Altered Gut Permeability Hypothesis
Gut permeability may be altered in patients with AM. Mucosal permeability is an indirect function of gut health. A study conducted by Bentley et al in 1995 compared the gut mucosal permeability between 11 children with diagnosis of AM and healthy controls. They found that gut mucosal permeability was significantly increased in patients with AM when compared to healthy controls. Three patients were followed longitudinally over 3 years with follow-up tests three times a year. They noticed that the gut mucosal permeability decreased with symptomatic improvement and vice versa. This might explain why nonsteroidal anti-inflammatory drugs are not beneficial in patients with AM as these drugs increase mucosal permeability. However, no further research has been conducted to test this hypothesis and its implications in the management of children with AM. Of note, this study was done before specific guidelines were published for the diagnosis of AM.
Basic Analgesics: Acetaminophen And Ibuprofen
For mild, acute pain , acetaminophen and ibuprofen are the agents of choice . No other NSAID has been sufficiently studied for efficacy and safety in the pediatric population so as to be recommended as an alternative to ibuprofen. Although there is evidence for the superior analgesic properties of ibuprofen versus acetaminophen, it is considered to be of limited value because the studies were mostly performed in acute pain settings and lack long-term safety data. Both acetaminophen and ibuprofen have potential toxicities. There are concerns about renal and gastrointestinal toxicity, and bleeding with ibuprofen and other NSAIDs, and risks of hepatotoxicity and acute overdose are associated with acetaminophen . Celecoxib enzyme inhibitor) might be considered, if classical NSAIDs are contraindicated . Celecoxib does not display less renal toxicity as compared to classic NSAIDs. Safety and efficacy have been established only in children two years of age or older with juvenile rheumatoid arthritis, and for a maximum of six months of treatment.
With the exception of ibuprofens proven efficacy in reducing pain at the onset of a migraine episode , basic analgesics generally are not used to treat primary pain disorders in the absence of new tissue injury. As discussed earlier, daily use of analgesics in headache patients incurs significant risk of leading to medication overuse headaches .
Fast-Acting NSAID: Ibuprofen-Sodium
Chronic Headache And Central Pain Conditions
Chronic headache is one of the most common medical problems. The vast majority of headaches fall into one of three primary headache categories: tension-type, migraine, or cluster headaches. Tension-type headaches are the most common, with a yearly prevalence of 60 to 80% .1 TTH are usually mild or modest, associated with cranial and/or cervical muscle tenderness, and often do not prompt a healthcare visit. Migraine headaches are usually unilateral, throbbing, and often associated with aura, nausea, photophobia, and phonophobia. Migraine headaches are sub-divided into those with or without aura and affect 10 to 15% of the population, with women affected three times as often.2 Cluster headaches are now part of a new headache category termed trigeminal autonomic cephalgia by the International Classification of Headache Disorders, 3rd edition. These headaches are characterized by sudden, severe, recurrent headaches with autonomic symptoms on the same side, which may include ptosis, miosis, rhinorrhea, and nasal congestion. Cluster headaches are present in less than 1% of the population and are more common in males. Many patients experience both migraine and TTH migraine typically worsens a tension headache.
Each of these primary headache types is, by definition, central in nature. Headaches may also be secondary, such as from a space-occupying mass, a vascular abnormality, an infection, or a systemic or metabolic disease.
You May Like: Anti Anxiety Meds For Migraines
Coping With Chronic Headache Pain
Daily life with chronic headaches can be tough. Sometimes, medications and complementary treatments aren’t enough to help you cope. When you have chronic headaches, seeking support may help you get through the hard times.
Support groups and online pain forums are great coping resources. Make sure you have a good relationship with your healthcare provider and that he or she is evaluating the effectiveness of your treatment plan often.
What Is Chronic Migraine
Chronic migraine is defined as having headache on at least 15 days per month, with eight of these having migraine symptoms, for at least three months. People who have fewer headache days with migraine symptoms have episodic migraine.
