How to spot migraine headaches

This article discusses how to spot a migraine headache from other types of headaches.

Migraines are severe headaches that are extremely tough to deal with, but how would you know if you  are suffering from a migraine or just a normal headache? Well, here are the symptoms of a migraine that can help you tell it apart from just another headache.

The symptoms vary

It is important to realize that the symptoms of migraines are extremely subjective – they differ from person to person. Moreover, there are actually three phases to a migraine – before the onset of the condition called prodrome, during the episode and after the episode (postdrome). Here is what you might experience in all three states.

Before a migraine starts

Some people report experiencing depression, irritability, excessive hunger, thirst, feeling of euphoria (in some cases), and restlessness and nervousness.

Another phenomenon of a migraine is that some people notice an aura. People notice this about thirty minutes before a migraine strikes and it usually appears as wavy lines, or a bright flashes of light. Some of them also experience a ‘pins-and-needles’ sensation down one’s hands, arms and face.

During the migraine:

This is usually the most painful and debilitating part of the condition. A person suffering from it will notice the following symptoms:

• Throbbing pain on one or both side of one’s head
• Pain behind the ears
• A headache that is extremely severe and inhibits normal activity
• Pain that gets worse with normal, everyday activity
• Nausea and vomiting
• Pain that gets worse when there is light, too much sound, and sensitivity to some smells.

While these are the most common symptoms, there are other uncommon symptoms like tingling around the face, arms and shoulders, inability to speak and experiencing temporary weakness on one side of the body.

After the migraine:

After the migraine has passed patients usually feel tired, fatigued and in some cases dizzy. There are rare cases where some people feel euphoric after an episode of migraine.

But, not all headaches are migraines:

While these are the most common symptoms of a migraine, a severe headache can also be a sign of other more serious conditions. If you experience sudden ‘thunderclap’ (extremely painful) headaches, a headache with fever, confusion and disorientation or those kinds of headaches that get worse on coughing or exertion etc, visit your doctor  immediately. They could be a sign of something far more serious.

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Headaches and migraines in teens can be caused by chewing gum

Headaches and migraines in teenagers could be caused by or worsened by frequently chewing gum due to the joint between the jaw and the skull.

Teenagers are notorious for chewing a lot of gum. The lip smacking, bubble popping, discarded gum stuck to the sole give teachers and parents a headache.

Now, Dr. Nathan Watemberg of Tel Aviv University-affiliated Meir Medical Center has found that gum-chewing teenagers, and younger children as well, are giving themselves headaches too. His findings, published in Pediatric Neurology, could help treat countless cases of migraine and tension headaches in adolescents without the need for additional testing or medication.

"Out of our 30 patients, 26 reported significant improvement, and 19 had complete headache resolution," said Dr. Watemberg. "Twenty of the improved patients later agreed to go back to chewing gum, and all of them reported an immediate relapse of symptoms."

Right under our noses

Headaches are common in childhood and become more common and frequent during adolescence, particularly among girls. Typical triggers are stress, tiredness, lack of sleep, heat, video games, noise, sunlight, smoking, missed meals, and menstruation. But until now there has been little medical research on the relationship between gum chewing and headaches.

At Meir Medical Center's Child Neurology Unit and Child Development Center and community clinics, Dr. Watemberg noticed that many patients who reported headaches were daily gum chewers. Teenage girl patients were particularly avid chewers -- a finding supported by previous dental studies. Dr. Watemberg found that in many cases, when patients stopped chewing gum at his suggestion, they got substantially better.

Taking a more statistical approach, Dr. Watemberg asked 30 patients between six and 19 years old who had chronic migraine or tension headaches and chewed gum daily to quit chewing gum for one month. They had chewed gum for at least an hour up to more than six hours per day. After a month without gum, 19 of the 30 patients reported that their headaches went away entirely and seven reported a decrease in the frequency and intensity of headaches. To test the results, 26 of them agreed to resume gum chewing for two weeks. All of them reported a return of their symptoms within days.

Two previous studies linked gum chewing to headaches, but offered different explanations. One study suggested that gum chewing causes stress to the temporomandibular joint, or TMJ, the place where the jaw meets the skull. The other study blamed aspartame, the artificial sweetener used in most popular chewing gums. TMJ dysfunction has been shown to cause headaches, while the evidence is mixed on aspartame.

Gumming up the works

Dr. Watemberg favors the TMJ explanation. Gum is only flavorful for a short period of time, suggesting it does not contain much aspartame, he says. If aspartame caused headaches, he reasons, there would be a lot more headaches from diet drinks and artificially sweetened products. On the other hand, people chew gum well after the taste is gone, putting a significant burden on the TMJ, which is already the most used joint in the body, he says.

