A: Occipital nerve stimulators have been studied for the treatment of occipital neuralgia and chronic daily headache (chronic migraine, chronic cluster headache and hemicrania continua). They are primarily implanted in patients who have headaches in the back of the head (in the occipital region) and who have failed multiple preventive drug therapies, or in those who experience significant side effects from common migraine preventive medications. Deep brain stimulation has been analyzed in a few smaller studies in patients with chronic cluster headaches, and 50% to 70% of the patients showed significant clinical response. Continued research in larger patient populations will be needed to further determine whether nerve stimulation (occipital nerve or deep brain stimulation) will show clinical promise in patients with chronic cluster headache or chronic migraine.
George R. Nissan, DO, Co-Director, Diamond Headache Clinic, Chicago, IL
]]>A. It is common for migraine and fibromyalgia to coexist in many patients. Although the majority of chronic migraineurs can gain at least some relief from onabotulinumtoxin A injections, a good number of people do not respond.
I am a strong believer in carefully evaluating migraineurs in the context of their other medical conditions. The approach to chronic headaches must include careful evaluation of behavioral problems such as anxiety and depression, sleep disorders such as sleep apnea, and other conditions, including systemic illness such as autoimmune diseases and connective tissue disorders. Everything is important.
Patients commonly tell me that, when it comes to medication, they’ve been on “everything.” It is important to know whether those treatments matched the headache diagnosis. We also need to know whether the optimal dose of an appropriate medication was used for an adequate length of time, whether appropriate medications were used in synergistic combinations, or whether certain combinations of medications actually neutralized each other or produced side effects that led to their discontinuation. Often, medications are switched too quickly, before the medication has had a chance to work. It sometimes takes many weeks to know whether the medication will be beneficial. Keep at it, and don’t give up!
Edmund Messina, MD, Michigan Headache Clinic, East Lansing, Mich.
]]>“These data suggest that PFO may contribute to the [cause] of migraine with aura in children and have implications for clinical decision making,” said lead author Rachel T. McCandless, MD, in the study’s conclusion.
Researchers examined 109 children ages 6 to 18 who were diagnosed with migraine by pediatric neurologists at the Primary Children’s Medical Center in Salt Lake City between February 2008 and September 2009.
The relationship between migraine and PFO is not fully understood, but if PFO does contribute to migraines, health care professionals might be able to treat affected children with a simple catheter device.
]]>Connie Gray Prigg, 47, of Baltimore, Md., has been there. It was around the time of Thanksgiving in 2008 when Prigg was at work. After she lifted a heavy box off the floor, she experienced a surging headache. She’d had headaches her whole life, but this felt different. So she Googled the worst case scenario, and then visited her primary care physician. Following an MRI, the physician told Prigg she had a brain tumor and suspected it was a benign meningioma—a non-cancerous tumor in the brain.
But Prigg’s case isn’t typical. Generally headache alone is not enough to signal a brain tumor—and brain tumor is rare. “If you take all the patients with headache, less than one in 100 will have brain tumor,” said Vincent T. Martin, MD, professor of medicine at the University of Cincinnati. “I’ve been in a headache clinic for 17 years and have only seen a handful of malignant brain tumors.”
To determine whether you should ask your physician to evaluate you for brain tumor, it is important to understand the symptoms.
Recognize Your Symptoms
Classic symptoms of brain tumor include:
Seizure: Someone with no prior history of seizure who suddenly has seizures should see a physician to rule out brain tumor, says Henry Brem, MD, neurosurgeon-in-chief at The Johns Hopkins Hospital in Baltimore, Md. Seizure is an early warning sign and could help physicians identify the tumor before it’s grown to a damaging size.
Neurological complications: Loss of vision, double vision, weakness on one side of the body, facial weakness and speech problems could suggest a neurological abnormality, says Dr. Martin, and this warrants a medical evaluation to exclude a brain tumor.
Increased intra-cranial pressure: “This is less common and is manifested by headache, nausea, vomiting and, at later stages, decreased mental function,” says Dr. Brem. That requires an urgent evaluation because it means there could be increased pressure in the brain, a signal that the tumor may have already progressed, Dr. Brem says.
If headache does manifest at a later stage in brain tumor development, it will likely show up as an exertion headache (e.g., head pain when you cough or jump), new onset headache if you’re over age 50, a nighttime headache or a morning headache. And it will get progressively worse over time. “They generally don’t just come and go,” says Dr. Brem.
But, Dr. Martin warns, these headaches could be caused by a number of other factors and do not signal brain tumor on their own. “It’s very unusual to have a brain tumor without any abnormal neurologic signs or seizure disorder,” Martin says.
Understand the Causes
So how does a brain tumor come about? According to Dr. Brem, researchers have found some causes of brain tumor including carcinogens and high doses of radiation. Brain tumors are also more common in someone with a history of cancer in other parts of the body, as it could have spread to the brain.
But common fears about cell phones are unfounded.
“There’s not a shred of evidence that cell phones cause brain tumors,” says Dr. Brem. “There was a study once that showed you get warming of the brain, but you know that anyway: It’s hot in your hand, it’ll get hot by your head. That doesn’t mean it will lead to brain tumor.”
Find Relief
Treatment for malignant (cancerous) tumors usually involves removing as much of the tumor as is safe to do, then following up with chemotherapy, chemotherapy implants, radiation therapy and/or medication. Though the outlook is generally bad for brain cancer, Dr. Brem says the average survival has doubled in recent years. Research has shown that today, 1 in 5 of patients diagnosed with malignant brain tumor are alive a year later; thirty years ago, fewer than 1 in 10 were alive six months after diagnosis.
If a tumor is benign, physicians may recommend removing it—or they may suggest leaving it in place and monitoring it to make sure it doesn’t grow and become cancerous. Dr. Brem, who served as Prigg’s neurosurgeon, gave her the option to leave it in place.
“I’m one of those people that, once I know I have something, I think I’m better off not having it,” said Prigg.
Brem also warned Prigg that her tumor was close to the superior sagittal sinus, an area that allows blood to drain from the brain. He said that if the tumor were to grow and intertwine with the blood vessel, it would be more difficult to remove down the road. So Prigg opted to have the tumor removed right away.
Prigg continues to have an MRI every six months to make sure the tumor hasn’t come back, and she still has headaches.
“But I was grateful to that persistent exertion headache,” she says. “It led me to talk to my primary care doctor and helped to roll out my treatment.”
]]>In fact, light sensitivity (also known as “photophobia”) is probably the most common sensitivity that migraineurs face, affecting anywhere from 66 to 88 percent of migraineurs. “It’s even more common than nausea and sensitivity to sound,” says Vincent Martin, MD, vice president of the National Headache Foundation and professor of medicine at the University of Cincinnati.
