Posts tagged headache
Articles and news from the latest research reports.
Most headaches in pregnancy and the postnatal period are benign, but healthcare professionals must be alert to the rarer and more severe causes of headaches, suggests a new review published in The Obstetrician & Gynaecologist (TOG).
The review looks at common causes for headaches during pregnancy and the postnatal period, possible conditions that may be associated with headaches and how healthcare professionals should manage the care of the woman appropriately.
There are 85 different types of headache. Approximately 90% of headaches in pregnancy are migraine or tension-type headaches. However, pregnancy can lead to an increased risk of certain secondary headaches, a headache caused by an underlying health condition, states the review.
The review states that most headaches in pregnancy are benign but in some cases can be more serious. According to the Confidential Enquiries into Maternal Deaths in the United Kingdom 2006 – 2008 report, neurological conditions were the third most common cause of death, considering both direct and indirect causes. The authors of the review therefore emphasise the need for all medical staff to be well trained to take a full history and examination, make a provisional differential diagnosis and know when to seek neurological expertise.
Migraine is a common form of headache; the condition is more common in women, with the highest prevalence rates during the childbearing years. The review states that pregnancy leads to a reduction in the frequency and severity of attacks of migraines without aura, also known as a common migraine. However, women who do experience migraines have a more than two-fold increased risk of pre-eclampsia than those who do not. Women therefore need to be aware to consult a healthcare professional if their headache is different from their usual migraine, highlights the review.
Another condition associated with a headache in pregnancy is idiopathic intracranial hypertension, a build up of high pressure inside the skull, a rare condition but more prevalent in obese women of childbearing age. The condition may present for the first time in pregnancy and pre-existing disease tends to worsen in pregnancy. It can be fatal if it is not treated promptly as a medical emergency.
Pregnancy is also a recognised risk factor for cerebral venous thrombosis (CVT), the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Caesarean section, systematic infection, vomiting and anaemia increase the risk and headache is the most frequently (80 – 90%) occurring symptom in CVT and often the first symptom reported by patients.
The review also discusses imaging and advises that imaging of the brain should never be withheld because a woman is pregnant and women should be reassured that imaging is safe.
Kirsty Revell, Specialist Registrar, Obstetrics and Gynaecology at the Princess Anne Hospital, Southampton and co-author of the review said:
“Headaches are common in life and in pregnancy. Most headaches are benign, for example migraine or tension headaches, but some headache types can be more serious and an indication that something is seriously wrong.
“It is vital that both GPs and obstetricians are aware of the signs and symptoms associated with these conditions and know when to seek advice from a specialist.”
Jason Waugh, TOG Editor-in-chief added:
“Many women experience headaches during pregnancy and the postpartum period and most are managed by women themselves or within primary care.
“Women presenting with headaches in pregnancy and the postnatal period may be at home, on a maternity ward, in an antenatal clinic, at a tertiary referral centre or in an emergency department. All medical staff should be aware of the symptoms, signs and appropriate response to the rarer and more severe causes of headaches that continue to cause avoidable morbidity and mortality.”
(Image: iStockphoto)
Brrrrrrrrr! It’s Brain Freeze Season
Brain freeze is practically a rite of summer.
It happens when you eat ice cream or gulp something ice cold too quickly. The scientific term is sphenopalatine ganglioneuralgia, but that’s a mouthful. Brain freeze is your body’s way of putting on the brakes, telling you to slow down and take it easy. Wake Forest Baptist Medical Center neuroscientist Dwayne Godwin, Ph.D., explains how it works.
"Brain freeze is really a type of headache that is rapid in onset, but rapidly resolved as well," he said. "Our mouths are highly vascularized, including the tongue - that’s why we take our temperatures there. But drinking a cold beverage fast doesn’t give the mouth time to absorb the cold very well."
Here’s how it happens: When you slurp a really cold drink or eat ice cream too fast you are rapidly changing the temperature in the back of the throat at the juncture of the internal carotoid artery, which feeds blood to the brain, and the anterior cerebral artery, which is where brain tissue starts.
"One thing the brain doesn’t like is for things to change, and brain freeze is a mechanism to prevent you from doing that," Godwin said.
The brain can’t actually feel pain despite its billions of neurons, Godwin said, but the pain associated with brain freeze is sensed by receptors in the outer covering of the brain called the meninges, where the two arteries meet. When the cold hits, it causes a dilation and contraction of these arteries and that’s the sensation that the brain is interpreting as pain.
