tag:theconversation.com,2011:/ca/topics/headaches-1097/articlesHeadaches – The Conversation2024-03-01T13:33:37Ztag:theconversation.com,2011:article/2220572024-03-01T13:33:37Z2024-03-01T13:33:37ZAltitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare<figure><img src="https://images.theconversation.com/files/577770/original/file-20240225-28-vk2tcl.jpg?ixlib=rb-1.1.0&rect=77%2C33%2C7271%2C4869&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Altitude sickness is rare at elevations of less than 8,200 feet but becomes much more common at higher altitudes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girls-having-fun-royalty-free-image/854544188?phrase=mountain+adventure+travel&adppopup=true">Maya Karkalicheva/Moment via Getty Images</a></span></figcaption></figure><p>Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above.</p>
<p>Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. </p>
<p>While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey.</p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way.</p>
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<a href="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Researcher wearing cold-weather gear stands in front of a health clinic in the Himalayas." src="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The author in front of the Himalayan Rescue Association clinic in Nepal.</span>
<span class="attribution"><span class="source">Brian Strickland</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<h2>The science behind altitude sickness</h2>
<p>Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. </p>
<p>The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. </p>
<p>When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">most severe forms of altitude sickness</a>.</p>
<p>Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. </p>
<p>As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level.</p>
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<figcaption><span class="caption">Tips for preventing or reducing the risk of altitude sickness.</span></figcaption>
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<h2>The importance of gradual ascent</h2>
<p>High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. </p>
<p>This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. </p>
<p>People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. </p>
<p>Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">severe forms of altitude sickness</a>.</p>
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<a href="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five tents glow against the night sky with a tall mountain in the background." src="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Adventure tourism is growing rapidly, but general awareness and education around altitude sickness and ways to prevent it remains low.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/milky-way-over-mitre-peak-view-from-concordia-camp-royalty-free-image/1936855402?phrase=mountain+adventure+travel&adppopup=true">Punnawit Suwuttananun/Moment via Getty Images</a></span>
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<h2>Effective medications</h2>
<p>For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma#">treatment of glaucoma</a>, a condition that causes increased pressure within the eye.</p>
<p>If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent.</p>
<p>Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. </p>
<p>Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes#">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize.</p>
<h2>Unproven therapies and remedies are common</h2>
<p>As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend.</p>
<p>Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective.</p>
<p><a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. </p>
<p><a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness.</p>
<p>Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. </p>
<p>Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness.</p>
<p>The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.</p><img src="https://counter.theconversation.com/content/222057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Strickland does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether you’re ascending to high altitudes for casual travel or for adventure tourism, there are specific strategies to help you acclimate and reduce the likelihood of altitude sickness.Brian Strickland, Senior Instructor in Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196492023-12-13T13:07:58Z2023-12-13T13:07:58ZDo you get a headache after a good red wine? This might be why<figure><img src="https://images.theconversation.com/files/564858/original/file-20231204-16-cef1p6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6313%2C4338&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/es/image-photo/red-wine-pouring-bottle-into-glass-1707012739">Shutterstock</a></span></figcaption></figure><p>Headaches affect 16% of the world’s population <a href="https://doi.org/10.1186%2Fs10194-022-01402-2">on a daily basis</a>, and alcohol consumption is one of the main causes. </p>
<p>Although excessive consumption of any alcohol can cause headaches, <a href="https://doi.org/10.1007%2Fs11916-017-0642-8">red wine is the biggest culprit</a>: the headaches it causes <a href="https://doi.org/10.1007%2Fs10194-008-0006-1">come on more quickly</a> than those caused by white wine, beer or spirits. Another important difference is that red wine headaches can be caused by only a glass or two, while other drinks only cause problems once a large amount has been ingested. </p>
<p>When our livers metabolise ethanol (the chemical name for alcohol), it turns into <a href="https://en.wikipedia.org/wiki/Acetate">acetate</a> via a two step process. The first stage is the reaction that converts it into the to the highly toxic substance acetaldehyde. When we consume large amounts of alcohol, our bodies accumulate this chemical, which is twenty times more toxic than alcohol itself and <a href="http://monographs.iarc.fr/ENG/Monographs/vol71/mono71.pdf">highly carcinogenic</a>. This molecule is the main cause of the characteristic hangover symptoms: nausea, sweating, facial flushing and headaches.</p>
<p>The second step is the subsequent conversion of acetaldehyde to acetate by an enzyme called aldehyde dehydrogenase (ALDH). One particular type of this enzyme, <a href="https://es.wikipedia.org/wiki/ALDH2_(aldeh%C3%ADdo_dehydrogenase),%20is%20essential%20for%20removing%20poisonous%20acetaldehyde%20from%20the%20blood:%20it%20reduces%20its%20concentration%20by%20%5Bone%20thousand%20times%5D(https://doi.org/10.1111%2Facer.13904">ALDH2</a> from the levels it reaches in the liver.</p>
<p>An accumulation of acetaldehyde is responsible for the strong facial flushing effect which is seen in approximately 40% of people of Asian descent. This is because of a genetic predisposition to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0140673694916292">producing a dysfunctional</a> variant of ALDH.</p>
<p>Certain drugs, such as <a href="https://en.wikipedia.org/wiki/Disulfiram">disulfiram</a>, can even be used to discourage alcohol consumption by inhibiting ALDH production, causing an accumulation of acetaldehyde. This leads directly to unpleasant hangover-like effects when alcohol is consumed, including headaches, without the prior intoxication.</p>
<h2>Headaches and wine</h2>
<p>Red wine headaches are often <a href="https://doi.org/10.1159%2F000237304">attributed to certain components in the drink</a>, such as amines, sulphites, or tannins, but so far no convincing evidence has been found to support these hypotheses, nor has an alternative explanation been proposed. However, the higher concentration of flavonoids in red wine – which is ten times higher than in white wine – makes them <a href="https://doi.org/10.1111%2Fhead.12365">the main suspects</a> for causing headaches.</p>
<p>A <a href="https://www.nature.com/articles/s41598-023-46203-y#:%7E:text=With%20the%20concurrent%20consumption%20of,needed%20to%20verify%20this%20hypothesis.">research paper</a> published on 20 November may well have identified the culprit: a flavonoid called quercetin, one of the <a href="https://www.sobreestoyaquello.com/2020/07/flavonoides-una-botica-en-la-nevera.html">9,000 recorded flavonoids</a> found in many foods such as cabbage, onions, capers, coriander, cranberries, green tea, apples and grapes.</p>
<p>When several flavonoids in wine known to block ALDH2 were tested, the most potent was <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Querciturone">quercetin-3-glucuronide</a>. This compound inhibited ALDH2 almost three times more than any other. This suggests that when we drink red wine, the liver converts quercetin into quercetin-3-glucuronide, which causes us to accumulate acetaldehyde.</p>
<p>It is important to note that quercetin alone does not cause headaches. Onions, for example, contain much more quercetin than wine, but few people complain of headaches after eating them: alcohol and quercetin act together to cause a buildup of poisonous acetaldehyde.</p>
<h2>The better the wine, the stronger the headache</h2>
<p>If the combination of quercetin and ethanol causes headaches, why is it that some people can drink red wine without any effect, while others experience headaches when they drink it? There are several potential factors that may explain this.</p>
<p>Although <a href="https://www.nature.com/articles/cas-redirect/1:CAS:528:DC%2BD1cXhsVyltLjL">red wine has a significantly higher quercetin content</a> than white, concentrations can vary considerably between red wines of different types and origins. This has been found in, among others, <a href="https://www.ajevonline.org/content/56/2/139">Spanish wines</a>.</p>
<p>Different <a href="https://doi.org/10.1021%2Fjf9909757">winemaking processes</a>, such as fermentation and ageing, also affect the chemical content that ends up in a bottle. One well-known factor is the <a href="https://doi.org/10.5344%2Fajev.2002.53.3.171">amount of sun exposure</a> that grapes receive. In vineyards that produce high quality wines, practices such as trellising, vine thinning and defoliation (removing leaves) cause the grapes to receive more sunlight and accumulate more quercetin than conventional vineyards that produce cheaper wines.</p>
<p>A study showed that the total flavonoid content was four times higher in <a href="https://www.ajevonline.org/content/50/1/91">“ultra-premium”</a> wines than in lower quality ones. This suggests that one way to avoid headaches might be, unexpectedly, to buy cheaper wine.</p>
<p>Lastly, it is possible that the enzymes that digest quercetin differ from one person to another. Acetaldehyde may also trigger headaches only in genetically predisposed individuals, as is the case in a higher proportion of Asian people.</p><img src="https://counter.theconversation.com/content/219649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Manuel Peinado Lorca is a member of the PSOE Federal Biodiversity Group.</span></em></p>Researchers have linked red wine headaches to the chemical compound quercetin, which is much more present in high quality wines.Manuel Peinado Lorca, Catedrático emérito. Director del Real Jardín Botánico de la Universidad de Alcalá, Universidad de AlcaláLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076062023-08-09T12:30:07Z2023-08-09T12:30:07ZWomen get far more migraines than men – a neurologist explains why, and what brings relief<figure><img src="https://images.theconversation.com/files/534170/original/file-20230626-17-9dp3vw.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6240%2C4128&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Migraines are more common and intense during a woman's reproductive years. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/some-days-are-just-one-big-headache-royalty-free-image/1034390470?phrase=migraine%2Bheadache%2Bwoman%2Bin%2Bbed">PixelsEffect/iStock via Getty Images Plus</a></span></figcaption></figure><p>A migraine is far <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/">more than just a headache</a> – it’s a debilitating disorder of the nervous system. </p>
<p>People who have migraines experience severe throbbing or pulsating pain, typically on one side of the head. The pain is often accompanied by nausea, vomiting and <a href="https://theconversation.com/migraine-sufferers-have-treatment-choices-a-neurologist-explains-options-beyond-just-pain-medication-181348">extreme sensitivity to light or sound</a>. An attack may last for hours or days, and to ease the suffering, some people spend time isolated in dark, quiet rooms. </p>
<p>About 800 million people worldwide <a href="https://doi.org/10.1001/jama.2021.21857">get migraine headaches</a>; in the U.S. alone, <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/#">about 39 million</a>, or approximately 12% of the population, have them regularly. </p>
<p>And most of these people are women. More than <a href="https://www.npr.org/sections/health-shots/2012/04/16/150525391/why-women-suffer-more-migraines-than-men">three times as many women</a> as compared to men get migraines. For women ages 18 to 49, migraine is the leading <a href="https://doi.org/10.1186/s10194-020-01208-0">cause of disability throughout the world</a>.</p>
<p>What’s more, research shows that women’s migraines are <a href="https://doi.org/10.1007/s10072-020-04643-8">more frequent, more disabling and longer-lasting</a> than men’s. Women are more likely than men to <a href="https://doi.org/10.1007/s10072-015-2156-7">seek medical care and prescription drugs</a> for migraines. And women who have migraines <a href="https://doi.org/10.1186/s10194-021-01281-z">tend to have more mental health issues</a>, including anxiety and depression. </p>
<p><a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29586">As a board-certified neurologist</a> who specializes in headache medicine, I find the gender differences in migraines to be fascinating. And some of the reasons why these differences exist may surprise you.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lorXYK2OtAA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A variety of medications and therapies offer relief for migraines.</span></figcaption>
</figure>
<h2>Migraines and hormones</h2>
<p>There are several factors behind why men and women experience migraine attacks differently. These include hormones, genetics, how certain genes are activated or deactivated – an <a href="https://www.psychologytoday.com/us/basics/epigenetics">area of study called epigenetics</a> – and the environment. </p>
<p>All of these factors play a role in shaping the structure, function and adaptability of the brain when it comes to migraines. The hormones <a href="https://www.healthline.com/health/womens-health/estrogen-vs-progesterone#functions">estrogen and progesterone</a>, through different mechanisms, play a role in regulating many biological functions. They affect various chemicals in the brain and may contribute to <a href="https://doi.org/10.1093/brain/aws175">functional and structural differences</a> in specific brain regions that are involved in the development of migraines. Additionally, sex hormones can <a href="https://doi.org/10.1007/s10072-020-04643-8">quickly change the size of blood vessels</a>, which can predispose people to migraine attacks.</p>
<p>During childhood, both boys and girls have an <a href="https://doi.org/10.1177/0333102409355601">equal chance of experiencing migraines</a>. It’s estimated that about <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/">10% of all children will have them</a> at some point. But when girls reach puberty, their likelihood of getting migraines increases. </p>
<p>That’s due to the <a href="https://doi.org/10.3389/fmolb.2018.00073">fluctuating levels of sex hormones</a>, primarily <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/estrogens-effects-on-the-female-body">estrogen</a>, associated with puberty – although other hormones, including <a href="https://my.clevelandclinic.org/health/body/24562-progesterone">progesterone</a>, may be involved too.</p>
<p>Some girls have their first migraine around the time <a href="https://doi.org/10.1002/jnr.23903">of their first menstrual cycle</a>. But migraines are often most common and intense <a href="https://doi.org/10.1136%2Fbmj.39559.675891.AD">during a woman’s reproductive and child-bearing years</a>.</p>
<p>Researchers estimate about 50% to 60% of women with migraines <a href="https://americanmigrainefoundation.org/resource-library/menstrual-migraine-treatment-and-prevention/">experience menstrual migraines</a>. These migraines typically occur in the days leading up to menstruation or during menstruation itself, when the <a href="https://doi.org/10.1007/s10194-012-0424-y">drop in estrogen levels can trigger migraines</a>. Menstrual migraines can be more severe and last longer than migraines at other times of the month.</p>
<p>A class of medicines that came out in the 1990’s – <a href="https://www.healthline.com/health/triptan-migraine#side-effects">triptans</a> – are commonly used to treat migraines; certain triptans can be used specifically for menstrual migraines. Another category of medications, called <a href="https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids">nonsteroidal anti-inflammatory drugs</a>, have also been effective at lessening the discomfort and length of menstrual migraines. So can a variety of birth control methods, which help by keeping hormone levels steady. </p>
<h2>Migraine with aura</h2>
<p>But women who have <a href="https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072#">migraine with aura</a>, which is a distinct type of migraine, should generally avoid using estrogen containing hormonal contraceptives. The combination can increase the risk of stroke because estrogen can promote <a href="https://doi.org/10.1016/j.thromres.2020.05.008">the risk of blood clot formation</a>. Birth control options for women with auras include progesterone-only birth control pills, the Depo-Provera shot, and intrauterine devices.</p>
<p>Auras affect about 20% of the people who have migraines. Typically, prior to the migraine, the person most commonly begins to see dark spots and zigzag lines. Less often, about 10% of the time, an inability to speak clearly, or tingling or weakness on one side of the body, also occurs. These symptoms slowly build up, generally last less than an hour before disappearing, and are commonly followed by head pain.</p>
<p>Although these symptoms resemble what happens during a stroke, an aura tends to occur slowly, over minutes – while strokes usually happen instantaneously. </p>
<p>That said, it may be difficult and dangerous for a nonmedical person to try to discern the difference between the two conditions, particularly in the midst of an attack, and determine whether it’s migraine with aura or a stroke. If there is any uncertainty as to what’s wrong, a call to 911 is most prudent. </p>
<figure>
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<figcaption><span class="caption">If you’re a woman and your migraines happen at the same time every month, it might be menstrual migraines.</span></figcaption>
</figure>
<h2>Migraines during pregnancy, menopause</h2>
<p>For women who are pregnant, migraines can be particularly <a href="https://www.stanfordchildrens.org/en/topic/default?id=headaches-in-early-pregnancy-134-3">debilitating during the first trimester</a>, a time when morning sickness is common, making it difficult to eat, sleep or hydrate. Even worse, missing or skipping any of these things can make migraines more likely. </p>
<p>The good news is that migraines generally tend to lessen in severity and frequency throughout pregnancy. For some women, they disappear, especially as the pregnancy progresses. But then, for those who experienced them during pregnancy, migraines tend <a href="https://americanmigrainefoundation.org/resource-library/postpartum-headache/">to increase after delivery</a>. </p>
<p>This can be due to the decreasing hormone levels, as well as sleep deprivation, stress, dehydration and other environmental factors related to caring for an infant. </p>
<p>Migraine attacks can also increase during <a href="https://my.clevelandclinic.org/health/diseases/21608-perimenopause">perimenopause</a>, a woman’s transitional phase to menopause. Again, fluctuating hormone levels, <a href="https://www.verywellhealth.com/perimenopause-and-migraines-4009311">particularly estrogen, trigger them</a>, along with the chronic pain, depression and sleep disturbances that can occur during this time. </p>
<p>But as menopause progresses, migraines generally decline. In some cases, they completely go away. In the meantime, there are treatments that can help lessen both the frequency and severity of migraines throughout menopause, including <a href="https://www.webmd.com/menopause/menopause-hormone-therapy">hormone replacement therapy</a>. Hormone replacement therapy contains female hormones and is used to replace those that your body makes less of leading up to or after menopause.</p>
<h2>Men’s migraines</h2>
<p>The frequency and severity of migraines slightly increase for <a href="https://doi.org/10.1177/0333102409355601">men in their early 20s</a>. They tend to slow down, peak again around age 50, then slow down or stop altogether. Why this happens is not well understood, although a combination of genetic factors, environmental influences and lifestyle choices may contribute to the rise.</p>
<p>Medical researchers still have more to learn about why women and men get migraines. Bridging the gender gap in migraine research not only empowers women, but it also advances understanding of the condition as a whole and creates a future where migraines are better managed.</p><img src="https://counter.theconversation.com/content/207606/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wilhour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For women ages 18 to 49, migraines are the leading cause of disability throughout the world.Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2072862023-07-12T12:38:49Z2023-07-12T12:38:49ZStrep throat can easily be confused with throat infections caused by viruses – here are a few ways to know the difference<figure><img src="https://images.theconversation.com/files/536374/original/file-20230707-23-bxbi1g.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6640%2C4220&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Strep is most common in children between the ages of 5 and 15.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/male-pediatrician-examining-little-child-patients-royalty-free-image/1306247195?phrase=doctor+checking+for+strep&adppopup=true">aquaArts studio/E+ via Getty Images</a></span></figcaption></figure><p>“My sore throats, you know, are always worse than anybody’s.”</p>
<p>So declares Mary to Anne in “<a href="https://jasna.org/austen/works/persuasion/">Persuasion</a>,” Jane Austen’s 1817 book. Most of us can relate to this feeling. There is no such thing as “just a sore throat.” The pain, headache, fever and aches associated with a sore throat can make you feel terrible.</p>
<p>While sore throats can occur at any time of year, strep throat is <a href="https://www.cdc.gov/groupastrep/surveillance.html#">more common in the fall, winter and early spring</a>.</p>
<p>I am a <a href="https://facultyprofiles.tufts.edu/allen-shaughnessy">professor of family medicine</a>, a pharmacist and an expert on evidence-based medicine. My work involves the evaluation of research performed by others, and I have been following and analyzing research findings on strep for the past 30 years. </p>
<p>Many people incorrectly assume that all sore throats are due to strep throat, a bacterial infection of the pharynx, the middle throat area behind the nose and mouth, and patients often come to our family medicine office wanting to be checked and treated for strep with antibiotics.</p>
<p>However, neither testing nor treatment is always needed for a sore throat. Regardless of the cause, rest and pain relievers form the cornerstone of sore throat treatment.</p>
<p>Here’s some guidance on whether and when testing is necessary.</p>
<h2>Bacterial versus viral sore throats</h2>
<p>Most <a href="https://www.cdc.gov/antibiotic-use/sore-throat.html">sudden-onset sore throats</a> are caused by viruses – the same ones that cause the common cold, the seasonal flu and COVID-19. There are <a href="https://www.nih.gov/news-events/nih-research-matters/understanding-common-cold-virus#">more than 200 viruses</a> that can cause sore throat and other symptoms related to the common cold. </p>
<p>But bacteria can also be the culprits behind a sore throat. One of the most common examples is <a href="https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#">strep throat</a>, or <a href="https://www.cdc.gov/streplab/groupa-strep/index.html">group A pharyngitis</a>.</p>
<p>Strep is caused by certain strains of <em>Streptococcus pyogenes</em> bacteria.
