Study: Those with ongoing central pain may be linked to ADHD

A study indicates that those with central pain could also have ADHD.

More than a third of people with ongoing "central pain" may also have ADHD, a small study suggests.

Central pain stems from damage to the central nervous system -- the brain, brain stem and spinal cord. It differs from ongoing pain from bone or muscle conditions such as arthritis, or peripheral nerve pain like diabetic neuropathy.

Researcher Forest Tennant, MD, of Intractable Pain Management, presented the findings at the PAINWeek 2015 conference.

For the study, 45 people with chronic pain attending a treatment clinic completed a 16-item questionnaire. The questions asked whether the person had trouble with concentration, attention, distractibility, impulsivity, reading and retention, coordination, temper, and short-term memory.

A positive answer to five or more questions was considered to indicate ADHD

Results showed that 37.8% of the people met these criteria for the disorder.

Most people with centralized pain have an overactive autonomic nervous system, the part of the nervous system responsible for functions like breathing. This contributes to the ADHD (which is sometimes called ADD, or attention deficit disorder).

The finding might help explain why some people with pain have trouble with activities in their daily lives, Tennant says.

"For years, I've seen the same kind of ADD in these patients that you see in children -- they can't remember half the time, they can't concentrate," he says. "It's amazing how many of these patients actually quit reading or doing things, but they won't tell you."

But once they start taking medication for ADHD, "their pain gets better and they can remember and concentrate."

Tennant stressed that the findings [do not apply to] those with arthritis or neuropathic pain.

Jack LeFrock, MD, a pain specialist at Above and Beyond Pain Management and Laser Center, says Tennant's finding "makes sense."

"I agree with him; I think he's right on," he says.

Read more here

The link between insomnia and chronic pain

This study looks into a potential link between insomnia and chronic pain.

People who have problems sleeping may also be more sensitive to pain, thus potentially worsening the effects of chronic pain conditions, new research from Norway shows.

In the study, researchers measured pain sensitivity in more than 10,000 adults who were participants in the Tromsø Study, an ongoing public health study in Norway that began in 1974.

The results of the study showed that people who had insomnia were more sensitive to pain than people who didn't have sleep problems. In particular, people who were experiencing chronic pain and who also had insomnia showed a greater increased sensitivity to pain. Pain sensitivity was also linked to the amount of time it took to get to sleep.

The findings show that "the need to improve sleep among chronic pain patients, and vice versa, is evident," the study authors, led by Børge Sivertsen of the Norwegian Institute of Public Health in Bergen, Norway, wrote in their article.

In the study, the researchers first asked questions of the participants about their experience with insomnia, how long it took them to fall asleep and other sleep issues. For example, participants rated their experiences with insomnia during the previous year on a four-point scale, ranging from "never" to "more than once a week." Out of all of the participants, 10.5 percent had what the researchers considered an insomnia disorder.

The participants then completed the cold-pressor test — a standard method used to mimic chronic pain in which people are asked to place their hands in cold water for a set period of time. People who remove their hands early show a decreased tolerance to pain. In this study, the participants were asked to keep their hands in water at 3 degrees Celsius (37 degrees Fahrenheit) for 106 seconds.

The results showed that 42 percent of patients who had insomnia took their hands out of the water before the 106 seconds were up, whereas only 31 percent of all of the participants did so. This increased sensitivity to pain was greater in those with more severe or more frequent insomnia. For example, people who had insomnia once a week were 52 percent more likely to take their hands out of the water early, compared to those without insomnia. Moreover, patients who had insomnia monthly were 24 percent more likely to take their hands out of the water early.

The total amount of time that people spent sleeping showed no effect on their pain tolerance, according to the study.

The link between sleep problems and chronic pain appeared especially pronounced, according to the study. The patients with both severe insomnia and chronic pain were more than twice as likely to take their hands out of the water earlyas participants who had neither condition. This effect was "synergistic," meaning the two conditions combined had a greater effect than one would expect from just summing their individual effects, the study authors reported.

That synergy between chronic pain and sleep disorders suggests health care providers should consider jointly treating the two conditions in some patients, the authors stated. Both cognitive-behavioral therapy and medications are used to treat the two conditions separately, the authors noted, so further studies should look at using these methods to treat the conditions together.

Future research should look into not only clinical implications, but also the role of neurotransmitters in the co-occurrence of sleep disorders and pain, the authors said.

Read more here

Study: A mother's presence soothes infants' brains

A study shows that a mother's presence and care can make an infant's pain go away and changes the infant's brain activity.

A mother's "TLC" not only can help soothe pain in infants, but it may also impact early brain development by altering gene activity in a part of the brain involved in emotions, according to new study from NYU Langone Medical Center.