Though it may not be possible to control all lighting in your environment, you can make your surroundings more bearable by better understanding how light can impact migraine.
The Migraine Brain and Light Sensitivity
Migraineurs are generally more sensitive to triggers (such as light) than the average person, says Robert Kaniecki, MD, director of The Headache Center at the University of Pittsburgh Medical Center.
“The migraine brain is fundamentally sensitive to multiple different sensory stimuli,” Dr. Kaniecki says. Although light may top the list, you might also struggle with sensitivity to certain smells or sounds, and these can trigger a migraine.
Although researchers have not yet concluded exactly how light triggers migraine, Dr. Kaniecki attributes some of the connection to pain and light signals that converge upon the brain, which then processes the signals together.
For many migraineurs, light doesn’t just trigger migraine pain—it may also make an existing migraine worse. “Your hypersensitive brain becomes even more sensitive during a headache or migraine,” Dr. Kaniecki says, “and the baseline sensitivities will become amplified during the course of the attack.”
Tips to Avoid Light Triggers
Following are four types of migraine-inducing light that you can avoid or deflect.
1. Sunlight
The sun is the most commonly reported light trigger, according to research published in the June 2009 issue of the journal Headache. Sunglasses can help to block out some of this light—if you know it’s coming.
Dr. Kaniecki says his patients sometimes complain about the unexpected and sudden contrast from darkness to sunlight that occurs when stepping out of a movie theater. To avoid this unpleasant surprise, he suggests switching the lenses in your everyday eyeglasses to photochromic lenses that automatically darken when exposed to ultraviolet light.
2. Fluorescent lights
Although fluorescent lights are considered more energy efficient than the incandescent kind, Dr. Kaniecki says the whitish-blue color of fluorescent light is problematic for migraineurs.
The easiest solution for this lighting problem is to switch to incandescent bulbs or at least to switch to less-intense 60 to 70 watt bulbs. A simple dimmer switch, available at home improvement stores, can also help you control indoor lighting. Dr. Kaniecki says that those who work in an office environment should “try to use as much natural lighting as you can.”
3. Filtered lights
Dr. Kaniecki has found that certain types of blinds filter light differently and that the horizontal light patterns negatively affect his patients.
The solutions here seem obvious: close the blinds, or swap blinds for shades or dark curtains. The important thing is to be aware that these window treatments that you might overlook could be the very objects triggering your pain.
4. Flickering lights
The visual cortex, or part of the brain that reads visual information, doesn’t like flashing or flickering lights. Computers, particularly older computers, tend to have a subtle flicker effect that can irritate the eyes and trigger headaches, Dr. Kaniecki says.
To solve this issue (particularly if you sit at a computer all day at work), try a plastic guard. Or consider swapping that old computer screen for an anti-glare screen or an LED monitor. LED uses the same flat-panel technology that LCD uses—just without the use of fluorescent lights.
Whether you’re the kind of migraineur who must wear sunglasses 24/7 or simply need to close the curtains on the brightest days, be proactive in identifying how light affects you. Adjusting your environment to your needs can help to eliminate the harshest triggers and remove the fear of the fluorescent bulb.
How Photophobia Affects Color Perception
Photophobia, or sensitivity to light, may cause some migraineurs to lose their perception of color. Patients experiencing migraine have a generalized impairment in the perception of the color red, according to research published in the June 2007 issue of the journal Headache. Perception of red was particularly worse for migraineurs who experienced sensitivity to light, so researchers noted that “it is conceivable that photophobia was responsible for the difficulties that migraine patients had in seeing red.”
]]>Understanding the most effective therapies, haggling over which costs are covered by insurance providers and putting a figure to the inevitable out-of-pocket expenses can all feel like a shell game, says Bray Patrick-Lake, a migraine sufferer and patient representative for the Food and Drug Administration (FDA).
“You see a migraine specialist, you pay for the appointment, you start the therapy and 30 days later you get a letter [from the insurance company] saying, ‘We won’t pay for this medication so you need to switch to this cheaper drug,’” Patrick-Lake says. “It’s very frustrating.”
That’s why it’s essential to get a handle on the process. Here are four recommendations gleaned from physicians, health insurance insiders and patient advocates to help remove potential roadblocks to care and put you in control of your life.
1. Love the Fine Print
When it comes to insurance coverage, the cliché says it all: The devil is in the details. Most physicians and benefit industry reps agree that patients need to understand even the tiniest minutiae of their coverage.
“Benefit or plan documents often get put into the kitchen drawer and never looked at or read,” says John Whitney, MD, an internal medicine and pulmonary specialist who is also manager and medical director for medical policy with insurer WellPoint. “One of the first things you can do is find them and read them.”
Unfortunately, some insurance plan documentation is so thick and laden with industry lingo that even the symbologist from the Da Vinci Code wouldn’t be able to tell whether, for instance, Imitrex falls under the coverage umbrella.
If migraine or headache sufferers don’t understand something about their benefit plan coverage, they should direct specific questions to their insurance companies, says Alan B. Rosenberg, MD, a physician and National Headache Foundation board member who has also served as an executive for a number of health benefit companies.
“Benefit plan documents are sometimes difficult for individuals to understand,” Dr. Rosenberg says. “But headache patients can always call their benefit plan customer service number, and most large benefit companies have online query processes. Electronically submitted questions, given that they are written, provide a response that is clearly documented for the beneficiary.”
The takeaway from your research should be an encyclopedic knowledge of exactly what your plan covers—the specialists and physicians that are in-network, any copay requirements, the cost of generic versus name-brand prescriptions, the kinds of treatments classified as medically necessary, etc.
Moreover, Dr. Rosenberg says patients filing claims should understand which benefit they are trying to access. This is particularly important as it relates to pharmaceutical or medical benefits, as these may be directed to different places. For example, retail or mail-order pharmacy benefits are generally covered through pharmaceutical benefits. Physician office appointments, emergency room visits, hospital procedures, physical therapy and diagnostic imaging are generally covered through medical benefits. To make matters even more confusing, some medications given to migraineurs in the emergency room or in-office may be covered through medical benefits, not pharmaceutical.
Patrick-Lake learned of these classifications first hand after undergoing Botox treatments for her chronic migraines. Her insurance provider covered the $500 injection procedure fee, but the $1,500 drug got billed in an area of coverage that had a separate deductible, Patrick-Lake says.
2. Get to Know Your Doctor
Headache patients need a physician who can do more than just diagnose and treat their illness; they need a true partner in care. Tackling both chronic pain and insurance authorizations demands a team effort.
“It’s about finding the headache specialist who will go to bat for you,” Patrick-Lake says.