If you have chronic migraine your symptoms may include:
- frequent headache
- increased sensitivity to light, sound or smells
- vomiting .
Other symptoms include aura , dizziness and vertigo .
Recommended Reading: Medications For Seizures And Migraines
Impact Of Chronic Migraine
If you have chronic migraine it will have a huge impact on your daily life. Chronic migraine is related to greater disability and has a huge impact on your physical, social and work life. It can also have a huge impact on your relationships. Many people with chronic migraine report lower quality of life and poorer health than people with episodic migraine.
It can be challenging to find an appropriate treatment and you may have spent years trying to find a way to make your migraine manageable.
If you are struggling with chronic migraine speak to your GP, specialist or contact our Helpline.
Migraine Vs Sinus Headache
It isnt always easy to tell the difference between a migraine and a headache, much less a sinus headache, but each condition does have its own set of specific symptoms. While some are shared, others are very distinct to the condition. This creates a strong case for keeping a migraine diary and documenting the details of and surrounding your headaches.
According to Dr. Ailani, the symptoms of migraine and sinus headache are similar because of the region of the brain that is activated during an attack:
Migraine can also have associated symptoms, symptoms that come WITH the headache pain that can be confused for a sinus or allergy problem. You can have a runny nose, watery eyes, your eyes can turn red. These symptoms, called autonomic symptoms, come on because of the area in the brain, the hypothalamus, that gets turned on during migraine.
Following this section are common symptoms for migraines as well as sinus migraine, sinus headaches and sinusitis. As you can see, many of them are identical or nearly identical. Its no wonder that patients struggle to describe their head pain and doctors struggle to diagnose it. The problem is, without a proper diagnosis you cant get proper treatment. If you are diagnosed with sinus headaches but you actually have migraines, it could delay your migraine treatment for years.
Don’t Miss: Mayo Clinic Headache
What Are The Causes
Doctors are learning more about what brings on these headaches, which often run in families. Some are the result of changes in your brain chemicals. Abnormal brain activity is also involved.
Every person who has migraines has different triggers, but common ones include a lack of sleep, caffeine, and being under stress.
Most people who get chronic migraines are women. This may be because hormone changes are another well-known cause. These shifts happen around your monthly period, as well as during pregnancy and through menopause. Birth control can also play a role.
Sinusitis And Sinus Headaches
What most people dont realize is that true sinus headaches are actually quite uncommon and are often over diagnosed or misdiagnosed. Sinusitis is an inflammation of the sinuses, often due to a bacterial infection. The sinuses are air pockets that are situated at certain points in the facial bones. Scientists are not certain the exact purpose of sinuses. Some believe that it helps enhance the voice through resonation while others believe it may be a way for the body to humidify the air during inhalation. They are usually empty but do have a very thin mucus layer along the walls.
There are four pairs of paranasal sinuses, meaning that there are two at the same points on the left and right. They are:
- Frontal sinuses: above the eyes just over the eyebrows
- Maxillary sinuses: on each side of the nose, in the cheekbone
- Ethmoid sinuses: between the eyes, under the bridge of the nose
- Sphenoid sinuses: behind the eyes and ethmoid sinuses
Inflammation of the sinuses can occur due to bacterial, viral, or fungal causes and can present in one of the sinus pair, or several. If there is an infection present, it is important that it is treated. Failure to properly treat a sinus infection can cause serious health risks and can create a propensity to develop sinus infections in the future.
Read Also: Can Headaches Cause Vomiting
Sinus Migraine: When Sinus Pain Is More Than A Headache
You have a headache. It extends over your eye and you have pressure in your face. Your nose even runs a little. You take some Sudafed or ibuprofen, tell everyone you have a sinus headache or even a sinus migraine, and lay down for a while. Two or three hours later you are better. You might have a little residual soreness and you might be a little tired, but the worst of the headache is over. Youve just had a sinus headache or was it?