By carefully analyzing what genes were active in infant rat brains when the mother was present or not present, the NYU researchers found that several hundred genes were more, or less, active in rat infants experiencing pain than in those that were not. With their mothers present, however, fewer than 100 genes were similarly expressed.

According to senior study investigator and neurobiologist Regina Sullivan, PhD, who is scheduled to present her team's findings at the Society for Neuroscience annual meeting in Washington, D.C., on Nov. 18, the research is believed to be the first to show the short-term effects of maternal caregiving in a distressed infant pup's brain. The study was also designed to support her research into the long-term consequences of differences in how mammals, including humans, are nurtured from birth.

"Our study shows that a mother comforting her infant in pain does not just elicit a behavioral response, but also the comforting itself modifies -- for better or worse -- critical neural circuitry during early brain development," says Sullivan, a professor at the NYU School of Medicine and its affiliated Nathan S. Kline Institute for Psychiatric Research.

For the study, researchers performed genetic analyses on tissue from the almond-sized amygdala region of the infant rat pups' brains that is responsible for processing emotions, such as fear and pleasure.

Sullivan, whose earlier research showed how the mother's presence controlled electrical signaling in the infant pup's brain, says her latest findings shed insight on the complexity of treating pain in newborns.

"Nobody wants to see an infant suffer, in rats or any other species," says Sullivan. "But if opiate drugs are too dangerous to use in human infants because of their addictive properties, then the challenge remains for researchers to find alternative environmental stimuli, including maternal presence, coddling, or other cues, such as a mother's scent, that could relieve the pain."

Sullivan cautions, however, that the long-term consequences of these genetic modifications must also be compared to the short-term benefits for tying pain stimuli during infancy to such a powerful symbol of safety and security as the infant's mother.

"The more we learn about nurturing the infant brain during infancy, the better prepared we are to deal long-term with treating problems that arise from pain, and physical and mental abuse experienced during infancy," says Sullivan.

Read more here

Study: Children with ADHD benefit from treating sleep problems

A study shows that children with ADHD benefit from treating underlying sleep problems.

Addressing sleep problems often improves psychiatric symptoms in children and teens, including those with attention-deficit/hyperactivity disorder and chronic pain.

Sleep-focused treatment improves mood and quality of life in children with attention-deficit/hyperactivity disorder (ADHD), asthma, chronic pain, and cancer, according to speakers at symposium on sleep in children with chronic health conditions at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Children with ADHD are two to three times more likely to have trouble sleeping than children without the disorder, said Penny Corkum, Ph.D., a professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia. Their sleep problems may undermine daytime performance, said Corkum, who directs research and training at Colchester Regional Hospital’s ADHD Clinic.

In research reported at the meeting, she and colleagues assessed sleep in 30 children newly diagnosed with ADHD and 30 age- and sex-matched typically developing controls. The children’s mean age was about 8.5. At baseline, children with ADHD took 47 minutes to fall asleep in the sleep laboratory, while controls took 24 minutes. Children with ADHD slept about 30 minutes less than controls.

In a four-week medication trial, the researchers gave the 30 children with ADHD either a standard single daily morning dose of methylphenidate or a placebo, in random order for two weeks. While children took longer to fall asleep and slept less when taking the stimulant than when taking the placebo, parents and teachers said their behavior improved.

Children being evaluated for problems with attention, Corkum said, should also be screened for sleep disorders. Consequences of sleep disorders such as obstructive sleep apnea, insomnia, and periodic limb movement disorder/restless leg syndrome may mimic symptoms of ADHD.

Children with and without ADHD, she added, benefit from having a consistent bedtime, learning to fall asleep on their own, sleeping in a dark room, and avoiding television, computers, telephones, and other electronic devices near bedtime.

Children and adolescents with persistent pain commonly report difficulty falling or staying asleep or complain of poor quality sleep, said symposium speaker Tonya Palermo, Ph.D., a professor of anesthesiology and pain medicine at the University of Washington, Seattle.

About 5 percent to 8 percent of children and adolescents in community samples experience moderate to severe disability from persistent pain, most often in the head, abdomen, or limbs, she noted. Common causes include headache disorders, juvenile arthritis, and sickle-cell disease.

Some have depression. Their pain medications may be sedating. These youngsters often say, “I’m always tired,” Palermo noted. Many take frequent and often long naps that may interfere with school or social activities. Concerned parents may allow children to stay in bed late in the morning.

Engaging children and adolescents in self-assessment, Palermo said, may foster improved sleep habits. She asks them to abstain from watching television in their bedroom for a week, for example, to see how that affects their sleep. She also encourages them to use an alarm clock and get up on their own and to maintain a consistent weekday/weekend schedule.

