New York Times Diagnosis

Did you know that sinus headaches are the number 1 misdiagnosis in migraine? There are many other headache disorders as well that can mimic a sinus infection. The trigeminal autonomic cephalalgias (TACs) are a group of headache disorders in which sinus type symptoms and allergy type symptoms are characteristic.  In the New York Times article written by Lisa Sanders, seen below, an example of this is explored.

By: Audrey L. Halpern, M.D.

Her Allergies Were Getting Better, So Why Were Her Sinus Headaches Getting Worse?

– By Lisa Sanders, M.D.

“It was the pain that woke her that night — the worst pain the 60-year-old woman had ever felt. It was as if a C-clamp were tightened around her head and face, punctuated with pulsations of what seemed like an electrical current.

The feeling eased after 20 excruciating minutes. All that was left was a dull ache. And exhaustion: Her husband found her in a fetal position on the floor of their home in a suburb of Baltimore. He helped her into bed. She had to go to the E.R., he said. “What am I going to tell them?” she answered. “That I had a headache?”

The pain returned many times over the next two weeks, usually when she was asleep. Her eyes would water, her nose would run and then she would get this intense pressure behind her cheekbones and eyes. It felt like the worst sinus headache she’d ever had — and she’d had many since her bout with cancer 30 years before.”

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FDA approves new CGRP monoclonal antibodies!

On September 14th, the FDA approved Ajovy for migraine prevention, and now Emgality has been approved as well. These are the 2nd and 3rd monoclonal antibodies to be approved specifically for the prevention of migraine. A very exciting time for migraine research, migraine treatment, for migraine patients and care providers!

While each of these treatments, Aimovig, Ajovy, and Emgality, all have their differences, they have some similarities too. They are all intended for migraine prevention, they are all monthly injections, or in the case of Ajovy, there is a once every 3 month protocol that was approved as well. Also, tolerability is very good across all of these treatments.

One of these might be the right medication for you. Make an appointment to see a headache specialist to talk about migraine treatment options.


CGRP, Headache Specialist, Headaches, Migraine treatment

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.


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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.


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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?


General Information, Headaches, Other Neurological Conditions, , , , , ,

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.


Headaches

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.


Brain Trauma, Headaches, , ,

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


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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.


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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.


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