Once you have located the right healer (chosen from a list of in-network doctors), it’s important to get involved in the continuum of care, from diagnosis to follow-ups. A good place to start is where many migraine and headache sufferers square off with their benefit companies—over the prescription medications used to treat their conditions.
Some patients find name-brand drugs more effective than their generic counterparts, while others don’t get enough triptans to cover all of the migraine attacks they experience in a month. In these cases, patients can find themselves digging deeper into their pockets—sometimes to the tune of hundreds of dollars per month—for drugs their payers won’t approve.
Merle L. Diamond, MD, headache specialist and president of the Diamond Headache Clinic in Chicago, says it’s unfair to penalize patients who don’t want to take generic drugs that might not work as well.
“We’re not Keebler cookies that all sit in the box and look the same,” she says. “Genetically, there are clearly distinctions in how patients respond to medication.”
Headache patients and their physicians, however, can often build a case for covering their preferred treatments. Not surprisingly, it’s all in the paperwork.
Both parties should ensure the medical records submitted to the insurance company properly reflect what’s going on. WellPoint’s Dr. Whitney suggests migraine and headache sufferers involved in complex care keep a detailed journal that meticulously documents the incidence and length of the medical issue, specific medications taken, other treatment interventions and side effects.
“It helps the doctor and demonstrates the [condition’s] severity,” he says, adding that the information can also be a valuable record of treatment when presented to an insurance provider.
And while it might be an uncomfortable conversation, patients need to speak openly with their physicians about payment and ways to save money on treatments if their coverage is limited or possibly denied.
Some offices even bundle treatments together to give patients more reasonable rates for care, though Dr. Diamond cautions “not all offices are that creative or willing to do it.” Be sure to inquire about all possibilities.
3. Study the Rules of the Game
Migraine and headache sufferers need to make every effort to understand how their care is evaluated so they can equip themselves to deal with unfavorable health care decisions levied by their insurance companies.
Most major health insurance plans base their policy decisions on credible scientific evidence published in peer-reviewed medical literature, Dr. Rosenberg says. Published clinical trials make a treatment more likely to be covered than one based purely on anecdotal testimonials.
But for patients with chronic pain, some physicians enlist a battery of treatments, such as acupuncture or magnets, that are not covered by a benefit plan.
“Individual doctors may try a lot of things to see what works with migraineurs,” Dr. Rosenberg says. “But health care companies are looking for more systematic evidence to see that a treatment actually works better than the placebo.”
Even medications that have met benchmarks required by the FDA can be sidelined by providers until they are fully vetted. For example, Botox for migraine relief is classified as an off-label therapy by some providers because of the dearth of studies demonstrating its effectiveness.
Dr. Rosenberg suggests checking a benefit company’s website for its coverage and medical policies to see if specific treatments are covered. He also recommends migraine and headache sufferers enroll in reputable, well-constructed clinical trials to evaluate newer treatments and advance the clinical evidence upon which providers base their decisions.
“If there’s good clinical evidence supporting a medical treatment, usually the benefits will follow,” he says.
Migraine and headache patients also have ways to appeal services that are denied coverage. Most major health insurance plans allow for both an internal review and an independent external review if a patient and his or her physician think a denied treatment is medically necessary. In addition, federal legislation passed last year, the Patient Protection and Affordable Care Act, entitles patients whose benefit plans are covered under the act to an independent review process.
However, be forewarned: There are limitations to what a patient can procure through the appeals process. For example, if a benefit plan explicitly states a provider will cover only a certain amount of a drug, that determination may not be subject to an independent external appeal, Dr. Rosenberg says.
“If a person starts by reading what’s in his or her specific benefit plan and if the treating physician submits the relevant clinical information, the appeals process is much more likely to be effective,” he says.
4. Don’t Go it Alone
Like other people with chronic pain, migraine and headache sufferers can be at a disadvantage when charting their course of care. In addition to pain, patients often struggle with work issues related to their condition, a lack of time and money, and other health ailments—all of which make it difficult to spend time skimming coverage packets and questioning claims representatives.
“Patients often say, ‘I’m too sick to take action,’” Patrick-Lake says. “But we have friends and family that can take action on our behalf. If we don’t, we will continue to be denied therapies.”
Strong patient advocates can help research health care plans, compare pharmaceutical prices, and speak with doctors and insurance companies on your behalf. It also pays to think slightly outside the box when choosing a resource. Patrick-Lake says people looking to switch health care plans or providers should talk to their doctor’s front-office staff to see which companies respond promptly to requests for approval.
“I want to know the staff ’s impressions on various insurance carriers because those are the folks processing claims on my behalf,” Patrick-Lake says. Navigating the United States’ convoluted health care system is a stressful process, but don’t become discouraged by missteps, bad news or what appears to be an endless uphill climb.
“I’m a highly educated advocate, and I still got a surprise last year of close to $2,000 in out-of-pocket expenses that I wasn’t expecting to pay,” Patrick-Lake says. What’s most important for migraine and headache sufferers is to keep lobbying for the benefits they need—whether that’s alternative therapies or specialist referrals—and not to take no for an answer, Dr. Diamond says.
“Patients need to be persistent,” she says. “Not just for themselves but for the care they need.”
If you need help paying for prescription drugs, try these NHF-approved patient assistance programs.
Price of Triptans
If health care costs are crippling your finances, you’re not alone. Take a look at the unsubsidized cost of a single dose of these commonly used triptans based on national retail averages.
Relpax (20 mg) - $34
Frova (2.5 mg) - $37
Maxalt (5 mg) - $38
Amerge (2.5 mg) - $43
Imitrex (25 mg) - $39
Generic Sumatriptan (25 mg) - $24
Imitrex Nasal Spray (20mg) - $61
Generic Sumatriptan Nasal Spray (20 mg) - $44
Zomig (5 mg) - $38
Zomig Nasal Spray (5 mg) - $53
Source: Consumer Reports
]]>In 2009, Levy, the Cooper chair of English at Butler University in Indianapolis, Ind., released a book documenting his experience with migraines titled A Brain Wider Than the Sky: A Migraine Diary. The book received rave reviews thanks to its delicate prose and well-researched view of the history of migraine. Levy recently spoke with Head Wise to discuss his experience with migraine, how he copes and why modern culture still stigmatizes the pain.
Head Wise (HW): Why did you decide to write your book and share your story with others?
Levy: So many migraineurs muddle their way through, and I think it is totally unnecessary to do so. I felt that I was in a position to honestly admit that I had migraines and to talk about them and describe them in some detail that might help people. It was liberating to write about pain, to take control of it in that way, to beat it in that way.
HW: Do you have a known family history of migraine?
