the-counter ibuprofen. Follow the instructions on the package for the appropriate dosage and do not give it to your child more than three times in a week. If it persists for a few days or worsens, call your child's pediatrician.

Fortunately the majority of headaches in children are not a cause for alarm. However, there are a few instances which require a little more investigation. If your child's headaches have become more frequent or severe, if he wakes up in the morning of the middle of the night from it, or if the headache causes vomiting, it's best to have your child evaluated by your pediatrician.

He or she will perform a physical exam and decide if any tests need to be done. Brain MRIs and CT scans are rarely needed. If your pediatrician suspects a migraine, she might refer your child to a neurologist who is familiar with medications to help prevent and treat them.

And if your child or teen is suffering from chronic headaches and migraines, recent research by Cincinnati Children's found that adding cognitive behavioral therapy to treatment of pediatric migraines improves relief.

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How to manage your migraine headaches

This article discusses how to manage and cope with migraine headaches.

Migraines can be debilitating, and can affect people in different ways. There may be blurred vision, a pulsating headache, nausea, vomiting, etc. They can negatively affect your work, social life and general well-being. Therefore, learning ways of coping with migraines is very important.

Migraines occur when certain arteries in your head constrict and dilate. This may stimulate a pain response in some nerves.

Although the exact mechanisms that cause migraines are not clearly understood, there are a number of factors that have been associated with increased incidence and severity of these headaches. These may include hormones, mental state, diet and environment.

The hormonal fluctuations in a woman's menstrual cycle often trigger migraines. If women suffer from migraines during other times, they are often not as severe. Furthermore, hormonally induced mood changes are also associated with migraines.

Your mental state is an important consideration in these headaches. Stress (including Post Traumatic Stress Disorder) and depression have both been associated with increased incidence, as has chemical exposures and even obesity.

Diet is obviously an important consideration. The foods we eat can not only affect our weight, but also have the potential to trigger migraines in other ways. Food sensitivities should definitely be considered in treating migraines, as their elimination may decrease the amount of migraines experienced.

Because so many imbalances are associated with migraine headaches, working toward correcting the imbalances that contribute to migraine triggers are an important aspect of treatment.

Therapies such as herbal and homeopathic remedies in combination with lifestyle choices and diet may be used to gently detoxify your body. This may be used to help eliminate harmful chemicals and toxins, thus supporting the normal function of your body. By doing this, the factors affecting hormonal imbalances and chemical triggers may be reduced.

Another treatment that may be considered is acupuncture. Acupuncture may be used to balance your body's energetic system and is an amazing tool for pain relief.

By working toward bringing balance to your body and mind, a number of factors such as your hormones and mental and emotional well-being may be improved. By improving these factors, it may be possible to reduce the incidence and severity of the migraines you experience.

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Common treatments for migraines

This article provides information on migraine headaches and discusses treatments for migraine headaches.

Suffering from migraines can have a seriously negative impact on both your work and social life, but what exactly causes those splitting headaches?

Men, women and children can suffer from migraines. Some people may have a migraine as often as a few times a week, whereas others might only experience them occasionally.

According to the NHS, there are several types of migraine. These include:

• Migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights.

• Migraine without aura – where the migraine occurs without warning signs.

• Migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.

Although the exact cause of migraine is unknown, triggers are thought to include hormonal, emotional, physical, dietary, environmental and medical changes to your usual routine.

If you suffer from regular migraines it is important to visit your GP, as some experts have found migraines to indicate other underlying health issues such as abnormal blood vessel structure in the brain.

Migraine remains undiagnosed and under-treated in at least 50% of patients, and less than 50% of migraine patients consult a physician – but your GP could really help you to reduce your suffering.

GPs can help you to identify the triggers of your migraine and also prescribe medication to help you manage your condition like painkillers, triptans (medications that can help reverse the changes in the brain that may cause migraines), or anti-emetics (medications often used to reduce nausea and vomiting).

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App to track migraine headaches

An app, currently only available overseas, helps people track what triggers their migraine headaches.

A new migraine tracking smartphone app analyses what causes your headaches and suggests how to stop them from happening.

The app, Migraine Buddy, asks questions about your migraine, habits, and medication with a questionnaire.

It also collects data about your sleep and movement patterns using your smartphone’s sensors.