There are many species of strep; other common forms of strep that cause different infections in humans include “<a href="https://www.cdc.gov/groupbstrep/index.html">group B strep</a>” and “<a href="https://www.icliniq.com/articles/infectious-diseases/group-d-streptococcus-infections">group D strep</a>.” Group A strep usually lives peacefully among the many other types of bacteria growing on our skin and doesn’t cause any problems, until we get a break in the skin such as a cut or a scrape. This allows it to overwhelm the immune system’s ability to keep it in check.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teenage girl is lying on a sofa, feeling unwell and holding a thermometer in her mouth to check her temperature." src="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536145/original/file-20230706-18-5qdns0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fever, headache and confusion can be symptoms of a severe case of strep.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-teenager-resting-at-home-and-monitoring-royalty-free-image/1482421648?phrase=strep+throat&adppopup=true">RealPeopleGroup/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Group A strep can also live in the back of the throat – up to 30% of people without any evidence of a sore throat will have <a href="https://doi.org/10.3389/fcimb.2019.00137">this strain in their throat</a>. <a href="https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html#">Up to 3 in 10 children and 1 in 10 adults</a> feeling sick with a sore throat due to a virus or other cause will test <a href="https://doi.org/10.1371/journal.pntd.0006335">positive for group A strep</a>. That means that people with a sore throat caused by a virus could also be positive for strep, even if it’s not causing the symptoms.</p>
<p>Not all group A strep bacteria are the same, though. Some varieties are better at evading the immune system than others and can grow quickly. Others produce byproducts that can cause a sore throat and sometimes lead to <a href="https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479">tonsillitis</a>, an infection of the tonsils, or cause ear or <a href="https://www.cdc.gov/antibiotic-use/sinus-infection.html">sinus infections</a>. </p>
<p>Still other strep strains produce a toxin that can cause a characteristic <a href="https://www.cdc.gov/groupastrep/diseases-public/scarlet-fever.html">skin rash</a> or lead to effects on the <a href="https://www.cdc.gov/groupastrep/diseases-public/rheumatic-fever.html">heart</a>, <a href="https://www.cdc.gov/groupastrep/diseases-public/post-streptococcal.html">kidneys</a> or even the <a href="https://www.nimh.nih.gov/health/publications/pandas">brain</a>. </p>
<p>Rarer still, group A strep can enter the bloodstream and cause <a href="https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384">toxic shock syndrome</a>, a life-threatening, overwhelming infection. These latter conditions are examples of invasive strep, meaning that the infection is in parts of the body typically free from germs; they <a href="https://www.cdc.gov/groupastrep/igas-infections-investigation.html">seem to be on the rise</a> after a marked <a href="https://www.cdc.gov/groupastrep/igas-infections-investigation.html">reduction in their occurrence during the COVID-19 pandemic</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/W50S0dCCFPs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Like other illnesses that made a comeback after COVID-19 prevention measures were relaxed, strep cases have returned to pre-pandemic levels.</span></figcaption>
</figure>
<h2>To test or not to test</h2>
<p>Doctors or other clinicians can easily test for strep by using a swab to collect a bit of the fluid from the back of the throat. This sample can identify group A strep in about a minute. </p>
<p>While researchers have been studying group A strep <a href="https://www.ncbi.nlm.nih.gov/books/NBK333430/">for over 75 years</a> and there are thousands of research papers focused on infections caused by strep, there is still <a href="https://www.nice.org.uk/guidance/ng84/chapter/Summary-of-the-evidence">controversy</a> over whether it needs to be tested for and treated. </p>
<p>To decide whether to test for group A strep, clinicians use a set of criteria based on <a href="https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis">five questions</a> that can help determine whether strep testing is needed. These are:</p>
<p>– How old is the patient? Strep throat is most common in children <a href="https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html#">between ages 5 and 15</a> and least common in <a href="https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#">adults over age 45</a>. </p>
<p>– Are the tonsils swollen or do they have a white or yellow coating? Both conditions often accompany strep. However, this question alone isn’t definitive, since viruses can also affect the tonsils.</p>
<p>– Are the <a href="https://www.verywellhealth.com/cervical-lymph-nodes-2252142">cervical lymph nodes</a> swollen or tender? Normally these bumps, which are in the front of the neck along the sides of the windpipe, cannot be seen or felt, but are often palpable when strep is present.</p>
<p>– Does the person have a fever? Lack of a fever makes strep less likely.</p>
<p>– Does the person have a cough? A cough is indicative of a viral cause and makes strep the less likely cause of the sore throat.</p>
<p>While none of these questions alone can provide a clear answer, taken together they can tell your clinician whether strep is more or less likely. </p>
<p>Using this scoring tool, an adult with a sore throat but without changes to the tonsils or lymph nodes, without a fever and with a cough has only a <a href="https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis">1 in 40 chance, or 2.5%, of having strep throat</a>. For such patients, a strep test is not necessary. </p>
<p>On the other hand, when a first grader meets all five of these criteria, there is a 50% chance that strep is causing his or her sore throat. Based on recent research I have reviewed, by using these questions <a href="https://doi.org/10.7326/0003-4819-159-9-201311050-00003">adults can determine</a> when strep is the likely cause of a sore throat. </p>
<p>In the <a href="https://www.nice.org.uk/guidance/ng84">United Kingdom</a> and <a href="https://doi.org/10.1370/afm.741">other European countries</a>, doctors do not routinely test for strep. Antibiotic treatment can at times <a href="https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/au_arent_always_the_answer_fs_508.pdf">cause allergic reactions, rash, diarrhea, stomach upset, yeast infections and other side effects</a>. Authorities in these countries feel any benefit of testing and treatment does not outweigh these risks.</p>
<h2>Treatments for strep</h2>
<p>Once group A strep is confirmed, doctors may prescribe an antibiotic treatment. </p>
<p>Penicillin or amoxicillin are the most commonly prescribed antibiotics for strep. These medicines will not reduce pain or tiredness but may help symptoms resolve earlier, typically by <a href="https://www.nice.org.uk/guidance/ng84/chapter/Summary-of-the-evidence">about a day</a>. Doctors may also suggest use of a pain reliever such as acetaminophen or ibuprofen to help relieve symptoms.</p>
<p>Antibiotic treatment does not seem to lower the likelihood of <a href="https://doi.org/10.1136/bmj.38503.706887.AE1">spread of the infection between children</a> – which is common in schools and dormitories – <a href="https://doi.org/10.1136/bmj.f6867">or adults</a>.</p>
<p>Health care practitioners recommend staying home until fever has subsided. They also recommend taking the full course of antibiotics, even if the symptoms have abated. </p>
<p>With sore throats causes by viruses – against which antibiotics are ineffective – few treatments exist aside from using pain relievers to help soothe immediate symptoms. For this reason and because <a href="https://www.cdc.gov/antibiotic-use/index.html">antibiotic overuse is a major problem in the U.S.</a>, it is best not to assume that your sore throat is caused by strep and to treat it accordingly.</p><img src="https://counter.theconversation.com/content/207286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Shaughnessy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite an abundance of research on strep, there is still a great deal of debate in the scientific community over whether and when people should get tested and treated for it.Allen Shaughnessy, Professor of Family Medicine, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059532023-05-23T14:26:06Z2023-05-23T14:26:06ZHeadaches after exercise: here’s why they happen – and how to prevent them<figure><img src="https://images.theconversation.com/files/527780/original/file-20230523-19-5ooi3s.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5716%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people describe exercise headaches as feeling similar to a migraine.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-after-jogging-fitness-park-has-2246510531">voronaman/ Shutterstock</a></span></figcaption></figure><p>For some people, going for a run can trigger what’s known as a “runner’s high”, a short-lasting feeling of euphoria or relaxation. But for others, running can trigger something far less pleasant: a headache.</p>
<p>Exercise or exertion headaches were <a href="https://www.sciencedirect.com/science/article/abs/pii/S002571251632870X?via%3Dihub">first described by researchers in 1968</a>. They occur during or after a period of intense, strenuous physical activity – such as running, sneezing, heavy lifting or sex.</p>
<p>While symptoms vary from person to person, <a href="https://ichd-3.org/other-primary-headache-disorders/4-2-primary-exercise-headache/4-2-1-probable-primary-exercise-headache/">exertion headaches</a> typically involve a pulsating feeling on both sides of the head, which some describe as similar to a <a href="https://www.uspharmacist.com/article/exerciseinduced-headaches-prevention-management-and-treatment">migraine</a>. They can last anywhere from a few minutes to a couple of days. Some people may also experience multiple headache episodes. </p>
<p>But despite affecting an anywhere between <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-008-0063-5">1% and 26% of adults</a> (and up to <a href="https://link.springer.com/article/10.1007/s11910-018-0840-8">30% of adolescents</a>), there’s still limited scientific data on exertion headaches. </p>
<p>This may be because they aren’t significantly painful enough to stop people exercising, they cease when people stop exercising or because the symptoms overlap with those of other headaches (such as migraine), meaning people are treated for those instead. So in all likelihood, they could be more common than we think.</p>
<p>But where studies with small numbers of people have been done, such headaches appear to be most common in people aged <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098066/">22</a> to <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-008-0063-5">40</a>, though they most often begin <a href="https://journals.sagepub.com/doi/10.1046/j.1468-2982.2002.00466.x">before the age of 30</a>. </p>
<p>Men in these studies were also <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-008-0063-5">more likely to suffer them</a>, accounting for around 80% of the small number of sufferers taking part. More research will be needed to establish more clearly whether men are more likely to have them and, if so, why.</p>
<h2>Why they happen</h2>
<p>When we exercise, <a href="https://www.scientificamerican.com/article/why-do-you-think-better-after-walk-exercise">blood flow to the brain</a> increases in order to ensure it has enough oxygen to keep our body moving. But this also means there’s an increase in the amount of CO₂ and heat our brains need to get rid of. To cope with this, our blood vessels expand and this stretching can cause pain.</p>
<p>Since everyone has different anatomy and physiology, for some people the additional demands that exercise places on their circulatory system may be enough to trigger a headache. But for others, certain conditions may cause exertion headaches.</p>
<p>Exercising in hot weather is one example. The brain naturally runs at a <a href="https://www.ukri.org/news/healthy-human-brains-are-hotter-than-previously-thought/">hotter termperature</a> than the rest of the body, and it cannot dissipate heat through the skin by sweating. The only way it can get rid of heat is by widening the blood vessels to increase blood flow to through the brain, helping to take away some of the heat.</p>
<p>Since hot and humid weather already increase the brain’s temperature, adding exercise into the mix only makes it hotter, leading to an even greater swelling of our blood vessels to cope. This may explain why some people only get the characteristic pulsating headache when they exercise on a hot day. </p>
<figure class="align-center ">
<img alt="A young female runner holds her head in pain." src="https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527781/original/file-20230523-3478-6dx0wi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Warmer weather can also make them more likely to happen.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-athlete-runs-park-has-severe-2105720657">voronaman/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Training at altitude also increases the likelihood of exertion headaches. This is due to the <a href="https://www.ncbi.nlm.nih.gov/books/NBK539701/">reduced oxygen-carrying capacity</a> of the blood at altitude. This means <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=74397">more blood has to go to the brain</a> to supply all the oxygen it needs, causing swelling and triggering pain.</p>
<p>People with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160088/">personal or family history of migraine</a> of migraine may also be more likely to get exertion headaches. This is probably because the same changes that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083225/">bring on migraines</a> – such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088188/">changes in blood vessel size</a> – are also involved in exertion headaches. </p>
<h2>How to prevent them</h2>
<p>Exertion headaches will resolve shortly after stopping exercise. This will usually be within an hour or two, once your heart rate has decreased and there’s less demand for oxygen from the brain. </p>
<p>But if your headache is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280611/">linked to dehydration</a>, it will probably take a bit longer to resolve until you’ve replenished your fluid levels. This typically takes about three hours. </p>
<p>If symptoms do persist or your headache is particularly painful, over-the-counter pain medications – such as paracetamol or ibuprofen – may help. But if exertion headaches are a common experience to you, you might want to speak to your doctor about trying <a href="https://www.nhs.uk/medicines/propranolol//">certain prescription drugs</a> which may <a href="https://pubmed.ncbi.nlm.nih.gov/25467407/">reduce symptoms</a> and in some cases decrease chances of these headaches from happening.</p>
<p>There are also things you can do to prevent exertion headaches from happening the first place.</p>
<p>It’s thought that doing strenuous exercise after a long period of inactivity might cause exertion headaches, as your cardiovascular system is not fit enough to cope with the demands. </p>
<p>That’s why it’s good to ease back into exercise gradually if you haven’t exercised for a while. It’s also good to <a href="https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.1985.hed2506317.x">warm up gradually</a> each time you exercise to help your circulatory system cope with changes in blood pressure and flow.</p>
<p>Staying hydrated is also important. This ensures the brain’s blood vessels can function properly. <a href="https://pubmed.ncbi.nlm.nih.gov/16483514/">Adequate rest</a> will also ensure the brain works at its best and help you feel <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892491/">less sensitive to pain</a>. </p>
<p>Although exertion headaches are annoying, they shouldn’t prevent you from exercising, especially in warmer weather when they can be more common. Gradual warm-ups and avoiding hot days or altitude may help lower your risk of them happening. Trying other types of exercise which do not have a sustained peak heart rate level – such as yoga or weightlifting – may be beneficial.</p><img src="https://counter.theconversation.com/content/205953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exercise or exertion headaches could affect up to a quarter of the adult population.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923902022-11-10T13:43:24Z2022-11-10T13:43:24ZConcussions can cause disruptions to everyday life in both the short and long term – a neurophysiologist explains what to watch for<figure><img src="https://images.theconversation.com/files/494518/original/file-20221109-16873-evqs5d.jpg?ixlib=rb-1.1.0&rect=400%2C16%2C5166%2C3638&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleep plays a critically important role in the recovery process in the days following a concussion.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/skiing-accident-royalty-free-image/164528977?phrase=concussion&adppopup=true">nicolamargaret/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://www.cnn.com/2022/10/19/sport/nfl-tua-tagovailoa-concussion-spt-intl">repeat concussions</a> suffered by Miami Dolphins quarterback Tua Tagovailoa less than a week apart in September 2022 have brought the seriousness of traumatic brain injury back into the public eye and <a href="https://www.washingtonpost.com/health/2022/09/30/tua-concussion-protocol-nfl/">triggered scrutiny</a> of the NFL’s concussion protocols. And the upcoming World Cup soccer competition, which begins Nov. 20, 2022, will likely include highly visible head injuries.</em></p>
<p><em>The Conversation asked David Howell, <a href="https://profiles.ucdenver.edu/display/15074432">director</a> of the <a href="https://medschool.cuanschutz.edu/orthopedics/research/labs/howell-concussion-lab/our-research">Colorado Concussion Research Laboratory</a> at the University of Colorado School of Medicine, to explain the latest science behind concussions and why a recently injured brain is more vulnerable to repeat injury. Howell’s work focuses on the many different areas of concussion-related dysfunction and recovery, including <a href="https://doi.org/10.3390/s20216297">movement deficits</a>, <a href="https://doi.org/10.1097/jsm.0000000000000803">sleep problems</a> and <a href="https://doi.org/10.1177/03635465211069372">rehabilitation</a>.</em></p>
<h2>How widespread are concussions?</h2>
<p>The word concussion can evoke a variety of different images for different people. While concussions are most visible during high-profile sporting events, they can also occur on the playground, during the junior varsity football team practice or on the ski slope. The effects can be just as severe for children and teens as for high-profile athletes.</p>
<p>Concussion effects range from mild to severe, from short term to long term, and can affect many different facets of life. A concussion is defined as a traumatic brain injury caused by an impact to the head, resulting in an alteration of brain function. </p>
<p>A concussion often leads to disruptions to everyday life – whether it be a job, academics, sports, physical activity or sleep. Given how unique people’s brains are and how differently they may respond to the injury, concussion recognition, diagnosis and treatment remain challenging for patients and clinicians alike. </p>
<h2>What happens to the brain during a concussion?</h2>
<p>There is a complex set of events that occur within the brain during and after a concussion occurs. </p>
<p>As a result of the trauma to the brain, brain cells – or neurons – stop functioning as they typically do when healthy. Generally there is not one specific area of the brain that is affected by a concussion. Instead, the injury can affect a widespread set of brain regions, not necessarily at the impact point. Thus, each person may experience a unique set of symptoms or functional problems following the injury. </p>
<p>One main problem that arises following a concussion is an <a href="https://doi.org/10.1016/j.csm.2020.08.001">energy crisis</a> of sorts. This occurs when the brain requires a large volume of energy, in the form of glucose delivered by blood flow to the brain, to restore the injured processes. The body also may have trouble delivering blood to the brain because of a brain blood flow disruption <a href="https://doi.org/10.3389/fneur.2018.00196">caused by the injury</a>, at the very time the brain needs extra energy to restore the injured areas. This mismatch can produce a variety of different symptoms people experience following a concussion.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7Lfc7aZfd0Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Research suggests that a concussion can alter the brain’s wiring.</span></figcaption>
</figure>
<h2>What signs should you look for if you suspect a concussion?</h2>
<p>Concussions produce a wide range of signs and symptoms, such as problems with walking and balance, dizziness, mood changes, disruptions to sleep and more. </p>
<p>Some of the main signs that health care providers look for following an impact to the head or body include unsteadiness of gait, loss of consciousness, seizures or other concussion symptoms like headache, cognitive impairment or problems with vision or balance.</p>
<p>It is critical that if a concussion is suspected, individuals cease playing their sport or activity. A simple mantra of “<a href="https://sportscotland.org.uk/media/3382/concussionreport2018.pdf">If in doubt, sit them out</a>” should always be applied, regardless of the setting. </p>
<h2>Why is the injured brain more vulnerable to repeat injury?</h2>
<p>Miami Dolphins quarterback Tua Tagovailoa, who was <a href="https://www.cnn.com/2022/10/19/sport/nfl-tua-tagovailoa-concussion-spt-intl">carted off the field</a> in late September 2022 after his second head injury in less than a week, serves as an example of how vulnerable the brain can be to additional trauma following an initial concussion.</p>
<p>Research shows that the rate of second concussions is highest in the immediate <a href="https://doi.org/10.1136/bjsports-2019-100579">days following an initial concussion</a>. In addition, recent studies have found that athletes who continue to play following a concussion <a href="https://doi.org/10.1177/0363546518757984">experience longer recovery times</a> and <a href="https://doi.org/10.1007/s40279-022-01668-1">more severe symptoms</a>. </p>
<p>While athletes of all ages may want to continue competing after a concussion, relying on a person with an injured brain to determine whether their brain is healthy enough to continue playing is flawed logic. Qualified health care professionals should always make these sorts of decisions for an athlete, rather than someone with a vested interest such as the athletes themselves or their coaches.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Football players stand in a circle looking at a teammate stretched on the ground." src="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494481/original/file-20221109-11066-izy6xc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Teammates gather around Miami Dolphins quarterback Tua Tagovailoa after an injury during the first half of an NFL game on Sept. 29, 2022.</span>
<span class="attribution"><a class="source" href="https://www.apimages.com/metadata/Index/Dolphins-Bengals-Football/2fc554f4223f4e0c9234f61e9f7e62da/1/0">AP Photo/Emilee Chinn/</a></span>
</figcaption>
</figure>
<p>Given the energy crisis described above that occurs following a head injury, the brain simply cannot handle the added and cumulative stress of two injuries occurring in short succession. A second insult to the brain is often simply too much for the brain to handle, and the brain will preserve its most basic functions, such as breathing, above all else. </p>
<p>This is why it is imperative that athletes who experience a concussion be removed from the field of play and allowed to recover fully before returning to unrestricted sport participation. This often involves <a href="https://doi.org/10.1136/bjsports-2017-097699">a stepwise reintegration approach</a>, which allows for a gradual and safe reintroduction into physical activity at first, and an appropriately safe return to play under medical care.</p>
<h2>You’ve had a concussion – now what?</h2>
<p>The first step following a concussion is to stop playing sports and to rest for a day or two. Sleep is <a href="https://doi.org/10.1089/neu.2021.0295">critically important</a> in the days following a concussion. </p>
<p>A myth that continues to persist is that a person should be woken up every hour following a concussion. This is simply not supported by science. In fact, poor sleep after a concussion has been widely documented as being a <a href="https://doi.org/10.1097/jsm.0000000000000803">predictor of poor outcomes</a>, including <a href="https://doi.org/10.1177/0009922816681603">longer recovery times</a> and more severe anxiety, depression or <a href="https://doi.org/10.1089/neu.2018.6257">cognitive symptoms</a>. Waking someone up every hour applies to <a href="https://doi.org/10.1093/bja/aem128">more severe brain injuries</a> that would be ruled out by a health care provider during diagnosis.</p>