Palermo and colleagues also found that poor sleep diminishes the effectiveness of cognitive-behavioral therapy for chronic pain. She said sleep-specific intervention may need to be delivered before pain-focused behavioral therapy starts.

Read more here

Common issues that hurt your sleep

This article discusses common issues that hurt people's sleep, and tells you what to do about them.

You might remember a time when you could drift off to sleep in an instant and remain in a state of blissful slumber well past lunchtime the next day. Now your sleep is more likely to be lighter and more fitful, and when you wake up in the morning you don't always feel refreshed.

A lack of good-quality sleep could be a natural consequence of changing sleep-wake patterns after menopause. It's also likely that the issue is physical--and fixable. Many conditions can disrupt your rest, and they can be treated. It's important to address these issues. Lack of sleep does more than make you drowsy. Chronic insomnia has been linked to a variety of health problems, including obesity, high blood pressure, heart disease, diabetes and depression.

Go through this list to see whether you might have one of these sleep-stealing conditions. Also check your medicine cabinet. Some medications, including corticosteroids, beta blockers, cold and flu remedies, and certain antidepressants also can interfere with sleep.

1. Sleep apnea

The conventional image of sleep apnea is of the overweight man who snores, but women of any size can also develop these repeated pauses in breathing while they sleep.

"A woman who has a narrow jaw or a change in muscle tone can get apnea," says Dr. Julia Schlam Edelman, clinical instructor in obstetrics and reproductive biology at Harvard Medical School and author of "Successful Sleep Strategies for Women and Menopause Matters: Your Guide to a Long and Healthy Life." Either of these anatomical issues can block oxygen from reaching your lungs (and subsequently the rest of your body) while you sleep. Snoring might not be your main symptom if you do have sleep apnea, but you will notice that you're especially sleepy during the day.

Solution: See a specialist for a sleep study. You may be able to relieve apnea with a few lifestyle adjustments, such as sleeping on your side or losing weight. Your doctor might also suggest an oral appliance or a CPAP machine that blows air into your airways to keep them open at night.

2. Diet

What you eat can affect your sleep. Spicy foods can contribute to painful heartburn. Big meals leave you uncomfortably full, and over time can contribute to obesity--a well-known risk factor for sleep apnea. Too much caffeine could keep you wide awake, even if you finish your coffee in the morning.

"It takes six hours to clear half of the caffeine from your body. If you have enough caffeine, it's still in your body at 4 in the morning," says Dr. Edelman. And though a glass of wine or two with dinner will make you feel relaxed or even sleepy, it won't help you sleep. "You can fall asleep, but once you're asleep you can't sleep deeply," she says.

Solution: Eat dinner at least a couple of hours before bedtime, and keep the meal light. Avoid spicy, fatty foods, as well as alcohol and caffeine. Also, don't drink too many fluids before bed. Having to constantly get up to go to the bathroom can disrupt your sleep, too.

3. Lack of exercise

Sleep and exercise complement each other. Working out regularly can help you sleep better, and conversely, you're more likely to exercise if you get a good night's rest.

Solution: Exercise every day if you can, ideally in the morning. Doing a high-energy aerobic routine too close to bedtime can have the opposite of the intended effect, making you too energized to sleep. A gentle yoga stretch before bed probably won't hurt, though. It might even help you relax.

4. Pain

Arthritis aches or any other kinds of pain don't make for restful slumber. Conversely, a lack of sleep can increase your pain. Researchers believe that a lack of sleep may activate inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain.

Solution: In addition to the pain remedies your doctor recommends, try using a heating pad or taking a warm bath before bed to soothe achy joints or muscles. Lying against a body pillow can put you in a more comfortable position while you sleep.

5. Restless legs syndrome

Women are twice as likely as men to have restless legs syndrome (RLS)--a condition that causes a creepy, crawly feeling and uncontrollable movements in the legs at night. It's often linked to hormonal changes early in life and during pregnancy, but RLS can continue as you get older. RLS isn't just miserably uncomfortable--researchers at Harvard have linked this condition to an increased risk for heart disease and depression in women.

Solution: Try simple interventions first. Exercise every day, take a hot bath before bed, massage your legs, and cut back on things that can make you jittery--like caffeine and tobacco. If these measures don't work, your doctor may recommend one of several medicines that reduce RLS symptoms--including ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro), or gabapentin enacarbil (Horizant).

6. Depression

"Depression is a common compromiser of sleep, and it's much more common in women than in men," Dr. Edelman says. Women who are depressed may sleep more than usual, but their sleep isn't restful. Some of the antidepressants meant to counteract depression, particularly SSRIs, can also interfere with sleep.