You could have had a migraine that isnt even related to any sinus issues and not realize it. You felt sinus pain and pressure, so your mind automatically went to sinus headache. Your doctor may even have told you it was sinus related and the subject of migraines never came up. It happens a lot more than you might think. In fact, nearly 90% of patients who visit their doctor and complain of sinus headache actually have a migraine or migraine-type headache.
This is an easy misdiagnosis, but its important to get it right because sinus-related headaches and straight-up migraines are treated differently. For a sinus headache, a decongestant could be key. But if youre having a migraine, you might benefit most from a simple pair migraine glasses like these, or other remedies that are designed for migraine.
The Puzzle Of Migraine Chronification
Len Barbieri started getting migraine headaches when he was 9 years old, although it was many years before they were labelled as such. The condition ran in his family both his father and his aunt experienced migraines. As a teenager, Barbieri remembers driving his father to the hospital, where only a shot of morphine could provide relief.
By the age of 16, Barbieri was also taking a prescription opioid for the pain. Unlike his relatives, he didnt experience neurological disturbances known as aura before the headache, or the sensitivity to light that confined them to darkened rooms. I just had terrible, terrible headaches, he says. Often the pain would start on one side of his head, then spread to both sides. Over a wider area, the pain felt more diffuse, but when it concentrated down to just one temple, it felt like he was being stabbed. I remember miserable days, he says.
Migraine is estimated to affect more than one billion people, and can vary widely from person to person. However, one notable feature of the condition is that some people see a persistent increase in the frequency of attacks, known as chronification. Every year, about 2.5% of people with episodic migraine, which is defined as fewer than 15 headache days a month, move to chronic migraine, experiencing 15 or more headache days monthly.
Recommended Reading: Migraine Vomit Relief
Onset And Risk Factors For Progression From Episodic Migraine To Chronic Migraine
Epidemiological and clinical observations support the progression of EM to CM Progression from EM to CM occurs in about 2.5% of those with EM annually . Because not all those with EM progress to CM, it is important to identify those at high risk for progression. Risk factors can be broken into two categories: those that are easily modified and those that are not readily modifiable . Identification of modifiable risk factors for progression to CM, such as obesity, depression, and medication overuse, is important because physicians can implement approaches through behavioral and pharmacologic interventions to help the patient maintain a stable, healthy lifestyle, thus reducing the risk of CM . Below are brief discussions of potential modifiable risk factors and their associations with the transition between EM and CM.
The Challenge Of Taking Acute Medication Early Enough But Not Too Often
Many people with migraine are prescribed triptans to stop a migraine attack in its early stages. But if you have chronic migraine, it can be difficult to know when to take them, says Dougherty.
People are told, Dont treat too often, but in order for the triptan to be effective, you need to treat really early, Dougherty says. If youre a rule follower trying to heed both of those things, that can be a real challenge, she adds.
Dougherty tells her patients that triptans can be a double-edged sword, in the sense that they can effectively relieve a migraine attack, but if taken more frequently than recommended, their use can lead to medication-overuse headache and raise the risk for chronic migraine.
Medication-overuse headache, also called rebound headache, is a chronic daily headache that happens when acute medications for headache or migraine are used more than two or three days per week, according to the American Migraine Foundation.
In addition to triptans, these headaches are linked with ergotamines, opioids, and over-the-counter pain relievers such as Tylenol , nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, and combination pain relievers that contain aspirin and caffeine, according to the American Migraine Foundation.
Because of these concerns, there are people who have angst every time they take a triptan, says Dougherty, adding that they may feel guilty and think they are contributing to their disease process.
Recommended Reading: Post Ictal Headache
Association With Atopy And Food Sensitivity
Studies have shown a correlation between AM and atopy. Patients with cephalic migraine have a higher incidence of atopy and other allergic disorders., In addition, dietary modification is central in the management of AM in a similar way as in cephalic migraine.
Bentley et al in 1995 studied the response of 12 patients with symptoms suggestive of AM to a modified dietary regimen avoiding potential allergens. Ten out of the 12 patients became symptom free or had diminished symptoms with dietary changes. Five out of 12 patients had a history of eczema, hay fever, or other forms of atopy.