Analyzing brain freeze may seem like silly science to some, but “it’s helpful in understanding other types of headaches,” Godwin said.
"We can’t easily give people migraines or a cluster headache, but we can easily induce brain freeze without any long-term problems," he said. "We can learn something about headache mechanisms and extend that to our understanding to develop better treatments for patients."
Is there a cure for brain freeze? Yes - stop drinking the icy cold beverage. You can also jam your tongue up to the roof of your mouth because it’s warm or drink something tepid to normalize the temperature in your mouth.
(Image: Erik S. Peterson/ Wikimedia Commons)
Genetic Mutation Linked with Typical Form of Migraine
A research team led by a Howard Hughes Medical Institute investigator at the University of California, San Francisco has identified a genetic mutation that is strongly associated with a typical form of migraine.
In a paper published on May 1 in Science Translational Medicine, the team linked the mutation with evidence of migraine in humans, in a mouse model of migraine and in cell culture in the laboratory.
The mutation is in the gene known as casein kinase I delta (CKIdelta).
“This is the first gene in which mutations have been shown to cause a very typical form of migraine,” said senior investigator Louis J. Ptáček, an investigator at HHMI and a professor of neurology at UCSF. “It’s our initial glimpse into a black box that we don’t yet understand.”
Migraine, the causes of which are still unknown, affects 10 to 20 percent of all people, and causes “huge losses in productivity, not to mention immense suffering,” said Ptáček. Typical symptoms include a pounding headache; lowered pain threshold; hypersensitivity to mild stimuli including sound and touch; and aura, which Ptáček describes as “a visual sensation that presages the headache to come.”
The paper presents both clinical and basic scientific evidence that the mutation causes migraine.
In the study, the scientists first analyzed the genetics of two families in which migraine was common, and found that a significant proportion of migraine sufferers in the families either had the mutation or were the offspring of a mutation carrier.
In the laboratory, the team demonstrated that the mutation affects the production of the casein kinase I delta enzyme, which carries out a number of vital functions in the brain and body. “This tells us that the mutation has real biochemical consequences,” said Ptáček.
The scientists then investigated the effects of the mutation in a line of mice that carry it. “Obviously, we can’t measure headache in a mouse,” Ptáček noted, “but there are other things that go along with migraine that we can measure.”
Pain threshold, explained Ptáček, can be lowered in mice by the administration of nitroglycerin. The mutant mice had a significantly lower threshold for nitroglycerin-induced peripheral pain than did normal mice.
Another piece of evidence was cortical spreading depression (CSD), a wave of electrical “silence” in the brain that follows electrical stimulation, spreading out from the point of stimulation in a predictable pattern. The researchers found that the mutant mice had a significantly lower electrical threshold for the induction of CSD.
The CSD experiments are “especially intriguing,” said Ptáček, because it is known that CSD spreads through the brain at 3 millimeters per minute. “Functional brain imaging has shown that in the occipital lobes of people with migraine aura, changes in blood flow spread at the same rate.”
Finally, Ptáček and his team found that astrocytes – brain cells that are essential to neuronal functioning and health – from the brains of mutant mice showed increased calcium signaling compared with astrocytes from the brains of normal mice.
“This is significant because we think astrocyte functioning is very, very relevant to migraine,” said Ptáček. “This is an enzyme, and so it modifies proteins. The question is, which protein or proteins does it modify that is relevant to migraine? How does it change astrocyte activity?”
The research “puts us one step closer to understanding the molecular pathway to pain in migraine,” he said. “And, as we come to a clearer understanding, we can start thinking about better therapies. Certain molecules might be targets for new drugs.” There are good drugs now, said Ptáček, “but they only help some patients, some of the time. The need for better treatments is huge.”
The CKIdelta mutation is “far from the only mutation likely to be associated with migraine,” Ptáček cautioned. “There are likely several, in different combinations in different people. This is simply the first one we’ve found.”
Choosing Wisely: AAN Cites Five Things to Question
In 2012, the AAN joined the Choosing Wisely campaign, a project initiated by the American Board of Internal Medicine (ABIM) Foundation to promote appropriate medical decision-making and the stewardship of health care resources. The campaign is designed to help consumers and physicians engage in conversations about the overuse of particular tests, procedures, and treatments and to help patients make smart and effective care choices.