"Every doctor knows that overuse of the TMJ will cause headaches," said Dr. Watemberg. "I believe this is what's happening when children and teenagers chew gum excessively."

Dr. Watemberg says his findings can be put to use immediately. By advising teenagers with chronic headaches to simply stop chewing gum, doctors can provide many of them with quick and effective treatment, without the need for expensive diagnostic tests or medications.

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Treating migraines in children

This article discusses how common migraine headaches are in children and discusses the many possible causes for them.

Migraine headaches are actually common in childhood and adolescence. It’s estimated that about 5 percent of children have migraine headaches. There is evidence that migraines are genetic disorder, occurring in families.

Migraines may occur as a result of changes in blood vessel diameter. Constriction or spasm of blood vessels to the brain and surrounding structures may decrease blood flow to these areas. Researchers believe that migraines are due to inflammation of the nervous system involving serotonin receptors (serotonin is a particular kind of neurotransmitter in the brain) . This can result in a severe headache, as well as other neurological symptoms such as visual changes, difficulty speaking, weakness or numbness in one part of the body, tingling sensations, and others.

Other symptoms can include nausea, vomiting, abdominal pain, and a sensitivity to light (photophobia). Toddlers and infants can have symptoms such as cyclical vomiting (sometimes called abdominal migraine) and torticollis (spasm of the neck muscles resulting in head tilt).

Several factors can trigger migraines, including: food, caffeine, sun, stress, menses, oral contraceptives, fatigue or stress.

There are several types of migraine. The classic type is preceded by auras (seeing rainbows/halos around lights or flashing lights), followed by headache pain, which can take up to 60 minutes to begin. The common type migraine, most prevalent in children, is not preceded by auras.

Most children who get migraines will appear to be in normal health during a physical examination. However, it’s important that they are examined in order to rule out other causes of headache.

One of the simplest things I do is to examine patients’ eyes. Oftentimes children complaining of headaches have vision problems and need prescription lenses. I also examine the mouth carefully to make sure that my patients do not have dental abcesses causing pain. Additionally, sinus infection can cause headaches in children as well as adults.

The two most serious causes of headache that a health care provider should rule out are meningitis or brain lesions (tumors).

Meningitis involves symptoms such as fever and neck stiffness along with a headache.

A brain tumor would involve symptoms such as morning headaches that improve throughout the day as well as weakness, double vision, difficulty walking and personality changes.

Children with complicated migraines (marked by neurological symptoms that persist after termination of the headache) may need special brain imaging (called a MRI or magnetic resonance imaging) to rule out brain abnormalities.

There are several things that can be done to prevent migraines and treat migraine pain: First it’s often helpful to create a “headache diary.”

The parent or older child can make note of the timing of the headache, what the child was doing at the time the headache struck, whether there were certain foods eaten or medications being taken.

I also suggest that parents eliminate or minimize certain headache triggers. Some foods, especially nitrite-containing foods (including hot dogs, bologna, luncheon meats), aged cheeses, chocolate and caffeinated beverages (including tea, coffee and many sodas) which can all trigger migraines. I encourage families to limit (preferably eliminate) these items. Sun is also an important trigger. I recommend that children who experience migraines regularly wear sunglasses outside and sit in parts of the class room with the least sun glare. Some patients may get relief by taking a nap in a dark room.

There are several medications that can be used to treat migraines. Acetaminophen and ibuprofen can be effective for many children. Aspirin and aspirin-containing medications (such as Excedrin) should be avoided in children under 14 years of age due to the risk of developing Reyes Syndrome (a life threatening liver condition).

There are also medications used to prevent migraines, including propranolol, some antihistamines and tricyclic antidepressants. Some children also are given anti-nausea medications if they have severe nausea or vomiting with their migraines. There are other medications for migraine, however, they have not been extensively studied in children.

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Twitter and Google Show Migraines Peak During Work Week

Data from twitter and google suggest that migraines occur most during the work week.

Scientists have found yet another reason to be glad it’s Friday. A new study found that the feeling we all have from time to time—that the work week gives us a headache—might not be all in our minds.

Sparked by curiosity about what online behavior could tell them about pain, researchers from Boston Children’s Hospital and Harvard Medical School probed search engine queries and Twitter posts that mentioned “migraine” or “headache.” What they found, in a study published online in the journal Cephalalgia, is that headache mentions peaked on weekdays, hitting their high early in the week and receding on Fridays.