Once the app collects enough data, it creates a report highlighting when the symptoms happened, and what were the top triggers.

It also finds out the most effective medication for you by recording when you used them and comparing that information with the severity of the migraines, Mashable reported.

“It mimics how a doctor prescribes different medication to patients to figure out what works,” said Veronica Chew, co-founder of Healint, the Singapore-based company behind Migraine Buddy.

“Most other migraine apps are not as comprehensive. We collect data that’s action-driven, so that we can help patients make the right decisions,” Chew said.

Currently, the application is only available in Singapore through a neurologist that is working with Healint.

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What to do about chronic headaches

This article discusses chronic headaches and what you can do about them.

From drinking too much last night to stressing out about finances or family concerns, there are so many possible causes of the common headache. However, when headaches go from being few and far between to frequent and long-lasting, it may be time to make an appointment to see your primary care physician.

"Practical clinical criteria defines chronic migraine as a headache that occurs greater than 15 days a month with each headache episode lasting longer than four hours for at least three consecutive months," said Dr. Denis G. Patterson, medical director of the Northern Nevada Pain Center and founder of Nevada Advanced Pain Specialists. "It does not matter how severe the headaches are — the medical term for chronic headaches is migraine headache."

According to Patterson, who is board-certified in pain medicine and physical medicine and rehabilitation, common headache triggers include hormonal changes in women, stress and changes in sleep patterns. Certain foods, such as alcohol, aged cheeses, chocolate, aspartame, too much caffeine, monosodium glutamate, processed and salty items, also may set off headaches. Among other potential triggers are bright lights, loud sounds, unusual smells, changes in the weather or barometric pressure, intense physical exertion or sexual activity.

"The causes of chronic headaches are not well understood," Patterson said. "Medical experts believe that genetics and environmental factors seem to both play a role."

No matter the cause, if you find that you're hampered by headaches a little too often, experts suggest first making an appointment with your primary care physician. If unable to alleviate the headaches, this doctor may then refer you to a headache specialist, such as a neurologist or pain management physician.

"A physician trained in treating headaches will likely diagnose the condition on the basis of your medical history, a review of your symptoms, and a physical and neurological examination," said Patterson, who specializes in common and complex neurological disorders, as well as musculoskeletal issues. "Your doctor may also recommend a variety of tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe."

As for treating chronic headaches, there are quite a few options for today's patients. Your doctor may advise starting with noninvasive and nonpharmacological solutions to see if the migraines can be reduced naturally. For example, you may be encouraged to engage in muscle relaxation exercises and commit to getting enough sleep. Other treatment options may involve alternative medicine, such as acupuncture or massage therapy.

Pain-relieving medications or preventive medications also might be prescribed to address chronic headaches. Finally, certain patients may need injections to ease or prevent the pain. This might involve the use of nerve blocks, nerve stimulators or Botox injections.

"Botox is the first and only preventive treatment approved by the FDA for adults with chronic migraine," Patterson said. "It may reduce the number of headache days a month and/or decrease the severity of headache episodes."

Without treatment, the frequent pain of chronic headaches can lead to decreased quality of life. If you find that your headaches go beyond the occasional hangover or tension-filled day, reach out for relief.

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Migraines worse for women during menopause

A study claims that women's migraines may get worse during menopause.

New research confirms what women with migraine headaches have told their doctors for years: migraine attacks seem to get worse in the years before and during menopause.

"In women who have migraine, headaches increase by 50 to 60 percent when they go through the perimenopause and menopausal time periods," said Dr. Vincent Martin, professor of medicine and co-director of the Headache and Facial Pain Program at the University of Cincinnati.

The new finding, Martin said, "basically confirms what women have been telling us physicians for decades. We finally have some evidence."

The perimenopausal period is the time when the body is transitioning to menopause -- when monthly periods end. Perimenopause can last several years, and is often marked by irregular periods, hot flashes and sleep problems. Perimenopause can begin in the 40s, and menopause occurs, on average, at age 51, according to the U.S. National Institute on Aging.

The study is due to be presented on Wednesday at the American Headache Society annual meeting in Los Angeles. Findings presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

Martin and his colleagues surveyed just over 3,600 women, aged 35 to 65, in a mailed questionnaire that asked about their menopausal status and whether they had migraines and, if they did, how often. The women were classified as having high frequency headaches if they had 10 or more headache days a month.