<p>In addition, <a href="https://doi.org/10.1136/bjsports-2018-100338">recent guidelines</a> and <a href="https://doi.org/10.1542/peds.2014-0966">past research</a> suggest that complete physical and cognitive rest, which is <a href="https://doi.org/10.1097/wco.0000000000000611">sometimes called cocoon therapy</a>, can actually be <a href="https://doi.org/10.3389/fneur.2019.00362">harmful to recovery</a>. </p>
<p>Therefore, it is important to keep a balanced approach in mind. Following a day or two of physical rest, people with a concussion should begin resuming <a href="https://doi.org/10.1016/j.jpeds.2020.07.049">light physical and cognitive activity</a> that does not provoke or exacerbate ongoing symptoms. </p>
<p>When a person begins to feel better following a concussion, they should gradually add in higher intensity and greater amounts and duration of exercise, dictated by whether their symptoms are not significantly provoked. Recent studies have focused on the value of an individualized aerobic exercise program in the week following a concussion. Past work suggests that performing aerobic exercise at a heart rate just below the level at which symptoms are exacerbated is <a href="https://doi.org/10.1016/s2352-4642(21)00267-4">safe and effective for recovery</a>.</p>
<p>It is important to note that the effects of a concussion may also result in secondary conditions, such as anxiety or depression due to the biological, social or psychological effects of the injury. A recent study showed that adolescents who sustained a concussion have a <a href="https://doi.org/10.1001/jamanetworkopen.2022.1235">higher risk of mental health issues</a> compared to those with an orthopedic injury.</p><img src="https://counter.theconversation.com/content/192390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Howell has received research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the National Institute of Neurological Disorders And Stroke, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation, and the Colorado Clinical and Translational Sciences Institute and he serves on the Scientific/Medical Advisory Board/owns shares for Synaptek, LLC.</span></em></p>While high-profile concussions in the NFL have brought renewed attention to the gravity of head injuries, they can also occur on the playground or during junior varsity practices – with lasting effects.David Howell, Assistant Professor of Orthopedics,, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1920632022-10-20T16:06:01Z2022-10-20T16:06:01ZThree reasons strong perfumes give you a headache<figure><img src="https://images.theconversation.com/files/490078/original/file-20221017-16-mo7d9w.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7856%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people find the smell of strong perfumes to be irritating.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/perfume-bottles-transparent-multicolored-glass-cosmetics-2001950825">GVLR/ Shutterstock</a></span></figcaption></figure><p>Humans can smell <a href="https://www.nature.com/articles/nature.2014.14904">over 1 trillion odours</a>. But no two people will react in quite the same way to the same smell. While there are some smells almost everyone agrees are unpleasant (such as paint thinner or rotten food), our reactions to other types of smells can be far more personal. </p>
<p>Take perfume. While one person may find the smell of a strong, floral perfume to be heavenly, another person may find it gives them a headache. There are many reasons why people can get a physical reaction to strong smells – but here are the three most common ones.</p>
<h2>1. Emotions</h2>
<p>Of all of our senses, only smell has a direct line to <a href="https://link.springer.com/chapter/10.1007/978-1-4612-2836-3_15">our emotional system</a>. It’s thought the reason for this link is because smell evolved first of all of our senses. This means we don’t just perceive smell based on the odour chemicals presented to us, but together with all <a href="https://doi.org/10.3758/BF03210754">our memories of that smell</a> – including the way it makes us feel, our past memories, and how we presently feel.</p>
<p>So let’s say you smell something you associate with a negative memory. Perhaps it’s the smell of cleaning chemicals used in a hospital, or the same perfume your ex used. One whiff may cause <a href="https://www.frontiersin.org/articles/10.3389/fnsys.2021.752320/full">all those negative emotions</a> to come rushing back to you, leading your body to <a href="https://www.jneurosci.org/content/33/39/15324.short">generate a fight or flight stress response</a>. </p>
<p>The fight or flight stress response is your body’s way of reacting to stress, anxiety or danger. It causes a number of physical changes, most of which are triggered by the brain going into high alert. One of the first changes you may notice during a fight or flight response is tension around the head and neck area. The reason for this is due to a vasodilation (widening of the blood vessels) which allows more blood to be diverted to the brain and parts of the body that need it.</p>
<p>Vasodilation also activates sensory receptors embedded in the blood vessels, which <a href="https://www.bloomsbury.com/uk/splitting-9781472971395/">we perceive as headache</a> pain if the blood vessels in the head and neck are the ones widening.</p>
<p>How we respond emotionally to certain smells is very personal, and based on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC20578/">myriad of experiences</a>. It may even be triggered by smells we may not even be conscious of smelling or consciously aware of our reaction to them. But if you tend to get headaches only when you smell certain scents, it may be due to the negative association you have to it.</p>
<h2>2. Sinus troubles</h2>
<p>The chemicals that activate the smell signals in our brain (called odorants) can sometimes irritate our sinuses. Smoke, perfume and chlorine are some of the most common odorants that cause irritation. </p>
<p>Our sinuses comprise of four distinct, air-filled cavities in the bones of our face. Each are lined with a mucus-secreting membrane. The mucus traps particles and bugs that come in through our nose and mouth. But in order to clear these trapped particles or potential irritants, the body needs to produce more and more mucus – resulting in allergy-like symptoms. This in turn causes our immune system to kick in and help out, which results in vasodilation and inflammation. The <a href="https://www.bloomsbury.com/uk/splitting-9781472971395/">end result for some is a headache</a>.</p>
<figure class="align-center ">
<img alt="A man presses his hands to his temples, his eyes shut in pain from his headache." src="https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490076/original/file-20221017-16-l7skur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many odorants can cause allergy-like symptoms that lead to a headache.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/displeased-handsome-guy-headache-rubbing-his-1933229045">Dean Drobot/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Some odours may also <a href="https://doi.org/10.1021/cn100102c">act directly on the nerve pathway</a> that transmits the sensory signals to the brain, too. Called the trigeminal pathway, this scoops up all the sensory signals from our head and carries them through the nerve cells to the brain for processing. </p>
<p>When this pathway is stimulated it causes inflammation because it detects a threat that only the immune system can sort out. This, too, can lead to a headache. Chemical smells such as formaldehyde, certain cleaning products and cigarette smoke are all known to act directly on the trigeminal pathway. </p>
<h2>3. Odour intolerance</h2>
<p>Osmophobia is defined as an intolerance to odours. While rare on its own, people who suffer from chronic headaches tend to also experience osmophobia.</p>
<p>Migraine sufferers are <a href="https://americanheadachesociety.org/news/whats-that-smell/#:%7E:text=Osmophobia%252C%2520a%2520sensitivity%2520to%2520smell,some%2520cleaning%2520products%2520and%2520foods.">particularly prone to osmophobia</a>. Some research has even shown that exposure to strong odours for two hours or more can actually trigger a migraine in <a href="https://journals.sagepub.com/doi/10.1177/0333102416636098#:%7E:text=In%2520our%2520study%252C%252034.7%2525%2520of,to%252070.0%2525%2520of%2520these%2520patients.">around 20% of migraine sufferers</a>. Cigarette smoke, perfumes, car exhaust and cleaning products are some of the most common triggering scents.</p>
<p>The nervous system of someone who experiences migraine can be particularly sensitive to certain sensory stimuli in their daily life. But during the prodrome phase (the first of four distinct migraine phases, which may happen a couple of days to hours before the headache attack) they may become <a href="https://www.bloomsbury.com/uk/splitting-9781472971395/">even more sensitive to certain stimuli</a> – including smells.</p>
<p>Many migraine sufferers experience certain signs that a migraine is coming during the podrome phase – such a yawning more and craving certain foods. Smells that wouldn’t ordinarily bother you may also <a href="https://doi.org/10.1007/BF00313864">upset you intensely</a>. You may also perceive smells that aren’t there – known as <a href="http://cep.sagepub.com/content/31/14/1477.full.pdf+html">phantom smells</a>. The most common phantom smell many report before a migraine is a burning smell. So while smell isn’t the migraine trigger in this instance, it may be a sign of an oncoming headache.</p>
<p>Science has yet to find an effective way to get around this. So, if you’re someone that tends to get headaches from certain scents (no matter the reason) perhaps it’s best to avoid them as much as you can. But since we can’t always avoid triggers, fresh air and painkillers may be the best way to manage any headaches that do occur.</p><img src="https://counter.theconversation.com/content/192063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ellison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No two people will react to the same smell in the same way.Amanda Ellison, Professor of Neuroscience, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1813482022-07-11T12:29:10Z2022-07-11T12:29:10ZMigraine sufferers have treatment choices – a neurologist explains options beyond just pain medication<figure><img src="https://images.theconversation.com/files/472113/original/file-20220701-26-9o11ui.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5084%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some, too much medication might make migraine worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/headache-conceptual-artwork-3d-illustration-royalty-free-image/1156927795?adppopup=true">peterschreiber.media/iStock via Getty Images Plus</a></span></figcaption></figure><p>Migraine headaches currently affect more than one billion people across the globe and are the <a href="https://doi.org/10.1186/s10194-020-01208-0">second-leading cause</a> of disability worldwide. Nearly one-quarter of U.S. households have at least <a href="https://doi.org/10.1046/j.1526-4610.2001.041007646.x">one member who suffers from migraines</a>. An estimated <a href="https://doi.org/10.1177/0333102410363766">85.6 million workdays</a> are lost as a result of migraine headaches each year. </p>
<p>Yet many who suffer with migraine dismiss their pain as simply a bad headache. Rather than seeking medical care, the condition often <a href="https://pubmed.ncbi.nlm.nih.gov/25588281/">goes undiagnosed</a>, even when other incapacitating symptoms occur alongside the pain, including light and sound sensitivity, nausea, vomiting and dizziness.</p>
<p>Researchers have discovered that genetics and environmental factors play a role in the condition of migraine. They happen when changes in your brainstem activate <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve">the trigeminal nerve</a>, which is a major nerve in the pain pathway. This cues your body to release inflammatory substances such as <a href="https://www.scienceofmigraine.com/pathophysiology/cgrp">CGRP</a>, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.</p>
<h2>For some, medication has its limits</h2>
<p>A migraine can be debilitating. Those who are experiencing one are often curled up in a dark room accompanied by only their pain. Attacks can last for days; life is put on hold. The sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to forego work, school, social gatherings and time with family.</p>
<p>Numerous prescription medications are available for both the prevention and treatment of migraine. But for many people, conventional treatment has its limitations. Some people with migraine have a poor tolerance for certain medications. Many can’t afford the high cost of the medicines or endure the side effects. Others are pregnant or breastfeeding and can’t take the medications.</p>
<p>However, as a <a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/29586">board-certified neurologist</a> who specializes in headache medicine, I’m always amazed at how open-minded and enthusiastic patients become when I discuss alternative options. </p>
<figure>
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<figcaption><span class="caption">Your brain sends you warning signals, such as fatigue and mood changes, to let you know a migraine may be on the way.</span></figcaption>
</figure>
<p>These approaches, collectively, are called <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine">complementary and alternative medicine</a>. It might be surprising that a traditionally trained Western doctor like me would recommend things like yoga, acupuncture or meditation for people with migraine. Yet in my practice, I value these <a href="https://doi.org/10.7326/0003-4819-135-5-200109040-00011">nontraditional treatments</a>. </p>
<p>Research shows that alternative therapies are associated with <a href="https://doi.org/10.1016/j.ctcp.2017.12.003">improved sleep, feeling better emotionally and an enhanced sense of control</a>. Some patients can avoid prescription medications altogether with one or more complementary treatments. For others, the nontraditional treatments can be used along with prescription medication. </p>
<p>These options can be used one at a time or in combination, depending on how severe the headache and the cause behind it. If neck tension is a contributor to the pain, then physical therapy or massage may be most beneficial. If stress is a trigger, perhaps meditation would be an appropriate place to start. It is worth talking to your provider to explore which options may work best for you. </p>
<h2>Mindfulness, meditation and more</h2>
<p>Because stress is a <a href="https://www.healthline.com/health/migraine-from-stress#bottom-line">major trigger for migraines</a>, one of the most effective alternative therapies is <a href="https://americanmigrainefoundation.org/resource-library/understanding-migraine-cattreatmentmindfulness-meditation-migraine/">mindfulness meditation</a>, which is the act of focusing your attention on the present moment in a nonjudgmental mindset. Studies show that mindfulness meditation can reduce <a href="https://medcentral.net/doi/full/10.4103/0366-6999.228242">headache frequency and pain severity</a>. </p>
<p>Another useful tool is <a href="https://americanmigrainefoundation.org/resource-library/biofeedback-and-relaxation-training/">biofeedback</a>, which enables a person to see their vital signs in real time and then learn how to stabilize them. </p>
<p>For example, if you are stressed, you may notice muscle tightness, perspiration and a fast heart rate. With biofeedback, these changes appear on a monitor, and a therapist teaches you exercises to help manage them. <a href="https://doi.org/10.1016/j.pain.2006.09.007">There is strong evidence</a> that biofeedback can lessen the frequency and severity of migraine headaches and reduce headache-related disability.</p>
<p><a href="https://www.medicalnewstoday.com/articles/yoga-for-migraine#can-it-help">Yoga</a> derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with a goal of uniting the mind, body and spirit. Practicing yoga consistently <a href="https://americanmigrainefoundation.org/resource-library/yoga-and-migraine/">can be helpful</a> in reducing stress and treating migraine.</p>
<figure>
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<figcaption><span class="caption">Meditation is an alternative therapy that could help with your migraine.</span></figcaption>
</figure>
<h2>Manipulation-based therapy</h2>
<p><a href="https://www.webmd.com/migraines-headaches/physical-therapy-for-migraine">Physical therapy</a> uses manual techniques such as <a href="https://www.myofascialtherapy.org/myofascial-therapy">myofascial and trigger-point release</a>, <a href="https://www.healthline.com/health/exercise-fitness/passive-stretching">passive stretching</a> and <a href="https://www.verywellhealth.com/manual-cervical-traction-2696409">cervical traction</a>, which is a light pulling on the head by a skilled hand or with a medical device. Studies show that <a href="https://doi.org/10.1016/j.apmr.2015.12.006">physical therapy with medication was superior</a> in reducing migraine frequency, pain intensity and pain perception over medications alone. </p>
<p>By lowering stress levels and promoting relaxation, massage can <a href="https://www.webmd.com/migraines-headaches/migraine-massage-therapy">decrease migraine frequency</a> and <a href="https://doi.org/10.1207/s15324796abm3201_6">improve sleep</a>. It may also reduce stress in the days following the massage, which adds further protection from migraine attacks. </p>
<p>Some patients are helped by <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture">acupuncture</a>, a form of traditional Chinese medicine. In this practice, fine needles are placed in specific locations on the skin to promote healing. A large 2016 meta-analysis paper found <a href="https://doi.org/10.1111/head.12857">acupuncture reduced the duration and frequency of migraines</a> regardless of how often they occur. Acupuncture benefits <a href="https://doi.org/10.1001/jamainternmed.2016.9378">are sustained after 20 weeks of treatment</a>.</p>
<p>What’s also fascinating is that acupuncture <a href="https://doi.org/10.2147/JPR.S162696">can change the metabolic activity</a> in the thalamus, the region of the brain critical to pain perception. This change correlated with a decrease in the headache intensity score following acupuncture treatment.</p>
<h2>Vitamins, supplements and nutraceuticals</h2>
<p><a href="https://my.clevelandclinic.org/health/drugs/15829-herbal-supplements">Herbal supplements</a> and <a href="https://americanmigrainefoundation.org/resource-library/nutraceuticals-for-migraine/">nutraceuticals</a>, which are food-derived products that may have therapeutic benefit, can also be used to prevent migraine. And there is evidence to suggest vitamins work reasonably well compared to traditional prescription medication. They also have fewer side effects. Here are some examples:</p>
<ul>
<li><p>Magnesium is believed to help regulate the <a href="https://doi.org/10.1111/j.1526-4610.2011.01847.x">blood vessels and electrical activity in the brain</a>. A study found that patients given 600 milligrams of magnesium citrate daily for 12 weeks had a 40% <a href="https://doi.org/10.1046/j.1468-2982.1996.1604257.x">decrease in migraine</a>. Side effects included diarrhea in nearly 20% of patients. </p></li>
<li><p>Vitamin B2, or riboflavin, <a href="https://doi.org/10.1111/head.12789">is also considered useful in migraine</a> prevention. When dosed at 400 milligrams daily for 12 weeks, researchers found it <a href="https://doi.org/10.1111/head.12789">reduced migraine frequency by half</a> in more than half of participants. </p></li>
<li><p>Another beneficial supplement is Coenzyme Q10, which is involved in <a href="https://doi.org/10.1073/pnas.95.15.8892">cellular energy production</a>. After three months, about half of those taking 100 milligrams of Coenzyme Q10 three times a day <a href="https://pubmed.ncbi.nlm.nih.gov/15728298/">had half the number of migraine attacks</a>. </p></li>
<li><p>A potential natural solution is <a href="https://headaches.org/feverfew-tanacetum-parthenium/">feverfew</a> or <em>Tanacetum parthenium</em>, a daisylike perennial plant known to have <a href="https://doi.org/10.4103/0973-7847.79105">anti-migraine properties</a>. Taken three times daily, feverfew <a href="https://doi.org/10.1111/j.1468-2982.2005.00950.x">reduced migraine frequency by 40%</a>. </p></li>
</ul>
<h2>Devices can be beneficial</h2>
<p>The Food and Drug Administration has approved several <a href="https://www.everydayhealth.com/migraine/guide/treatment/nerve-stimulation-devices/">neurostimulation devices</a> for migraine treatment. These devices work by neutralizing the pain signals sent from the brain.</p>
<p>One is the <a href="https://doi.org/10.3389/fpain.2021.753736">Nerivio device</a>, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare. </p>
<p>Another device that shows promise is the <a href="https://americanmigrainefoundation.org/resource-library/understanding-migrainecefaly-for-migraine-prevention/">Cefaly</a>. It delivers a mild electrical current to the <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve#">trigeminal nerve</a> on the forehead, which can lessen the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, and the relief lasted up to 24 hours. Side effects are uncommon and include sleepiness or skin irritation. </p>
<p>These alternative therapies help treat the person as a whole. In just my practice, many success stories come to mind: the college student who once had <a href="https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/">chronic migraine</a> but now has rare occurrences after a regimen of vitamins; the pregnant woman who avoided medication through acupuncture and physical therapy; or the patient, already on numerous prescription medications, who uses a neurostimulation device for migraine instead of adding another prescription. </p>
<p>Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.</p><img src="https://counter.theconversation.com/content/181348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wilhour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research suggests that alternative treatments for migraine, including physical therapy, massage and vitamin supplements, can make a difference.Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731342022-02-01T13:14:34Z2022-02-01T13:14:34ZWhy taking fever-reducing meds and drinking fluids may not be the best way to treat flu and fever<figure><img src="https://images.theconversation.com/files/439010/original/file-20211226-36920-246w3v.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5128%2C3426&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Using fever reducers or drinking too much fluid while battling the flu may upset the body's delicate balancing act. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-woman-taking-her-temperature-royalty-free-image/88689538?adppopup=true">Sam Edwards/OJO Images via Getty Images</a></span></figcaption></figure><p>As flu season progresses, so does the <a href="https://www.cdc.gov/flu/prevent/index.html">chorus of advice</a>, professional and otherwise, to drink plenty of fluids and take fever-reducing medications, like acetaminophen, ibuprofen or aspirin. </p>
<p>These recommendations, <a href="https://doi.org/10.1001/archpedi.1982.03970470017003">well-intentioned and firmly entrenched</a>, offer comfort to those sidelined with fever, flu or vaccine side effects. But you may be surprised to learn the science supporting these recommendations is speculative at best, harmful at worst and comes with caveats. </p>
<p><a href="https://education.wayne.edu/profile/gr7894">I am an exercise physiologist</a> who specializes in studying how the body regulates fluids and temperature. And based on a wide body of evidence, I can tell you that increased fluid intake and taking fever reducers, whether aspirin, acetaminophen or ibuprofen, may not always help in your recovery. In fact, in some cases, it could be harmful.</p>
<p>There’s a reason why people say fevers should be lowered when sick or after a vaccine. Both aspirin and acetaminophen, such as Tylenol, <a href="https://doi.org/10.1016/j.clinthera.2005.06.002">reduce fever, headaches and muscle aches</a>. But at the same time, <a href="https://doi.org/10.1093/infdis/162.6.1277">seminal</a> and <a href="https://doi.org/10.1098/rspb.2013.2570">newer studies</a>, including broad meta-analysis studies, show that <a href="https://doi.org/10.1258/jrsm.2010.090441">these medications</a> may weaken the immune response to infection or <a href="https://doi.org/10.1001/archinte.160.4.449">have unwanted side effects</a>.</p>
<h2>What is a fever?</h2>
<p>First, some background: Fevers are a regulated increase in core body temperature as a response to unwanted microbial invaders.