Solution: See your primary care doctor, psychologist, psychiatrist, or therapist for help, which may include medications, talk therapy, or both. If your antidepressant seems to be keeping you awake, ask your doctor to switch you to another drug.

7. Stress

It's impossible to sleep when the weight of the day is pressing on you. Finding a sense of calm before bed isn't easy, especially when you can't unplug from the demands of your day.

Solution: Establish wind-down time. Do a quiet, relaxing activity before bed that doesn't involve a screen. Talk to a friend or family member, sew, or read a real book--not one on a backlit tablet device.

"Just allow yourself to have quiet time," Dr. Edelman adds. And don't sleep with your smartphone on your bedside table.

8. Poor sleep habits

Sometimes insomnia stems from long-ingrained behaviors, like staying up too late or engaging in stimulating activities before bed.

Solution: Follow a few basic sleep hygiene strategies. Go to bed and wake up at the same times each day. Keep your bedroom cool, dark, and comfortable. Use your bed for sleep and sex only. If you can't fall asleep within 15 minutes, get up and leave the bedroom. Read or do another quiet activity for 15 to 20 minutes until you get sleepy.

Read more here

What can I do about my migraines?

This article discusses what someone who suffers from migraines can do about their headaches.

If you are one of the roughly 30 million Americans who suffer from the intense, throbbing misery of migraines, you'd probably try anything to ease the pain. Here are some options to consider and discuss with your doctor:

Pain-relieving medications.

Over-the-counter aspirin, ibuprofen or acetaminophen, as well as formulations marketed specifically for migraines, may help relieve mild to moderate pain. Take at the first sign of a headache. Prescription drugs may be needed for more severe attacks. Preventive therapies may also be an option if you suffer from frequent attacks, if they last a long time or if pain-relievers aren't helping.

Biofeedback.

This alternative therapy uses electrical sensors on your body to detect and monitor physical responses related to stress, such as muscle tension. Having that information helps you learn to make subtle changes — such as relaxing those specific muscles — to relieve headaches. A form of this therapy called neurofeedback, or EEG biofeedback, focuses on helping people alter brain waves, which some research suggests may ease migraine pain. Other alternative treatments include acupuncture and massage therapy.

Avoid your triggers.

Whether it's a type of food or smell, a specific medication, or even disrupted sleep or missed meal – many factors can set off an attack. Do your best to steer clear of them and maintain a consistent routine.

Read more here

Obesity and diabetes may be helped by migraine medication

A migraine medication that blocks specific pain receptors may also treat obesity and diabetes.

By blocking a key pain receptor in mice models, a team of researchers has discovered a potential new method for treating obesity and diabetes. 

In a study published in the May 22, 2014, issue of Cell, Andrew Dillin, PhD, and researchers at the University of California, Berkeley found genetically modified mice that lacked a certain pain receptor called TRPV1 lived 14% longer than mice that had it. 

“In long-lived TRPV1 knockout mice, the nuclear exclusion of the transcriptional coactivator CRTC1 within pain sensory neurons originating from the spinal cord … decreases production of the neuropeptide CGRP from sensory endings innervating the pancreatic islets, subsequently promoting insulin secretion and metabolic health,” the authors wrote. “In contrast, CGRP homeostasis is disrupted with age in wild-type mice, resulting in metabolic decline.”  

Furthermore, the researchers found TRPV1-deficient mice had lower levels of the CGRP proteins that are responsible for blocking insulin release and increasing blood glucose levels, which ultimately affect the development of type 2 diabetes and obesity. As a result, treated mice were able to quickly remove sugar from their systems, regardless of exercise frequency or aging. 

“We think that blocking this pain receptor and pathway could be very, very useful — not only for relieving pain, but (also) for improving lifespan and metabolic health, and, in particular, for treating diabetes and obesity in humans,” Dillin said in a press release. 

The investigators noted an anti-migraine medication produces similar results, since it inhibits a CGRP protein that triggers TRPV1. In fact, older mice treated with the drug in the study had increased longevity compared to untreated older mice, and they were also metabolically similar to younger mice. 

Moving forward, Dillin said he plans to further examine the influence of TRPV1 and CGRP in both mice and humans. 

“Our findings suggest that pharmacological manipulation of TRPV1 and CGRP may improve metabolic health and longevity,” Dillin noted. “Alternatively, chronic ingestion of compounds that affect TRPV1 might help prevent metabolic decline with age and lead to increased longevity in humans.”

Read more here

Twitter helps assess migraine trends

A study looked into how migraine sufferers discuss their migraine attacks on twitter and analyzed gender of the person, day of the week, and country the person lives in to assess trends about migraines.