In February 2013, the AAN participated in a news conference with the ABIM Foundation and Consumer Reports, where medical specialties announced their lists of the top five questionable tests and procedures each selected for patients and physicians to consider.
Read AAN’s Five Things Physicians and Patients Should Question
The AAN’s complete recommendations were published online ahead of print in the February 21, 2013, issue of Neurology®.
How Neurology Tests and Procedures Were identified
The AAN established a Choosing Wisely Working Group to develop its list of recommendations. Members of this group were selected to broadly represent varying practice settings and neurological subspecialties. Neurologists with expertise in evidence-based medicine and a broad range of subspecialty disciplines were also included. The working group solicited recommendations from AAN members, which were then rated based upon their judgments of harm and benefit that would result based upon compliance with the recommendation. Based on committee voting and a literature review, candidate recommendations were sent to relevant AAN sections, committees, specialty societies and patient advocacy groups for review and comment. The working group reviewed this feedback and voted on the final top five recommendations, which were approved by the AAN Practice Committee and Board of Directors.
Lightning May Trigger Migraine Headaches
Migraine sufferers know that a variety of influences—everything from stress to hunger to a shift in the weather—can trigger a dreaded headache. A new study published in the journal Cephalalgia, though, suggests that another migraine trigger could be an unexpected atmospheric condition—a bolt of lightning.
As part of the study, Geoffrey Martin of the University of Cincinnati and colleagues from elsewhere asked 90 chronic migraine sufferers in Ohio and Missouri to keep detailed daily diaries documenting when they experienced headaches for three to six months. Afterward, they looked back over this period and analyzed how well the occurrence of headaches correlated with lightning strikes within 25 miles of the participants’ houses, along with other weather factors such as temperature and barometric pressure.
Their analysis found that there was a 28 precent increased chance of a migraine and a 31 precent chance of a non-migraine (i.e. less severe) headache on days when lightning struck nearby. Since lightning usually occurs during thunderstorms, which bring a host of other weather events—notable changes in barometric pressure—they used mathematical models to parse the related factors and found that even in the absence of other thunderstorm-related elements, lightning alone caused a 19 percent increased chance of headaches.
Despite these results, it’s probably a bit premature to argue that lightning is a definitive trigger of migraines. For one, a number of previous studies have explored the links between weather and migraine headaches, and the results have been unclear. Some have suggested that high pressure increases the risk of headaches, while others have indicated that low pressure increases the risk as well. Other previous studies, in fact, have failed to find a link between migraines and lightening, in particular.
NuPathe’s Patch for Migraine Wins FDA Approval
Adults with migraine will soon have a new treatment option — Zecuity, a transdermal, battery-powered sumatriptan patch.
NuPathe, maker of the patch, said the FDA has approved the single-use patch to treat headache pain and nausea caused by migraine, with or without aura.
The patch is applied to the upper arm or thigh during a migraine and can deliver 6.5 mg of sumatriptan over the course of 4 hours once activated by push button.
The treatment system was approved based on the results of a phase III, placebo-controlled trial of 800 patients that showed the sumatriptan delivery method was safe and effective, the drugmaker said in a statement.
The FDA failed to approve a NuPathe application for a transdermal sumatriptan patch called Zelrix in August 2011.
In a complete response letter, the agency asked the company for additional data on Zelrix, citing concerns over the patch’s safety, chemistry, and manufacturing. The FDA’s approval of Zecuity may obviate the need for those additional studies.
The device is contraindicated in patients with heart disease, a history of heart disease or stroke, peripheral vascular disease, transient ischemic attack, blood circulation problems, uncontrolled blood pressure, basilar migraines, contraindication to sumatriptan or parts of the device, or Wolff-Parkinson-White syndrome or similar heart rhythm disturbances.
The system should not be used if taken within 24 hours of using another migraine medication or within 2 weeks of using a monoamine oxidase-A inhibitor.
Triptans, such as sumatriptan, can cause serotonin syndrome, which can be exacerbated when used with certain antidepressants.
Patients with heart disease, a family history of heart disease, stroke, high cholesterol or diabetes, have gone through menopause, who smoke, have had epilepsy or seizures, or are pregnant, nursing, or thinking about becoming a parent should consult a healthcare professional before using Zecuity.
(Image: Corbis)