The more <a href="https://doi.org/10.1016/j.amjms.2021.01.004">severe the infection, the higher the fever</a>. </p>
<p>Having a fever is not all bad; it’s how the body has evolved to recuperate from an infection. For many species, <a href="https://www.racgp.org.au/afp/2015/januaryfebruary/a-is-for-aphorisms/">fevers are advantageous</a> and beneficial for survival. </p>
<p>But fever comes with a cost. A body temperature that’s too high can be deadly. For every increase of 1.8 degrees Fahrenheit, metabolism goes up 10%; the body begins to burn more calories than normal, temperature continues to rise and the <a href="https://doi.org/10.1111/j.1749-6632.2000.tb05376.x">body releases hormones</a> to keep fever under control. </p>
<p>Many studies demonstrate what can happen when fever reducers are thrust into this complex dance. It turns out aspirin or acetaminophen may cause infected people to feel better, but they also spread more virus while suppressing their own immune response to the infection. </p>
<p>In one double-blind, placebo-controlled study, healthy people infected with a cold virus <a href="https://doi.org/10.1093/infdis/162.6.1277">who took aspirin or acetaminophen</a> for a week had a reduced immune response and an increase in viral shedding – meaning producing and expelling virus particles from the nose. Another study showed that taking aspirin effectively reduced fever symptoms but <a href="https://doi.org/10.1001/jama.1975.03240240018017">increased shedding</a>.</p>
<p>Although some of those traditional studies took place decades ago, their results still hold up today. A recent study warned that if everyone took fever suppressants, there would be even <a href="https://doi.org/10.1098/rspb.2013.2570">more flu cases and flu-related deaths</a>. Furthermore, elevated body temperature – or fever – can help fight COVID-19 by reducing the <a href="https://doi.org/10.1371/journal.%20pbio.3001065">growth of the virus within the lungs</a>. In other words, fevers can help the body fight viruses while reducing the rate of death and disease.</p>
<h2>Drinking fluids</h2>
<p>To prevent dehydration, the Centers for Disease Control and Prevention recommends drinking more fluids when one <a href="https://www.cdc.gov/flu/pdf/freeresources/general/influenza_flu_homecare_guide.pdf?web=1&wdLOR=c20031A15-D755-4A4D-B1B2-40CE51B88D3A">has a fever or infection</a>, or has received <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html#relieve_side_effects">a COVID-19 vaccine</a>. But there is <a href="https://www.washingtonpost.com/lifestyle/2021/11/05/what-do-doctors-mean-when-they-say-drink-plenty-fluids/">scant scientific evidence</a> to support this recommendation. </p>
<figure class="align-center ">
<img alt="A teenage girl with flu drinks a glass of water." src="https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439558/original/file-20220105-23-18gcely.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drinking fluids to excess can lead to overhydration.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenager-drinks-water-from-a-glass-indoors-royalty-free-image/1314353664?adppopup=true">Dina Morozova/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>It’s true that drinking fluids when dehydrated is <a href="https://doi.org/10.1001/archinte.1919.00090240119009">necessary to reduce fever</a>. But not everyone with a fever is dehydrated. For those who aren’t thirsty, forcing fluids <a href="https://doi.org/10.1073/pnas.1403382111">beyond thirst</a>, which is often unpleasant, may not be advisable. </p>
<p>[<em>Get fascinating science, health and technology news.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-fascinating">Sign up for The Conversation’s weekly science newsletter</a>.]</p>
<p>A study <a href="https://doi.org/10.1002/14651858.CD004419.pub3">that evaluated the advice</a> to “drink plenty of fluids” determined that increasing fluid intake when sick may not offer benefits, and that more high-quality studies are needed. Indeed, there was a potential <a href="https://www.webmd.com/diet/what-is-too-much-water-intake#1">risk from overhydration</a>. For some people, three liters, or about 12 eight-ounce glasses, is too much. Overhydration can cause nausea and vomiting, headaches and cramps; in severe cases, <a href="http://dx.doi.org/10.1136/bcr-2016-216882">excessive fluid intake</a> can cause seizures or coma. </p>
<p>Here’s why this happens. To stop dangerous escalations in fever, the body releases antidiuretic hormones. Urination is diminished, so <a href="https://doi.org/10.2165/11532070-000000000-00000">the body retains water</a> through the actions of the kidneys. So if someone with a fever drinks more water than necessary, water intoxication – or hyponatremia, a potentially fatal medical condition in which a patient’s blood sodium levels are too low – could follow. </p>
<p>One study found that nearly a quarter of patients who came to the hospital with COVID-19 had <a href="https://doi.org/10.1210/clinem/dgab107">hyponatremia upon admission</a>. In that study, hyponatremia increased the need for breathing support in the form of ventilation. And another study showed that the condition can lead to <a href="https://doi.org/10.1007/s40618-020-01301-w">poorer outcomes in COVID-19 patients</a>.</p>
<p>So maybe it’s time to rethink the conventional wisdom. If the fever is mild or moderate, stay warm, even use blankets, rather than try to actively reduce it. Rest, so your body can fight the fever. Conserve energy because your metabolism is already on overdrive. Use fever-reducing medications sparingly. Drink fluids, but only to tolerance, and preferably when thirsty.</p>
<p>And one final suggestion that should be soothing: When fighting a fever or vaccine side effects, consider sipping warm liquids that contain sodium. Broths containing sodium, like bullion, <a href="https://doi.org/10.1097/JSM.0000000000000221">may help avoid hyponatremia</a>. And although the actual scientific evidence is sparse and conflicting, <a href="https://doi.org/10.1016/j.chest.2020.06.062">chicken soup</a> may be a better antidote than water when fending off a fever or flu symptoms.</p><img src="https://counter.theconversation.com/content/173134/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamara Hew-Butler does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In some cases, fever reducers and extra fluid intake can weaken the body’s response to infection.Tamara Hew-Butler, Associate Professor of Exercise and Sports Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1612762021-12-28T19:22:14Z2021-12-28T19:22:14ZWhen should you go to hospital for a headache? A doctor explains how to tell if it’s an emergency<figure><img src="https://images.theconversation.com/files/415128/original/file-20210809-23-1e8sm8b.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-girl-headache-woman-migraine-pain-195500759">www.shutterstock.com</a></span></figcaption></figure><blockquote>
<p>I waited for hours in emergency last night with this dreadful headache, but eventually gave up and left. Should I have kept waiting at the hospital?</p>
</blockquote>
<p>This is a surprisingly common scenario I encounter as a <a href="https://www.betterhealth.vic.gov.au/health/serviceprofiles/General-practitioner-services">general practitioner</a>. If you’re wondering how bad your headache needs to be to go to hospital, here’s the advice I give my patients.</p>
<h2>Go to hospital now</h2>
<p>Let’s start with when you definitely <em>should</em> go to hospital for a bad headache. </p>
<p>Serious and urgent causes of headaches include infection, bleeding, clots and tumours. Don’t hesitate to go straight to hospital (via ambulance, or with a trusted driver) if you notice one or more of the following:</p>
<ul>
<li> sudden onset of the worst headache you’ve ever had</li>
<li> headache that worsens with exercise or sexual intercourse</li>
<li> neck stiffness (new since the headache started)</li>
<li> high fever that doesn’t lower with over-the-counter pain medication</li>
<li> headache after trauma to your head or neck</li>
<li> personality changes and/or strange behaviour</li>
<li> weakness/numbness on one side of your body.</li>
</ul>
<p>Three specific situations are also urgent:</p>
<ol>
<li><p>pregnant or recently pregnant women who develop a sudden severe headache</p></li>
<li><p>people who are immunocompromised (such as someone living with HIV or on strong immune-suppressing medications)</p></li>
<li><p>people who’ve had any COVID-19 vaccine in the previous four to 42 days, and who have a <a href="https://www.health.gov.au/sites/default/files/documents/2021/04/covid-19-vaccination-after-your-astrazeneca-vaccine-covid-19-vaccination-after-your-astrazeneca-vaccine.pdf">persistent headache despite taking simple painkillers</a>.</p></li>
</ol>
<p>If you are reading this and identify with any of the above, stop reading now and go straight to hospital.</p>
<h2>For most headaches, don’t go to hospital</h2>
<p>Thankfully, most headaches are less serious, and can be managed without a hospital trip. But they can still take a serious toll.</p>
<p>As you read this, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache">15% of Australians</a> are taking painkillers for a headache.</p>
<p>But just because you don’t need to race to hospital doesn’t mean you shouldn’t get help, especially if you’re experiencing regular headaches. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-causes-headaches-42254">Health Check: what causes headaches?</a>
</strong>
</em>
</p>
<hr>
<h2>When to see a doctor – and what they’ll ask you</h2>
<p>Start by making a long appointment to see a GP to discuss your headache and nothing else. Give it the time and attention it deserves. </p>
<p>It’s helpful to take a record of your headaches for your doctor’s appointment: a “<a href="https://headaches.org/resources/headache-diary-keeping-a-diary-can-help-your-doctor-help-you/">headache diary</a>”.</p>
<p>The most important tool doctors have to diagnose headaches is your <a href="https://www.aafp.org/afp/2013/0515/p682.html?utm_medium=email&utm_source=transaction#afp20130515p682-t1">history</a>. You may feel they are asking a lot of questions, but that’s because there are <a href="https://headacheaustralia.org.au/types-of-headaches/">so many possible causes</a>. Bear with your GP as they try to get you the most accurate diagnosis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A doctor sits with a patient, taking notes about his medical history." src="https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415137/original/file-20210809-13-1nsxkqw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Taking a detailed medical history can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-doctor-visiting-patient-home-care-1903375813">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Here are the kinds of questions a doctor may ask, or be asking themselves while they assess you:</p>
<p><strong>Is the pain caused by something straightforward?</strong></p>
<p>Possible common causes include dehydration, eye/neck strain, teeth grinding, lack of sleep or caffeine withdrawal. Even taking regular painkillers can cause “medication overuse” headaches; the cure can become the cause.</p>
<p><strong>Where in your head is the pain?</strong></p>
<p>Sometimes the location of the pain gives a clue. For example, <a href="https://www.statista.com/statistics/303460/woldwide-headache-consultations-in-primary-care-by-type/">about 35%</a> of headaches are “tension headaches”, which feel like a tight band around both sides of your head. Another 4% are “cluster headaches”, which start behind one eye (which can go red and watery) and are often associated with a stuffy nose.</p>
<p><strong>Do you have any other symptoms accompanying the headache?</strong></p>
<p>A <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache-migraine">migraine</a> episode may be preceded by an “aura” (such as flashes of light), and often includes symptoms like nausea or vomiting, extreme sensitivity to noise and light, and blurred vision.</p>
<p>Fevers, an altered sense of smell, fatigue and pressure in your ears are features associated with acute sinusitis.</p>
<p><strong>Is there a pattern to your headaches?</strong></p>
<p>Certain headaches, such as migraine episodes or tension headaches, may have triggers that set them off, including certain foods, sleep deprivation, particular smells, or emotional stress.</p>
<p>Hormonal headaches track with menstrual cycles. Once an association is noticed, you may be able to pre-empt and treat headaches early.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-is-a-headache-is-it-our-brain-hurting-112951">Curious Kids: what is a headache? Is it our brain hurting?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Do you have any other medical conditions?</strong></p>
<p>Rarely, very high blood pressure (<a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/hypertensive-crisis-when-you-should-call-911-for-high-blood-pressure">a hypertensive crisis</a>) can cause a headache. However, raised blood pressure during a headache is usually simply your natural response to pain.</p>
<p>It’s essential to have chronic and recurrent headaches diagnosed properly by a doctor. Your GP may send you to another specialist (such as a neurologist or ear, nose and throat surgeon) depending on how complicated your situation appears. </p>
<p>Headaches <a href="https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria">rarely need diagnostic investigations</a>, but if your doctor is worried they may organise a <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ct-scan">CT scan</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mri-scan">MRI scan</a> or <a href="https://www.healthdirect.gov.au/lumbar-puncture">lumbar puncture</a>.</p>
<p>Even if you’re sent for further testing, a specific cause may not be found. If that’s the case, your doctor’s goal will be to help you manage your headaches and lessen their impact on your life. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/get-headaches-heres-five-things-to-eat-or-avoid-76611">Get headaches? Here's five things to eat or avoid</a>
</strong>
</em>
</p>
<hr>
<h2>Why migraines are a particular pain</h2>
<p>Migraines deserve a special mention here as they can be so <a href="https://www.migraine.org.au/migraine_basics">debilitating and poorly understood</a>. </p>
<p>Many people self-diagnose “migraines” incorrectly. But a bad headache is <em>not</em> the same thing as a migraine attack, and some migraine attacks do not even include a headache!</p>
<p>If you think you have migraine attacks, get them diagnosed and treated properly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-5-aussies-over-45-live-with-chronic-pain-but-there-are-ways-to-ease-the-suffering-137891">1 in 5 Aussies over 45 live with chronic pain, but there are ways to ease the suffering</a>
</strong>
</em>
</p>
<hr>
<h2>Why headaches can be so costly for us all</h2>
<p>If you can avoid going to hospital unnecessarily when you have a headache, you’ll benefit yourself and Australia’s health-care system. </p>
<p>Every time you present to an emergency department, it costs you hours of your life, and the community <a href="https://www.ihpa.gov.au/sites/default/files/publications/round_22_nhcdc_infographics_emergency.pdf">an average of A$561</a>.</p>
<p>Seeing your GP is obviously more time-efficient and instead costs the community between <a href="http://www9.health.gov.au/mbs/search.cfm?q=23&sopt=I">A$38</a> to <a href="http://www9.health.gov.au/mbs/search.cfm?q=36&sopt=I">A$75</a>.</p>
<p>If headaches interfere with your life, please prioritise your health. See a doctor, get a management plan for them – and save yourself a painfully long wait in emergency.</p><img src="https://counter.theconversation.com/content/161276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with the RACGP</span></em></p>As a GP, bad headaches are among the most common topics I’m asked about. Here’s how you can assess whether to stay home, see a doctor — or head straight to emergency.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660512021-08-17T11:16:41Z2021-08-17T11:16:41ZSugar: why some people experience side-effects when they quit<figure><img src="https://images.theconversation.com/files/416483/original/file-20210817-22-ucg9h7.jpg?ixlib=rb-1.1.0&rect=44%2C0%2C7304%2C4902&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sugar is added to many different foods.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fast-food-concept-unhealthy-donuts-chocolate-1714786945">ilona.shorokhova/ Shutterstock</a></span></figcaption></figure><p>It might surprise you to learn that <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/943114/NDNS_UK_Y9-11_report.pdf?">sugar consumption</a> has actually been <a href="https://publichealthmatters.blog.gov.uk/2020/12/21/new-data-reveals-how-our-diets-are-changing-over-time/">steadily decreasing</a> since 2008. This could be happening for any number of reasons, including a shift in tastes and lifestyles, with the <a href="https://academic.oup.com/cdn/article/5/Supplement_2/391/6293502?login=true">popularity of low-carbohydrate diets</a>, like keto, increasing in the past decade. A greater understanding of the dangers of eating excess sugar on our health may also be driving this drop.</p>
<p>Reducing sugar intake has clear health benefits, including reduced calorie intake, which can <a href="https://www.bmj.com/content/346/bmj.e7492">help with weight loss</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717883/#:%7E:text=Dietary%20free%20sugars%20are%20the,protect%20dental%20health%20throughout%20life.">improved dental health</a>. But people sometimes report <a href="https://www.sciencedirect.com/science/article/pii/S0195666318301740?casa_token=-88mrtUZ9AAAAAAA:pJa6pGBG2GuwVLufkLGec8d5qg--x7tQ_wCwX-7S3YS-CqRgSyxOLYJAeE7gZux_FCB4QNZ2wQ">side-effects</a> when they try eating less sugar – including headaches, fatigue or mood changes, which are <a href="https://theconversation.com/fact-or-fiction-is-sugar-addictive-73340">usually temporary</a>. The reason for these side-effects is poorly understood. But it’s likely these symptoms relate to how the brain reacts when exposed to sugary foods – and the biology of “reward”. </p>
<p>Carbohydrates come in several forms – including as <a href="https://www.frontiersin.org/articles/10.3389/fnut.2020.00075/full">sugars</a>, which can <a href="https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-101">naturally occur in many foods</a>, such as fructose in fruits and lactose in milk. Table sugar – known as <a href="https://foodinsight.org/what-is-sucrose/">sucrose</a> – is found in sugar cane and sugar beet, maple syrup and even honey.</p>
<p>As mass production of food has become the norm, sucrose and other sugars are now added to foods to <a href="https://www.sugarnutritionresource.org/the-basics/functions-of-sugars-in-food">make them more palatable</a>. Beyond the improved taste and “mouthfeel” of foods with high sugar content, sugar has profound biological effects in the brain. These effects are so significant it’s even led to a debate as to whether you can be <a href="https://link.springer.com/article/10.1007/s00394-016-1229-6/">“addicted” to sugar</a> – though this is still being studied. </p>
<p>Sucrose activates <a href="https://pubmed.ncbi.nlm.nih.gov/2699194/.">sweet taste receptors in the mouth</a> which ultimately leads to the release of a chemical called dopamine in the brain. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479149/">Dopamine is a neurotransmitter</a>, meaning it’s a chemical that passes messages between nerves in the brain. When we’re exposed to a rewarding stimulus, the brain responds by releasing dopamine – which is why it’s often called the “reward” chemical.</p>
<p>The rewarding effects of dopamine are largely seen in the <a href="https://www.neuroscientificallychallenged.com/glossary/mesolimbic-pathway">part of the brain</a> involved in pleasure and reward. Reward governs our behaviour – meaning we’re driven to repeat the behaviours which caused dopamine to be released in the first place. Dopamine can drive us to <a href="https://www.sciencedirect.com/science/article/pii/S0149763407000589?casa_token=mOsD1bXevwUAAAAA:_5nc3nQivLBjcx0sT-EbcPjIr0ZOSSarmlZlyj_FFWKtC1axMUxZ8RzB-xN3zHw4zQZkXF9MrA">seek food</a> (such as junk food).</p>
<p>Experiments in both animals and people have shown how profoundly sugar activates these reward pathways. Intense sweetness <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000698">surpasses even cocaine</a> in terms of the internal reward it triggers. Interestingly, sugar is able to activate these reward pathways in the brain whether it’s tasted in the mouth or injected into the bloodstream, as shown in studies on mice. This means its effects are <a href="https://www.sciencedirect.com/science/article/pii/S0896627308001190">independent of the sweet taste</a>. </p>
<p>In rats, there’s strong evidence to suggest that sucrose consumption can actually <a href="https://pubmed.ncbi.nlm.nih.gov/15135221/">change the structures in the brain that dopamine activates</a> as well as altering emotional processing and modifying behaviour in <a href="https://www.sciencedirect.com/science/article/pii/S0149763418308613">both animals and humans</a>. </p>
<h2>Quitting sugar</h2>
<p>It’s obvious that sugar can have a powerful effect on us. So that’s why it’s not surprising to see <a href="https://www.healthline.com/health/sugar-detox-symptoms#symptoms">negative effects</a> when we eat less sugar or remove it from our diet completely. It’s during this early “sugar withdrawal” stage that both mental and physical symptoms have been reported – including depression, anxiety, brain fog and cravings, alongside headaches, fatigue and dizziness. This means giving up sugar can feel unpleasant, both mentally and physically, which may make it difficult for some to stick with the diet change. </p>
<figure class="align-center ">
<img alt="Man presses his hand to his forehead in pain. He has a water glass in the other hand." src="https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416484/original/file-20210817-17-1mpbkw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Headaches are one negative effect people report after quitting sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-suffering-strong-headache-migraine-1095874334">fizkes/ Shutterstock</a></span>
</figcaption>
</figure>
<p>The basis for these symptoms has not been extensively studied, but it’s likely they’re also linked to the reward pathways in the brain. Although the idea of “sugar addiction” is controversial, evidence in rats has shown that like other addictive substances, sugar is <a href="https://reader.elsevier.com/reader/sd/pii/S0149763407000589?token=D062399D31D49A5B16AA829A2BD338620C7466C7C5AEE9434C0F07F80B5C801E677FAC20F4171111E718F55EE1C17797&originRegion=eu-west-1&originCreation=20210813105952">able to induce bingeing, craving and withdrawal anxiety</a>. Other research in animals has demonstrated that the effects of sugar addiction, withdrawal and relapse are <a href="https://www.tandfonline.com/doi/abs/10.1080/10284150500485221">similar to those of drugs</a>. But most of the research that exists in this area is on animals, so it’s currently difficult to say whether it’s the same for humans. </p>
<p>The reward pathways in the human brain have remained unchanged by evolution – and it’s likely <a href="https://onlinelibrary.wiley.com/doi/10.1002/cne.22735">many other organisms</a> have similar reward pathways in their brains. This means that the <a href="https://www.sciencedirect.com/science/article/pii/S0031938408000103?casa_token=0F1tYn9YclwAAAAA:zEe_36yaoIXOnjSFLMyFZAYDqsuWtkgYjhNoc-ReytfDrBZyW81Qysa5HJgmjs8BgXhvNpNcDA">biological impacts of sugar withdrawal</a> seen in animals are likely to occur to some degree in humans too because our brains have similar reward pathways.</p>
<p>A change in the brain’s chemical balance is almost certainly behind the symptoms reported in humans who remove or reduce dietary sugar. As well as being involved in reward, dopamine also regulates hormonal control, <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/psb.1591">nausea and vomiting</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/26317601/#:%7E:text=There%20are%20evidences%20that%20dopamine,are%20important%20in%20mediating%20anxiety.">anxiety</a>. As sugar is removed from the diet, the rapid reduction in dopamine’s effects in the brain would likely interfere in the normal function of many different brain pathways, explaining why people report these symptoms. Although research on sugar withdrawal in humans is limited, one study has provided evidence of <a href="https://pubmed.ncbi.nlm.nih.gov/30385262/">withdrawal symptoms and increased sugar cravings</a> after sugar was removed from the diets of overweight and obese adolescents. </p>
<p>As with any dietary change, sticking to it is key. So if you want to reduce sugar from your diet long term, being able to get through the first few difficult weeks is crucial. It’s important to acknowledge, however, that sugar isn’t “bad” per se – but that it should be eaten in moderation alongside a healthy diet and exercise.</p><img src="https://counter.theconversation.com/content/166051/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Brown has previously received funding from the EU Horizon 2020 scheme to study personalised approaches to food choices.</span></em></p>The negative effects are likely caused by the same mechanisms behind why sugar makes us feel so good.James Brown, Associate Professor in Biology and Biomedical Science, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647542021-08-16T12:08:30Z2021-08-16T12:08:30ZDeciphering the symptoms of long COVID-19 is slow and painstaking – for both sufferers and their physicians<figure><img src="https://images.theconversation.com/files/415730/original/file-20210811-21-1xw5nik.jpg?ixlib=rb-1.1.0&rect=758%2C100%2C4801%2C3567&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People suffering from long-term effects of COVID-19 face uncertainty about the nature of their symptoms and how long they might last.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-senior-woman-with-face-mask-standing-royalty-free-image/1256056382?adppopup=true"> Halfpoint Images/Moment via Getty Images</a></span></figcaption></figure><p>My first patient that day was a woman in her early 40s, an avid marathon runner who had contracted COVID-19 in March 2020. Now, 13 months later, she noted that she still felt fatigued and short of breath. She also noticed her heart was racing whenever she walked around. She reported having daily headaches, numbness and tingling in her legs, and difficulty with memory, which had affected her work.</p>
<p>This woman was coming in to see me, a <a href="https://www.researchgate.net/scientific-contributions/Allison-Navis-2131988399">neurologist specializing in infectious diseases</a>, for symptoms that we physicians now all-too-commonly know as long, or long-haul, COVID-19.</p>