Clas Linnman, an instructor in anesthesia at Boston Children’s who led the work, said that he and his colleagues usually do brain imaging studies of people who suffer migraines and other forms of pain that can alter the brain. But after reading about researchers who used Twitter to track mood disorders, they began to wonder what Googling and tweeting could reveal about when migraines occurred.

First, the researchers analyzed five-and-a-half years of search activity on Google. They found that “migraine” searches seemed to take a break when people did—occurring far less frequently on the weekends or on Thanksgiving or Memorial Day than on the weekdays. The most migraine searches occurred on Tuesdays and the fewest on Fridays.

It makes sense to Linnman.

“People will get more migraines when they’re stressed,” he said.

Then, they looked at activity on Twitter and found that Monday had the highest number of migraine mentions and Friday the lowest. In a subset of tweets that mentioned “migraine,” the vast majority were by women, a gender breakdown that follows the pattern seen in large clinical studies.

Although the researchers didn’t put each tweet under the microscope, they did note that many of the brief missives included detailed information, such as symptoms, triggers, therapies, and the duration of the attack. Online behavior has been used to track everything from flu outbreaks to social unrest. Now, the researchers think they may provide not only evidence about when disease happens, but also information about factors like stress, eating, and sleeping habits that may play a role in triggering the disease.

Less severe complaints tracked the same general pattern. Tweets mentioning “headaches” also peaked during the work week, between 7 a.m. and 5 p.m.

With that in mind, take a deep breath: the weekend is near.

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New Device Helps Alleviate Pain From Migraines

A device developed by St. Jude Medical Center helps those who suffer from pain from chronic migraines.

There hasn't been a moment in the last 10 years in which Guinevere Janes' head didn't throb with migraine pain.

Before she was implanted with a St. Jude device that sends tiny pulses of energy to the occipital nerve at the base of her skull, her pain often measured a 10 on a scale of 1 to 10.

On Friday, she said her pain was a "3," thanks to the product she has had in her body since 2008 as part of a clinical trial here in the United States.

What does that reduction in pain mean for Janes, who is disabled by migraine? "It means that I am able to at least get up every day and read. It means that I can play with my niece and nephew," said the 38-year-old. "I am able to have a relationship with my family."

Increasingly, headache experts and med-tech companies such as Little Canada-based St. Jude are exploring the potential of peripheral nerve stimulation (PNS), using implantable medical devices to provide migraine relief to people for whom medication does not work. Clinical trials, such as the one in which Janes has been a participant, are showing promise.

"These are people who have headaches, more often than not, every day of their lives," said Dr. Stephen Silberstein, who founded and directs the Jefferson Headache Center at Thomas Jefferson University in Philadelphia and directs the trial in which Janes is enrolled. "We're taking the worst of the worst."

Last month, St. Jude Medical announced that it had received European approval for its Eon Mini neurostimulator, as well as its Eon and EonC neurostimulators, to treat intractable chronic migraine. The devices are like tiny pacemakers that send a programmable pulse to alleviate pain for people who have migraines at least 15 days a month. The devices still are awaiting approval by the U.S. Food and Drug Administration.

Before winning European approval, St. Jude conducted a large-scale study to evaluate PNS's impact on chronic migraine pain. After 12 weeks of stimulation, patients reported an average of six fewer headache days a month. After one year of stimulation, St. Jude reported that 65 percent of patients said they had excellent or good pain relief; 89 percent said they would recommend the procedure to someone else.

An estimated 36 million Americans suffer from migraines, according to the American Headache Society -- more than those who have asthma or diabetes combined. There is no cure for migraine, which is "characterized by pulsating or throbbing headache pain that can be moderate to severe in intensity," as well as other neurological symptoms.

Its severity can be disabling, painful enough to "cause work loss and absence from activities with family and friends," the society says, adding that migraine costs the United States more than $20 billion a year in direct medical costs and indirect expenses, such as missed workdays.

Most debilitating form

Intractable chronic migraine is considered even more debilitating. It is defined as a headache lasting at least four hours per day for 15 or more days per month, causing at least modest disability and not responding to three or more drugs.

The World Health Organization estimates that as many as 4 percent of adults have headaches 15 or more days per month. On a scale of 1 to 7, in terms of health impact and disability and 7 being the worst, the WHO ranks migraine as a 7.

Many treatments, including medications, alternative therapies and surgical options, are aimed at reducing migraine frequency or stopping the pain and associated symptoms after they've begun.

Doctors and med-tech companies have been studying and using pacemaker-like devices to treat pain and other afflictions -- everything from high blood pressure to incontinence to anxiety. So, Silberstein said, why not migraines?

