Posts tagged headaches
Articles and news from the latest research reports.
Migraine Attacks Increase Following Stress
Migraine sufferers who experienced reduced stress from one day to the next are at significantly increased risk of migraine onset on the subsequent day, according to a new study conducted by researchers at the Montefiore Headache Center and Albert Einstein College of Medicine at Yeshiva University. Stress has long been believed to be a common headache trigger. In this study, researchers found that relaxation following heightened stress was an even more significant trigger for migraine attacks. Findings may aid in recommending preventive treatments and behavioral interventions. The study was published online today in Neurology®, the medical journal of the American Academy of Neurology.
Migraine is a chronic condition that affects approximately 38 million Americans. To examine headache triggers, investigators at the Montefiore Headache Center and Einstein conducted a three month electronic daily diary study which captured 2,011 diary records and 110 eligible migraine attacks in 17 participants. The study compared levels of stress and reduction in stress as predictors of headache.
“This study demonstrates a striking association between reduction in perceived stress and the occurrence of migraine headaches,” said study lead author Richard Lipton, M.D., director, Montefiore Headache Center, professor and vice chair of neurology and the Edwin S. Lowe Chair in Neurology, Einstein. “Results were strongest during the first six hours where decline in stress was associated with a nearly five-fold increased risk of migraine onset. The hormone cortisol, which rises during times of stress and reduces pain, may contribute to the triggering of headache during periods of relaxation.”
Data were collected using a custom-programmed electronic diary. Each day participants recorded information about migraine attacks, two types of stress ratings and common migraine triggers, such as hours of sleep, certain foods, drinks and alcohol consumed, and menstrual cycle. They also recorded their mood each day, including feeling happy, sad, relaxed, nervous, lively and bored.
“This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine,” said Dawn Buse, Ph.D., director, Behavioral Medicine, Montefiore Headache Center, associate professor, Clinical Neurology, Einstein, and study co-author. “It is important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allowing a major build up to occur. This could include exercising or attending a yoga class or may be as simple as taking a walk or focusing on one’s breath for a few minutes.”
Tweeting a killer migraine in real time
Not even the pain of a migraine headache keeps people from Twitter.
Over the course of a week, students collected every tweet that mentioned the word migraine. Once they cleared out the ads, the retweets and the metaphorical uses of the word, they had 14,028 tweets from people who described their migraine headaches in real time — with words such as “killer,” “the worst” (almost 15% of the tweets) and the F-word.
The Twitter users also reported the repercussions from their migraines: missing school or work, lost sleep, mood changes.
The researchers found the information to be “a powerful source of knowledge” about the headaches, because usually sufferers are providing information after the fact in clinical situations.
“The technology evolves, and our language evolves,” Dr. Alexandre DaSilva, an assistant professor at the University of Michigan School of Dentistry and lead author of the study, said Wednesday by phone. Clinical researchers’ language — such as “throbbing” or “pulsating” — might not be as apt today, to “the generation that grew up with video games.”
Head hurts? Zap the wonder nerve in your neck
"It was like red-hot pokers needling one side of my face," says Catherine, recalling the cluster headaches she experienced for six years. "I just wanted it to stop." But it wouldn’t – none of the drugs she tried had any effect.
Thinking she had nothing to lose, last year she enrolled in a pilot study to test a handheld device that applies a bolt of electricity to the neck, stimulating the vagus nerve – the superhighway that connects the brain to many of the body’s organs, including the heart.
The results of the trial were presented last month at the International Headache Congress in Boston, and while the trial is small, the findings are positive. Of the 21 volunteers, 18 reported a reduction in the severity and frequency of their headaches, rating them, on average, 50 per cent less painful after using the device daily and whenever they felt a headache coming on.
This isn’t the first time vagal nerve stimulation has been used as a treatment – but it is one of the first that hasn’t required surgery. Some people with epilepsy have had a small generator that sends regular electrical signals to the vagus nerve implanted into their chest. Implanted devices have also been approved to treat depression. What’s more, there is increasing evidence that such stimulation could treat many more disorders from headaches to stroke and possibly Alzheimer’s disease.
The latest study suggests it is possible to stimulate the nerve through the skin, rather than resorting to surgery. “What we’ve done is figured out a way to stimulate the vagus nerve with a very similar signal, but non-invasively through the neck,” says Bruce Simon, vice-president of research at New Jersey-based ElectroCore, makers of the handheld device. “It’s a simpler, less invasive way to stimulate the nerve.”
Cluster headaches are thought to be triggered by the overactivation of brain cells involved in pain processing. The neurotransmitter glutamate, which excites brain cells, is a prime suspect. ElectroCore turned to the vagus nerve as previous studies had shown that stimulating it in people with epilepsy releases neurotransmitters that dampen brain activity.
When the firm used a smaller version of ElectroCore’s device on rats, it found it reduced glutamate levels and excitability in these pain centres. Other studies have shown that vagus nerve stimulation causes the release of inhibitory neurotransmitters which counter the effects of glutamate.
The big question is whether a non-implantable device can really trigger changes in brain chemistry in humans, or whether people are simply experiencing a placebo effect. “The vagus nerve is buried deep in the neck, and something that’s delivering currents through the skin can only go so deep,” says Mike Kilgard of the University of Texas at Dallas. As you turn up the voltage, there’s a risk of it activating muscle fibres that trigger painful cramps, he adds.
Simon says that volunteers using the device haven’t reported any serious side effects. He adds that ElectroCore will soon publish data showing changes in brain activity in humans after using the device. Placebo-controlled trials are also about to start.
Catherine has been using it for a year without ill effect. “I can now function properly as a human being again,” she says.
The many uses of the wonder nerve
Coma, irritable bowel syndrome, asthma and obesity are just some of the disparate conditions that vagus nerve stimulation may benefit and for which human trials are under way.
It might also help people with tinnitus. Although people with tinnitus complain of ringing in their ears, the problem actually arises because too many neurons fire in the auditory part of the brain when certain frequencies are heard.
Mike Kilgard of the University of Texas at Dallas reasoned that if people were played tones that didn’t trigger tinnitus while the vagus nerve was stimulated, this might coax the rogue neurons into firing in response to these frequencies instead. “By activating this nerve we can enhance the brain’s ability to rewire itself,” he says.
He has so far tested the method in rats and in 10 people with tinnitus, using an implanted device to stimulate the nerve. Not everyone noticed an improvement, but even so Kilgard is planning a larger trial. The work was presented at a meeting of the International Union of Physiological Sciences in Birmingham, UK, last month. The technique is also being tested in people who have had a stroke.
"If these studies stand up it could be worth changing the name of the vagus nerve to the wonder nerve," says Sunny Ogbonnaya at Cork University Hospital in Ireland.