Levy: Not on my father’s side, but my mother did experience migraine events and headaches so bad she needed to throw up. We think my grandmother experienced them, too. Back then she would close the door and disappear for hours at a time. Our guess is that she was experiencing migraines.
HW: How did you cope with migraines at first and how has that coping changed over the years?
Levy: Back in my 20s and 30s, I really didn’t do much. They were pretty infrequent, so I would take medication and they would go away. In 2006 when I realized I was having migraines, I changed my lifestyle, my diet, tried different medications and went to the doctor.
I got a CT scan to see if it wasn’t something more serious and then started taking Topamax®, an anti-epileptic drug. I would take it every day, but it gave me awful side effects. So I stopped taking it, cut my intake of caffeine and alcohol, and started taking sumatriptan.
HW: How do migraines affect your daily life?
Levy: They are a complete and total irritant; but the pain does make moments of productivity more precious. When it is 6 a.m. and I see weird stuff forming in front of my eyes, it is completely frustrating. The best case scenario is I take a pill right away and I’m OK by 8 a.m. and feeling good by noon.
If the migraine comes on for four or five days, I start to feel intense depression. After three or four days, I get acclimated to the feeling and that acclimation is pretty depressing.
HW: In your book, you put somewhat of a positive spin on migraine, writing that the pain “compels you to eat better and sleep regularly...and can be seen as God’s early warning system.” How did you come to this conclusion?
Levy: I see migraine as a smoke alarm that goes off when your toast is burning a little bit. It is loud and blaring, but it is telling you something. It would be great if your brain sent you more subtle signals to eat better and drink less and have less stress in your life. It would be great if it just gave you a gentle poke, but instead it gives you this massive punch in the side of the face. The pain has forced me to improve my life, to eat fewer sweets and drink less, and those are good things.
HW: In your book you attribute the onset of your migraines to the weather in the Midwest. Have you ever thought about moving to help your condition?
Levy: No. Whenever I go on vacation, I pay close attention to see if the weather is helping or hindering, but it turns out that barometric pressure in Ireland can be a trigger for me, as can a sunset in San Diego.
HW: In your book, you run through the history of migraine. What made you want to explore that history?
Levy: I found a lot of comfort in learning that famous people from the past lived with migraine. Before researching for the book, I didn’t know Thomas Jefferson had them. I didn’t know Sigmund Freud had a lot of them and was going to become a migraine specialist before he was the first true psychotherapist. In many ways, finding these profiles of people who were coping and being productive was really powerful to me.
It was also powerful to discover that there were 3,000-year-old reports of migraine. It made me feel like I was part of something deeper.
HW: You also write about evolution and the idea that modern environments are not suited for persons with migraines. What do you believe to be the tie between migraine and evolution?
Levy: Migraine is a disease often triggered by flashing light and there is much more of that in the contemporary world than 500 to 600 years ago. In the book, I suggest that for me, migraines precede storms. So if you think of someone 2,000 years ago, get- ting a message in their head that they needed to seek shelter at a time when it really mattered made total evolutionary sense. Today we don’t need to hide from weather anymore, but it still seems to me that the warning system will remain until we find a really good cure for migraine.
HW: One in 10 people experiences migraines. If so many people experience them, why do you think the disease is often stigmatized as “just a headache”?
Levy: I think migraine is still stigmatized in part because it’s been metaphorized; people will say “you are giving me a migraine.” That aggravates real migraineurs.
Also, outside of rushing yourself into an MRI machine and having your head tested, evidence of a migraine is really on one’s own testimony. And because the condition takes place inside your head, people associate it with psychosomatic moments. People think it is just stress and you can handle it.
In many ways, people stopped thinking of headaches as an actual disease needing real treatment a long time ago. If you go through 19th century literature, the number of female characters who have a headache that men dismiss or don’t take seriously is just massive. There is still that stigma that women with migraine fake head pain to get out of housework, to get out of sexual obligations. It is very Victorian, but that thinking is still there.
HW: Do you think the stigma is going away at all?
Levy: I think the last 10 to 20 years has been going in that direction, but I still think there is a ton of work to do. Headaches are still the number one cause of lost sick days in the United States. But it is encouraging to see a lot more celebrities describing themselves as having headaches. You also see more athletes being scratched from athletic events for migraine, men and women, a fact that I find fascinating. Given the machismo that is a serious part of our sporting culture, that is pretty telling.
HW: What message would you like to give to those that suffer from migraines?
Levy: If you have any kind of headache or neurological disruption cutting into your life, go to your doctor right away. If you can’t find the advice you need, go to a headache specialist even if the office is 300 miles away. Don’t be ashamed to tell doctors what you have and how you experience it. Try not to feel any shame about it in terms of family and work. Have the conversation on the outside, not just internally with yourself.
Looking for more information about the history of headache and migraine? Read Headache Through the Ages by Seymour Diamond, MD, and Mary A. Franklin.
]]>Headaches are common in the pediatric population, and not just for children of military servicemen and women. In general, migraine incidence in children increases with age, from a few percent among young kids to 10 to 23 percent among high schoolers, according to Commander Michael J. Strunc, MD, child neurologist and sleep physician at the U.S. Naval Medical Center Portsmouth. Incidence is nearly equal among boys and girls prior to puberty, with a significant increase in girls as you move into adolescence, he says.
“As far as incidence of migraine, the numbers are the same for kids in the military as those not in the military,” Dr. Strunc says. “What is different is what may trigger the migraine. There are some triggers that are unique, or more often present, in a military situation.”
Stress and Anxiety in Military Children
One trigger is the upheaval of moving, a routine event in the lives of many military families.
“Military kids have the excitement of moving every three to four years, on average,” Dr. Strunc says. “They may move in first grade after making friends, then move in fourth grade and then in high school. And high schoolers, in particular, get a lot of stress from geographic moves because they’ve started forming stronger friendship bonds.”
In addition to moving, there’s the stress, fear, anxiety and worry that children experience when they say goodbye to a parent who is being deployed. And all too often, kids keep their emotions hidden, which only exacerbates their head pain and the co-morbidities that often accompany headaches, including somatic complaints such as abdominal pain, and mood disorders such as depression and anxiety.
“When there’s stress for any reason, there’s a higher chance to trigger a migraine,” Dr. Strunc says. “When I see a child who has a migraine, and his dad left last week for Iraq and will be gone for a year, and he’s not sure what his dad is going to do, and he’s worried his dad might not come home, but he doesn’t talk about it? That’s a trigger, and one that most kids do not encounter.”
Of course, children aren’t the only members of the household who suffer stress during a deployment. One of the best things parents can do to help their child during this time is find ways to effectively deal with their own stress, says Major Dalila Lewis, MD, FAAP, United States Air Force, child neurologist at the U.S. Naval Medical Center Portsmouth and Joint Base Langley-Eustis.