The device is implanted just beneath the skin of the upper chest or near the hip. The Eon Mini is about the size of a man's wristwatch.

Tiny wires run just beneath the skin from the device to the occipital nerve -- considered one area affected by migraine.

"Put your hand at back of head, under the bone where it's soft," Silberstein said, describing the location of the occipital nerve. "How does it work? The pulse acts as a break on the pain signals ... turns the volume down."

Those with constant pain, he said, keep the device pulsating all the time.

Silberstein acknowledged that not all the patients enrolled in the trials were happy with the device. Some found the stimulation uncomfortable. Others had problems with the electrodes moving. For others, he said, it just doesn't work.

Worth continued study

Dr. Roger Cady, a headache specialist and official with the National Headache Foundation, said implanted medical devices probably can have a benefit for people with intractable migraine pain.

Migraine has long mystified doctors, he said. It used to be thought of as a blood vessel disease. Now it is considered a neurologic disease, affected by cranial and peripheral nerves in the brain.

"Suddenly, these types of devices may have some value," he said.

While medication helps many, Cady said, there are those who have come to have little hope for relief. For these sufferers, devices like the Eon may be an option.

"It definitely needs more study. We don't have clear answers," he said. "A lot of what is happening right now is learning how to do this best."

Cady, who has no connection to St. Jude or its study, said the work of Silberstein and St. Jude shows promise.

"Six more days [without headache] in the life of someone with this disease is huge," he said. "Lord knows we would like to do more, but this is a start."

Janes said she is hopeful that once the device is approved for sale in the United States, and Medicare agrees to pay for the implantation of more electrodes to other nerves, she may find enough relief to return to a more full life.

Once in a master's program at the University of Wisconsin, Janes, who now lives in suburban Philadelphia, said her pain became so severe and so constant that she had to leave school and quit working. There were days she couldn't even get out of bed. Now, with the decrease in pain, there is hope.

"I am incredibly lucky. I have family that supports me. I have some of the best doctors in the world," she said. "My story isn't done yet. I could someday be able to go and get a part-time job and become a member of society."

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Researchers Show Migraines Linked To Behavioral Problems In Kids

New research claims that children who suffer from migraines are more likely to have behavioral issues, anxiety, or depression.

Children with migraines are much more inclined to suffer from behavioral issues, such as anxiety, depression, and social and attention issues than those who do not have headaches.

The more recurrent the headaches, the more likely the chance of a behavioral disorder developing, according to the new study published in Cephalagia. 

Marco Arruda, director of the Glia Institute in São Paulo, Brazil, together with Marcelo Bigal of the Albert Einstein College of Medicine in New York, conducted a study of 1,856 Brazilian children ages 5 to 11 which looked at the connection of emotional symptoms with migraine and tension-type headaches (TTH).

The study used headache surveys, in addition to the Child Behavior Checklist (CBCL), to measure emotional symptoms. The researchers instructed teachers how to walk parents through the questionnaires, step by step.

Children with migraines had a much greater probability of irregular behavioral scores than children without headaches, primarily in social, anxiety-depressive, internalizing, and attention areas. 

Children with TTH were affected in the same areas, but to a lesser extent. With more frequency of headaches, abnormal behavioral scores increased. Over half of the migraine sufferers had issues with internalizing behaviors. Externalizing behaviors, such as breaking rules or becoming aggressive, were no more likely among the children with headaches. The authors advised that the CBCL may not be efficient enough to measure this correlation in detail.

Arruda explains:

"As previously reported by others, we found that migraine was associated with social problems. The 'social' domain identifies difficulties in social engagement as well as infantilized behavior for the age and this may be associated with important impact on the personal and social life."

Children frequently suffer from migraines, which affect over three percent to one fifth of children from early childhood to adolescence. Earlier research has suggested that children with migraines are more likely to have other psychological and physical problems, includingdepression, anxiety, hyperactivity, and attention disorders. 

Authors suggest including factors, such as headache frequency, is important, although often left out of studies - until recently. Health providers can now be aware of this possibility in children and properly treat the problem.

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Study: Female migraine sufferers respond to folate, B6 and B12 supplementation

A new study shows that women with migraines saw less severe symptoms when given folate, vitamin B6, and vitamin B12 daily.

New research from Australia's Griffith University has found that women withmigraine had a 14% reduction in severity of migraine when they ate foods which had a higher folic acid content. The research, reported by Medical Search this morning, builds upon the results of previous studies which have also found links between B vitamin supplementation and better outcomes for migraineurs.

• What is a migraine?