<p>While we have yet to determine a precise definition for long COVID-19, we typically consider it the persistence or development of new symptoms that last more than <a href="https://doi.org/DOI:%2010.1136/bmj.m3026">four weeks after COVID-19 recovery</a>. Long COVID-19 often involves a constellation of symptoms affecting many parts of the body, but the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025619621003566">most commonly reported</a> are fatigue, shortness of breath, chest pains, cognitive changes, headaches, sensory changes and pain. </p>
<p>A year and a half into the COVID-19 pandemic, it remains unclear how many people are affected by long COVID-19. Some data suggests <a href="https://doi.org/10.1038/s41591-021-01292-y">4.5% of people</a> infected with COVID-19, or about 1 in 22, will have symptoms beyond eight weeks post-COVID, while other studies point to <a href="https://doi.org/10.1186/s12879-021-06359-2">closer to 49%</a>. Some studies show that among people hospitalized for COVID-19, <a href="https://doi.org/10.1016/S0140-6736(20)32656-8">up to 63%</a> continued to have symptoms – specifically fatigue or muscle weakness – six months later.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Doctors treating elderly man during COVID-19 pandemic" src="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People hospitalized with COVID-19 have a far greater chance of developing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-checking-patient-in-ward-during-covid-19-royalty-free-image/1296010649?adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>In April 2020, because of the overwhelming number of patients we had, I was pulled from my regular duties as a neurologist and asked to take care of patients on a COVID-19 unit in the hospital. It was my first experience seeing how sick people were and the extent of harm the virus could cause. Given the severity of illness, we were concerned that many people would need long-term care. </p>
<p>So my institution, Mount Sinai, decided to open one of the <a href="https://www.mountsinai.org/about/covid19/center-post-covid-care">first multidisciplinary centers for post-COVID care</a>. I was asked to be the lead clinical neurologist for the center. Since then, I have personally seen several hundred long COVID-19 patients and worked on research studies with the aim of untangling the complexities of <a href="https://doi.org/10.1056/NEJMp2109285">what is happening with the condition</a>.</p>
<h2>The puzzling nature of long COVID-19</h2>
<p>While data on long COVID-19 has <a href="https://doi.org/10.1038/s41591-021-01433-3">started to emerge</a>, less is known about the neurological symptoms. The most common neurological symptoms appear to be <a href="https://doi.org/10.1002/acn3.51350">cognitive changes</a>, including “brain fog” – such as sluggishness and lack of sharpness – as well as headaches, sensory changes, muscle or nerve pain and loss of smell. </p>
<p>We are also seeing many cases of “dysautonomia,” or impaired regulation of the nervous system that controls heart rate and blood pressure – the “fight or flight” part of the nervous system. This condition can lead to sensations of a racing heart and dizziness.</p>
<p>Part of the challenge in understanding long COVID-19 is that many of the symptoms, like fatigue and brain fog, can stem from a variety of conditions from hormonal or metabolic changes to sleep disruption or depression. Trying to determine a direct line between cause and effect in the general public, regardless of COVID-19 infection, often does not lead to clear answers. </p>
<p>Although many long COVID-19 sufferers tend to report the same general symptoms, it is likely that there are different underlying causes leading to these symptoms in different people. For example, <a href="https://doi.org/10.1515/jtim-2016-0016">post-intensive care syndrome</a> (PICS) can occur in anyone who has had a prolonged stay in the ICU, whether or not it was related to COVID-19. PICS is caused by prolonged immobility, mechanical ventilation and metabolic changes that occur during severe illness or infection. The symptoms of PICS often overlap with those of long COVID. </p>
<p>For other symptoms, such as joint or back pain, doctors might be able to pinpoint a cause, like arthritis or a pinched nerve. But the question remains whether that was present before the COVID-19 infection and the infection simply triggered a response that caused the pain to be unmasked, or whether these are new developments in a patient’s body.</p>
<p>What’s more, many diagnostic tests come back normal, or they show common and nonspecific changes. We are not observing widespread strokes, lesions or inflammatory changes on imaging. We may see small changes in blood vessels, known as <a href="https://doi.org/10.1111/j.1749-6632.2010.05758.x">microvascular ischemic changes</a>, but these are extremely common in anyone with high blood pressure, diabetes or even migraines. And tests of the nerves in the arms and legs may show damage in some cases – what we call neuropathy. But that is not always the case, and these can occur regardless of COVID-19 status. This makes it challenging to draw a direct link to COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Screens displaying coronavirus and brain wave research" src="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Brain imaging has so far yielded inconclusive evidence about what is causing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laboratory-equipment-coronavirus-and-brainwave-royalty-free-image/1295324817?adppopup=true">janiecbros/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>What we do know</h2>
<p>This doesn’t mean we are at a complete loss about what is happening. The constellation of symptoms resembles a <a href="https://www.healthline.com/health-news/fauci-warns-about-post-viral-syndrome-after-covid-19">post-viral syndrome</a>, which refers to prolonged symptoms after an infection. Sometimes the infection might be from a known source, <a href="http://dx.doi.org/10.1136/pgmj.64.753.559">such as Epstein-Barr virus (which causes mononucleosis)</a>, but often symptoms follow a general viral illness. </p>
<p>Many people suffering from those conditions will report experiencing some viral-type illness and afterward having persistent fatigue, brain fog and other symptoms that we now often see with sufferers of long COVID-19. The similarity in symptoms suggests that long COVID-19 may not be unique to COVID-19 but rather a general post-infectious process. </p>
<p>Long COVID-19 symptoms can also closely resemble those of <a href="https://www.cdc.gov/me-cfs/index.html">myalgic encephalomyelitis</a>, often known as chronic fatigue syndrome, or another poorly understood disease called <a href="https://doi.org/10.1161/CIRCULATIONAHA.112.144501">postural orthostatic tachycardia syndrome</a>. Both of these are associated with fatigue, dysautonomia and brain fog, among other symptoms. We researchers don’t yet understand what causes either condition. But medications for symptoms, pacing of exercise and physical therapy <a href="https://www.cdc.gov/me-cfs/treatment/index.html">can be helpful</a> for both myalgic encephalomyelitis and long COVID-19.</p>
<h2>Where do researchers go from here?</h2>
<p>I often tell my patients that normal test results don’t mean everything is normal. Our tests may not be sensitive enough, or we are looking at the wrong thing, or we need to develop new tests. <a href="https://doi.org/10.1002/acn3.51350">Neuropsychological evaluations</a> can provide formal information on cognitive functioning and may show changes in memory, attention, language or problem-solving. These results can be helpful in determining rehabilitation strategies for brain fog, but unfortunately, they are not designed to explain why these changes are occurring. </p>
<p>Imaging of the brain, with MRI or CT scans, has so far not provided much information on the underlying cause. It could be that they are not sensitive enough to pick up on small changes; if this is the case, different types of scans – such as functional MRIs – that are either able to get better pictures or look at metabolic changes in the brain might be helpful. However, these are not commonly available outside of research. </p>
<p>Other studies that might enlighten us about the underlying cause of symptoms include bloodwork that might show <a href="https://doi.org/10.1093/cid/ciab611">elevations in autoimmune markers</a> or <a href="https://doi.org/10.1007/s11910-021-01130-1">changes in hormones</a>. The immune system involves a balance of many factors, and impaired regulation of this system after an infection can cause inflammation; this, combined with hormonal or metabolic changes, could potentially lead to long COVID-19 symptoms. While these are not answers, they offer potential leads and further clues for researchers to explore.</p>
<p>To better understand long COVID-19, we need to have a clear picture of who is affected. While communities of color have often been <a href="https://doi.org/10.1001/jamanetworkopen.2020.21892">more severely affected</a> by COVID-19, they are also <a href="https://www.pbs.org/newshour/show/in-medical-research-racial-diversity-is-a-matter-of-life-or-death">likely to be</a> <a href="https://doi.org/DOI:%2010.3390/jcm9082442">underrepresented in studies</a>. </p>
<p>As a result, we researchers need to engage broadly across communities to ensure we fully understand who is affected by long COVID-19, as well as what risk factors might be at play in determining long-term outcomes. Research needs to also focus on gaining a better understanding of the less understood diseases like myalgic encephalomyelitis, as they seem to most resemble what we are seeing.</p>
<p>The ultimate goal in understanding long COVID-19 is to figure out how to prevent it from happening – and prevent as much suffering as we can. While I have seen people get better from long COVID-19, I have many patients who continue to suffer over a year later. It has also affected the health care workers whose goal is to help others heal, but are left with few answers to provide. Until research yields more answers on what could be causing long-COVID, we are left with trying to minimize symptoms and waiting.</p><img src="https://counter.theconversation.com/content/164754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allison Navis receives funding from the NIH Loan Repayment Program</span></em></p>Researchers are piecing together clues to better understand the puzzling array of symptoms in those who never seem to fully recover from COVID-19.Allison Navis, Assistant Professor of Neurology, Icahn School of Medicine at Mount SinaiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1582582021-04-19T13:29:15Z2021-04-19T13:29:15ZCan bad weather really cause headaches?<figure><img src="https://images.theconversation.com/files/395723/original/file-20210419-15-108e9fe.jpg?ixlib=rb-1.1.0&rect=23%2C11%2C7706%2C5388&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad weather and humidity can both cause headaches.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rainy-weather-icon-girl-terrible-headache-1473153995">Prostock-studio/ Shutterstock</a></span></figcaption></figure><p>We all know somebody who claims they can predict the weather with their body. Whether it’s your arthritic relative who knows rain is on the way when their knees ache or your lifelong pal who gets a headache when a storm is approaching. Having <a href="https://www.bloomsbury.com/uk/splitting-9781472971418/">written a book on headaches</a>, I hear a lot from people I meet about headaches that are related to the weather. But as it turns out, there actually is a scientific basis for why some people are able to sense changes in the weather by the headaches they cause.</p>
<p>While it’s difficult to say how many people actually suffer from weather-related headache, research shows over 60% of people who suffer from migraines think they’re <a href="https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/j.1526-4610.2004.446008.x">sensitive to the weather</a>. In 2015, researchers who collected daily sales figures of a <a href="https://link.springer.com/article/10.1007/s00484-014-0859-8">headache medication</a> in Japan showed that sales peaked significantly when average barometric pressure decreased. This often happens before bad weather.</p>
<p>But why do these headaches happen? There are two mechanisms of action here. </p>
<p>One is related to the sinuses – the four small air-filled cavities in the bones of the face. Just as people’s <a href="https://theconversation.com/curious-kids-why-do-our-ears-pop-97259">ears “pop”</a> when air pressure changes, atmospheric pressure changes can create an imbalance in sinus pressure causing inflammation and pain. This feels different depending on which sinus is most affected, ranging from forehead pain, pain between and behind your eyes, pain in your face, or a more diffuse headache in the front or back of your head. Which you are more prone to depends on the individual structure of your head.</p>
<p>The other way this type of headache happens is related to the way in which pressure changes alter blood flow in the cerebrovascular system – which controls how blood is circulated around your head. Blood is highly toxic to neurons and so it’s very important that blood is <a href="https://theconversation.com/explainer-what-is-the-blood-brain-barrier-and-how-can-we-overcome-it-75454">kept separate from the brain</a>. The blood vessels of the cerebrovascular system have receptors that activate if blood vessels widen too much, acting as an early warning system that something isn’t quite right. We perceive this activation as pain.</p>
<p>Both of these will at the very least cause a generalised headache in those who are sensitive to pressure changes. But even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684554/pdf/40064_2015_Article_1592.pdf">small drops in pressure</a> have been correlated with increases in migraine episodes in sufferers.</p>
<figure class="align-center ">
<img alt="Dark gray storm clouds gather above houses in a village." src="https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395725/original/file-20210419-15-1xdrcmr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Painkillers and decongestants might be the only remedy when the weather outside is frightful.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/storm-clouds-gather-over-residential-housing-1590125845">1000 Words/ Shutterstock</a></span>
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</figure>
<p>Falling pressure associated with bad weather isn’t the only thing that can affect us. <a href="https://www.sciencedirect.com/science/article/pii/S0160412019300662?via%3Dihub">Rising humidity</a> can also cause headaches through our sinuses. This is because high humidity can <a href="https://www.bloomsbury.com/uk/splitting-9781472971418/">increase the amount of mucus</a> produced by the lining of the sinuses in order to trap allergens, dust and pollution particles that are plentiful in the dense, moist air. This can cause congestion, inflammation and discomfort in the sinuses – often leading to a sinus headache.</p>
<h2>Medicines and other remedies</h2>
<p>There’s little any of us can do about the weather. So outside of locking ourselves in pressure-regulated chambers, painkillers and decongestants are probably the only way to remedy your pain until the weather outside passes through.</p>
<p>It’s also worth noting, however, that headaches rarely happen due to one trigger alone – and changes in atmospheric pressure may not always cause a headache. Bad posture and inflammation in the body (usually the result of stress) may both cause headaches. Muscles that are contracted over long periods time need more blood flow to deliver oxygen and other nutrients – and this is the hallmark of inflammation over time. Stress increases the levels of adrenaline and cortisol in our body, which can also cause inflammation and widen the blood vessels in your head – leading to headaches and pain. </p>
<p>Proper posture and reducing stress may help prevent headaches. Staying hydrated and eating a varied diet containing essential minerals and vitamins, and avoiding trigger foods and drinks (if you know them), will also help. </p>
<p>When bad weather is impending, vigorous chewing (such as with chewing gum) can help the pressure equalise in your sinuses through your mouth, nose, and Eustachian tube (which runs from the middle ear to the throat and is really important in equalising pressure) – and may ward off a pressure headache. And choosing sugar-free gum sweetened with <a href="https://academic.oup.com/jac/article/54/1/225/746868">xylitol</a> may also have the added benefit of stopping nasty respiratory bugs from sticking to your mucus membranes by changing their cell wall structure, according to one study.</p>
<p>Boosting our natural painkillers, such as serotonin and dopamine, is important too. These neurochemicals block the pain signal on its way to our brain and so can lessen how much pain <a href="https://www.bloomsbury.com/uk/splitting-9781472971418/">we feel</a>. They are also intimately involved in our mood, so it’s no wonder that low serotonin concentrations are triggers for migraine, and we often experience this as a <a href="https://www.themigraineinstitute.com/migraine-overview/pre-and-post-migraine/#:%7E:text=Migraine%20prodrome%20symptoms%20vary%20from,confusion%20and%2For%20difficulty%20concentrating">low mood</a>. It’s why in the days preceding a migraine episode people often crave chocolate (which contains a chemical that turns into serotonin in our body) and <a href="https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.2006.00470.x">intimacy</a>, which boosts serotonin, dopamine and the bonding hormone, <a href="https://www.sciencedirect.com/science/article/pii/S0143417912001321?casa_token=uFEFanoh7dgAAAAA:2-1Y6ihdXkTxQEvMzSQtn-iGKptI9Ynn-iEbigdG7tTH8Qdqca-eIZA-Flkypz7ryLkfggs">oxytoxin</a> – which is also a powerful painkiller.</p>
<p>Keeping these neurotransmitters topped up by doing things we like – be it chatting with friends or listening to music – will ensure good hormonal hygiene, and reduce the impact headaches, even barometric ones, have on our daily lives. So when the weather outside is bad, settling down to watch a movie with a loved one and some chocolate to eat may be as good a remedy as any.</p><img src="https://counter.theconversation.com/content/158258/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ellison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Barometric pressure headaches are often the result of pressure changes in our sinuses.Amanda Ellison, Professor of Neuroscience, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1545192021-02-15T16:12:12Z2021-02-15T16:12:12ZHeadaches: three tips from a neuroscientist on how to get rid of them<figure><img src="https://images.theconversation.com/files/383754/original/file-20210211-19-1q3m9x4.jpg?ixlib=rb-1.1.0&rect=4850%2C1383%2C7131%2C4455&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-people-over-vintage-colors-background-1125851795">Krakenimages.com/Shutterstock.com</a></span></figcaption></figure><p>Everyone experiences headaches. From dull throbbing dehydration headaches to incapacitating migraines, a sore head is an extremely common complaint. This is perhaps especially true at the moment. COVID-19 <a href="https://covid.joinzoe.com/us-post/covid-clusters">can cause them</a>, as can sitting at desks for too long and not getting out of the house enough.</p>
<p>When headaches strike, many people’s reaction is to reach for a painkiller. And these can do the job. But a better solution is often to probe the reasons behind the pain – especially if you get similar types of headaches a lot.</p>
<p>Even though they all entail pain, where the pain is can clue us into what type of <a href="https://www.nhs.uk/conditions/headaches/">headache</a> we are experiencing. Pain in the face and forehead are markers of sinus-related headache whilst the sensation of a pneumatic drill somewhere in our cranium is often <a href="https://www.nhs.uk/conditions/migraine/">migraine</a>.</p>
<figure class="align-center ">
<img alt="Illustration of four different types of headache – migraine, sinus, tension and cluster – on green background." src="https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=491&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=491&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=491&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=617&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=617&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383759/original/file-20210211-17-134ihn5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=617&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Where you experience the pain can be some clue as to what type of headache you have.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-different-types-headache-on-622158569">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>But ultimately, all headaches are caused by vasodilation in the head – the widening of blood vessels near the brain. This stretches sensory receptors in the vessel wall and we feel that sensation as pain.</p>
<p>To understand why we need to think about the constraints the contents of our head are working under. Blood is toxic to brain tissue and so is kept separate through the blood-brain barrier. If a blood vessel leaks or breaks, this results in a haemorrhage and the death of the brain tissue the blood seeps into. So, if our blood vessels dilate beyond comfortable limits, the sensory receptors will fire off signals to the brain, which we interpret as pain. </p>
<p>Headaches are an early warning system. The best way to counteract them is to work out what they are warning us about.</p>
<h2>1. Think beyond your head</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=918&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=918&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=918&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1154&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1154&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383758/original/file-20210211-23-ykcyo1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1154&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Bloomsbury Publishing</span></span>
</figcaption>
</figure>
<p>This means thinking beyond your head. Yes, headache pain is generated somewhere in our head and we feel it in our head and that is why it is called headache. But headache is so much more than that – which is why I’m fascinated by them, have studied them for the past 20 years and recently published <a href="https://www.bloomsbury.com/uk/splitting-9781472971418/">a book</a> on the subject.</p>
<p>It’s a two-way street. The cause of our headache can sometimes come from our body or our behaviour. And of course headaches affect both our body and our behaviour. If we see headache as something isolated to our cranium then we will never truly understand its cause, our experience of it, or how we can best mitigate it. </p>
<p>Frequent migraine sufferers intimately understand this and often <a href="https://www.migrainetrust.org/living-with-migraine/coping-managing/keeping-a-migraine-diary/">religiously track</a> their food intake and their activities as well as the weather in order to work out what triggers them. But the normal headache sufferer is often less in tune with the causes of their pain.</p>
<p><a href="https://www.nhs.uk/conditions/tension-headaches/">Tension headache</a> is a really good example of how this works. It feels like a tight band squeezing around your head with a tonne weight sitting on top for good measure. We are all aware of their occurrence at times of great emotional stress (lockdown homeschooling anyone?) but they can equally be caused by the stress we put on our body, with bad posture for example, or recovery from injury.</p>
<p>Both entail over-activity of the musculature around the head and neck, which sets up an inflammatory response involving prostaglandins and nitric oxide, both of which are chemicals that act to widen blood vessels. Inflammatory chemicals also directly activate the <a href="https://www.healthline.com/human-body-maps/trigeminal-nerve">trigeminal nerve</a> – the most complex of the cranial nerves and the one responsible for sensation and movement in the face.</p>
<p>Taking too many things on, rushing around trying to get things done in negative time, and trying to be all things to all people are common behavioural markers that will predict a tension headache. That and the actions we take when the pain begins.</p>
<figure class="align-center ">
<img alt="Woman sitting at desk clutches her neck and back in pain." src="https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383762/original/file-20210211-14-rvfpk9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bad posture – especially that associated with desk work – can lead to tension in the neck and then to headache.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-pain-bad-posture-woman-sitting-1772913518">Andrey_Popov/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>2. Listen to the pain</h2>
<p>If you have a pain in your leg, it might stop you from playing in that tennis match or turning up for five-a-side football. You know that if you play on it, you might do more damage and your recovery will take longer. But we don’t tend to do that with headache. We take a painkiller or an anti-inflammatory and carry on as normal even though our pain receptors are screaming at us that there is something wrong.</p>
<p>Taking paracetamol or ibuprofen will act to avert the danger, reducing the inflammation, the dilation and the perception of pain, but the headache will reoccur unless we can address the cause. Sometimes it’s obvious – if you have a sinus headache you’re just going to have to wait for your sinuses to clear, so taking a painkiller or a decongestant may be a good approach – but sometimes our coping strategy can make things worse.</p>
<p>We may decide a bottle of wine and a takeaway is just the kind of treat we need to relax and de-stress. But both lead to dehydration, another ubiquitous cause of headache. With your brain made of <a href="https://www.usgs.gov/special-topic/water-science-school/science/water-you-water-and-human-body?qt-science_center_objects=0#qt-science_center_objects">more than 70%</a> water, if your kidneys need borrow some to dilute alcohol or salts and spices, it usually comes from this oasis. The brain loses water such that it literally shrinks in volume, tugging on the membranes covering the brain and triggering pain.</p>
<h2>3. Use the brain’s natural painkillers</h2>
<p>So what else can we do? One way is to lean into the brain’s natural painkiller system and to boost neurochemicals associated with happiness (such as serotonin and oxytocin) and reward (dopamine). Having a laugh at a comedy, enjoying a good friend’s company or indulging in some intimacy with a partner will all boost these hormones to various degrees. </p>
<p>Each block pain signals coming from the body, not only helping you get a handle on your headache but also redressing the balance of neurochemicals that were the mechanism of your upset emotional state.</p>