The women in the study were about evenly divided among the three groups: premenopausal, perimenopausal and postmenopausal.

While 8 percent of the premenopausal group had frequent headaches, 12.2 percent of the perimenopausal group did along with 12 percent of the menopausal women.

At first, the results might seem puzzling, since experts know that younger women often get migraines right before and at the beginning of the menstrual cycle, said study researcher Dr. Richard Lipton, director of the Montefiore Medical Center Headache Center and professor of neurology at the Albert Einstein College of Medicine, in New York City.

"Women with migraine are most likely to get them a couple days before bleeding through the first few days of the cycle, when estrogen and progesterone both fall. The idea that women who have fewer periods [during perimenopause] would get more migraines seems paradoxical," said Lipton.

However, he said, experts believe decreasing estrogen levels explain the headaches in both cases.

The study provides welcome information on the problem of migraines, according to Dr. Elizabeth Loder, chief of the division of headache and pain in the department of neurology at Brigham & Women's Hospital in Boston.

"I think this study is particularly valuable because they went to the trouble of carefully determining what phase the women were in," she said.

Loder agreed that the study validates what patients have been telling doctors for years. Its size also lends credibility.

However, she said, it's important to put the study in perspective. "Although the relative differences [in headache frequency] between groups look big, the absolute numbers are not," Loder said. She pointed out that 8 percent of premenopausal women and about 12 percent of older women had frequent headaches.

For relief, Martin suggested, women could ask their headache specialist about adjusting or switching their migraine medicine.

The women might also ask about taking hormone replacement therapy for a brief time, he added, reasoning that raising estrogen might help decrease headaches. However, women and their doctors should discuss the benefits and the risks -- such as an increased risk of stroke -- with hormone use.

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Facts about migraines

This article details facts about migraines, and discusses some tips for treatment.

While many people turn to prescription drugs to try to control migraines once they start, there aren’t any that are terribly effective and none that will stop the migraines before they happen. There is, however, another option and it doesn’t involve taking medication.

The Problem

Almost 5 million people in the U.S. experience at least one migraine attack a month. More than 11 million people blame migraines for causing moderate to severe disability and 91 percent of them can’t function normally during migraine attack, according to the American Migraine Study, which also reveals that the average migraine sufferer misses two days of work per year.

It’s an expense both in terms of career—lost work—and medical costs. Migraine sufferers use 2.5 times the amount of prescription drugs and have six times as many diagnostic tests and services as nonsufferers. The average monthly health cost of a migraine sufferer is 60 percent higher than that of people who don’t suffer from migraines, according to the National Institutes of Health.

According to The Migraine Trust, migraine often occurs for the first time in teens and young adults but is most common in the 30-something age group.

Who Can Help

Specially trained neuromuscular dentists can perform a dental procedure that can help. They use special equipment to find the optimal resting position of the jaw and create an orthotic—which looks like an athlete’s mouth guard. When inserted into the mouth, it can change your bite. Many treated this way find their chronic migraines are prevented.

Why It Works

That’s because chronic moderate to severe headaches, including migraine, are a common indicator of malocclusion, or a bad bite, commonly called TMD or jaw joint disorder.

“That’s particularly true of headaches that are focused behind the eyes, near the temples, around the jaw and ears, or at the back of the head in the area of the neck and shoulders,” explains Mark Duncan, clinical director at LVI Global, where many of the dentists train.

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Headaches in pregnant women

A review of headaches during pregnancy shows that there are 85 different types of headaches a pregnant woman can have, some of which may be serious.

Most headaches in pregnancy and the postnatal period are benign, but healthcare professionals must be alert to the rarer and more severe causes of headaches, suggests a new review published today (23 May) in The Obstetrician & Gynaecologist (TOG).

The review looks at common causes for headaches during pregnancy and the postnatal period, possible conditions that may be associated with headaches and how healthcare professionals should manage the care of the woman appropriately.

There are 85 different types of headache. Approximately 90% of headaches in pregnancy are migraine or tension-type headaches. However, pregnancy can lead to an increased risk of certain secondary headaches, a headache caused by an underlying health condition, states the review.