Someone's drilling an icicle into your temple, you're throwing up, and light and sound are unbearable.

Yes, it's another migraine attack. But now in 140 characters on Twitter, you can share your agony with other sufferers. It indicates a trend toward the cathartic sharing of physical pain, as well as emotional pain on social media.

"As technology and language evolve, so does the way we share our suffering," said principal investigator Alexandre DaSilva, assistant professor and director of the Headache and Orofacial Pain Effort at University of Michigan School of Dentistry. "It's the first known study to show the instant and broad impact of migraine attacks on modern patients' lives by decoding manually each one of their individual attack-related tweets."

DaSilva's team, including research fellows Thiago Nascimento and Marcos DosSantos, worked with 50 students and residents to categorize 21,741 tweets. They eliminated advertising, metaphor and nonrelated migraine tweets, which has not been done in previous studies. Further, they analyzed the meaning of each individual migraine tweet.

"We sought to evaluate the instant expression of actual self-reported migraine attacks in social media," DaSilva said.

Results generated unique information about who suffers from migraines and what, how, where and when they use social media to describe their pain. The findings overlapped significantly with other traditional epidemiologic migraine studies, DaSilva and colleagues said.

Among other things, they examined the most common descriptors for migraines, including profanities, tweet times and locations, and impact on productivity and mood. Only 65 percent of the migraine tweets were from actual sufferers of migraines posting in real-time. Other tweets were advertising, general discussion, retweets, etc., indicating that not everything in social media is meaningful to the patient, DaSilva said.

Among the findings: Females accounted for about 74 percent of migraine tweets; males accounted for 17 percent. The higher global peak of migraine tweets occurred Mondays at 14:00 GMT, or 10 a.m Eastern Daylight Saving Time. The U.S. accounted for 58 percent of migraine tweets, followed by Europe at 20 percent. In the U.S., migraine tweets peaked at 9 a.m. and 8 p.m. on weekdays. The morning tweets peaked later on weekends. Roughly 44 percent of tweets reported that migraine attacks immediately impacted mood. The most common migraine descriptors were "worst" at nearly 15 percent and "massive" at 8 percent.

Migraines pose a huge public health problem, harming mood, productivity and overall quality of life. An estimated 12 percent of the Western world population suffer migraine attacks, and of those, 75 percent see reduced functionality and 30 percent require bed rest.

Read more here

Fibromyalgia may be a sleep disorder

A neurologist can detect alpha intrusion on a sleep study. JR

A study claims that fibromyalgia syndrome may be a sleep disorder, or at least linked to one.

Nobody says, "I don't believe hypertension exists," or "I don't believe 'stroke' is a real thing." People with fibromyalgia syndrome (FMS) suffer not only from constant widespread pain, but they also sometimes face judgment and distrust from medical professionals who doubt if their condition is real. They are labeled as annoying and needy. In the literal sense, insult is added to injury.

The root cause of FMS is poorly understood, which may explain why its legitimacy is questioned by some healthcare professionals. FMS is characterized by chronic widespread musculoskeletal pain, stiffness, and tenderness at multiple points. The prevalence of FMS ranges from 2 percent to 3 percent of the general population, with women affected six to nine times more frequently than men.

In addition to pain symptoms from head to toe, people with FMS also complain of poor sleep, chronic fatigue, depressed mood, headaches, and many other symptoms. However, complaints of poor sleep and chronic fatigue may be more significant to individuals with FMS than pain symptoms. Analysis of slow-wave sleep in individuals with FMS often demonstrates characteristic alpha-wave intrusions in slow wave sleep, which are thought to contribute to poor sleep in this population. Furthermore, a trial using sodium oxybate, a medication known to increase slow-wave sleep, demonstrated improvement in fibromyalgia symptoms.

As the association between FMS and sleep has been further studied, more evidence has mounted that FMS in many cases is a byproduct of a sleep disorder. A 2006 study demonstrated a more than ten-fold increase in FMS in subjects with sleep-disordered breathing (SDB) compared to the normal population.

Research suggests that FMS is a disorder of hypersensitivity of the central nervous system (CNS). The peripheral nervous system (PNS) is constantly sending signals from various areas of the body to the CNS. The CNS then filters these signals, ignoring the insignificant while responding to the more pressing. Due to the hypersensitivity of the CNS in FMS, those lesser signals are not filtered, leading to widespread pain.

Poor sleep quality has a similar effect on CNS signal filtration. Many with chronic pain syndromes (e.g., arthritis) describe improvement in pain with a good night's sleep and vice versa. It is a well-known phenomenon in the neurology community that sleep deprivation is a powerful trigger for seizures. Seizures are caused by inappropriate hyperexcitation of certain neurons leading to a cascade of electrical discharges in the cerebral cortex that overcome (or "seize") the function of that region of the brain.