“Children often pick up on their parents’ feelings of stress,” Dr. Lewis says. “Parental stressors can often heighten the stress of the child.”
In fact, according to research published in the August 2009 issue of the Journal of Developmental & Behavioral Pediatrics, “the most significant predictor of child psychosocial functioning during wartime deployment was parenting stress.” Decreasing the level of stress perceived by children is one way parents can actively help prevent children’s headaches.
Communication to De-Stress Military Children
When a family member is deployed, it might seem easier to ignore the pain it may cause. But a lack of communication could impact the entire family’s emotional and physical health.
“Communication is really the best thing that parents can do, especially for adolescents, who are more likely to discuss things with their friends,” Dr. Lewis says.
From a child’s perspective, talking to a parent or sibling about stress is very different than talking to a friend or professional counselor. Children may feel safer talking about sensitive topics with someone outside of the family unit, especially when those topics relate to family problems. If you don’t feel like your child is engaging in a dialogue with you, seek out a professional to help, Dr. Lewis says. When the child begins to talk about his or her headaches and associated factors, it assists parents and physicians in identifying potential headache triggers.
“I talk to kids about what is going on in their family, and that’s a window into the stress level of the child,” Dr. Strunc says. “When there’s stress or anxiety in children, it can be hidden. It’s not very often that a teenager says, ‘Mom, I’d like to tell you about the stress and anxiety going on in my life.’”
Parents aren’t the only external factor that can contribute to stress-induced headache. Media influences may exacerbate children’s fears surrounding their parents’ deployment, Dr. Lewis says.
“It’s suspected that media enhance fears of deployment, which is somewhat hard for physicians and parents to combat,” Dr. Lewis says. “Some parents don’t recognize what their children are watching and how much that exposure is contributing to their child’s stress.”
This is where an open forum for dialogue can really pay off. “It is very common for headache to increase during the time of deployment,” Dr. Lewis says. “If parents can anticipate that—and not just parents but the community and teachers—and allow a forum for talking, that helps.”
]]>A: Migraine can start at any age and what you describe sounds very much like it. The tiredness would be a “prodrome,” a warning sign that she is starting a headache. Migraine is most often on one side of the head, and often around the eye, temple and forehead. (Sometimes people think they don’t have migraine because their entire head hurts but migraine can be on both sides of the head, one side, or move from one side to another.) Most children who get migraines tend to get pale and vomiting is common. Most adults who had migraine as a child report that as they got older they no longer vomited with every attack.
Please be sure and have your granddaughter seen by a healthcare professional. It is quite likely that some treatment can be found to help relieve her headaches without her having to vomit and go to bed for several hours.
James W. Banks, MD, Ryan Headache Center, St. Louis, MO
]]>She had her first migraine with aura at age 20 and, until this year, only got a migraine about twice a year. I thought she got off easy compared to her oldest sister who suffered from severe migraine all through high school, and her other sister who had, but outgrew, cyclic vomiting syndrome.
My daughter has had all the tests you can imagine and is seeing a neurologist who diagnosed her with chronic daily migraine. He says the next step is for her to work up to 200 mg. of Topamax®. I’m concerned because she tried up to 50 mg. before, but experienced tingling in her hands and nausea.
My daughter’s quality of life is suffering and we are desperate for relief for her. Do you have any advice?
A: Your daughter’s situation is actually quite common among headache specialty practices, and it sounds as though she should be under the care of a provider who specializes in headache management. There are headache specialists throughout the U.S. Check the National Headache Foundation’s Physician Finder for the names of headache specialists in your area.
Three things stand out in your letter. First, that another daughter had cyclical vomiting, which is a type of migraine syndrome, supports the genetic tendencies of migraine. That she improved should be reassuring for your younger daughter. She, too, will most likely be able to get relief and back to a functional, satisfying life. Second, the tingling of the hands and feet is not uncommon with Topamax. It is not dangerous and, in fact, may well indicate that she will respond to Topamax. Usually the tingling resolves once a person stays at a particular dose level for a while.
Many people report trying and failing numerous preventive medications, but upon taking a more careful history, we often find that the dose was not adequate and/or the medication wasn’t tried for a sufficient length of time to make it an adequate trial. Sometimes it takes a combination of two or more medications to get effective control of headaches. It is always a trial and error process. There is no test that can tell a physician what specific medication will work for a particular patient. What may work for one person may not work for another or what one person may tolerate another may not, even within the same family!
Finally, there is more and more evidence linking the use of narcotic pain medications such as Vicodin (hydrocodone) and butalbital (Fioricet®, Esgic®) with worsening of headaches, actually making people refractory to more appropriate medications. I strongly discourage the use of those medications.
Don’t give up hope. Have your daughter check out the NHF website and search for a headache specialist. The website also has some excellent suggestions for biobehavioral tools that can help manage chronic headaches.
James W. Banks, MD, Ryan Headache Center, St. Louis, MO
]]>Migraine has been views as a pain problem by many patients and health professionals in the past. Yet most migraineurs will acknowledge that pain is only one piece of the puzzle. Symptoms that accompany a migraine attack are just as intolerable as the head pain.
Viewing migraine merely as a pain problem leads to unintended consequences, namely promoting the use of painkiller medications as treatment—particularly narcotic drugs (such as opioids). While narcotics can be effective at relieving pain, their ability to eliminate associated symptoms and return patients to normal function is not well proven. Further, narcotics commonly cause drowsiness, which diminishes a person’s capacity to perform daily work or household activities. Thus, these medications may not be the ideal migraine treatment option.
Other research concludes that overuse of narcotics can cause episodic migraine to transform into a pattern of daily or near-daily headache. The American Academy of Neurology 2012 “Guidelines on Treating Migraine” state that opioids “may play a significant role in headache progression and patterns.”
Additionally, clinicians and patients often have concerns that the use of narcotic drugs could result in patterns of medication consumption best described as dependence or abuse. As a result, the use of narcotics for migraine remains controversial—yet, these drugs continue to be used widely.
Recent information from the American Migraine Prevalence and Prevention Study explored how narcotic medications are prescribed and consumed. Researchers sent questionnaires to 120,000 households across the United States. Information from a group of about 6,000 migraine respondents was analyzed. The results showed:
Patterns of non-narcotic medication use were explored. In comparison to individuals not using narcotics, the annual rate of visiting a doctor’s office was three times higher for people currently or previously prescribed narcotics. The number of headache days per month was lowest among those not using narcotics (three days) and highest among narcotic dependent patients (nine days). Further, the emergency room visitation rate was four times higher for prior narcotic users, five times higher for current users and 24 times higher among dependent patients.