The review states that most headaches in pregnancy are benign but in some cases can be more serious. According to the Confidential Enquiries into Maternal Deaths in the United Kingdom 2006 -- 2008 report[i], neurological conditions were the third most common cause of death, considering both direct and indirect causes. The authors of the review therefore emphasize the need for all medical staff to be well trained to take a full history and examination, make a provisional differential diagnosis and know when to seek neurological expertise.

Migraine is a common form of headache; the condition is more common in women, with the highest prevalence rates during the childbearing years. The review states that pregnancy leads to a reduction in the frequency and severity of attacks of migraines without aura, also known as a common migraine. However, women who do experience migraines have a more than two-fold increased risk of pre-eclampsia than those who do not. Women therefore need to be aware to consult a healthcare professional if their headache is different from their usual migraine, highlights the review.

Another condition associated with a headache in pregnancy is idiopathic intracranial hypertension, a build up of high pressure inside the skull, a rare condition but more prevalent in obese women of childbearing age. The condition may present for the first time in pregnancy and pre-existing disease tends to worsen in pregnancy. It can be fatal if it is not treated promptly as a medical emergency.

Pregnancy is also a recognized risk factor for cerebral venous thrombosis (CVT), the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Caesarean section, systematic infection, vomiting and anemia increase the risk and headache is the most frequently (80 -- 90%) occurring symptom in CVT and often the first symptom reported by patients.

The review also discusses imaging and advises that imaging of the brain should never be withheld because a woman is pregnant and women should be reassured that imaging is safe.

Kirsty Revell, Specialist Registrar, Obstetrics and Gynaecology at the Princess Anne Hospital, Southampton and co-author of the review said: "Headaches are common in life and in pregnancy. Most headaches are benign, for example migraine or tension headaches, but some headache types can be more serious and an indication that something is seriously wrong.

"It is vital that both GPs and obstetricians are aware of the signs and symptoms associated with these conditions and know when to seek advice from a specialist."

Jason Waugh, TOG Editor-in-chief added: "Many women experience headaches during pregnancy and the postpartum period and most are managed by women themselves or within primary care.

"Women presenting with headaches in pregnancy and the postnatal period may be at home, on a maternity ward, in an antenatal clinic, at a tertiary referral centre or in an emergency department. All medical staff should be aware of the symptoms, signs and appropriate response to the rarer and more severe cause

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Link between migraines and bipolar disorder

A study shows that there may be a link between migraine headaches and bipolar disorder.

Doctors who work with patients with bipolar disorder should keep in mind that those people are also at high risk for migraine headaches, a Pennsylvania State University researcher says.

A new study led by Erika Saunders, executive vice-chair of psychiatry at the Penn State Milton S. Hershey Medical Center, found that people with bipolar disorder were far likelier than the general population to get migraines and that those who got the awful headaches were at risk for worse psychosocial functioning, more severe depression, and earlier onset of bipolar symptoms.

"All of those are markers for more severity of bipolar disorder," Saunders said.

Bipolar disorder, which affects 2.6 percent of the U.S. population, is characterized by extreme mood shifts. Symptoms can include hallucinations and delusions.

Six percent of Saunders' healthy control group had migraines, compared with 31 percent of the 412 bipolar patients. In both groups, migraines were more common in women than in men.

Men with bipolar disease who got migraines tended to have bipolar II, a variant with more severe depression and less severe mania or "high" periods.

Migraine was more common in patients who had suffered emotional or sexual abuse or emotional neglect.

The study, done with researchers from the University of Michigan, was published in the Journal of Clinical Psychiatry.

Saunders suspects that many psychiatrists do not know their patients also have migraines. The doctors may be distracted by the many other medical problems such patients tend to have. Patients may consider headaches a problem for a primary care doctor, not a psychiatrist.

She now wants to explore the possibility of a shared biological link between bipolar disorder and migraine. Valproic acid, an antiseizure medicine, is used to treat mania and prevent migraines. Abnormal inflammatory mechanisms have been found in both, and both are episodic conditions. "There is something going on in the brain that's happening only at certain times for some reason," she said.

Saunders plans to study a dietary program she hopes will affect the inflammatory response, improve mood stability, and reduce migraines. She said it would involve changing the intake of fatty acids, but wouldn't talk about the details.

Some patients, she said, have more stable moods when their migraines are well-controlled.

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