Have Questions About Your Va Claim Or Va Disability Benefits
If the VA has denied your disability claim for compensation, or you received a lower rating than expected, contact the team at Hill & Ponton today. Our law firm specializes in veterans law. We help veterans and their family members obtain the benefits that theyre entitled to through legal advice and representation. Contact us today for a free evaluation of your VA claim.
Don’t Miss: Best Thing To Take For Migraine
If Your Application Is Denied
Most people who apply for disability based on migraine headaches alone are initially denied benefits. But some of these cases can be won on appeal. You can file a request for reconsideration by yourself, but hiring a lawyer at this point will help your chances of getting benefits. When you’re interviewing disability lawyers, ask if they’ve been successful in winning any migraine cases on appeal.
|Take our disability quiz to help you determine whether you qualify for benefits.|
Teenage Migraines 504 Plans And Pain
Asked by Sheila Berg
Teenage Migraines, 504 Plans, And Pain
My 16 year old, academically gifted student has just been diagnosed with chronic migraines by a pediatric neurologist. We are meeting next week to discuss a 504 plan for her and I want to know if we should be looking for anything else besides modified and extended time for makeup work. Her teachers have been supportive thus far, but with no end in sight, we are looking at long term accommodations, and make sure we have her covered.
As far as her migraine issues go… Today is her 18th day of current migraine pain. She simply can’t function to do any work right now. She has been told to only take rescue meds 2 days a week if necessary. Doctor thinks she has rebound migraines from Imitrex. How can I let her suffer like this? Any insight would be appreciated.
You May Like: Do You Take Advil For Headaches
Service Connection Of Migraines
Migraines are one of the more prevalent claimed disabilities among Veterans. It is currently ranked 8th in most prevalent disabilities in new compensation claims. Studies suggest that approximately 36% of those returning from Iraq experience migraine-type headaches. Another study showed that of those suffering from migraine-type symptoms, about 22% showed symptoms of anxiety, 50% showed symptoms of depression, and almost 40% had symptoms of PTSD. The exact causes of migraines remain unknown, but there are links.
There are several injuries that can occur in active duty that might be linked to migraine headaches. Traumatic brain injuries such as exposure to explosives, extremely loud noises, and actual head injuries are leading factors in migraines. However, there are now links to exposures to chemicals such as burn pits and chemical solvents. There may also be secondary comorbidities such as neck, eye, or back injuries, fibromyalgia, and mental health issues. There can also be other secondary issues from the migraines such as sleep disorders, sleep apnea, chronic mental health issues such as depression and post-traumatic stress disorder. Detailed information on how migraines are rated can be found here.
Do You Suffer From Chronic Headaches
ByMatt Murren | Submitted On September 05, 2008
Do you suffer from chronic headaches? The type of pain you are experiencing determines the care that you will need. The first step is to identify which type of headache you are suffering from. There are five kinds of headaches that you should be aware of. They are tension, cluster, sinus, rebound and migraines, and it is important to identify which type of headache you are suffering from in order to receive the correct treatment from your doctor.
The most common type of headache is from tension, where you will feel a constant pressure or ache around your head, especially at the temples or back of the head and neck. Most experts believe that they may be caused by contractions of the muscles in your neck and scalp and possible changes in the chemicals in your brain. They will rarely stop you from continuing your regular activities, and they are not usually accompanied by nausea and vomiting. They are treated by ibuprofen or acetaminophen, or aspirin, which is obtained over the counter.
Cluster headaches appear quite suddenly and are accompanied by severe, often debilitating pain on one side of your head and they are accompanied by watery eyes, nasal congestion, and a runny nose on the same side of the face. They seem to affect men more than women, and the exact cause is still unknown, though it is suspected that genetics play some role in this type of headache.
Migraines can last anywhere from 12 hours to several days.
Read Also: What Helps Migraine Nausea