<p>The knowledge that we can leverage our behaviour and our body to keep our brain’s neurochemicals in balance gives us a way to break the headache cycle. So next time you have a headache for which the causes aren’t glaringly obvious – you’re not otherwise sick and you’ve been keeping hydrated – take a look at your life and see what you can change there. The pain, after all, is trying to tell you something.</p><img src="https://counter.theconversation.com/content/154519/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ellison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When headaches strike, many people reach for a painkiller. Probing the reasons behind the pain is often a better idea.Amanda Ellison, Professor of Neuroscience, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1390962020-06-11T22:02:36Z2020-06-11T22:02:36ZStrange physical symptoms? Blame the chronic stress of life during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/340478/original/file-20200609-165397-btma4q.jpg?ixlib=rb-1.1.0&rect=502%2C10%2C5985%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic stress can lead to inflammation, which can result in physical symptoms as well as mental health symptoms.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>During the current COVID-19 pandemic have you been wondering why you’re getting headaches more often? Or stomach aches? Or feeling itchy or getting pimples? Or why your periods are irregular or more painful than usual? Exciting recent science suggests that the answers may lie in our body’s <a href="https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780190681777.001.0001/oxfordhb-9780190681777">biological reactions to stress</a>. </p>
<p>Our biological stress response system — the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181830/pdf/DialoguesClinNeurosci-8-383.pdf">hypothalamic-pituitary-adrenal</a> (HPA) axis — evolved hundreds of millions of years ago to help our vertebrate ancestors quickly mobilize energy to confront imminent, life-or-death threats, such as predator attacks. In the short term, this system is exquisite in its efficiency and crucial to survival. </p>
<p>The problem with our current situation is that it has been going on for months, and the end is not clearly in sight. <a href="https://doi.org/10.1177%2F2470547017692328">Chronic stress</a> sends the HPA axis into overdrive, with effects felt throughout the body. These symptoms can even serve as further sources of stress. Understanding why our bodies are reacting in these ways can help us develop strategies to prevent stress from getting under our skin.</p>
<h2>The biological stress response</h2>
<p>When animals perceive a threat in their environment, the HPA axis stimulates the adrenal glands to release the hormone cortisol. Cortisol, along with adrenaline, work to pump oxygen to the major muscles to enable the animal to fight or escape. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341207/original/file-20200611-80746-1izi19h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Human stress response was designed to cope with short-term threats like predator attacks, not the chronic stress of things like COVID-19.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This “fight/flight” response produces physical symptoms such as heart palpitations and chest tightness (the heart pumping oxygen to the major muscles), and stomach butterflies, nausea and tingling (blood leaving the stomach and extremities to get to the major muscles). </p>
<p>The HPA axis also interacts with the <a href="http://www.doi.org/10.1093/oxfordhb/9780190681777.013.24">immune system</a> to help with the aftermath. Cortisol is a potent anti-inflammatory and binds to large numbers of <a href="https://doi.org/10.1155/2012/403908">receptors in the skin</a> to help repair wounds and fight infection.</p>
<p>The HPA axis doesn’t know the difference between the life-or-death threat of a predator attack and modern stressors. So, in the early stages of this crisis, if your stomach did flip-flops, or you felt your heart racing, when reading about surges in COVID-19 cases, your body was doing what it was designed to do even though at that moment you were not in any imminent physical danger.</p>
<h2>The problem of chronic stress</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341210/original/file-20200611-80770-1q5jfpa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic stress can lead to inflammation, which can result in physical symptoms as well as mental health symptoms.</span>
<span class="attribution"><span class="source">(Piqsels)</span></span>
</figcaption>
</figure>
<p>A predator attack is time-limited. In contrast, the COVID-19 pandemic has been going on for weeks, and may be compounded by social isolation, job or financial insecurity and care-taking responsibilities. Unfortunately, all the HPA axis knows is that it needs to release stress hormones when we perceive a threat in our environment. So, if we perceive our environment as threatening all the time, then the HPA axis will release these chemicals all the time. </p>
<p>One of the most pronounced effects of long-term cortisol release is <a href="http://doi.org/10.1111/j.1749-6632.2012.06633.x">glucocorticoid resistance</a>. This is when cells in the immune system become less sensitive to the anti-inflammatory effects of cortisol. As a result, cortisol starts to increase inflammation throughout the body and brain. </p>
<p>So, your itchiness and rashes? All of the cortisol receptors in your skin may no longer be receptive to cortisol’s anti-inflammatory effects and instead, chemicals are released that <a href="https://doi.org/10.1155/2012/403908">inflame the skin</a>. </p>
<p>Your <a href="https://doi.org/10.1038/s41582-019-0216-y">headaches or stomach aches</a>? <a href="http://dx.doi.org/10.1136/oem.2003.012302">Painful periods</a>? All of these symptoms can also be the result of inflammation in these organ systems caused by chronic HPA axis activation. </p>
<p>Even psychological symptoms, such as feelings of <a href="http://www.doi.org/10.1093/oxfordhb/9780190681777.013.24">depression or loneliness</a>, have been linked to the release of pro-inflammatory chemicals caused by chronic stress. </p>
<h2>Taking control of your stress response</h2>
<p>Much of what is perceived as stressful on a day-to-day level is not specific to contracting the COVID-19 virus, but instead is the result of changes that we have had to make in our lives. A switch to working from home, or not working, has disrupted our sleeping, eating and activity schedules that regulate our internal circadian clock. Staying indoors means lower exercise and activity levels. Many people, especially those living alone, are socially isolated from friends and loved ones. </p>
<p><a href="https://doi.org/10.1186/s41606-017-0019-2">Disrupted circadian routines</a>, <a href="https://doi.org/10.1371/journal.pone.0078350">lack of exercise</a> and <a href="https://doi.org/10.1016/j.neubiorev.2020.02.002">social isolation</a> have all been strongly linked to dysregulation of the body’s stress and immune systems, and release of pro-inflammatory chemicals in the body and brain. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340248/original/file-20200608-176560-6u5bkq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical distancing during COVID-19 shouldn’t mean losing contact with loved ones.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Fortunately, even small positive changes in these areas can have strong stress-reducing effects. Keeping a <a href="https://doi.org/10.1038/nri3386">regular routine</a> by going to bed, getting up and eating at consistent times each day has been linked to greater overall health by promoting healthy function of the HPA axis and immune system. Even 20 minutes of <a href="https://doi.org/10.1016/j.bbi.2016.12.017">moderate exercise</a>, which inside could include exercise videos or jogging around at home, regulates the HPA axis, reduces inflammation and has strong mood-lifting effects. </p>
<p>Finally, talking regularly with friends and loved ones, even remotely or at a distance, is one of the best things you can do to protect against the biological and <a href="https://doi.org/10.1111/aphw.12000">psychological</a> effects of stress. Remember, we’re all in this together!</p><img src="https://counter.theconversation.com/content/139096/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Harkness receives funding from the Social Sciences and Humanities Research Council. Kate Harkness receives royalties from sales of the Oxford Handbook of Stress and Mental Health. </span></em></p>Itchy skin? More aches and pains? Unusual rash? Headaches? Pimples? If you’ve been experiencing unusual physical symptoms recently, the stress of the COVID-19 pandemic may be the reason.Kate Harkness, Professor of Psychology and Psychiatry and Director of the Mood Research Laboratory, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1397002020-06-02T09:24:12Z2020-06-02T09:24:12ZCluster headache is more than ‘just a headache’ – but this excruciating condition is often misdiagnosed<figure><img src="https://images.theconversation.com/files/338875/original/file-20200601-95042-16g61kp.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C7000%2C4767&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Attacks can last from 15 minutes to a couple of hours, several times a day.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-illustration-headache-human-xray-medical-1007012911">MDGRPHCS/ Shutterstock</a></span></figcaption></figure><p>Cluster headache is more than just a headache. It is a severe neurological condition, sometimes known as a “suicide headache” because many patients have <a href="https://journals.sagepub.com/doi/10.1177/0333102419845660">suicidal thoughts during attacks</a>. The pain experienced during a cluster headache attack is excruciating and is said to be comparable to the pain of childbirth. Such attacks can last from <a href="https://ichd-3.org/3-trigeminal-autonomic-cephalalgias/3-1-cluster-headache/">15 minutes to three hours</a> and can occur several times per day. The pain is almost always on one side and typical features of an attack may include bloodshot or teary eyes, droopy eyes and a runny nose or blocked nostrils.</p>
<p>Around <a href="https://www.migrainetrust.org/about-migraine/types-of-migraine/other-headache-disorders/cluster-headache/">one in 1,000 people</a> experience cluster headache. It’s perceived as a rare disease, but in fact is as common as well-known neurological conditions such as <a href="https://pubmed.ncbi.nlm.nih.gov/26718593/">multiple sclerosis</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/26718594/">Parkinson’s disease</a>. Getting the right treatment for this condition is difficult, as our recent study showed. </p>
<p>We found that many healthcare professionals do not know cluster headache or <a href="https://doi.org/10.3399/bjgp20X710417">how to diagnose the condition</a>. This has serious consequences for those suffering. Our research also shows patients regularly face long delays and undergo unnecessary procedures and referrals to specialist care before receiving the correct diagnosis and treatment.</p>
<p>Our team examined the understandings and experiences of cluster headache and the impact of the condition. GPs and neurologists who work in the north of England, were interviewed by a medical sociologist. We explored their knowledge around the diagnosis and treatment of cluster headache, how they usually refer patients to a specialist, and the ways they communicate with other clinicians.</p>
<p>Our main finding is that cluster headache is neglected among health professionals. Many healthcare professionals do not know what a cluster headache is. This frequently leads to <a href="https://pubmed.ncbi.nlm.nih.gov/30306398/">misdiagnosis of the condition</a> and huge delays in receiving the correct diagnosis. Some clinicians interviewed in the study were not aware of cluster headache, while others thought that cluster headache is the same as “<a href="https://pubmed.ncbi.nlm.nih.gov/17367596/">cluster migraine</a>”, which can cause nausea and sensitivity to light alongside severe head pain.</p>
<p>Our interviewees gave plenty of examples of the consequences a patient faces when they don’t receive a timely and correct diagnosis. Cluster headache is often misdiagnosed as migraine or <a href="https://www.nhs.uk/conditions/trigeminal-neuralgia/">trigeminal neuralgia</a> (a severe, sudden form of face pain), but also as sinusitis or dental problems. Patients occasionally undergo unnecessary procedures, such as teeth extraction, sinus washouts and intracranial surgery because they are in despair. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338882/original/file-20200601-95054-1q0xmy7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sufferers may also experience mental health problems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depression-140446075">Twin Design/ Shutterstock</a></span>
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<p>The condition has a huge impact on sufferers’ everyday life and they try <a href="https://maps.org/about/fiscal/5967-new-york-magazine-psychedelic-mushrooms-cured-my-cluster-headaches">all kinds of treatments</a> hoping to find some relief from the excruciatingly painful attacks. Indeed, cluster headache can have significant influence on a patient’s mental health and on their ability to remain in employment. People with cluster headache often suffer from <a href="https://ashleyhattle.com/open-letter-to-cluster-headaches-depression-suicide/">severe mental health conditions</a>, such as chronic depression, suicidal thoughts and may self-harm. Family, friends and employers often don’t grasp the severity of the condition and the enormous impact it has.</p>
<h2>Challenges with treatment</h2>
<p>Due to the nature of the attacks, cluster headache is treated differently compared to other headache conditions, like migraine or a <a href="https://www.nhs.uk/conditions/tension-headaches/">tension-type headache</a>. These are normally treated with painkillers – but if these occur frequently they will require regular preventive treatment. Cluster headache attacks are treated with <a href="https://pubmed.ncbi.nlm.nih.gov/26635477/?from_term=cluster+headache+buture&from_pos=3">nasal sprays or injectable medication (triptans)</a> and <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0917-4">inhalation of oxygen</a>. </p>
<p>Our study also highlights tensions between primary and secondary care around prescribing these treatments because of the cost. Sometimes GPs don’t follow the treatment instructions received from neurologists in secondary care. This is especially the case if GPs think the suggested medication is not cost effective.</p>
<p>For example, the injectable triptans were often not prescribed because of their high cost. Some GPs instead prescribed cheaper oral triptans. But these are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646474/">not effective for cluster headache</a> patients. Many interviewed clinicians were not aware of <a href="https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0917-4">the prescription policies for oxygen</a>, which is an effect treatment for cluster headache.</p>
<p>GP participants in our study rarely referred patients with cluster headache symptoms to neurologists. When patients get referred, it is more likely to provide the patient with reassurance that their condition is not life-threatening. In some cases, patients with cluster headache get referred to neurologists to begin specialised treatments for cluster headache, such as the drugs <a href="https://pubmed.ncbi.nlm.nih.gov/26635477/?from_term=buture+cluster+headache&from_pos=3">verapamil and lithium</a>.</p>
<p>Our study shows an urgent need to <a href="https://ouchuk.org/">increase awareness of cluster headache</a> among health professionals and the general public. This will prevent misdiagnosis and delays in diagnosis.</p><img src="https://counter.theconversation.com/content/139700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Lisa Dikomitis received funding from the Headache Research Trial Fund at the Hull University Teaching Hospitals NHS Trust to carry out the CHIPS study.</span></em></p><p class="fine-print"><em><span>Fayyaz Ahmed has served on the advisory board of Allergan, ENeura, Electrocore, Novartis, TEVA and Eli Lilly for which the honorarium received has been paid to charitable organisations i.e., British Association for the Study of Headache, Migraine Trust and Anglo-Dutch Migraine Association and has received funding from the Headache Research Trial Fund at the Hull University Teaching Hospitals NHS Trust to carry out the CHIPS study.</span></em></p><p class="fine-print"><em><span>Alina Buture does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study found that many GPs aren’t even aware of cluster headache, and often give patients the wrong treatment.Lisa Dikomitis, Professor in Anthropology and Sociology of Health, Keele UniversityAlina Buture, PhD researcher, Hull York Medical School, University of HullFayyaz Ahmed, Professor of Clinical Neurology, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1243302019-11-28T11:42:12Z2019-11-28T11:42:12ZFluorescent lighting in school could be harming your child’s health and ability to read<figure><img src="https://images.theconversation.com/files/304269/original/file-20191128-178101-1nltr18.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C2963%2C2120&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reading problem or problem with the lights?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/school-education-literacy-concept-asian-girl-419267809?src=37ae4cb7-cf31-4335-a7ad-59c3fbc30f8b-1-15">shutterstock/ Chinnapong</a></span></figcaption></figure><p>If you step into any British classroom, chances are you’ll be greeted by the bright white light of fluorescent lamps. Schools began to introduce fluorescent lighting in the mid 1950s and rows of these low cost, long life, high efficacy lamps tend to be the lighting of choice in many schools around the world.</p>
<p>But some fluorescent lighting could actually be <a href="https://insights.ovid.com/crossref?an=00006324-199108000-00012">causing eye-strain and headaches</a>. This is down to the fact that many fluorescent tubes (but not all) vary in colour and brightness continually. This is because the light of fluorescent bulbs is produced by a gas discharge (like lightning) twice with each cycle of the alternating current.</p>
<p>The variation in colour comes about because ultraviolet light from the discharge is converted to visible light by a coating of phosphor on the inside of the lamp and this continues to glow between flashes. The resulting coloured flicker is too rapid to be seen, but it results in an electrical signal from the back of the eye, indicating that our <a href="https://insights.ovid.com/crossref?an=00006324-199108000-00012">cells respond to the variation</a>. </p>
<p>This rapid fluctuation of light from fluorescent lamps is known to affect the way our <a href="https://journals.sagepub.com/doi/10.1177/001872088602800108">eyes move across text</a> and it interferes with <a href="https://journals.sagepub.com/doi/abs/10.1177/14771535950270040301">the performance of visual tasks</a>. And while it does not affect everybody, it can have a serious effect on a few. <a href="https://journals.sagepub.com/doi/10.1177/096032718902100102">Indeed, one study</a> found incidences of headaches and eye-strain in a London office halved when the fluorescent flicker was reduced. </p>
<h2>How colour can help</h2>
<p>Fluorescent lighting installed in the last ten years does not usually flicker in this way. But a 2009 <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272494408001011">survey</a> found 80% of classrooms were still lit with the old-fashioned flickering fluorescent lighting – so it’s reasonable to suspect that there may well be some of the old-fashioned bulbs still lurking in schools across the UK.</p>
<p>Some children affected by the flicker see an improvement in the clarity of text when a sheet of coloured plastic – <a href="https://www.wiley.com/engb/Reading+Through+Colour%3A+How+Coloured+Filters+Can+Reduce+Reading+Difficulty%2C+Eye+Strain%2C+and+Headaches-p-9780470851166">a coloured overlay</a> – is placed on the page. Children who use coloured overlays find they are able to read more quickly – and often report a reduction in eye strain and headaches. One possible reason is that a coloured filter can reduce the <a href="https://journals.sagepub.com/doi/10.1177/096032719002200205">variation in colour</a> that occurs with the old-fashioned fluorescent lighting. </p>
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Read more:
<a href="https://theconversation.com/ive-always-wondered-do-fluorescent-lights-emit-uv-and-can-it-harm-me-90317">I've always wondered: do fluorescent lights emit UV, and can it harm me?</a>
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<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303708/original/file-20191126-112539-5wacd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If you have to spend a lot of time under fluorescent light, make sure fluorescent lamps are controlled by high-frequency electronic circuitry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lights-ceiling-211201642?src=486d24e8-eccd-46d8-bb04-436aac40bdb6-1-1">Shutterstock/addkm</a></span>
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<p>Some colours will be more suitable than others at reducing any effects of the rapid variation in colour and brightness from fluorescent lights, depending on the phosphors in the lamps, and how much the children have experienced the flicker and adapted to it. </p>
<p>Experience has also shown that some children will use their overlays for a limited time until they report the overlay is no longer effective. When this occurs, a change in colour can sometimes restore the beneficial effect. Many children who find coloured overlays useful benefit from wearing <a href="http://www.s4clp.org/">glasses with coloured lenses</a>. Indeed, research shows that people who wear coloured lenses experience <a href="https://www.sciencedirect.com/science/article/pii/S0042698916300402">long-term effects of adaptation</a> on their perception of colour.</p>
<h2>The migraine link</h2>
<p>Of course, fluorescent lighting isn’t just found in schools and the impact isn’t just something that affects children. Many offices are filled with tube lighting and it’s known there’s a link between fluorescent lighting and migraines, too.</p>
<p>Many children, for example, who benefit from coloured overlays suffer headaches and have a history of <a href="https://www.ncbi.nlm.nih.gov/pubmed/8265152">migraine in the family</a>. The brain is <a href="https://journals.sagepub.com/doi/10.1111/j.1468-2982.2007.01502.x">excitable</a> in people with migraine, and their brains use large amounts of oxygen when they look at things they find uncomfortable.</p>
<p>But research has found that normal oxygenation is <a href="https://journals.sagepub.com/doi/10.1177/0333102411409076">restored with coloured filters</a> – provided the colour is individually chosen as comfortable for viewing text. Indeed, people with migraine often have an aversion to fluorescent lighting, and for reading, often choose colours that are <a href="https://www.mdpi.com/2411-5150/3/4/62">not typical</a> of conventional lighting. </p>
<p>Clearly, then, it would be preferable for schools and workplaces to replace the old-fashioned fluorescent lighting with newer electronic circuitry that removes the 100-per-second variation. This would not only be healthier for children and teachers but also reduce the running costs. This is particularly important given that <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/409409/Reading_the_next_steps.pdf">one in five children</a> in England cannot read well by the age of 11 – and, for at least some of these children, fluorescent lighting could be part of the problem.</p><img src="https://counter.theconversation.com/content/124330/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arnold J Wilkins designed the _Intuitive Colorimeter_ . He also designed the Intuitive Overlays but no longer receives royalties. </span></em></p>But there is an answer.Arnold J Wilkins, Professor of Psychology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1264212019-11-25T13:28:23Z2019-11-25T13:28:23ZHow does a piece of bread cause a migraine?<figure><img src="https://images.theconversation.com/files/300725/original/file-20191107-10952-x1ge1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tens of millions of people worldwide suffer from migraines, according to the World Health Organization.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/headache-migraine-people-doctor-woman-stressed-241533844?src=d9933340-92b5-4cb9-a272-96e4577deb08-1-44">Maridav/Shutterstock.com</a></span></figcaption></figure><p>Migraine is the <a href="http://doi.org/10.1186/1129-2377-14-1">third most prevalent illness</a> in the world and causes suffering for tens of millions of people. In fact, nearly <a href="http://doi.org/10.1212/wnl.58.6.885">1 in 4 U.S. household</a> <a href="http://doi.org/10.1111/head.12878">includes someone with migraines</a>. </p>
<p>Migraine is not just a headache but also includes a collection of associated symptoms that can be debilitating. These include nausea, vomiting, light sensitivity and dizziness. Often people struggle to determine what triggers their migraines. It can be environmental, hormonal, genetic, secondary to an underlying illness, or <a href="https://americanmigrainefoundation.org/resource-library/migraine-and-diet/">triggered by certain foods</a>, such as cheese, red wine or chocolate. One food that has received a lot of <a href="http://doi.org/10.3988/jcn.2017.13.3.215">attention in recent years is gluten </a> - a protein found in wheat, rye and barley. </p>
<p>As a registered dietitian and board-certified neurologist who specializes in headache management, I often will have my patients try a gluten-free diet. </p>
<h2>Celiac disease vs. gluten sensitivity</h2>
<p>When someone suffers from <a href="https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease">celiac disease</a> – a digestive disorder caused by an autoimmune response to gluten – there is a clear link between <a href="http://doi.org/10.1111/j.1526-4610.2012.02260.x">migraine headaches and gluten</a>. <a href="https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/">Gluten triggers immune cells to release antibodies</a> to attack substances the body sees as foreign. </p>
<p>When someone without celiac disease eats gluten, it goes into the gastrointestinal tract where food is broken down and the nutrients are absorbed. In the case of celiac disease, that person’s immune system sees the gluten as a foreign substance (like a virus or bacteria that shouldn’t be there) and attacks it with a specific antibody – called transglutaminase (TG) 2 serum autoantibodies – to destroy the gluten. </p>
<p>The problem is the person’s own healthy tissues gets destroyed in the process. In other words, when people who are sensitive to gluten consume it, the immune system sees this protein as an invader and creates antibodies to capture and destroy the protein. If the protein is sitting in the GI tract or has been absorbed by other organs, the antibodies go looking for it and attack whatever <a href="http://doi.org/10.1038/cmi.2010.65">tissue is harboring the gluten protein</a>. </p>