A 2009 study by Queensland researchers found that when migraine sufferers were given 2 mg of folic acid which is a synthetic form of folate, 25 mg vitamin B6, and 400 μg of vitamin B12 daily for six months, their homocysteine levels reduced by nearly 40% and the level of disability from migraine that they suffered halved, including a reduction in pain and severity as well as frequency of migraine attack.

In the current study, researcher Sarah Ingle and colleagues from Griffith University monitored the diets of 147 Australian women with clinically-diagnosed migraine with aura.

During the six-month study, participants were eating more foods with folic acid and blood folate levels had also increased when compared to baseline data. With this increase, came a 14 per cent reduction in migraine severity.

Presenting her research at the International Congress of Dietetics in Sydney this week, Ingle said the results were unexpected.

"We did not anticipate that one month into the study, Australia would start its mandatory fortification of folic acid in all bread-making flour. We think the increased intake of folic acid from the mandatory fortification may have played a role in the decline in migraine severity during the trial," said Ingle.

Diet is just one of many suspected triggers for migraines and stress and lifestyle, genetics and hormonal triggers can all play a role in its development.

Some of the best dietary sources of folate include:

• leafy greens such as spinach, kale, broccoli, Asian greens, collard greens, turnip greens
• legumes such as lentils, chickpeas, kidney beans, navy beans, lima beans black beans

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Results from Phase 3 Trial of Rescue Medication in Acute Migraine Treatment

This article discusses the results of the phase 3 trial testing a rescue medicine for migraines.

An orally inhaled dihydroergotamine studied for the rescue treatment of acute migraine exhibited significant pain relief compared with placebo, according to the results of a pivotal phase 3 trial presented at PAINWeek 2012.

The efficacy of the acute treatment of migraine can be evaluated by the extent of rescue medication use (RMU) when headache symptoms persist or recur 2–24 hours after the initial abortive treatment. Shashidar Kori, MD, and colleagues from MAP Pharmaceuticals, Inc., Mountain View, CA, reported the results from two analyses of RMU in the acute treatment of migraine episodes. The frequency of RMU use was recorded during a randomized, placebo-controlled, double-blind trial of MAP0004, an investigational, orally inhaled dihydroergotamine (DHE).  In this Phase 3 trial, MAP0004 was shown to be superior to placebo for the acute treatment of migraine.  In addition to their ad-hoc analysis of RMU, the researchers also reported their subgroup analysis of patients with severe migraine pain at baseline during the double-blind period.

RMU was permitted in this study if migraine symptoms were not relieved by 2 hours after the study drug was administered. The post-hoc analysis included 794 patients randomized (1:1) to receive double-blind treatment with MAP0004 or placebo.

Patients receiving MAP0004 experienced statistically significant reduction of migraine symptoms compared with patients receiving placebo. RMU in the double-blind period was consistently lower with MAP0004 than with placebo at 2 hours (4.3% vs. 8.1%, P=0.0261); 4 hours (19.6% vs. 37.9%, P<0.0001); 24 hours (36% vs. 54%,P<0.0001); and 48 hours (42% vs. 59%, P <0.0001) after study drug administration. RMU was also significantly lower with MAP0004 than with placebo across demographic and baseline characteristics. Among patients who reported pain relief at 2 hours, MAP0004-treated patients had significantly lower RMU at 4, 24, and 48 hours than placebo-treated patients. In this study, RMU was significantly lower with MAP0004 than with placebo overall and across demographic and baseline characteristics.

In a second presentation, Dr. Kori and colleagues reported their post-hoc analysis of the efficacy of MAP0004 compared with placebo using Fisher's exact test in the Phase 3 trial. Severe baseline migraine pain was reported in 366 of the 794 subjects. Subjects with severe migraine pain treated with MAP0004 experienced statistically significant pain relief compared with those treated with placebo (P<0.05) in as little as 10 minutes after receiving MAP0004 and at every subsequent prescheduled evaluation time point. Compared to subjects treated with a placebo, the treatment groups experienced significantly less pain (P<0.05) by 60 minutes, and at all subsequent time points following treatment. Sustained pain relief and sustained pain-free values, both between 2–24 hours and between 2–48 hours, were statistically significantly higher for MAP0004 relative to placebo. Among subjects with severe migraine, headache recurrence over 24 hours occurred in 6.2% of those treated with MAP0004, compared to 18% when treated with placebo.

Based on the results of this Phase 3 trial, the investigators concluded that MAP0004 was effective for the acute treatment of patients with severe migraine.

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Study: Migraines not tied to greater weight gain

This article discusses a study showing no correlation between migraines and weight gain.