Whether narcotic use is a sign or cause of increased migraine severity remains an unanswered question. Until research is conclusive, narcotics should be reserved for situations when migraine-specific drugs or non-narcotic pain medications are ineffective, cause significant adverse effects or are contraindicated. In situations where prescribing a narcotic may be appropriate, patients’ overall ability to function should be regularly monitored as should their use of other medications and worsening of other illnesses.
Richard Wenzel, PharmD, Staff Pharmacologist, Diamond Headache Unit, St. Joseph Hospital, Chicago, Ill.
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Q: What’s the most frustrating thing about living with migraine?
A: I can’t articulate what I go through when I have a migraine. People look at me and say, “You’re always so happy-go-lucky. You couldn’t be as sick as you’re saying.” That’s what the public thinks when they look at you—you’re pretending. I’ve stopped trying to convince people I’m sick.
Q: What are you most thankful for?
A: Having a supportive family. My mother suffered from migraine so she was really, really supportive. My dad was supportive of my headaches, too. And now that I’m married, my best support system is my husband, Isiah.
Q: What’s your greatest achievement?
A: I think my greatest achievement is the fact that I was able to rear wonderful, God-fearing children.
Q: How do you live your day-to-day life?
A: When my kids used the word “can’t,” that was like profanity in my household. We’d say, “What do you mean you can’t? You can do anything.” And that’s the way I try to live. Anything I think I can do, I try to do. I’m the little engine that could.
Q: What’s your favorite book?
A: The Bible—reading the Healing Scriptures.
Q: What’s your idea of happiness?
A: Living from day to day and week to week with as few migraines as possible.
Sheila Jones-Lineberry is an early-childhood coordinator for Save the Children at Dover Elementary School, Orangeburg Consolidated School District 5.
A. The way I look at migraine is that there are three main components: There is the migraine pain, which is really severe; then there’s the tension pain where the headaches don’t reach migraine proportion and there isn’t any sensitivity to light or noise; and at the lowest level, there is the pressure sensation you get. What?we have found in some studies is that if you have migraine or tension-type headache and you have pressure, your headaches tend to be more frequent and more disabling. It looks like the pressure sensation is a predictor for more severe migraine. About 80 percent of migraineurs report pressure over their sinuses.
What may be causing this? A migraineur has a hypersensitive nervous system that probably picks up all sorts of changes in your head, since nerves go to your sinuses. Anytime the sinuses get clogged or you have nasal congestion, the brain perceives that as pressure. I would suspect that pressure sensations are occurring from this phenomenon where the sinus gets blocked, causing negative pressure on the membranes in the sinuses.
I believe that sinus pressure is going to be best treated with some sort of decongestant or a nasal steroid; the steroid would work over days, whereas?the nasal decongestant would work much quicker, particularly if it is in a nasal spray. However, you don’t want to use a nasal spray decongestant for more than two or three days at a time because you can form a dependence on the medication, and every time you don’t use it, your nose just swells completely shut. If you want long-term improvement from the pressure, you could use nasal steroids or a nasal antihistamine. Anti-inflammatories are very effective for treating pain originating from the sinuses. It’s very possible that you could treat the after-effects of the sinus problem on the nerves by treating with the anti-inflammatories.
Vincent Martin, MD, University of Cincinnati College of Medicine, Cincinnati
]]>Robert’s excellent and immersive guidebook, Living Well With Migraine Disease and Headaches: What Your Doctor Doesn’t Tell You … That You Need to Know, is an easy-to-read, comprehensive resource for anyone suffering from head pain—and the family members and friends who are trying to understand them. Robert, a patient advocate and migraine sufferer herself, writes directly from the heart, and her stories connect with readers because she has gone through the same painful experiences.
She opens the book by sharing anecdotes from her lifelong battle with migraine disease and the struggles she’s had finding good—or even adequate, non-dismissive—treatment. Her accumulated knowledge will help other people living with pain avoid the challenges she faced.
Migraine is not “just a headache,” and this is not just another headache book. It might be better described as a migraineur’s toolkit or workbook. Living Well With Migraine Disease and Headaches covers everything you need to know to take control of your condition, including migraine and headache basics, treatments, medications, triggers, alternative therapies and medical risks. Robert also delves into new research, discusses how to find a headache specialist and covers patient rights.
Unlike many other migraine books that espouse a specific philosophy (try X, Y and Z and you’ll feel better!), Robert takes a more realistic and practical approach. She stresses that there is no cure-all for migraine disease. Instead, she takes a holistic view that incorporates lifestyle changes, medication, patient education and alternative therapies. Speaking from more than 40 years of experience, Robert urges readers not to let migraine take control of their lives and to become active participants on their health care team.
Robert’s philosophy is that migraine and headache patients are ultimately responsible for their own health, so they must take responsibility for their care. She preaches a message of empowerment: You do not have to accept the pain. You can do something about your condition. The more you educate yourself about your disease, the better you will be at managing it.
There is also a permanent website for the book, www.helpforheadaches.com, with supplemental materials that are available for reference and/or download. Readers can go online to find resources, such as a medical checklist, an emergency room visit form, and a letter to give to your family and friends to educate them about your disease. As simple as these resources seem, they can be a lifesaver for someone in the throes of a migraine attack.
In the interest of full disclosure, I can relate to Robert’s experiences because I have suffered from migraine disease and other headache disorders since I was 8 years old. I remember when I went to a local ER for the first time, they needed all of my information. Having to look for my insurance card and driver’s license and write down my medical history all while having a severe migraine attack was unbearable. Robert provides treatment registration information documents in her book and on the corresponding website. You and your doctor can fill out all of the necessary information when you’re feeling good, so you have it ready if you ever have to go to the ER.
Of course, as with any book bold enough to include Web links, several of the items referenced in the text are now out of date. For example, in one of the resource appendices, she mentions that you can purchase migraine awareness wristbands, but they are no longer available.
Like most migraineurs, I have a bookshelf full of treatises on migraine and headache, but this is the only one I keep returning to. I check in with it when I have questions. I refer back to it for advice. I check the online resource guide and go to the complementary website. In fact, my copy looks more like a college textbook, complete with dog-ears, scribbled notes and yellow streaks of highlighter.
But as in-depth as this book is, it is far from a textbook. Writing a compelling book about pain is no easy task, but Robert rises to the occasion. The majority of the books I’ve read on this topic are extremely dense, cold and clinical. Although Robert covers a wide range of information, her text is still user-friendly. She provides all of the necessary tools and information you need to start tackling this disease head on, but she also personalizes the book by sharing her own stories and letters from other migraine sufferers.