<p>This triggers an inflammatory reaction that puts the body in high alert that injures various healthy organs. Organs then release molecules that cause blood vessels to become leaky and release water, electrolytes and protein into the tissues and cause swelling. </p>
<p>This is an inflammatory response that affects the whole body, not just the brain. In addition to headaches, it can cause broader symptoms including gastrointestinal problems, fatigue and learning difficulties, just to name a few. </p>
<h2>Step by step, how gluten leads to migraines</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302228/original/file-20191118-66953-n5h6j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The trigeminal nerve innervates three different areas of the head.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/trigeminal-nerve-three-different-innervation-areas-264570833">ellepigrafica/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>But just looking at a gluten-intolerant person’s inflammatory response doesn’t provide the whole picture on gluten’s link to migraine.</p>
<p>In recent years scientists have gained a better understanding of how and why migraines occur. Migraine is now considered <a href="https://ghr.nlm.nih.gov/condition/migraine#inheritance">a genetic condition</a> that is found commonly within families. </p>
<p>Early theories suggested migraines occurred because of enlargement or dilation of the blood vessels. But now neurologists realize this isn’t the whole story. We now know the cascade that leads to a migraine involves the nerves in the trigeminovascular pathway (TVP) – the collection of nerves that control sensation in the face as well as biting and chewing. </p>
<p>When TVP is activated by the presence of gluten, for example, it causes the release of many chemicals including histamine, a substance that immune cells produce when responding to injury, allergic and inflammatory events. The TVP nerves also produce a recently discovered trigger for migraines; a protein called <a href="http://doi.org/10.1111/head.13081">calcitonin gene-related peptide</a> (CGRP). </p>
<p>When CGRP is released it causes the dilation of blood vessels in the meninges – the layer of tissue protecting the brain. As the blood vessels dilate they leak water and proteins into the <a href="http://doi.org/10.1038/s41582-018-0003-1">meninges which causes swelling and irritation</a>. The swelling activates the trigenimial nerves which relay messages to other regions of the brain, including the thalamus which creates the perception of pain that is associated with a migraine. </p>
<p>Within the past year a new class of medications has gained FDA approval for migraine prevention. These medications are called <a href="http://doi.org/10.1002/brb3.1215">CGRP monoclonal antibodies</a> and have proven to be an effective preventative treatment. They stop the protein CGRP from getting into its receptor. </p>
<h2>What to do about food triggers</h2>
<p>In both gluten sensitivity, or celiac disease, and migraine, there is an inflammatory process occurring within the body. I hypothesize that the inflammatory response to gluten makes it easier to activate the trigeminovascular pathway, thus triggering a migraine. There has never been a large study of how exactly gluten triggers migraines, and this is something I hope to explore in future studies.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/302543/original/file-20191119-111645-1x3q9wr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Triggers for migraines are varied but here are a few of the most common.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/migraine-triggers-headache-infographic-flat-design-363739847">Arthur NN/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Typically, a food trigger will cause a migraine to start within 15 minutes of exposure to that substance. </p>
<p>If someone tests positive for celiac, or wheat allergy, then the answer is simple: remove gluten from the diet. So the question arises when someone tests negative should we still eliminate gluten? It is often worth a try, because there is a condition called non-celiac gluten sensitivity. </p>
<p>If someone does not have celiac disease but suffers from symptoms of gluten sensitivity, an elimination trial of gluten is often helpful for reducing migraine frequency or severity. The reason I suspect is that removing gluten will reduce chances of an inflammatory response that will activate the trigeminal nerves and trigger pain. Gluten elimination for migraines is still experimental.</p>
<p>We need to treat the whole person in medicine. This includes looking at potential triggers for headache and doing an elimination diet can be of benefit. There are so many gluten-free products currently on the market, it makes removing gluten from the diet easier. </p>
<p><em>This article has been changed to clarify the definition of celiac disease.</em></p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/126421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Green does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many migraine headaches are triggered by certain foods. Recently, a lot of attention has focused on gluten. An expert explains how a piece of bread can cause pain in your head.Lauren Green, Clinical Assistant Professor of Neurology, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1127742019-05-06T01:49:31Z2019-05-06T01:49:31ZCurious Kids: what is brain freeze?<figure><img src="https://images.theconversation.com/files/262784/original/file-20190307-82672-1w3fju9.png?ixlib=rb-1.1.0&rect=5%2C5%2C3988%2C1988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A brain freeze is an intense 'squeezing' sensation on your head.</span> <span class="attribution"><span class="source">Nina Maile Gordon/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em><a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a> is a series for children. If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
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<p><strong>What is brain freeze? – Question from the students of Ms Young’s Grade 5/6 class, Baden Powell College, Victoria.</strong> </p>
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<p>Australia had one one of its <a href="https://theconversation.com/2018-19-was-australias-hottest-summer-on-record-with-a-warm-autumn-likely-too-112616">hottest summers on record</a> this year (thanks, climate change, thanks a lot). Many of us probably gobbled up an ice cream and perhaps <em>too quickly</em>. </p>
<p>After doing this, you may have been unlucky enough to get an intense squeezing or stabbing sensation on your forehead, your temples or the back of your head. This is brain freeze, also known as an “ice cream headache”.</p>
<p>“So” you say, feeling smart, “brain freeze is just a kind of headache! <a href="https://theconversation.com/curious-kids-what-is-a-headache-is-it-our-brain-hurting-112951">I already know all about those</a>”.</p>
<p>You are, of course, correct. But brain freeze is a bit weird. While it’s true that you do put ice-cream inside your head to eat it (your mouth is technically part of your head), you don’t typically put it into the parts of your head that hurt when you experience brain freeze. To put ice-cream into your forehead or temples would be a very weird surgical procedure that I do not advise you to try at home or anywhere else. It’s also hard to imagine a situation in which it would be medically necessary so it seems unlikely that it would be available on Medicare.</p>
<h2>So why do your forehead and temples (or even the back of your head) hurt when you put ice cream in your mouth too fast?</h2>
<p>There are several different ideas as to why, but the answer definitely has something to do with what happens when we cool down the roof of our mouth. </p>
<p>When you cool down the roof of your mouth, the coldness is picked up by nerve cells that live there and whose job it is to detect cold. This information about coldness is sent to your brain via a nerve. When the roof of your mouth is very cold, these cells (and so this nerve) will be very active. </p>
<p>Now, <a href="https://en.wikipedia.org/wiki/Trigeminal_nerve#Spinal_trigeminal_nucleus">this nerve also contains information from other cells</a>, including the ones that detect cold and painful stimuli from other parts of your head, including your very face. </p>
<p>It <em>may</em> be (we’re honestly not sure) that when the cells that sense cold in the roof of your mouth are very active, this <em>somehow</em> also activates the bits of the brain that are usually activated by the face cells. As a result, the cold fools your brain into thinking that your forehead hurts.</p>
<p>Another possibility is that, as delicious icy treats quickly cool down our tongues and mouths, it actually cools the blood in blood vessels that supply blood to your head. These blood vessels respond by changing how much blood flows into your brain. Only a few scientists have actually tried to measure this, and those that have don’t even agree about whether there is <a href="https://www.fasebj.org/doi/abs/10.1096/fasebj.26.1_supplement.685.4">more</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127417/">less</a> blood going into your head. Everyone, however, agrees that it hurts.</p>
<p>It may be some combination of these two things: that activation of nerves causes a change in how much blood is going into your head. It might even be <a href="https://www.ncbi.nlm.nih.gov/pubmed/1555929">both things together!</a></p>
<h2>Why don’t we know how brain freeze works?</h2>
<p>Here’s the thing about science: “what is brain freeze” is a fantastic question for a curious scientist to ask, but to get the answer, scientists need to convince other people (politicians, other scientists and members of the public) that they should be given the time and money to answer that question. </p>
<p>Unfortunately, the availability of time and money are not as boundless as the curiosity of scientists. </p>
<p>The result of all this is that sometimes, simple and beautiful questions like “what is brain freeze?” don’t get as much attention as other questions that might seem more pressing. </p>
<p>Instead, these beautiful questions fall away, like a scoop of ice cream loosened by an enthusiastic but careless scientist who may not have the time or resources to investigate brain freeze in the lab, but excitedly discusses it with a friend over an ice cream anyway. My advice? Stay curious. Eat ice cream. Slowly.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-if-australia-is-at-the-bottom-of-the-world-why-are-we-the-right-way-up-92416">Curious Kids: If Australia is at the bottom of the world, why are we the right way up?</a>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p>
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<p><em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p>
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Read more:
<a href="https://theconversation.com/curious-kids-if-australia-is-at-the-bottom-of-the-world-why-are-we-the-right-way-up-92416">Curious Kids: If Australia is at the bottom of the world, why are we the right way up?</a>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p>
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<p><em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/112774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Farmer is employed on a grant awarded by the NHMRC and is a Senior Research Officer at The Florey Institute of Neuroscience and Mental Health and an Honorary Fellow at the University of Melbourne. In addition to doing neuroscience (as a supposed grown-up), he is a passionate advocate for science. He likes to perform at comedy festivals, talk on the radio and write articles. He hopes that you enjoyed this one. Very much. </span></em></p>There are several different science ideas around why, but the answer may have something to do with what happens when we cool down the roof of our mouth.David Farmer, Researcher, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1025282018-09-05T09:01:21Z2018-09-05T09:01:21ZDoes the brain really feel no pain?<figure><img src="https://images.theconversation.com/files/234660/original/file-20180903-41720-1va9p8j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/762879901?src=ErImHdiQpFaBNlE32PN-7A-1-0&size=huge_jpg">Happy cake Happy cafe/Shutterstock.com</a></span></figcaption></figure><p>The brain has no nociceptors – the nerves that detect damage or threat of damage to our body and signal this to the spinal cord and brain. This has led to the belief that the brain feels no pain. A belief that has entered popular culture.</p>
<p>In the 2001 movie Hannibal, there is a gut-twisting scene in which the eponymous Hannibal Lecter cuts out part of the brain of an FBI agent who is fully awake, though drugged, and seated at a dinner table. </p>
<p>“See the brain itself feels no pain,” Lecter tells an aghast Clarice Starling.</p>
<p>But if the brain feels no pain, what causes headaches?</p>
<p>Although the brain has no nociceptors, many of the other <a href="http://cdmbuntu.lib.utah.edu/utils/getfile/collection/EHSL-NOVEL/id/551/filename/996.pdf">structures in our head</a> do, including blood vessels, muscles, and nerves in the neck, face and scalp. Headaches are caused by problems with these structures. </p>
<p>Different types of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964977/">nociceptors</a> are activated by pressure, damage, extremes of temperature and some chemicals, such as capsaicin (the active ingredient in chilli peppers). </p>
<p>“Brain freeze” or “ice-cream headaches” seem to be caused by sudden changes in blood flow in the veins that lie between the <a href="https://www.fasebj.org/doi/abs/10.1096/fasebj.26.1_supplement.685.4">back of the throat and the brain</a>. Dehydration causes headaches by irritating the blood vessels in the head and is one reason for the throbbing head that many experience after a night of drinking. And any dentist can tell you that a headache could indicate <a href="https://www.nhs.uk/conditions/temporomandibular-disorder-tmd/">you over-exert your jaw</a>, perhaps by grinding your teeth when you sleep.</p>
<p>The cause of pain during migraine is still not well understood but is thought to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494713/">the activation of nociceptors in the meninges</a> – the cellophane-like wrapping that encases the brain and spinal cord. What might cause this activation, though, is still unclear. </p>
<p>Even though the brain has no nociceptors, a headache can still signal a problem with the brain. Headaches that are prolonged and don’t respond to drugs, or that are <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/thunderclap-headache">sudden and extraordinarily severe</a>, can be signs of a serious problem with the brain, such as a tumour, bleeding or infection. Although these problems cause pain, it is not by activating nociceptors in the brain itself – because it doesn’t have any – but because the brain swells and puts pressure on other structures in the head.</p>
<h2>More than just a sensory experience</h2>
<p>In a fundamental sense, Hannibal Lecter was wrong about the brain feeling no pain. Although the brain has no nociceptors, the brain “feels” <em>all</em> our pain. This is because our brain is the organ through which we interpret, evaluate and experience all the sensory signals from our body. </p>
<p>Scientists distinguish between <em>nociception</em> – the nervous signal of damage to our body – and <em>pain</em>, the unpleasant emotional and cognitive experience that normally results when our nociceptors are activated.</p>
<p>This means that pain is more than just a sensory experience, it is influenced by our thoughts, feelings and social relationships. For example, how we experience pain is affected by our thoughts, such as what we believe the pain might mean, and what we remember of previous painful experiences. </p>
<p>Pain is also an emotional experience: people with depression report that they <a href="https://www.ncbi.nlm.nih.gov/pubmed/26867484">experience more pain in daily life</a>. And inducing a low mood in otherwise normal people <a href="https://www.ncbi.nlm.nih.gov/pubmed/18325674">increases pain ratings and lowers tolerance to pain</a>. </p>
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<figcaption><span class="caption">Janet Bultitude: Pain is not just about what we feel.</span></figcaption>
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<p>It is also a social experience. In one experiment, students who were asked to hold their hand in painfully cold water for as long as possible <a href="https://www.ncbi.nlm.nih.gov/pubmed/15494194">tolerated the pain for longer</a> if they thought the experimenter was one of their professors than if they thought the experimenter was a fellow student. This shows that who asks us about our pain is important.</p>
<p>The social influences on pain also show the benefits of having support from those who care about you. In another study that used the same ice bucket method, people had a greater tolerance for the painful cold <a href="https://www.ncbi.nlm.nih.gov/pubmed/28141635">when another person silently observed the experiment</a>, compared with being alone with the experimenter. And if the “observer” was a friend of the same sex, the participants had higher tolerance even if the friend was not actually inside the room, but was merely nearby. </p>
<p>Given the many influences on how we experience pain, it is no wonder that finding relief from pain can be complex and frustrating. The good news is, each of these influences also represents a way to manage pain. Helping people change their thoughts and feelings about their pain are important parts of pain management, as is maintaining social relationships.</p>
<p><em>University of Bath are <a href="https://www.bath.ac.uk/campaigns/pain-free-volunteers-needed-for-research-investigating-body-perception-in-chronic-pain/">looking for volunteers</a> to take part in research investigating body perception in chronic pain.</em></p><img src="https://counter.theconversation.com/content/102528/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Bultitude does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In one sense, the brain feels no pain. In another sense, it feels all the pain.Janet Bultitude, Lecturer in Cognitive and Experimental Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1001632018-08-20T06:02:54Z2018-08-20T06:02:54ZHealth Check: why do I get a headache when I haven’t had my coffee?<figure><img src="https://images.theconversation.com/files/231860/original/file-20180814-2915-1vef0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A study found the headache went away when participants were given decaf but didn't know. </span> <span class="attribution"><span class="source">nathan dumlao unsplash</span></span></figcaption></figure><p>Caffeine is our favourite drug. But if we miss out on our fix, it can be a real headache, in more ways than one.</p>
<p>Caffeine is a stimulant. It quickly enters our brain and blocks the (adenosine) receptors that are responsible for dulling brain activity. By blocking the dulling of our brain, we feel a sense of invigoration, focus and subtle euphoria. These feelings can also enhance our performance of certain focused tasks, like driving or staying awake through the whole lecture. </p>
<p>This is the upside of caffeine. The downside is how we feel when we are not getting our usual dose. Because of the anticipated highs of brain activity after our cup, the lows without it seem longer and deeper.</p>
<p>The other problem is that caffeine is addictive. When we aren’t getting what we’re used to, we can feel tired, inattentive, irritable and moody. This is known as <a href="https://www.ncbi.nlm.nih.gov/pubmed/18625110">withdrawal</a>. Many people regularly drink caffeinated beverages just to avoid feeling this way.</p>
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<a href="https://theconversation.com/health-check-four-reasons-to-have-another-cup-of-coffee-40390">Health Check: four reasons to have another cup of coffee</a>
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<p>By far the most common symptom of caffeine withdrawal is headaches. These are typically mild and short-lived, usually only lasting for a day or two, although they can sometimes last for up to week. They usually feel a bit like a tense band wrapped across your head and are sometimes called <a href="http://headacheaustralia.org.au/headachetypes/tension-type-headache/">tension-type headaches</a> as a result. However, caffeine withdrawal can also trigger a full-on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975726/">migraine</a> in some sufferers.</p>
<p>Why we get headaches with withdrawal (as well as many other causes) is mostly because our face and head is the most active as well as the most sensitive part of our body. For our brain to accurately know what’s happening, the signals it receives from the senses have to be spot on. </p>
<p>Any distortion of the signal and the message can become lost in translation, or even result in the wrong message being received. One theory for headaches is our fuzzy brain misinterprets some of the innocuous signals it gets from our head, and calls them a headache.</p>
<p>Some level of caffeine withdrawal <a href="https://www.ncbi.nlm.nih.gov/pubmed?term=15448977">would be experienced by maybe half</a> of all regular tea or coffee drinkers, if their regular drug supply would be completely cut off. The more we drink and the more regularly we drink caffeine, the more likely we’d experience withdrawal symptoms if we were to go without.</p>
<p>However, withdrawal can happen even in people who usually drink just a single cup every day who then forego caffeine. Equally, only <a href="http://jpet.aspetjournals.org/content/289/1/285.long">three days</a> of continuous coffee drinking is enough to make you feel bad when the coffee runs out.</p>
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Read more:
<a href="https://theconversation.com/research-check-does-drinking-coffee-help-you-live-longer-99287">Research Check: does drinking coffee help you live longer?</a>
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<span class="caption">Only three days of continuous coffee drinking is enough to make you feel bad when the coffee runs out.</span>
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<p>Caffeine withdrawal only occurs with abstinence. Small amounts of caffeine (just a quarter of a cup) will keep the headaches at bay. Even if the espresso machine is broken and you have to have a (half-less caffeinated) latte, you won’t go into withdrawal.</p>
<p>But if you’re going cold turkey, withdrawal headaches typically peak <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.395.79&rep=rep1&type=pdf">a day or two</a> after removing all caffeine from the menu. Withdrawal does not happen within a few hours of the last cup, despite the protestation of the habitual coffee drinker.</p>
<p>Of course, if withdrawal is really the problem, the remedy is simple. Any headache caused by lack of caffeine is rapidly and often completely <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.395.79&rep=rep1&type=pdf">relieved</a> within 30 minutes to an hour of drinking a cup of tea or coffee.</p>
<p>Some of this is the fix and the anticipation of it. In fact, Australian <a href="https://www.ncbi.nlm.nih.gov/pubmed/26933153">researchers</a> have found giving someone experiencing caffeine withdrawal a de-caf, but telling them it’s caffeinated, is enough to make them feel better. Of course this trick won’t work if you buy the coffee yourself.</p>
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Read more:
<a href="https://theconversation.com/research-check-will-a-coffee-a-day-really-keep-heart-attacks-at-bay-87664">Research Check: will a coffee a day really keep heart attacks at bay?</a>
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<p>Surprisingly though, caffeine also has some painkiller properties. Simple pain-killers such as non-steroidal anti-inflammatories, aspirin or paracetamol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655397/">can be more effective</a> when formulated with some caffeine (in each dose about two to three times that in a regular cup of coffee). </p>
<p>For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5018099/#A33193R29">hypnic “alarm clock” headaches</a> that wake sufferers at night, hangover-headaches and some migraine-sufferers, a cup of tea or coffee can be an effective pain-killer on its own. </p>
<p>This analgesia is not just because we feel less stressed or less distracted by pain after a cup of tea or coffee. It turns out the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366829">same adenosine receptors</a> blocked by caffeine are also implicated in the origin of headache as well as other kinds of pain. </p>
<p>More than 90% of all adults drink coffee or tea, rousing us from our slumber and providing the revitalising energy to do the things that need to be done. It’s not hard to imagine the headaches without it.</p><img src="https://counter.theconversation.com/content/100163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merlin Thomas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve all experienced that tense pain in our heads when we’re withdrawing from caffeine. But why?Merlin Thomas, Professor of Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/971522018-05-25T10:47:33Z2018-05-25T10:47:33ZNew migraine drug: A neurologist explains how it works<figure><img src="https://images.theconversation.com/files/220207/original/file-20180523-51141-bd1mgs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pain from migraine headaches is a major cause of disability. A new drug could prevent them, in some cases.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/zionfiction/7484820084">R. Nial Bradshaw/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The FDA announced approval on May 17 of a novel preventive treatment for migraine headaches. <a href="https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm">Aimovig</a> is the first in a new class of migraine-specific drugs that works by blocking an action of a protein that is increased in people with migraine during headache attacks.</p>
<p>A migraine is a chronic disorder of the brain with recurrent severe attacks, from one or two times a year to nearly daily. The main feature of these attacks is severe headache. Other common features are nausea or even vomiting. Many people have sensitivity to light, odors or sounds and are unable to carry on daily activity.</p>
<p>As a neurologist who studies and treats migraine, I am encouraged by the efficacy of this new drug and others that target the same protein. But there are limitations.</p>
<h2>A disabling brain disorder</h2>
<p>Migraine typically runs in families, with about 90 percent of people with migraine having close relatives with this disorder. It affects <a href="http://migraineresearchfoundation.org/about-migraine/migraine-facts/">1 of every 7 adults</a> in the U.S. It is three times more common in women than men.</p>
