Pain From The Occipital Nerve
Q. Do some people just get occipital neuralgia sporadically? If so, what have been some of the causes? What test would I need to be diagnosed?
A. Occipital neuralgiapain arising from the occipital nervecan have different origins, either secondary due to some mechanical, inflammatory irritation of the nerve, or primary . Usually neurological examination and MRI and MRA of the brain and cervical spine are satisfactory for diagnosis.
George Urban, M.D.Chicago, IL
Protein Powder And Migraine: Which One Is Best
Those who start a migraine diet are often surprised to find their meal replacements and protein shakes have to go out the window. What makes these protein powders a potential migraine trigger? And what is the best protein powder for migraine sufferers? Well, the answer is kind of tricky.
Some sites will tell you protein powder is filled with MSG and thats not entirely accurate. What makes this so confusing is migraine brains tend of be sensitive to glutamate in general, whether it is MSG or naturally occurring glutamate. So even if a protein powder doesnt contain sugar substitutes or additives and is in a natural form, some people might find they still have issues with migraine attacks. Whey Protein and Migraines
For people following a migraine diet like Heal Your Headache, there are forms of glutamate that need to be strictly avoided during the elimination period. Often these names come with protein or isolate at the end of them.
For instance, youll see these in many common protein powders and diet shakes:
- Whey Protein
- Soy Protein Isolate
- Hydrolyzed Protein
The idea is that the processed versions of these items are high in glutamate and act similar to MSG in the brainof someone who is sensitive. Sensitivity to glutamate can vary from person to person. Some find they are able to tolerate natural items higher in glutamate, like tomatoes, but not anything processed, like protein isolates.
When To Use Imaging For Migraine: A Few Determinations
Nonetheless, the authors found the evidence to be mostly consistent and convincing. Study subjects with concerning clinical or exam features frequently have abnormalities which require attention and should be imaged, the authors wrote. Neuroimaging may be considered for a variety of atypical situations, such as migraine with confusion, hemiplegic migraine, migraine with brain-stem aura, post-traumatic headache, or a change in clinical features .
On the other hand, the AHS team found no evidence to support routine neuroimaging of patients with migraine with no atypical features or red flags . In these cases, the authors stated, There is no evidence that routine imaging is more likely to reveal meaningful abnormalities compared to the general health population in the absences of worrisome features.1
Comorbidities and other considerations
The guideline authors found no indication for the routine use of gadolinium contrast imaging short of a strong reason to suspect multiple sclerosis or breast cancer. However, they did point out that some individuals with significant psychiatric co-morbidities might benefit from the reassurance of having a normal scan.
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What Types Of Migraine Occur In Children And Adolescents
There are two main types. A migraine without an aura occurs in 60% to 85% of children and adolescents who get a migraine. A migraine with an aura occurs in 15% to 30%. In young children, migraine often begins in the late afternoon. As the child gets older, migraine often begins in the early morning.
Abortive Medications For Acute Attacks
- intravenous medications: magnesium, Toradol, and anti-emetics
- oral medication: nonsteroidal anti-inflammatory drugs , Ubrelvy, and Nurtec
- selective serotonin receptor agonist
Hemiplegic migraine is caused by changes to genes. A few genes have been linked to hemiplegic migraine, including:
Genes carry the instructions for making proteins that help nerve cells communicate. Mutations in these genes affect the release of brain chemicals called neurotransmitters.
When the genes are mutated, communication between certain nerve cells is interrupted. This can lead to severe headaches and vision disturbances.
In FHM, the gene changes run in families. In SHM, the gene changes happen spontaneously.
Migraine often has triggers specific to you that can cause an attack. Keeping a diary of what you were doing or experiencing prior to each attack can help you narrow them down.
Common triggers of hemiplegic migraine attacks include:
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Medications And Devices For Treating Migraine Attacks
Many different medications are used to treat migraines. Some migraines respond to non-prescription pain relievers such as ibuprofen, acetaminophen, naproxen, or aspirin. Among prescription drugs, triptans and ergotamine are the only types of medications approved by the U.S. Food and Drug Administration for migraine treatment.