Diagnosis and treatment of SDB and other chronic sleep conditions can lead to significant improvement in FMS independent of any other therapy. However, since the overwhelming majority of FMS sufferers are women, and many women with SDB have more subtle airflow disruptions than their male counterparts, it is essential that testing be sensitive enough to detect these less obvious changes. Those who have had a prior negative sleep study or who do not snore should seek a sleep center that focuses on diagnosing and treating subtle SDB, such as Upper Airway Resistance Syndrome. Esophageal manometry can be used to measure intrathoracic pressure during sleep. This metric can help detect increased respiratory effort and subtle changes in airflow during sleep that can cause sleep fragmentation and that otherwise would be missed.

FMS sufferers with poor sleep may experience frequent nighttime arousals, tossing and turning in bed, morning headaches, nasal congestion in the morning that was not present upon going to bed, dry mouth during the night, episodes of waking up with palpitations, teeth clenching or grinding at night, temperomandibular joint (TMJ) or jaw pain in the morning, and acid reflux during the night or in the morning. While these are not specific signs independently, they all are suggestive of irregular breathing during sleep.

So for the four to six million Americans suffering from FMS, perhaps it's time to see a sleep specialist. A proper night's sleep just might cure what ails you.

Read more here

Device to relieve migraine pain approved by the FDA

The FDA has approved a device that can relieve the pain of migraines when preceded by an aura.

The Food and Drug Administration has approved the marketing of the first transcranial magnetic stimulation (TMS) device for the relief of pain caused by migraine headaches preceded by an aura. Studies show the device is effective about a third of the time.

The Cerena TMS is a handheld prescription device meant to be used after the onset of migraine pain. The device is placed at the back of the head to release a pulse of magnetic energy to the occipital cortex in the brain, which may stop or lessen the pain associated with migraine headaches.

“Millions of people suffer from migraines and this new device represents a new treatment option for some patients,” said Christy Foreman, director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health.

About 31 million adult Americans suffer from migraine. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to sound and light (aura).

TMS had previously been approved by the FDA to treat depression, but it is also being used off-label to treat addiction, fibromyalgia and migraines.

TMS generates highly concentrated magnetic fields to target a part of the brain involved with mood regulation. The magnetic fields produce small electric currents that activate cells within the brain, which are thought to release neurotransmitters (serotonin, norepinephrine and dopamine), chemical messengers that improve mood and make depressed people feel better.

The FDA reviewed the Cerena TMS device in a small clinical trial of 201 patients who had mostly moderate to strong migraine headaches, and who had auras preceding their migraines at least 30% of the time.

The study showed that nearly 38% of the patients who used the Cerena TMS were pain-free two hours after using the device, compared to about 17% of patients in a control group. After 24 hours, nearly 34% of the Cerena TMS users were pain-free, compared to 10 percent in the control group.

The study did not show that the Cerena TMS is effective in relieving other migraine symptoms, such as sensitivity to light, sensitivity to sound, and nausea.  Nor did the study evaluate the device’s performance when treating other types of headaches besides migraines.

The FDA reviewed the Cerena TMS through a regulatory pathway for low- to moderate-risk medical devices that are not similar to an approved device already on the market. The device is only approved for people 18 years of age and older.

The FDA said dizziness may be a side effect of using the device.

The Cerena device is manufactured by eNeura Therapeutics of Sunnyvale, California. The device has already been approved for use in Great Britain where it is sold as the Spring TMS Total Migraine System.

A similar device worn on the head uses neurostimulation to deliver small electrical signals to a nerve center in the brain to prevent or treat migraines and headaches. Wearing the stimulator for just 20 minutes a day reduces the number of migraines just as effectively as migraine drugs or other types of migraine therapy, according to a small study published in Neurology, the medical journal of the American Academy of Neurology.

Read more here

Study: Migraine sufferers are twice as likely to also have depression

A study claims that depression is twice as likely in people who suffer from migraines in comparison to those who do not.

People who suffer from migraines are about twice as likely to be depressed and have suicidal thoughts, according to Canadian researchers, who say women and young people with migraines are particularly vulnerable to what Winston Churchill has called “the black dog” of depression.

Researchers at the University of Toronto surveyed more than 67,000 Canadians, over 6,000 of those reporting they had been diagnosed with migraine by a health care professional.

Both women and men with migraine were more than twice as likely to suffer from depression as those without the disease (women: 12.4% vs. 5.7%; men: 8.4% vs. 3.4%).