Many of these letters are touching, sad or horrifying, but they provide information migraine and headache sufferers need to know. By demonstrating the absolute worst risks of migraine disease, Robert makes readers aware of the responsibility they have when using medications and treatments.
I finished this book feeling truly empowered and inspired to take my migraine disease into my own hands. I’ve had migraine and headaches for 18 years and can honestly say I learned more in this book than I ever have in a doctor’s office.
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On the Shelf
If you’re looking to read more about migraine and headache disorders, try these other helpful works.
A Brain Wider Than the Sky, By Andrew Levy
Levy, who has suffered from debilitating migraines for much of his life, eloquently shares his personal struggle and delves into the history of the disease.
The Migraine Cookbook, By Michele Sharp
This NHF-approved book offers more than 100 healthy and delicious recipes—from appetizers to main courses—that avoid common migraine food triggers.
The Migraine Brain, By Carolyn Bernstein, MD, and Elaine McArdle
Dr. Bernstein, founder of the Women’s Headache Center near Boston, offers advice on mitigating migraine’s effect on every aspect of life.
Is it normal to get severe head pain from riding roller coasters? Could it just be that I had a low-level migraine before I started, and the coasters exaggerated it? It was a very hot day—could dehydration have been an issue? Could the rides have caused a concussion? Is there something I can do to avoid this in the future and ride pain free? – Phyllis E.
A. Roller coasters are fun, but people with migraine are often very sensitive to movement—even carsick- ness is more common in those with migraine. I am certain that roller coasters are generally safe, but many types of brain injuries have been reported following these rides. Significant headaches after the rides should always prompt a neurological evaluation.
Mark Green, MD, Mount Sinai School of Medicine, New York City
]]>A: While possibly related to migraine, visual disturbances like you describe could be a result of transient ischemic events, also known as mini strokes. These attacks trigger symptoms similar to stroke, but they only last a few minutes. Although they cause no permanent damage, they can be a warning of other problems. You should consult your physician as soon as possible for further evaluation and treatment.
Frederick Freitag, DO, Baylor Health Care System, Dallas
]]>Tension in the jaw—and the resulting tension radiating from the jaw—can cause muscle tension headaches and contribute to migraines by restricting blood flow. That’s why relaxing your jaw is crucial to eliminating headache pain.
Some people are aware that they clench or grind their teeth, but others have no idea they are doing it—for example, people who grind their teeth when they sleep. Here are some questions that can help you determine whether you hold tension in the jaw area:
There are many reasons people have excess tension in their jaw. People clench or grind their teeth when they are feeling physical pain, repressing anger or holding back something they want to say. Problems can also result from poor dental work or a motor vehicle accident, which can throw the jaw out of alignment, creating temporomandibular joint (TMJ) disorders.
Dentists often prescribe night splints if a person has a problem with clenching or grinding. These splints can help protect the teeth from damage and wear, but they generally do not get to the root of the problem—the contraction of the muscles in the jaw.
That’s why it pays to familiarize yourself with the bones and muscles in the TMJ area. Take particular notice of the masseter and pterygoid muscles, as these are the muscles that generally constrict when people clench and/or grind their teeth. The masseter, located directly below the surface of the skin, is the primary muscle used for chewing, talking, and opening and closing the mouth. The supporting pterygoid muscles are deeper and can be felt only from within the mouth.
Constriction in the masseter and pterygoid muscles creates jaw tension, but it can also create increased muscle tension in the head that radiates into the temples, causing the temporalis muscles to tighten. This can, in turn, lead to headaches.
Taking Control
Excess clenching or grinding can damage your teeth—and necessitate very expensive dental work—but it is also preventable. You simply need to become aware of the problem and learn how to control it.
Here are a few feel-good tips that can help you relax your jaw area:
1. Jaw and temple massage: This is a quick and effective massage you can do while at your desk or watching television. With your teeth apart, use your fingertips to massage firmly around the TMJ. Then move your fingertips downward and massage the muscles lower on the jaw. Finally, move your fingertips up to the temporalis muscle and massage it in a circular motion. You should notice this area feeling really good after just a couple of minutes.
2. Pterygoid massage: The pterygoid muscles are located inside the mouth near the TMJ, so they are harder to access. Prepare by washing your hands thoroughly or using latex gloves.
Go into your mouth with your index finger and massage the pterygoid muscles, making sure to move in the direction of the muscle. If these muscles hold any excess tension, it will be easy to find them, as they will be somewhat tender or sore to the touch. Use firm pressure and massage for 30 to 60 seconds on each side. After removing your hand, pause for a moment to notice how these muscles now feel. They should feel slightly tender from being worked. If they don’t, try going a little deeper next time. Conversely, if they feel extremely sore, use softer pressure in the future.
If you are not sure you are doing this technique correctly, you can have a chiropractor, a massage therapist or an osteopathic physician guide you through pterygoid muscle massage.
There are a number of factors that contribute to head pain. If you want to keep your headaches in check, it’s important to mitigate as many of these factors as you can. Start today with these two simple exercises, and you can help keep jaw tension—and the resulting headaches—at bay.
Kelsie Kenefick, MPS, BCB, LMHC, is the author of the award-winning book Migraines Be Gone and the founder of Naturally Pain Free. She created a home program that helps headache sufferers learn how to control their headaches. Learn more at www.naturallypainfree.com.
But as any migraineur knows, that’s easier said than done.
When all you can focus on is the throbbing, aching and everything else that comes with a migraine attack, you’re probably not thinking about how the rest of your body is working. You might not notice that your fingertips are cold or that your breathing has gone shallow. And even if you do notice these phenomena, you might not think they have anything to do with the awful feeling going on in your head.
But, as it turns out, it’s all connected—and focusing on relieving some of the physiological symptoms of migraine can go a long way toward easing your pain. A system called biofeedback, which involves tracking the body’s functions and using visualization and stress-relief techniques to manage them, is gaining fans in the migraine community.
Biofeedback may not consistently halt a migraine, but it can be useful in helping reduce headache intensity and duration, says Morris Levin, MD, professor of neurology and psychiatry at Dartmouth Medical School and the co-director of Dartmouth’s Headache Center. The idea has been percolating for decades, as physicians and specialists in emotional and behavioral health have worked together to learn about the connections between thoughts and feelings and the tangible issues they create in our bodies.
The bottom line, he says, is that the way the body handles stress—whether it’s just the daily grind or a particularly difficult event—can spark a harmful chain reaction.
“I think there’s something about the way humans respond to stress,” Dr. Levin says. “The fast heart rate, higher blood pressure, tighter muscles, cold hands and feet—the whole situation we get into in the fight-or-flight response causes all sorts of physical problems, like headaches.”