<p>That doesn’t tell the whole story, though. According to the research group Global Burden of Disease, migraine was ranked the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561509/">sixth most disabling disease</a>. What is more, among neurological disorders, <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(17)30299-5/abstract">migraine is the second most disabling</a> after stroke.</p>
<p>Individual migraine attacks can sometimes be successfully treated by over-the-counter pain relievers such as aspirin, acetaminophen or naproxen. These medications need to be taken early. They should not be overused, as overuse can cause more headaches. Some over-the-counter medications also include caffeine, which has the potential to trigger <a href="https://americanmigrainefoundation.org/understanding-migraine/medication-overuse-headache-2/">rebound headaches</a>, especially in individuals who drink a lot of coffee or caffeinated drinks such as soda and energy drinks.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220211/original/file-20180523-117628-hdwrvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman at a pharmacy. Over-the-counter drugs like aspirin and acetaminophen can help with the pain from migraine, but they do not work for everyone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-patient-pharmacy-needs-medicine-against-1062848966?src=oYieLsxMpZpGcTdBBm8Qpw-1-61">Dan Race/Shutterstock.com</a></span>
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</figure>
<p>If over-the-counter medications are not effective, a class of drugs called <a href="https://www.ncbi.nlm.nih.gov/books/NBK47287/">triptans</a> can be very effective. Triptans, the first drugs developed specifically for migraines, were developed in the 1980s and have remained the best option for treatment of individual migraine attacks. Triptans are not pain killers but rather work through serotonin receptors involved in the development of migraine.</p>
<p>Triptans can also cause medication overuse headache. And, they have the potential to cause the spasm of blood vessels. Therefore, <a href="https://www.mdedge.com/neurologyreviews/article/96884/headache-migraine/aan-and-ahs-update-guideline-treatment-acute">triptans should not be used</a> if a person has had a heart attack, stroke or peripheral vascular disease. </p>
<h2>In some cases, prevention a goal</h2>
<p>If headache attacks are too frequent or not well controlled with acute therapies, preventive therapy becomes a priority. The goal of preventive therapy is quite different. Unlike acute therapies, these medications are typically prescribed daily to reduce frequency and severity of individual migraine attacks. Most commonly used medications for prevention of migraine are medications from three drug classes: anti-seizure drugs <a href="https://medlineplus.gov/druginfo/meds/a697012.html">topiramate</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181204/">divalproex/sodium valproate</a>; the blood pressure drug <a href="https://www.healthline.com/health/propranolol-oral-tablet">propranolol</a>; and some antidepressants, such as <a href="https://www.healthline.com/health/amitriptyline-oral-tablet">amitriptyline</a> or <a href="https://medlineplus.gov/druginfo/meds/a682620.html">nortriptyline</a>. These medications can be quite effective in reducing headache days.</p>
<p>Yet they, too, all can have unwanted side effects. Taking medications daily can be cumbersome, especially if they should be taken several times a day. And, none of these medications work immediately, and it may take weeks to month to get their full effect.</p>
<p>And,<a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0080797/"> fewer than half</a> of patients have success with most of first line preventive daily medications.</p>
<h2>Could this novel drug targeting CGRP be a solution?</h2>
<p>The protein that causes migraines, called calcitonin gene-related protein, or <a href="https://www.sciencedirect.com/science/article/pii/0166223685900505?via%3Dihub">CGRP</a>, was discovered in 1980. It proved to have a role in migraine when <a href="https://www.ncbi.nlm.nih.gov/pubmed/20855363">intravenous infusions of this protein</a> triggered typical migraine attacks only in people susceptible to migraine, but not in healthy individuals. Currently, several drugs targeting <a href="https://www.nature.com/articles/s41582-018-0003-1">CGRP</a> are in the final stage of development. Some of the drugs are designed for acute treatment, because they work rapidly and get cleared relatively fast. These are small molecules that work against CGRP. These drugs are small molecules compared to CGRP antibodies, which allows them to penetrate brain and block painful effects of CGRP. As a drug class, they are called gepants.</p>
<p>Other drugs are designed using advanced technology to create <a href="https://www.britannica.com/science/antibody">antibodies</a> against the CGRP <a href="https://www.britannica.com/story/what-is-the-difference-between-a-peptide-and-a-protein">peptide</a>, blocking it completely, or blocking the receptor for CGRP. The end result is the same: They reduce the painful effect of CGRP in the body. These medications are called CGRP <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/monoclonal-antibody">monoclonal antibodies</a>. They have a structure similar to naturally produced molecules that bind to toxic or infectious agents, but they are designed to bind to only one protein and do not affect other functions.</p>
<p>These molecules are very large, and they do not penetrate the brain but rather block the effects of CGRP in the brain’s lining. These molecules are not cleared by the liver, which is why they may have less interaction with other medications. Because they are proteins, they have to be injected so that they are not destroyed in the stomach. </p>
<p>The good news is that they stay in the body for a long time, and they need to be injected very infrequently. Only one of these medications have to be injected through the vein, but the other three can be injected at home under the skin.</p>
<p>The newly approved medication Aimovig is largely designed as an antibody against CGRP itself and involves once-a-month injections under the skin using self-injectors with a hidden needle. Like any <a href="https://pi.amgen.com/%7E/media/amgen/repositorysites/pi-amgen-com/aimovig/aimovig_pi_hcp_english.ashx">injectable medication</a>, it can cause skin reaction. In clinical trials, that occurred in only 5 to 6 percent of participants.</p>
<p>Clinical trials show so far that all CGRP antibodies are very well tolerated and that fewer people dropped out from studies because of side effects compared to current daily preventatives. The convenience of monthly injections compared to daily medications is certainly an advantage. The drug seems to work faster, and the effect can become apparent after the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/head.13302?af=R">first injection</a>.</p>
<p>But as with any new medications that are only studied for a limited time in carefully selected individuals, one should be cautious. These medications do not prove to cure migraine. All clinical trials of these new drugs showed average reduction by one to two migraine days compared to a placebo. This is about the same reduction that was achieved in clinical trials of most of currently available daily medications. So the efficacy of new and currently available drugs is on average similar, although there is a subset of people who have outstanding response to the treatment and achieve complete freedom from pain. This is true for available <a href="https://jamanetwork.com/journals/jama/fullarticle/2681173">daily preventive medications</a> as well. </p>
<p>Because these medications are so new, there is no data on the long-term effects. What happens if a woman on these medications got pregnant? Will that do harm to her unborn child? Will this have an effect on breastfeeding? Until we know the answer, experts recommend that women who use these medications do not get <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2680898">pregnant until the medication is cleared</a> from the body, which may take many weeks.</p>
<p>Another question is if these medications are safe for people who have <a href="https://www.ncbi.nlm.nih.gov/pubmed/27338837">coronary artery disease</a>, stroke or peripheral artery disease. While monoclonal antibodies against CGRP do not cause spasm of the vessels, blocking the molecule that serves as safety mechanism during vascular emergencies, such as high blood pressure, heart attacks or strokes is a concern. Would this affect the outcome of these serious conditions?</p>
<p>Finally, these medications are very expensive. Aimovig in the U.S. costs $6,900 annually. Meanwhile, insurers likely will require trials of less expensive treatments with good evidence for <a href="https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/">their efficacy</a>. </p>
<p>Keeping this in mind, we can celebrate a new chapter in migraine treatment with migraine-specific medicine, designed based on advanced knowledge of the science of migraines.</p><img src="https://counter.theconversation.com/content/97152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yulia Orlova does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new preventive drug for migraines was approved recently by the FDA. Here’s how it works, and how others in the pipeline might be able to help the millions who suffer from migraines.Yulia Orlova, Assistant Professor of Neurology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/824952018-02-13T23:35:33Z2018-02-13T23:35:33ZCurious Kids: How does pain medicine work in the body?<p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky!</em> </p>
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<p><strong>I want to understand how pain medicine like Panadol works in our body. – Freddie, age 6, Melbourne.</strong></p>
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<p>In short, pain medicine is able to block the processes that cause the feeling of pain. To understand why, we need to explain a bit more about how pain works.</p>
<p>Pain happens when electrical signals travel from the spot where you hurt yourself up your nerves, to the spinal cord and then up to the brain. </p>
<p>When the pain signal gets to the brain, it lets your brain know there’s a big problem happening so we can respond. </p>
<p>So when we feel pain from a burnt hand, we quickly remove it from a fire. Or if a dog bites us, the pain tells us to run away.</p>
<p>So even though pain hurts, pain is important. It can protect us from more injury. Feeling no pain at all is actually quite dangerous.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-do-animals-sleep-like-people-do-snails-sleep-in-their-shells-90941">Curious Kids: Do animals sleep like people? Do snails sleep in their shells?</a>
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<p>But your question was about pain medicine like Panadol. Panadol is just one brand of medicine called <em>paracetamol</em> – there are a lot of different brands.</p>
<p>Inside our bodies, paracetamol is able to block the processes that cause the feeling of pain.</p>
<p>Paracetamol not only acts at the site of the pain (like your burnt hand or sore arm) but also in the brain where the pain is felt.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-dont-cats-wear-shoes-75308">Curious Kids: Why don’t cats wear shoes?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1556&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1556&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1556&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1956&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1956&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196449/original/file-20171127-2055-1j57ten.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1956&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Paracetamol, and also other pain medicines such as ibuprofen (you might know it as Nurofen), block the formation of prostaglandins.</span>
<span class="attribution"><span class="source">Marcella Cheng/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>At the place where pain starts, such as a sore throat, a burnt finger or a broken arm, a lot of chemicals are made and released. These chemicals make you feel pain and also make your body send more blood flowing to the painful area. This is why the painful area is often red and swollen. </p>
<p>The extra blood flowing to the area includes white blood cells – special parts of our blood that fight disease. These white blood cells bring important chemicals. One of these chemicals goes by the name of “prostaglandin”. It increases pain and inflammation (swelling).</p>
<p>Paracetamol, and also other pain medicines such as ibuprofen (you might know it as Nurofen), stop your body from making prostaglandins. </p>
<p>When you swallow some paracetamol, it dissolves in your tummy and most of it is absorbed into your blood. The paracetamol then travels around the body to reach both the painful spot and your brain, where it then starts to reduce the feeling of pain. </p>
<p>Paracetamol is very safe if the dose taken over 24 hours (that’s one day and one night) is kept below a maximum amount. It is very important not to take too much paracetamol, as it can be very dangerous if you take too much. </p>
<p>So make sure to never, ever take paracetamol without being sure that the dose has been checked by an adult who has read the instructions on the box. Otherwise you could take too much and get very sick or even die.</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. They can:</em></p>
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<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age, and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/82495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Day has received consulting fees, paid to his institution, from
GlaxoSmithKline Australia, and fees for meeting participation from Reckitt
Benckiser.</span></em></p><p class="fine-print"><em><span>Garry Graham has received support from GlaxoSmithKline for research on paracetamol.</span></em></p>In short, pain medicine is able to block the processes that cause the feeling of pain. To understand why, you need to know a bit about how pain works.Ric Day, Professor of Clinical Pharmacology, UNSW SydneyGarry Graham, Honorary Professor of Pharmacology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816392017-07-27T15:04:44Z2017-07-27T15:04:44ZThe scientific reason you don’t like LED bulbs — and the simple way to fix them<figure><img src="https://images.theconversation.com/files/179991/original/file-20170727-8486-1sch1ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There’s a handy trick for reading station signs that otherwise fly past in a blur as you travel in a high-speed train. Look at one side of the window and then immediately at the other side of the window. When you change your gaze, your eyes will automatically make a rapid jerking movement, known as a saccade. If the direction of the saccade is the same as that of the train, your eyes will freeze the image for a split second, long enough to read the station name if you time things right. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK10991/">Saccades are</a> very fast movements of the eyes. Their exact speed depends on the size of the movement, but large saccades can move the eyes at the same rate as a high-speed train. The image of the station name becomes visible because it is travelling at the same speed as the eye, and the images before and after the saccade are blurred and so don’t interfere with the image of the sign. This shows us that our vision is still working when our eyes move rapidly during saccades. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180001/original/file-20170727-8492-y4e1h4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Blink and you’ll miss it.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>Scientists used to think we could see no more than about 90 flashes of light a second but now we know <a href="https://www1.essex.ac.uk/psychology/overlays/2014-222.pdf">it’s more like 2,000</a> because the eyes move so rapidly when we change gaze from one point to another. During the eye movement, the flicker of light creates a pattern that we can see. And this has some surprising consequences for our health thanks to the way some types of lighting can affect us. In particular, it could discourage people from using more energy-saving LED lightbulbs.</p>
<p>Most lighting is electric and powered by an alternating current supply, which makes the bulbs continually dim and then brighten again at a very fast rate. Unlike filament lamps and to a lesser extent fluorescent lamps, LEDs don’t just dim but effectively <a href="https://www1.essex.ac.uk/psychology/overlays/2010-195.pdf">turn on and off completely</a> (unless the current is maintained in some way).</p>
<h2>Health concerns</h2>
<p>We know from earlier work on fluorescent lighting that even though the flicker is too fast to be visible, it remains a likely health hazard. In 1989, my colleagues and I compared fluorescent lighting that flickered 100 times a second with lights that appeared the same but didn’t flicker. <a href="https://www1.essex.ac.uk/psychology/overlays/1989-82.pdf">We found</a> that office workers were half as likely on average to experience headaches under the non-flickering lights.</p>
<p>No similar study has yet been performed for LED lights. But because LED flickering is even more pronounced, with the light dimming by 100% rather than the roughly 35% of fluorescent lamps, there’s a chance that LEDs could be even more likely to cause headaches. At best, it’s likely to put some people off using LED bulbs because of the annoying, distracting effect of the flickering, which we know can be detected during saccades.</p>
<p>One obvious way of avoiding the flicker is to operate the lamps with a direct current so the light is constant, but this involves <a href="http://ieeexplore.ieee.org/abstract/document/7070737/?reload=true">more expensive</a>, shorter-lived components. Another solution is to design the lights so that the flicker can’t be detected. But just how fast must the flicker be in order to be harmless?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180000/original/file-20170727-22996-1kd5bkc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">See the light.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>To find out, my colleagues and I asked people to make a saccade across a flickering source of light and to report when they could see a pattern of multiple images of the light during the eye movement. When the light flickered 1,000 times a second the pattern could clearly be seen. At about 3,000 per second, <a href="https://www1.essex.ac.uk/psychology/overlays/2013-207.pdf">the images became invisible</a>.</p>
<p>In contrast, some LEDs flash only 400 times per second. This flicker is still far too rapid to be seen directly, but some people can see multiple images of the lamps every time they make a saccade, which is unpleasantly distracting. The flickering of these LEDs may limit the uptake of the bulbs, just as many people <a href="http://www.huffingtonpost.com/frank-morgan/why-i-dont-like-energyeff_b_2047147.html">dislike energy-saving fluorescent lamps</a>.</p>
<p>When you buy an LED bulb, you currently have no way of telling whether or not it will flicker. But there are already <a href="https://standards.ieee.org/findstds/standard/1789-2015.html">standards for LEDs</a> that would limit flicker to acceptable levels. So ensuring these are met could make a big difference to our attempt to make our homes and workplaces more energy efficient.</p><img src="https://counter.theconversation.com/content/81639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arnold J Wilkins received funding from the Medical Research Council and the Wellcome Trust.</span></em></p>That flicker in the corner of your eye isn’t your imagination.Arnold J Wilkins, Professor of Psychology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/696212017-01-01T18:33:53Z2017-01-01T18:33:53ZHealth Check: does my brain really freeze when I eat ice cream?<figure><img src="https://images.theconversation.com/files/148830/original/image-20161206-25746-95rx47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little does this woman know what happens to her brain when she licks the ice cream.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/435069991?src=up5tXtzXv9_SlCpFnzUswg-3-17&id=435069991&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>It’s a long, hot summer’s day and you’re looking forward to an ice cream. But within seconds of your first bite, you feel a headache coming on: a brain freeze.
What’s going on?</p>
<p>Your brain isn’t literally freezing, or even sensing cold. It can’t sense cold or pain because it lacks its own internal sensory receptors. In fact, surgeons usually perform brain surgery on conscious, sedated patients with the only pain coming from the scalp, skull and underlying tissues, not from the brain itself.</p>
<p>An <a href="http://cep.sagepub.com/content/33/9/629.full">international team of neurologists</a> classifies brain freeze or ice cream headache as a:</p>
<blockquote>
<p>headache attributed to ingestion or inhalation of a cold stimulus. </p>
</blockquote>
<p>Anything cold (solid, liquid or gas) that passes over the roof of the mouth (the hard palate) and/or the back of the throat (posterior pharyngeal wall) can trigger a brain freeze headache.</p>
<p>Pain can be to the front of the head or the temples and while short lasting, can be intense, though not debilitating. People who have these headaches <a href="http://onlinelibrary.wiley.com/doi/10.1111/head.12688/abstract">usually do not seek treatment</a>, so there has been very little research into how brain freeze occurs.</p>
<p>The transient nature of these headaches means common “treatments”, <a href="http://www.wikihow.com/Stop-Brain-Freeze">like putting your tongue on the roof of your mouth</a>, are unlikely to have any major effect.</p>
<p>People most likely to have brain freeze also tend to suffer from migraines, suggesting a common underlying mechanism for both.</p>
<p><a href="http://cep.sagepub.com/content/24/4/293.abstract">One study</a> compared how common brain freeze was in people with migraine alongside those with tension type headaches. When an ice cube was placed on the hard palate of their mouths for 90 seconds, 74% of migraine sufferers reported pain along their temples versus 32% of those with a history of primary headache disorders (headaches that do not have an underlying or identifiable cause). </p>
<p><a href="http://cep.sagepub.com/content/early/2016/05/19/0333102416650704.abstract">Only 12%</a> of volunteers without a history of primary headache disorder experienced brain freeze headache with the same stimulus. These observations are robust and have been <a href="http://cep.sagepub.com/content/32/15/1123.abstract">replicated</a>.</p>
<h2>What causes brain freeze?</h2>
<p>An old fashioned idea about the cause of migraine suggested excessive blood flow through the blood vessels that supply blood to the brain caused the pain. However, this vascular hypothesis for migraine, <a href="https://en.wikipedia.org/wiki/Migraine">although still popular</a>, is now largely <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev-physiol-030212-183717">discredited</a>.</p>
<p>Just like migraines, brain freeze headaches are accompanied by <a href="http://www.fasebj.org/content/26/1_Supplement/685.4.abstract">changes in blood flow</a> through <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127417/">the arteries of the brain</a>. The link between pain associated with altered brain artery blood flow has <a href="http://www.wakehealth.edu/News-Releases/2013/Brrrrrrrrr!_It_s_Brain_Freeze_Season.htm">led some to speculate</a> the blood flow changes may actually <a href="http://cep.sagepub.com/content/early/2016/05/19/0333102416650704.abstract">cause the pain</a>. But an association between blood flow and pain doesn’t necessarily mean one causes the other.</p>
<p><a href="http://www.nature.com/scientificamerican/journal/v299/n2/full/scientificamerican0808-56.html">Another theory</a> about what causes migraine relates to altered excitability of neuronal pathways that detect and transmit the sensation and pain in the head via the <a href="http://emedicine.medscape.com/article/1873373-overview">trigeminal system</a>, the major nerve that transmits sensory information from the head to the central nervous system.</p>
<p>Ordinarily the cold sensation is not painful. However, if the trigeminal system is prone to over-excitability in people with migraine, pain kicks in at lower level (a lower threshold). If an over-excitable trigeminal system also applies to people with brain freeze, then the threshold may be low enough to activate pain after only a brief exposure to ice cream.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1171&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1171&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1171&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150029/original/image-20161214-18882-uz447v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><span class="source">Zenobia Ahmed / The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Researchers are studying what causes hyper-excitability of the trigeminal system. The effects of a specific chemical signalling molecule CGRP (calcitonin gene-related peptide) released by trigeminal neurons are a <a href="http://www.nature.com/scientificamerican/journal/v299/n2/full/scientificamerican0808-56.html">necessary component of migraine pain</a>.</p>
<p>In genetically inherited migraine, the cellular processes that result in the release of CGRP from trigeminal neurons <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev-physiol-030212-183717">has been altered</a>. These same mechanisms may explain the hypersensitivity to cold stimulus in ice cream headaches.</p>
<p>It seems likely that all headaches are the result of changes in activity in the trigeminal system, although why we perceive them in the front of the head and at the temples in particular is a mystery.</p>
<h2>Is there anything I can do to stop brain freeze?</h2>
<p>While we do not know exactly what causes brain freeze, there may be a simple way to reduce your chances of having one this summer.</p>
<p>Research shows how long brain freeze headaches last relates to the <a href="http://cep.sagepub.com/content/early/2016/05/19/0333102416650704.abstract">surface area</a> of the mouth that comes into contact with the cold stimulus. So, if you want to reduce your chance of a brain freeze, you may want to avoid gulping down your ice cream all at once. Take small nibbles instead.</p><img src="https://counter.theconversation.com/content/69621/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s a long, hot summer’s day and you’re looking forward to an ice cream. But within seconds of your first bite, you feel a headache coming on: a brain freeze. What’s going on?Yossi Rathner, Lecturer in Human Physiology, Swinburne University of TechnologyMark Schier, Senior Lecturer in Physiology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.