Serious thoughts of suicide – also known as suicide ideation – were also more common for migraine sufferers (women: 17.6% versus 9.1%; men: 15.6% versus 7.9%). Migraine sufferers under the age of 30 had four times the odds of suicidal ideation than those 65 and over.

Previous studies have also shown a link between migraines, suicide and depression, but this is one of the first to dig deeper and look at other factors associated with the comorbidities.  The study is published online in the journalDepression Research and Treatment.

Among both women and men with migraine, being younger, unmarried, poor, or disabled increased the odds of depression – in some cases dramatically. Single people with migraine were found to have 50% and 70% higher odds of depression and suicidal thoughts.

“The vulnerability of young people with migraine to depression and suicidal ideation is particularly worrying. For both genders, migraineurs under the age of 30 had at least six times the odds of current depression and four times the odds of lifetime suicidal ideation when compared to those aged 65 and above,” wrote lead author Esme Fuller-Thomson, a professor in the Department of Family & Community Medicine, University of Toronto.

“Older migraineurs, by contrast, have had a longer time to adjust to their condition, for example, by learning effective coping mechanisms or achieving adequate treatment, which may reduce the perceived burden of their illness.”

The first onset of migraine is typically experienced in late adolescence and early adulthood. The researchers believe diagnosis of migraine at a young age may interfere with normal developmental processes, such as obtaining an education, building a career, and starting a family.

“We are not sure why younger migraineurs have such a high likelihood of depression and suicidal ideation. It may be that younger people with migraines have not yet managed to find adequate treatment or develop coping mechanisms to minimize pain and the impact of this chronic illness on the rest of their lives,” said study co-author and former graduate student Meghan Schrumm.

The researchers say health care providers treating patients with migraine should be alert to signs of depression, particularly if the patient is younger and single.

“Informing a wider range of health professionals and migraine sufferers themselves about the patterns of depression and suicidal ideation surrounding age, marital status, and activity limitations may help to increase awareness of the comorbidities of migraine and empower migraineurs to come forward with their mental health concerns,” said Fuller-Thomson.

Read more here

Migraine medication overuse

A report claims that people with chronic migraines often overuse their migraine medication, which can make headaches worse over time.

As anyone who has ever suffered from migraines can tell you, the pain in unbearable and they will do almost anything to make it go away. But some medications designed to alleviate the suffering may be doing more harm than good.

Speaking at the Congress of the European Pain Federation in Florence, Italy, Professor Paolo Martelletti – one of the world’s foremost experts on headaches — said the high frequency of medication overuse is a common problem associated with migraine treatment.

“Between 50 and 80% of chronic migraine patients seen in headache clinics overuse acute medications. Although these drugs provide relief from the pain and other symptoms associated with migraine, overuse can actually make headaches worse,” said Martelletti, who is President of the Italian League of Headache Sufferers and a Professor of Internal Medicine at the School of Medicine, Sapienza University of Rome.

There are two types of medication treatment options that can help patients manage their headaches and migraines. Preventive medications, which help stop headaches or migraines from occurring, and acute medications that help stop the pain once the headache or migraine has begun.

While migraine patients are all too familiar with the intense pain caused by the neurological condition, those who have not experienced a severe headache or migraine may not be able to appreciate the wider, unseen impact that the problem can have, Martelletti explained.

“The disruptive nature of regular attacks can affect those around them and can prove detrimental to many aspects of everyday life, bringing about high levels of stress and depression,” he said.

Medication overuse can also influence the onset of comorbidities such as psychiatric and cardiovascular disorders or gastrointestinal complications.

Medication overuse is defined as the regular use of analgesics, ergotamines, triptans or opioids on ten or more days per month for more than three months; or regular use of simple analgesics or any combination of these drugs on more than 15 days per month for more than three months.

“An attempt should be made to limit the use of acute medication to treatment of no more than two or three headaches per week, and with no more than two doses per headache,” said Martelletti.

“Medication overuse should be treated by withdrawing acute medications, and with the use of preventives,” he added.

Martelletti says one promising new treatment for migraines is Botox injections in the muscles of the head, face and neck.

“Botox injections provide a valuable, evidence-based approach to the treatment of chronic migraine. Regular treatments with Botox provide an effective approach to the long-term management of chronic migraine and may have a disease-modifying effect in some cases where the chronic condition, though not entirely cured, may revert to its episodic form,” he said.

According to the World Health Organization, migraines are the third most common condition in the world and more prevalent than other common disorders such as diabetes and asthma.

Worldwide, headaches affect nearly 50% of adults each year. Approximately 11% of cases meet the criteria for migraines. Women are twice as likely to get migraines as men.

