The Thalamus and Migraine at AHS

Yesterday, The 53rd Annual Scientific Meeting of the American Headache Society started.  The day went great.  The afternoon talks focused on the role of the thalamus (an area of the brain) in migraine.  It was a fascinating afternoon.  The thalamus is an area of the brain that you might think of as a relay center and an area where inputs from all other areas of the brain come together and get directed to the right place.  Already we have discovered pathways whereby light can modulate migraine pain, through the thalamus.  It is also believed that persistent pain arising from discrete episodes of pain is a transition modulated by the thalamus.  That is, episodic migraine (<15 days per month) into chronic migraine (15 or more days per month)?  It is an area where the information taken from one area of the nervous system can affect all others, changing perception, changing pain states, and many other things.  Certain medications that we use in migraine have been shown to modify the firing of neurons in the thalamus, in the areas where pain is modulated.  Very very exciting indeed.

Mother’s Day Gift Ideas for the Migraine Sufferer

Does that special someone in your life suffer from migraines?  Looking for gift ideas that won’t trigger them?  Follow this list of do’s and don’ts…

Gifts worth giving:

1. Chocolate, preferably dark chocolate, and preferably in small to moderate amounts – chocolate contains many chemicals that promote general health, and may even help stave off a migraine.

2. Fragrance free beauty or bath products – we all want beautiful skin, or a nice bubble bath.  Try these products if your special someone is sensitive to smells.

3. Unscented candles – these can be beautiful without the potential hidden migraine trigger.

4. Herbal Tea (caffeine free) – many can help relieve migraines and promote good digestion and / or relaxation.  Often, you can find a gift set with some nice boxes or mugs too.

5. Massage – definitely can promote relaxation, but some migraine sufferers cannot be massaged during a migraine, so best used in between attacks to promote stress reduction.

6. Hot or cold packs – some have very luxurious features, made to form around the neck or head, to promote relief from headaches or neck pain.

7. Eye covers to keep the bright light out and enhance sleep, and some ear plugs too.

8. Sunglasses w/ FL-41 tint – may help to reduce the type of UV light that is most likely to trigger or aggravate migraines.

9. Instructional DVDs for meditation and relaxation – these types of DVDs can go a long way in promoting general well being and stress reduction, as well as sometimes helping actually abort an acute migraine attack.

10. Love, Hugs, and Kisses – well, enough said.

Gifts to avoid:

1. Perfume – odors, even one’s that seem pleasant to most, can be very irritating, and even trigger a migraine.

2. Flowers – both allergies to flowers and their scents can be detrimental to migraineurs.

3. Food gifts containing cheeses, sausages, nuts – all are foods that may potentially trigger migraines.

4. Champagne and red wine – although alcohol in general can trigger migraines, these may be the worst offenders.  If you absolutely need to go there, opt for lighter colored wines and liquors.

5. Scented candles – these can be beautiful without the possible harm.

Brain activity increases with cell phone use

A study recently published revealed that cell phone signals increased brain activity.  It was actually a very interesting study, in which participants held a cell phone to each ear, unaware if turned on or off.  After 50 minutes, brain activity was increased in the area of the brain in closest proximity to the antenna. 

So, do cell phones cause cancer?  It’s way to early to say that, in fact, and it’s not clear how increasing the brain’s activity would effect one’s health.  It may be, for instance, that increases in brain activity would be helpful in certain conditions in the right area of the brain.  It could also be that the increase in activity for sustained periods over many years, could have a detrimental effect.  It’s just too early to say.  We also don’t know how these signals may affect the brains of developing children and teens, who can expect to be exposed for prolonged periods over decades.

Many studies have looked for correlations between cell phone use and brain cancer, and long story short, the evidence in it’s entirety does not support that claim.  Of course, all studies have their problems, but despite looking, the connection has not been found in any convincing way.

This study is very interesting, that radio signals affect brain function, but what it means no one really knows.  There is also a small amount of evidence that using cell phones, especially within a couple of hours of bedtime, impairs sleep, and may cause headaches.  Hmmmm.

 So… what to do with your cell phone?  If you’re an average adult user, and don’t spend prolonged periods of time on the phone, there’s probably nothing to worry about.  If you use your phone more often, or for prolonged periods, you can wear a wired earpiece that transmits the sound with out adding any electromagnetic waves and keep the antenna further from your brain.  As for you kids?  Well, they don’t really need cell phones, do they?