Other types of drugs, including opioids and barbiturates, are sometimes prescribed off-label for migraine treatment but they can have dangerous side effects. Opioids and barbiturates are not approved by the FDA for migraine relief.
Snris For Vestibular Migraine
Dr. Michael Teixido’s inaugural talk on Vestibular Migraine at the 2019 Migraine World Summit included his positive experience using SNRIs to treat patients with Vestibular Migraine
Recent studies have shown they are an effective and safe treatment, particularly for those who also have anxiety that accompanies their Migraine attacks.
Anxiety is a common trait of Vestibular Migraine attacks, which makes sense considering how frightening some of the symptoms can be.
A meta-analysis of 6 controlled trials testing 418 patients revealed that those taking SNRIs had fewer Migraine days than those taking placebo
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The Basics About Hemiplegic Migraine
Migraine can present in a variety of ways. Hemiplegic migraine is a rare form of migraine where people experience weakness on one side of their body in addition to the migraine headache attack. The weakness is a form of migraine aura and occurs with other forms of typical migraine aura like changes in vision, speech or sensation. Hemiplegic migraine is divided into Familial hemiplegic migraine or Sporadic hemiplegic migraine . This is a very rare migraine type so if you ever experience new or never-evaluated weakness with your headache, you should seek immediate medical evaluation and not assume you have hemiplegic migraine.
Both familial and sporadic hemiplegic migraines often begin in childhood. Diagnosing hemiplegic migraine can be difficult, as the symptoms can mimic stroke, seizures or other conditions. A full neurological work up, including obtaining imaging of the brain and vessels in the head, and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of hemiplegic migraine. Family medical history is especially helpful in diagnosing familial hemiplegic migraine.
The Who And Why Of Migraine
Q. What causes migraine headaches? How many people have them?
A. Approximately 12% of the US population suffers from migraine, and up to 18% of women between the ages of 16 and 40 have migraine. Many patients with migraine have a positive family history of migraine in a first-degree relative.
Migraine is known as a neurovascular disease, meaning that both the nervous system and vascular system play a role. We believe that the signal for migraine is generated in a primitive part of the brain called the thalamus. The trigeminal nerve also plays a role, and there is excitability in the brain that ultimately leads to the release of inflammatory substances. A number of external factors can trigger a migraine in some patients, from certain foods to barometric pressure changes.
George R. Nissan, D.O.
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Study: Migraine With Visual Aura Linked To Increase Risk Of Irregular Heartbeat
People who experience Migraine with visual aura may have an increased risk of an irregular heartbeat called atrial fibrillation, according to a study published in the November 14, 2018, online issue of NeurologyÂ®, the medical journal of the American Academy of Neurology.
Visual aura during a Migraine attack usually occurs before the acute head pain begins. American Migraine Foundation estimates that about 1 in 4 people with Migraine experience aura. Examples of visual aura include sparkles or zigzag lights in the vision that may move, flash, or get larger
Atrial fibrillation is a form of arrhythmia meaning the heart’s normal rhythm is out of sync. This could lead to blood pooling in the heart, possibly forming clots that make their way to the brain, causing a stroke
“Since atrial fibrillation is a common source of strokes caused by blood clots, and previous research has shown a link between migraine with aura and stroke, we wanted to see if people who have migraine with aura also have a higher rate of atrial fibrillation,” said study author Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia in a press release.
“Our research suggests that atrial fibrillation may play a role in stroke in those with migraine with visual aura. Atrial fibrillation can be managed through medication, but many people do not realize that they have atrial fibrillation.”
The study looked at nearly 12,000 people with an average age of 60. The AAN press release reports:
There Have Been Recent News Stories That People Who Have Received Facial Fillers Should Avoid The Moderna Vaccine Because They May Have A Severe Allergic Reaction Should I Be Worried About A Similar Reaction If I Get Botox Injections As Treatment For Migraine
Facial fillers are implants doctors inject beneath your skin to reduce wrinkles. While there have been reports of people who have had facial fillers developing temporary swelling of their face after receiving the Moderna vaccine, its important to note that Botox® is not a facial filler. Please refer to question 5 to learn more about Botox® and the Moderna vaccine.