Like obesity, high blood pressure and anxiety disorders, migraines have high prevalence rates in the general population, so it’s possible that patients with chronic migraine may be visiting their doctor to discuss these disorders and not their migraines, said Martelletti.

That is why an accurate diagnosis of chronic migraine is crucial.

“Understanding the current medical and emotional state of the patient – as well as having a thorough understanding of patient’s current medication use – is of paramount importance to designing effective therapy.”

Read more here

Common migraine triggers to avoid

This article discusses seven common migraine triggers that those prone to migraines should avoid.

It’s estimated that 28 million americans suffer from migraines. Migraines are intense headaches that are often accompanied by nausea, vomiting and sensitivity to light. They don’t simply come and go; each migraine can last between four hours and three days. Most migraine sufferers know to avoid certain things like dairy, alcohol and food with excessive additives, but there are other external factors that could trigger a migraine. Here are some to watch out for.

1. Change in Routine

For some migraine sufferers, routine is key to keeping the headaches at bay.  Change in sleep patterns, work hours or even holidays can create stress and lead to migraines.

2. Stress

As mentioned above, migraines and stress are strongly linked. Some people report migraines start when stress reduces, sometimes leading to “weekend headaches” after a stressful work week.

3. The Environment 

High altitude, weather changes and humidity can all trigger migraines.

4. Computer Screens

Both the posture you take when sitting in front of a computer and the glare from the screen can lead to migraine pain. Be sure to sit comfortably to avoid muscle tension and use an anti-glare screen.

5. Lack of Food

Insufficient food is one of the main dietary triggers of migraines. Avoid missing meals or snacking on treats high in sugar. Eating small, nutritious snacks throughout the day can help control migraine attacks.

6. Hormonal Change (In Women)

Fluctuation in estrogen may cause headaches in women who suffer from migraines. These women often report an increase in migraines immediately before or during their menstrual cycle, when there is a major drop in estrogen levels.

7. Sensory Overstimulation

Bright lights, loud noises and unusual smells, including perfume and secondhand smoke can trigger migraines. 

Migraine triggers are unique to every individual, and can happen as early as 6 to 8 hours prior to a migraine attack.

Read more here

Australian vitamin treatment can significantly reduce migraine severity and frequency

A treatment developed in Australia claims to significantly reduce migraine severity and frequency by using vitamins that work with gene mutations.

AUSTRALIAN migraine sufferers won't have to live in the dark much longer.

Queensland-led genetics researchers have just launched a final, phase three clinical trial for a treatment that could drastically reduce symptoms in 20% of sufferers.

The trial is headed by Professor Lyn Griffiths, the new Executive Director of QUT's Institute for Health and Biomedical Innovation.

She and her world-leading team have identified several genes implicated in migraine and are translating that genetic information into new diagnostics and treatments.

Professor Griffiths said one of those genes causes a mutation in a particular enzyme, which stops the enzyme from working properly.

"We're trialling a specific combination of vitamins that can make that enzyme work better and make the gene then function properly," she said.

"Results so far have shown that, taken preventatively, the treatment has a very big impact on migraine - significantly reducing how severe they are, how frequent they are and the pain associated with any migraines.

"That can be very beneficial to sufferers with that gene mutation.

"This last phase in the trial is focused on dosage levels and, if it proves successful, we expect to have a tablet on the market in just over a year."

This week is Headache and Migraine Week, an initiative of the Brain Foundation.

Roughly 12 per cent of Australians suffer from migraine. It affects around 18 per cent of woman, six per cent of men and four per cent of children.

And there is a strong genetic link - about 90 per cent of people who experience migraines are not the only one in their family.

Professor Griffiths was one of the first scientists in the world to study the DNA links for migraine.

"I suffered from migraine as a teenager, my mum suffered from migraine, but as a geneticist looking at genes for various disorders I didn't even think about migraine until my son at about the age of four started suffering from migraine, including visual disturbances.

"So when you have someone close in your family who you really care about, you realize just how debilitating, how severe, it is; and I thought something needed to be done.

"We haven't identified all the genes yet. There's still a lot more research needed to identify all of them."

Professor Griffiths is urging people who suffer from migraine to join the Headache Register atheadacheaustralia.org.au.

There, sufferers can access the latest in migraine news and research, learn about current and upcoming treatment trials and download a Headache Diary to help them manage their disorder.

Professor Griffiths is confident researchers will find more targeted treatments in the future.

"You can't do this sort of research unless you have people in the public helping you," she said.

"I don't think people realise just how common migraine really is - it's a really common disorder, extremely debilitating and there's a real need to develop new treatments for it.

"We believe there are a number of different gene mutations that play a role in migraine and those different gene mutations need different treatments."

Read more here