Not Tonight Honey…

Headaches, and especially migraines, may make you want to stay in bed, un touched, and lying still.  This inevitably makes someone NOT want to engage in intimate affairs.  But what if a good romp could actually help?  It may, but of course you need to get over your fear of all that movement and closeness. 

For many sufferers, asking this is too much.  Unless you want stomach contents spewed out on the bed.  Sorry for the visual.  But for some sufferers or some headaches, it might be worth a try.  Endorphins are hormones with pain killing effects that flood your body with vigorous exercise or even sexual encounters. 

There are other benefits too.  An active healthy sex life, for many, suggests a healthy overall lifestyle with plenty of sleep, good nutrition and good stress reducing techniques.  All things that are great for headache sufferers.

There are some headaches that can be triggered by intimate encounters, though.  If you get one of those, you probably need to see your doctor and discuss this symptom with him or her.

Brain Injury Awareness Month

Headache is the most common symptom of concussion. Brain Injury Awareness Month is coming in March, an effort to increase awareness of brain injuries and their significance. The Brain Injury Association of America recently updated their definition of traumatic brain injury: TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.  Even seemingly mild jolts to the brain can actually cause a concussion.  Ever get that feeling of being dazed?  That’s a concussion, too.  Headaches can occur immediately at the time of impact or in the ensuing days afterwards, and can be brief, or can result in prolonged and chronic problems.

Morning Headaches Are A Signal To Talk To Your Doctor

Morning headaches, if occurring consistently, are a reason to talk to your doctor.  On a recent appearance on the Dr. Oz show, a panel of experts helped design a quiz to test your level of health.  As a headache specialist, I felt that morning headaches were important to discuss.  Morning headaches can be due to a number of ailments, many of which should be treated, aside from treating the actual headache. 

Sleep apnea, medication overuse headaches (also called rebound headaches), and even brain tumors, can cause headaches when you awake in the morning.  All 3 of these conditions need to be evaluated and treated or they can worsen.  There are other conditons as well, that may lead to morning headaches, and as some migraine sufferers already know, often morning migraines can be among the most difficult to treat.  You can see my discussion of the topic at  http://www.youtube.com/user/AudreyHalpernMD

Holiday Hidden Dangers for Migraineurs

As joyful and wonderful as the holidays are, they can be a dangerous time for migraine sufferers.   Almost all of the positive aspects of the holidays have hidden dangers, that if avoided, may help reduce the chances of getting a migraine.  When so many potential triggers are present, it’s even more important to know how to limit your exposure to them.  So, what are the dangers?

DANGER:  Vacation – It’s great to finally get time off from work, but may aspects of vacations can trigger migraines… sleeping in (too much sleep can trigger a migraine, as can skipping that morning cup ‘o’ joe), changing sleep habits, travel through time zones, sharing a hotel room with your screaming kids

SOLUTIONS:  Try to keep the same sleep schedule, and don’t skip that morning coffee.  If you want to cut down on your caffeine intake, this is probably not the time to experiment, and it needs to be done gradually.  Also, bring ear plugs and a sleep mask, consider trying melatonin which may help regulate sleep.

DANGER:  Stress – From planning the holiday meal, to preparing for guests and shopping there are many stressors during the holidays.  Some people may have a migraine triggered by stress, and some will get ‘stress let-down’ migraines.  This occurs when after a stressful event, you’re finally feeling relieved that it’s all over and you can relax, and BANG!  There it is.

SOLUTIONS:  Plan ahead over a period of time.  Write things down, shop in advance and slowly prepare for the holidays.  Trying to get it all done in one week for some people can be a recipe for disaster.  If you need to, consider letting another friend or relative host the party or guests.  Be extra careful about exposing yourself to triggers during this period, as they are more likely to trigger a migraine attack during this time.  Lastly, if you are prone to ‘stress let-down’ migraines, you may want to talk to your doctor about how to take medication to prevent the headache from coming.

DANGER:  Parties and Holiday Meals – The food and drink is in abundance, and you look forward to it every year.  Different foods and drinks may trigger headaches in different people, and it may take time for you to figure out if you have food and drink triggers, and what they are.  The amount of food you eat may also play a role.  And what about those smells?  People coming to the party dressed to impress, but too often scented to the max.  Scented candles and other holiday decorations and smoke may also be present, lingering in the air, awaiting your arrival.