People with facial fillers having a reaction is not totally surprising since vaccines work by activating our immune systems so that they can fight infections. In these cases, the vaccine caused the persons immune response to increase and the body started to fight against the fillers which it saw as a foreign substance. As always, check with your primary care or cosmetic doctor before getting the vaccine.
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Symptoms That Could Indicate A Serious Underlying Condition
Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon. A headache without other neurologic symptoms is not a common symptom of a brain tumor. People with chronic headaches may, however, miss a more serious condition by believing it to be one of their usual headaches. You should immediately call your provider if your headache or other accompanying symptoms change.
Be sure to call your provider for any of the following symptoms:
- Sudden, severe headache that persists or increases in intensity over the following hours, sometimes accompanied by nausea, vomiting, or altered mental status .
- Sudden, severe headache, worse than any headache ever experienced .
- Chronic or severe headaches that begin after age 50 years.
- Headaches accompanied by other symptoms, such as memory loss, confusion, loss of balance, changes in speech or vision, loss of strength in or numbness or tingling in arms or legs .
- Headaches after head injury, especially if drowsiness or nausea are present .
- Headaches accompanied by fever, stiff neck, nausea, and vomiting .
- Headaches that increase with coughing or straining, or are worse when laying down .
- A throbbing pain around or behind the eyes or in the forehead, accompanied by redness in the eye and perceptions of halos or rings around lights .
What Is An Aura
An aura is a warning sign that a migraine is about to begin. An aura usually occurs about 30 minutes before a migraine starts. The most common auras are visual and include blurred or distorted vision; blind spots; or brightly colored, flashing, or moving lights or lines. Other auras may include changes in ability to speak, move, hear, smell, taste, or touch. Auras last about 20 minutes.
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I Heard That The Second Dose Of The Vaccine Causes More Severe Side Effects Than The First If I Get A Headache From The First Dose Should I Skip Or Delay Getting The Second Dose
Both the Pfizer and Moderna vaccine require two doses to achieve optimal immunity and protection against COVID-19 infection. The Pfizer vaccine should be repeated in 21 days and the Moderna vaccine repeated one month after the first dose. If you receive only one dose or delay the second dose past the recommended schedule, you will not be fully protected. Remember, the headache, even if it is slightly worse than the one from the first vaccine, is short-lasting and mild. The headaches and other vaccine side effects may make you uncomfortable for a few days. But it is a small price to pay considering that COVID-19 can be deadly or lead to long-term disability.
Optical Neuralgia A Trial For Family
Q. How would you recommend treating optical neuralgia? My daughter has suffered with pain around the top of her left eye for well over a year that never goes away. It is most upsetting and slowly tearing our family apart.
A. Facial neuralgias are a difficult group of disorders to treat. One type of medication that is sometimes useful is the sodium channel blockers, which presumably work on the more peripheral nerves, slowing the transmission of pain impulses back to the brain. Examples include carbamazepine and lamotrigine. Medications that work more centrally in the brain to inhibit pain transmission include baclofen, gabapentin and pregabalin. Tricyclic antidepressants can be helpful in combination with one of the other two classes of drugs.
Osteopathic approaches can be helpful, too, by reducing secondary muscle tension that can lead to a variety of head and neck pains. Alternative approaches such as acupuncture and training in self-hypnosis have also been shown to be effective. Many times a combination of medications and mind-body approaches turns out to be best for improving quality of life. Understanding and treating other family members who are stressed by the illness are also key to successful management.
Of course, before any therapy is undertaken, it is important to rule out underlying disorders that might be producing the type of pain around the eyes you described. Neurological consultation with appropriate imaging and blood work are central to treatment.
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Link Between Migraine And Heart Disease May Not Be Genetic
Researchers in 2015 were surprised to learn that genes may not be to blame for the connection between Migraine and heart disease. This is especially unexpected since Migraine is primarily a genetic disease.
A large study published in the journal Neurology Genetics looked at 159,000 people, including 20,000 people with Migraine and 21,000 people with heart disease.