Learning and listening
Biofeedback is actually more of a learning process than a treatment. It’s taught by a variety of professionals, including psychologists, physicians and physical therapists, and can be a good fit for many people, according to Dr. Levin. Experts say even children and teens can benefit from learning about the connection between their body and their pain.
“[Good candidates are] patients who have not done well with other treatments; patients who don’t like taking medications or don’t want to try more invasive surgical options; or patients who say to their physician, ‘I feel like this is all stress, and if I could just relax, I’d feel better,’” he says.
The experience usually begins in the same way—with an appointment at a clinic where patients get an up-close look at how their body is working. Thermometers, monitors and other sensors provide relevant physiological information, such as skin temperature, heart rate and muscle tension.
Derek Schwartz, PhD, a California-based psychologist and biofeedback expert, says this is a valuable experience for patients, who are often out of touch with their body’s responses and the internal factors that may contribute to their migraines.
“With biofeedback, patients can see this information displayed on a computer screen, which can potentially help them control certain physiological functions and responses that may affect their headaches,” he says. “They can look at it and say, ‘Oh, that’s why I’m feeling better.’”
This information often holds some pretty surprising information. For example, cold hands can be a clear signal that something isn’t right, says Kathleen Farmer, PsyD, co-founder of the Headache Care Center in Springfield, Mo.
“Your finger temperature is a predictor of how much stress your body is carrying,” she says. “The average finger temperature in an average person is 85 degrees. Migraineurs often have finger temperatures in the 70s. The goal of biofeedback is to warm the finger temperature to 96 degrees.”
Warmer fingers, Farmer says, help put the brain in a state that promotes relaxation and concentration. In other words, when you’re stressed out and in pain, your fingers are probably cold. Feeling good? You’ve likely got warm hands.
Putting knowledge into action
Of course, knowing the temperature of your fingers or the efficiency of your breathing isn’t much good to you if you can’t do anything about it. Once the numbers are in, the next step in biofeedback is empowerment. The patient must recognize that he or she can do something to change those numbers—and in doing so, help manage a migraine.
A practitioner typically guides the patient through a series of visualization exercises aimed at reducing stress levels. As the migraineur imagines him or herself in a quiet, peaceful place, for example, the monitors track various indicators.
A beep or flashing light often helps alert patients to changes in their body. After a few sessions, which usually last around one hour, patients should begin to see the connection between how they think and how they feel.
Armed with that information, many migraine sufferers can start using biofeedback on their own, without any help or fancy equipment. Farmer says she’s had patients get so comfortable with recognizing and controlling their physiological processes that they’ve been able to go from having a migraine every day to only getting them occasionally. Others have been able to ease the severity of their attacks.
Some at-home practitioners use CDs or DVDs to provide the same type of step-by-step guidance they would get at a clinic. Music or recordings of soothing nature sounds can also be helpful. Eventually, many people figure out what their body needs and how to accomplish it without using a finger thermometer or heart rate monitor.
But no matter how skilled biofeedback practitioners become, they can still get rusty if they don’t put in some effort.
“It’s up to the person to do it,” Farmer says. “I can demonstrate how to do it, and they can actually experience it. But they have to practice. It’s not like taking a pill.”
One drawback of biofeedback is that in-office sessions can be fairly expensive. A typical clinic session generally runs between $75 and $150. For hypertension patients, insurance will cover a portion of the treatment—Farmer says it’s usually about 50 percent—but that can vary quite a bit from provider to provider. For at-home practitioners, the additional cost can be minimal or significant depending on which tools they use. High-tech biofeedback machines sell for hundreds, and sometimes thousands, of dollars.
Schwartz says some of those tools can be valuable on a basic level, but the most important thing is to fully understand the mind-body connection—the interaction between a person’s thoughts, behaviors, emotions and physiology.
“From a holistic perspective, biofeedback is about creating physiological, cognitive and emotional awareness,” he says. “It’s being more aware in the middle of craziness to take some deep breaths, drop the shoulders—do those kinds of things. Smell the roses.”
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Biofeedback Tool Kit
Type “biofeedback equipment” into any search engine, and it’s easy to get overwhelmed. You can spend anywhere from thousands of dollars on machines that measure your brain waves to just $14.95 on a relaxation CD.
Although most of this equipment can be purchased online, some of the most expensive biofeedback tools are found in a clinical setting. Here is a quick look at the tools of the trade:
Finger thermometers: These are used in a technique called finger warming. Higher temperatures generally mean more migraine relief.
Electrodes: Sensors, which are stuck to the skin with an adhesive and attached to a machine with cables, are used to measure brain or heart activity.
Portable sensors and monitoring devices: There are sensors for just about every function of the body, from a wristband that measures joint motion to a machine that measures changes in the activity of your sweat glands and the size of your pores.
Light and sound machines: These are aimed at reducing stress and helping patients feel calm.
CDs, DVDs and software: These can be handy for at-home guided visualization exercises.
]]>Just as painful headaches can keep a person awake at night, a lack of sleep or disrupted sleep can trigger headaches. To achieve better sleep and decrease associated headaches, it is important to first understand the underlying sleep disorders that could be triggering your headaches.
4 Sleep Disorders that Trigger Headache
Research shows that many common sleep disorders are associated with headaches:
INSOMNIA is considered a risk factor for tension-type headache. Research suggests this is also a bidirectional phenomenon: the pain of a nighttime headache or the use of sleep at odd hours to relieve a headache could keep sufferers from sleep at nighttime; conversely, that inability to sleep at regular intervals could lead to new headaches.
PARASOMNIAS, characterized by events during sleep that do not disrupt sleep (e.g., snoring, sleep-walking and sleep-talking), are more common among children with migraine and headache than children who do not experience headache. This connection has been observed, though researchers have not yet studied the reasoning behind this connection.
RESTLESS LEGS SYNDROME, characterized by a crawling or fidgety sensation in the legs during rest, is more prevalent among migraineurs. Researchers have proposed a number of theories for this connection, blaming the relationship on iron deficiency or comorbidity with depression, among other aggravating factors.
OBSTRUCTIVE SLEEP APNEA involves the collapse and obstruction of airways during sleep. People with sleep apnea frequently complain of morning headaches and, rarely, of headaches during sleep. But research suggests the condition could also trigger cluster headache; chronic paroxysmal hemicrania, a severe, frequent, one-sided headache; and hypnic headache, a regular headache that may awaken the sufferer from sleep and generally affects elderly people.
For people with sleep disorders and headache, treating the underlying sleep disorder could help improve an associated headache condition.
5 Tips for Better Sleep
Reference:
1. Mitsikostas et al. “Sleep and Headache: The Clinical Relationship.” Headache. 2010;50(7):1233-1245.
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