Women who have migraines may have no greater risk of becoming overweight than other women, despite what some research has suggested, according to an international study.

Some studies have found a connection between excess weight and a higher rate of migraines, but they have mainly studied people at one point in time, leaving unclear whether the weight or the migraines came first.

The current study, which appeared in the journal Cephalalgia, looked at data from the Women's Health Study, a long-term clinical trial that began following thousands of U.S. women in the mid-1990s.

"Our study should be reassuring that having migraine is not associated with future increase in relative body weight or obesity," researcher Tobias Kurth, of the French national research institute INSERM and the University of Bordeaux, said by email.

Overall, women who had migraines at the outset were no more likely than other women to become overweight or obese over the next 13 years. The average weight gain in both groups was almost identical, at around 4.5 kg (10 lb).

In theory, migraines could contribute to weight gain indirectly, such as frequent or severe headaches keeping a person from regular exercise.

The new findings are based on 19,162 female health professionals who were aged 45 or older, and of normal weight, when they entered the study. Almost 3,500 reported a history of migraines.

Over the next 13 years, 41 percent of those women became overweight, while about 4 percent became obese. But the odds of becoming obese were no greater among women with a history of migraine, and the risk of becoming overweight was only slightly higher -- 11 percent.

Severe migraines did not appear to carry a risk of extra weight either, Kurth's team found. Women who had migraines weekly to daily were at no greater risk of becoming overweight or obese than those whose migraines came a few times a year.

The study did not look at whether overweight or obese women are at increased risk of migraines or more severe ones.

"That is still possible. In fact, several studies have now shown that obesity is associated with increased migraine frequency," Kurth said.

There is also some evidence tying obesity to an elevated risk of developing migraines in the first place, but the prevalence of migraine has remained stable in recent decades, while obesity rates have soared, he added.

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New device can provide relief from painful headaches and migraines

Scientists in London have created a small electronic device that when pressed against the neck for 90 seconds can alleviate the pain from painful headaches and migraines.

A battery-powered gadget the size and shape of an electric shaver may be a new way to treat painful headaches.

Studies suggest the device – which is held against the neck for 90 seconds – may reduce the severity of migraine and cluster headache attacks, and even prevent them.

Researchers say that for some patients the device may be as effective as drugs, without any negative side effects. It has also worked for patients who have not responded to drugs.

Results of the first trials are expected to show a 50 per cent reduction in symptoms in half of patients.

Both migraine and cluster headaches are significant health problems in the UK.

An estimated 5.6 million people have migraine attacks, on average once a month, with three times as many women as men affected. The cause is unknown, but levels of serotonin, the so-called feel-good chemical, drop during a migraine.

Although drug treatments are effective for many patients, they do not work for all and can have side effects.

Cluster headaches, in which the attacks occur in succession or ‘clusters’, are less common, affecting around one in 1,000 people and mostly men. The pain, usually around one eye or the temple, is described by sufferers as excruciating.

The new device, developed by US-based ElectroCore, generates electrical signals and is held against the right side of the neck on the skin above the pulse of the carotid artery. A conductive gel is placed on the device to increase its effectiveness.

A small wheel is used to adjust the stimulation until moderate muscle-twitching is felt, with that power maintained for 90 seconds. In severe cases, multiple applications may be required.

Exactly how it works is not clear. One theory is it increases levels of the neurotransmitters serotonin and noradrenaline, which reduces pain perception.

The device is being tested in the US and Europe, including a study of around 50 patients at London’s Royal Free Hospital and a site in Dublin.

The gadget is available in Europe for professional and home use, but a doctor’s authorisation is required. It costs £250 for a device with 150 treatments, and £150 for one with 50 treatments.

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Migraines not harmful to the brain despite the pain

A new study concludes that migraines do not have any negative effects on the brain, except for the pain of course.

Migraines currently affect about 20 percent of the female population, and while these headaches are common, there are many unanswered questions surrounding this complex disease. Previous studies have linked this disorder to an increased risk of stroke and structural brain lesions, but it has remained unclear whether migraines had other negative consequences such as dementia or cognitive decline. According to new research from Brigham and Women's Hospital (BWH), migraines are not associated with cognitive decline.

This study is published online by theBritish Medical Journal (BMJ) on August 8, 2012. "Previous studies on migraines and cognitive decline were small and unable to identify a link between the two. Our study was large enough to draw the conclusion that migraines, while painful, are not strongly linked to cognitive decline," explained Pamela Rist ScD, a research fellow in the Division of Preventive Medicine at BWH, and lead author on this study.