“Surprisingly, when we looked for shared gene variants that might help explain part of the link between Migraine and heart disease, we found no shared gene variations between Migraine with aura and heart disease,” said study author Aarno Palotie, MD, of the Broad Institute of MIT and Harvard in Boston
“This is surprising because the evidence is stronger that people with Migraine with aura have an increased risk of heart disease than people with Migraine without aura.”
The Nervous System Could Help Explain How Migraine Stroke And Heart Disease Are Linked
The involvement of the nervous system in Migraine disease could help explain why stroke, Migraine, and heart disease are linked. Study author Dr. Sen continues:
“It is important to note that people with migraine with aura may be at a higher risk of atrial fibrillation due to problems with the autonomic nervous system, which helps control the heart and blood vessels.
More research is needed to determine if people with migraine with visual aura should be screened for atrial fibrillation.”
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What Is The Outlook For Children And Adolescents With Migraine
Treatment helps most children and adolescents with migraine. Fifty percent of children and adolescents report migraine improvement within 6 months after treatment. However, in about 60% of adolescents who experience their first migraine as an adolescent, the migraine may continue off and on for many years.
It should be noted that many of the medications listed in this handout have not been approved by the by the Food and Drug Administration for use in children and adolescents with headaches. This is a common practice in the field of medicine and is called off-label prescribing. It is one of the ways new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions and indications.
Rehabilitation program. Some hospitals and/or other health care facilities offer inpatient headache management programs for children and adolescents; ask your doctor if their facility offers such programs.
Patients typically accepted into these programs are those who have a chronic daily headache , missed an excessive amount of school, have overused over-the-counter medications, and have headache pain that is controlling their lives. The staff of such programs can include psychologists, pediatric rehabilitation specialists, occupational and physical therapists as well as access to a child psychiatrist. Stress factors are an important focus of this program; not rapid changes in medications.
Organizations For Resources And Help With Migraines
GARD: Genetic and Rare Disease Information Center . Hemiplegic Migraine. Retrieved April 25, 2017, from https://rarediseases.info.nih.gov/diseases/10768/hemiplegic-migraine
HEYCK, H. . VARIETIES OF HEMIPLEGIC MIGRAINE. Retrieved April 25, 2017, from http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.1973.hed1204135.x/full
Jen, J. C. . Familial Hemiplegic Migraine. Retrieved April 25, 2017, from https://www.ncbi.nlm.nih.gov/books/NBK1388/#fhm.Clinical_Description
Migraine Surgery;| Migraine Doctors. . Retrieved April 25, 2017, from http://www.themigrainereliefcenter.com/
Optics, A. . Reviewed: Top 5 Migraine Tracking Apps. Retrieved April 25, 2017, from https://www.axonoptics.com/top-5-migraine-tracking-apps/
Robertson, MD, C.E. . Hemiplegic Migraine. Retrieved April 25, 2017, from https://www.uptodate.com/contents/hemiplegic-migraine
Team, J. W. . Accommodation and Compliance Series: Employees with Migraine Headaches. Retrieved April 25, 2017, from http://askjan.org/media/Migraine.html
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Management Of Environmental Or Lifestyle Triggers
Since typical migraine triggers can also trigger hemiplegic migraines, eliminating those triggers can also help to manage the condition. Common migraine triggers include:
- Sensory stimuli:
- Odors secondhand smoke, perfume, gasoline, paint thinner, diesel and others
- Lights sun glare, bright lights, light glare at night, LED lights, fluorescent lighting
- Noise loud or repetitious sounds, heavy bass in music
- Beverages such as diet sodas and drinks that contain a lot of caffeine as well as wine and other types of alcohol
- Food additives like monosodium glutamate and aspartame
- Processed foods as well as aged cheeses and foods that are very salty
- Sleep issues sleep deprivation, too much sleep, interrupted sleep, apnea, jet lag
- Exertion intense exercise, extreme sexual activity, extensive physical exertion
- Medications nitroglycerin and other vasodilators as well as oral contraceptives and other drugs
- Environmental changes- barometric pressure changes, weather changes, climate changes , intense heat, intense cold
By identifying their migraine triggers and learning how to manage them, patients will often notice a significant improvement in the frequency of their migraines and symptoms, or they may find their headaches are eliminated altogether.