SOLUTIONS:  Firstly, don’t skip meals earlier in the day in anticipation of a large holiday meal.  Skipping meals may in and of itself trigger a migraine.  Avoid your food and drink triggers entirely, if possible.  If you don’t know what they are, try to stay away from cured meats and aged cheeses (skip the pepperoni and cheese plate), hot dogs (pigs in blankets), pizza, highly spiced foods, deli meats, MSG.  Opt for white wine or light colored liquor over red wine and darker liquors.  Or no liquor at all.  Try to stick to the most natural and unprepared foods, veggies, fruit, simple grilled meats breads.  Eat chocolate and other sugary things in moderation.  As for the smells, if you’re close enough to the hostess, you can contact her ahead and talk with her about your problem, maybe she can limit the scented candles.  Let your friends know ahead of time that perfumes and colognes may set off your migraines, and ask if they can refrain for this event.

Stick to your normal routines as much as you can.  It is the fluctuations and changes in the environment and lifestyle, that tend to trigger migraines.

The NFL’s New Rules

It was a notable weekend where numerous severe neurological injuries were incurred during football games.  Representatives from the NFL have stated that there will be new penalties enforced for devastating and illegal hits, to help protect players from concussion and other injuries.  

Protecting athletes from concussion is a good thing.  The most important issue here in my mind, is the NFL making a statement and setting a standard for younger players and their leagues.  When the NFL comes out with a strong statement like this, people listen.   How this will affect the game and the way players play is entirely another thing, and not something that I can truly comment on.

Concussion is under recognized, and under reported, and can have devastating neurological consequences, including even death.  Of course, most concussions are mild, and people recover from them.  It is more likely, though, that permanent brain damage will result if a first concussion is not fully healed before a second concussion happens.  You must allow the brain to heal FULLY before engaging in risky activity.  You should see a doctor to help determine when that healing is complete.

There is also an increased risk of sustaining permanent brain damage after recurrent concussions, and the more concussions you have, the more you’re likely to get. 

Knowledge and awareness helps to guide us through making important decisions.  The decision on whether to play should only be made with full awareness of the potential risks.  But in the end, it is the choice of the individual and/or parent, so providing the appropriate information on which to base decisions is an important step.

Botox for Migraines!!!!

The FDA recently approved onabotulinum toxin A (more commonly known as “Botox”) for the treatment of chronic migraines.  Chronic migraines are defined as occurring on 15 days or more per month.  Headache specialists have been injecting onabotulinum toxin A for migraine prevention for many years.  It is a generally safe treatment, although safety and effectiveness should be discussed with your doctor.  One of the nice things about Botox injections for migraine prevention is that if it works, it usually has none of the potential side effects that some of the prescription medications have.  For people who have tried other medications and modalities, it is a great option to discuss with your doctor.

Injections are done in the office, and take the same time as a regular office visit.  No special preparation is needed, and afterwards you can go about your day as your normally would with little restrictions.

Botox can be used for several other neurological conditions as well, in addition to cosmetic uses.

 

Vertigo and dizziness are common problems in migraine sufferers.  In general, as a neurologist, I see a lot of patients with dizziness.  The problem tends to be more prominent in migraineurs.  There are several different potential causes of vertigo, and even more in migraineurs.

Vertigo can be present as a part of migraine, is very common after concussion, and can be caused by a host of middle and inner ear disorders, as well as brain disorders.  In some cases, dizziness can be related to dehydration, blood pressure drops, or heart problems.
 
Vertigo can be an associated symptom of migraine (like nausea and sensitivity to light), it can be an aura-type symptom (preceding the migraine in a very distinct episode), it can be the only manifestation of migraine (migrainous vertigo, a variant of migraine) or it can be a symptom in the general life, intermittently and not associated with actual migraine attacks, of a migraineur, but related to the migraine by the genetic underlying sensitivities.
 
Of course, migraineurs can also get vertigo from the more typical and non-migraine related causes, such as inner ear infections, labyrinthitis, benign positional vertigo, menierie’s disease, other ear problems, and even strokes.
 
It is an interesting and common problem.  It, unfortunately, is very difficult to treat.  Keep yourself well hydrated and ask your doctor if any of your medications can be adding to the problem.  Often times it will go away on it’s own, if it is from a benign cause.  In severe chronic cases of vertigo, a special type of rehabilitation can be useful.