The research team analyzed data from the Women's Health Study, a cohort of nearly 40,000 women, 45 years and older. In this study, researchers analyzed data from 6,349 women who provided information about migraine status at baseline and then participated in cognitive testing during follow-up. Participants were classified into four groups: no history of migraine, migraine with aura (transient neurology symptoms mostly of the visual field), migraine without aura, and past history of migraine. Cognitive testing was carried out in two year intervals up to three times.

"Compared with women with no history of migraine, those who experienced migraine with or without aura did not have significantly different rates of cognitive decline," explained Rist. "This is an important finding for both physicians and patients. Patients with migraine and their treating doctors should be reassured that migraine may not have long term consequences on cognitive function."

There is still a lot that is unknown about migraines. However this study offers promising evidence for patients and their treating physicians. More research needs to be done to understand the consequences of migraine on the brain and to establish strategies to influence the course of the disease in order to optimize treatment strategies.

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Study: Sinus headache vs. Migraine headache

This study looks at the differences between a sinus headache and a migraine.

Headache disruptions in our daily routine and work productivity are common; the occasional headache plagues us all. But those who suffer from chronic headaches are desperate for relief from their frequent and disabling headache symptoms. Americans spend countless hours and dollars seeking migraine headache relief from over-the-counter pain medication, natural remedies, migraine prescription drugs, and trips to doctors and emergency rooms. Understanding sinus vs. migraine headaches can be very challenging, according to Dr. Brian Rotskoff, Chicago asthma, allergic rhinitis (hay fever), and adult sleep apnea expert.

However, those who believe they suffer from chronic sinus headaches may actually be experiencing migraines. Clarity Allergy Center's Dr. Rotskoff is an adult and pediatric allergy, asthma, and immunology specialist who teaches his patients that lasting headache relief can only be achieved through proper diagnosis. "Studies show almost 90% of patients with sinus headaches are misdiagnosed by their physician," he said, "Many patients are treated with frequent courses of antibiotics, anti-histamines/decongestants, allergy shots, and even sinus surgery. But the majority of these patients could actually have migraine headaches and not sinus problems. It can be very confusing and difficult to distinguish between a sinus headache and a migraine headache."

What's more, patients with allergies may be up to 10 times more likely to have migraines.

What Causes Headaches?

"Sinus headaches create such a buzz that when people suffer from frequent headaches over their forehead and cheeks, they're quick to blame their sinuses," says Dr. Rotskoff, "But before we can assume the headache is caused by a sinus or allergy problem, we have to dig deeper and look for the possibility of a migraine headache. For lasting relief, we have to address the source of the headache."

Migraine headaches, considered primary headaches, are typically caused by neurogenic or vascular changes that affect blood vessels or changes in serotonin levels. A family history of migraines can significantly increase your likelihood of suffering from them.

A sinus headache, on the other hand, is actually caused by a bacterial infection of the sinuses. "This may occur on a chronic basis or as an acute problem, simply arising from a cold or acute bacterial sinus infection," Dr. Rotskoff explains. Head pain caused by a sinus infection will respond to a course of antibiotics and treatment for any underlying allergies, if present.

Dr. Rotskoff stresses that professional diagnosis is key to not only unlocking your headaches, but also applying the right mix of prevention and treatment strategies.

Symptoms of a Migraine

• Pulsating, throbbing headaches often on one side of head
• Sensitivity to light and sound
• Nausea, possibly with vomiting
• Blurred vision
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Symptoms of a Sinus Headache

• Discolored (greenish/yellow) nasal discharge
• Decreased sense of smell and nasal stuffiness/congestion
• Accompanying sore throat or cough
• Fever (only during an acute infection)
• Pain and/or pressure over cheeks and forehead

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Migraine sufferers may have a different perception of time

Interestingly, a new study explains why people who experience migraines may have a different perception of time.

People with migraines may feel like time passes a bit more slowly than it actually does, if a small study is correct.

The difference in time perception seems subtle - it's seen in people's perception of milliseconds. But the findings help validate the common complaint of migraine sufferers that they feel a bit "off" at times, according to a headache specialist not involved in the study.

The new research, reported in the journal Headache, involved 27 adults with migraines and the same number of headache-free adults the same age. All of them took a test of time perception in which they estimated the amount of time a series of rectangles appeared on their computer screen.

Sometimes the image appeared for 600 milliseconds (six tenths of a second), sometimes for three seconds and other times five seconds.

In general, the researchers found, people with migraines overestimated the 600-millisecond time window. They thought it lasted twice as long - about 1.2 seconds, on average - while the non-migraine group gave an estimate of about 0.9 seconds.

That's a small gap. But the findings support the idea that "migraine does indeed affect cognitive function," write Kai Wang and colleagues at Anhui Medical Center in Hefei, China.

Dr. Jennifer Kriegler, an associate professor of neurology at the Cleveland Clinic Lerner College of Medicine, agreed.

"A lot of people who have migraines report that when they are in a bad headache period, they just feel like they are in a fog," said Kriegler, who was not involved in the current study. "They don't feel like they're processing information as clearly."

An extreme and very rare version of this effect, dubbed Alice in Wonderland Syndrome, has been seen in migraine and epilepsy sufferers. It involves distorted time perception and a sense of disconnection from reality and even self.

The current time perception study was small, Kriegler said, but it was well done. And it suggests that the foggy feeling migraine sufferers report is not just due to the pain.

"It may be because of differences in brain processing," Kriegler said.

Worldwide, it's thought that 11 percent of the population has had a migraine in the past year. In the U.S. alone, migraines cost an estimated $20 billion a year in medical care and lost work productivity.

Migraines typically cause an intense throbbing sensation in one area of the head, plus sensitivity to light and sound, and nausea or vomiting in some cases.

About 30 percent of people with recurrent migraines also have sensory disturbances shortly before their headache hits. Those disturbances, known as aura, are usually visual - like seeing flashes of light or blind spots.

It's not completely clear what causes migraines, but they do appear to involve abnormal brain activity. And like the current study, some others have linked migraines - particularly those with aura - to differences in memory, reaction times and certain other cognitive abilities.

In this study, migraine sufferers were different in their perception of the 600-millisecond time frame, but not the longer, three- to five-second windows.

It's not clear what to make of that. Kriegler said that since the study was so small more research is needed to see whether it really is only the millisecond arena where people with migraines differ.

She also said it was "significant" that study participants with migraines were not actively having headaches during the testing. So even in between migraines, Kriegler said, there's a difference in brain functioning.

What does that mean for people in real life?

"Is this something that's going to affect people's daily functioning? Probably not," Kriegler said. Or at least not in the short term, she added.

One unanswered question is what kind of treatment people with migraines in the study were taking.

The researchers note that 21 patients "received medicine," and the majority took painkillers after their head pain set in.

But there is no indication they were on drugs that prevent migraines - which people with recurrent migraines often take. (Wang, the senior researcher, did not respond to an email seeking comment.)

So it's not clear whether preventive medications might have any effect on time perception, according to Kriegler.

Also unclear is whether any cognitive differences might have implications for migraine sufferers' long-term brain health. Right now, there is no evidence that people with migraines have, for example, a faster mental decline as they age or a higher risk of Alzheimer's, Kriegler said.

The current findings, she said, offer some "validation" to people who have felt their migraines put them "off their game."

Doctors, she noted, may brush off such complaints. "But," she said, "that patient knows there's something wrong."

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Results of "Migraine in America 2012" Study

Below are the results of the "Migraine in America 2012" study which lists migraine causes, frequency, symptoms, and common triggers, as well as the impact migraines have on the people who get them.

Health Union, LLC, released the results of its landmark study "Migraine In America 2012" tonight via a live web conference. This patient survey was completed by over 2,600 migraine sufferers in May and June of this year and represents one of the largest studies of this type ever completed.

"The results of the Migraine In America Study are quite staggering," said Dr. Dawn Marcus, MD, Professor, Department of Anesthesiology at the University of Pittsburgh, "we've known for some time about the physical pain and suffering of migraine, but this study gives us an unprecedented glimpse into the real impact that migraine has on people's lives."

For example, the data showed that among participants in the survey:

• -Over 50% report that migraines have negatively impacted their professional development
• -Over 25% report that they have lost a job due to their migraines
• -Over 40% report that migraines have impacted their relationship with their children
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All study results are notably worse for those suffering from chronic migraine, defined as having over 15 days each month with headache symptoms lasting over four hours. For example over 38% of chronic migraine sufferers reported losing a job due to their condition.

The initial data presentation is available at http://migraine.com/mia2012/.

"This is an incredibly rich data set and we have just begun to scratch the surface," said Olivier Chateau, Co-Founder of Health Union, LLC the publisher of Migraine.com the largest and fastest growing online community dedicated solely to migraine, "over the coming months we will continue to analyze the data and will publish new findings on migraine.com."

Migraine impacts an estimated 37 million Americans[1]. Every 10 seconds someone in the United States goes to the emergency room with a headache or migraine, and American employers lose more than $13 billion each year as a result of 113 million lost workdays due to migraine.[2]

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