tag:theconversation.com,2011:/fr/topics/migraines-28119/articles
Migraines – The Conversation
2023-08-09T12:30:07Z
tag:theconversation.com,2011:article/207606
2023-08-09T12:30:07Z
2023-08-09T12:30:07Z
Women 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>
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<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>
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<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>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Tn91p-PY2h8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<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>
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<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 Campus
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/192063
2022-10-20T16:06:01Z
2022-10-20T16:06:01Z
Three 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">
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<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>
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<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 University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/181348
2022-07-11T12:29:10Z
2022-07-11T12:29:10Z
Migraine 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>
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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>
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<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>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ayfe4XWCZdg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<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 Campus
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/161276
2021-12-28T19:22:14Z
2021-12-28T19:22:14Z
When 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 University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/111334
2019-02-14T11:46:57Z
2019-02-14T11:46:57Z
Who’s stronger? An immunological battle of the sexes
<figure><img src="https://images.theconversation.com/files/257604/original/file-20190206-174887-yznwcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who has a stronger immune system?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/athlete-muscular-sportsmen-man-woman-hands-280168229?src=-zUOERaTql_d9KN408tPkA-1-2">Undrey/Shutterstock.com</a></span></figcaption></figure><p>Is there anything more exciting than a battle of the sexes? In popular culture, this usually focuses on societal gender roles. But, there’s another battle of the sexes, a biological war waged by the body’s immune system. Can this conflict finally tell us who is stronger – men or women? </p>
<p>In the United States, most people have, or know someone who has, an immune-related condition, like <a href="https://www.niaid.nih.gov/diseases-conditions/allergic-diseases">allergies</a>, <a href="https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page">migraines</a> or <a href="https://www.niaid.nih.gov/diseases-conditions/autoimmune-diseases">autoimmune diseases</a>. Chances are, these individuals are female. <a href="http://doi.org/10.1016/j.jaut.2016.02.011">Females have much higher rates of immune disorders</a>. One of these diseases is <a href="https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome">irritable bowel syndrome</a> (IBS), a disorder that causes significant abdominal pain. IBS affects 10 to 15 percent of the U.S. population, and is up to <a href="https://doi.org/10.1053/gast.2001.21908">four times more common in women</a> than in men.</p>
<p>To understand why, my research team is looking to mast cells, a type of white blood cell that is part of the immune system. <a href="https://www.researchgate.net/profile/Adam_Moeser">I am a gastrointestinal biologist</a>, and I’m interested in solving why factors, including being female or male, as well as life stress, increase vulnerability to certain disease, specifically through mast cells. At the Michigan State University College of Veterinary Medicine, my research team in the <a href="https://cvm.msu.edu/research/faculty-research/moeser">Gastrointestinal Stress Biology Laboratory</a> has discovered <a href="https://doi.org/10.1186/s13293-016-0113-7">unique sex differences in mast cells</a> that may explain why females are more prone to certain diseases compared with males.</p>
<h2>Female mast cells make and store more inflammatory substances</h2>
<p>When activated by stress or allergens, female mast cells release more inflammatory substances, which can provoke a more aggressive immune response such as <a href="https://medlineplus.gov/anaphylaxis.html">anaphylaxis</a> – a serious, potentially life-threatening allergic reaction – and <a href="https://www.verywellhealth.com/leaky-gut-syndromeintestinal-permeability-89258">leaky gut</a>. </p>
<p>We have discovered that mast cells isolated from <a href="https://doi.org/10.1186/s13293-016-0113-7">females make and store more inflammatory substances</a> – histamine, serotonin and proteases – than mast cells from males. These substances are responsible for many symptoms of mast cell-associated disease, including airway congestion, migraine headache, abdominal pain, digestive issues and shortness of breath. While mast cells from females and males have the same genes, with the exception of sex chromosome genes, their levels of gene activity differ significantly. In fact, we found that <a href="http://doi.org/10.1186/s13293-016-0113-7">more than 4,000 genes</a> were more active in female mast cells compared with those from males. </p>
<p>Further, many of the highly active genes in females produce proteins that are involved in manufacturing and storing inflammatory substances such as histamine and proteases. This unique difference in the ability of females to store and release more histamine and proteases may explain why female mast cells can trigger a more potent immune reaction. It also may suggest why women may be more vulnerable to certain diseases and disorders and men are more resistant. </p>
<h2>Men have higher mortality</h2>
<p>So far, it’s sounding pretty good for men. Their mast cells produce less inflammatory mediators and they are less prone to have hyperactive immune disorders like autoimmune disease, chronic pain disorders and IBS. But, there’s another side to the story that gives women a huge advantage. </p>
<p>Because <a href="http://doi.org/10.1002/bies.201200099">women have much stronger immune systems</a> than men, they can mount <a href="http://doi.org/10.1016/S1473-3099(10)70049-9">more effective immune responses against viruses</a> and bacteria. While the precise reason why females mount a greater immune response is not fully understood, mast cells are likely an important factor. </p>
<p>Mast cells are the first immune cells to become <a href="http://doi.org/10.1038/nri2782">activated in response to pathogen infections</a> and are critical for orchestrating the immune responses necessary for clearing infections and for developing protective immunity to prevent subsequent infections. Therefore, women’s immune systems are superior. </p>
<p>The immune system is also important for regulating the growth of cancer cells, which may be a major reason why <a href="https://doi.org/10.1038/s41467-019-08475-9">men have higher rates of</a> <a href="https://doi.org/10.1053/j.gastro.2007.04.061">death from cancer</a>. The greater immune response in females is not just in humans; this <a href="http://doi.org/10.1038/nri.2016.90">pattern is observed across species</a>. </p>
<h2>Sex differences emerge early in life</h2>
<p>As precision medicine continues to develop, sex-specific treatments for immune-triggered conditions may become available. These therapies could moderate mast cell activity and stop the onset of disease. To do this, research must identify exactly when mast cells begin behaving differently in both sexes.</p>
<p>Research already shows that many immune-triggered conditions show <a href="https://doi.org/10.1111/j.1398-9995.1998.tb03954.x">a sex bias in children</a> <a href="http://doi.org/10.1097/MPG.0000000000000714">before they reach puberty</a>. Because of this, my research team is looking beyond adult sex hormones as the main arbiter of sex differences in mast cell diseases. </p>
<p>Our current research at <a href="https://cvm.msu.edu/research/faculty-research/moeser">MSU’s Gastrointestinal Stress Biology Laboratory</a> focuses on when sex differences in mast cells emerge during development. We are also examining whether or not exposure of the fetus to hormones called androgens can contribute to sex differences in mast cells and disease susceptibility throughout life. At MSU, instead of looking at adult sex hormones we are beginning to look much earlier in the life cycle.</p>
<p>This exploratory research focusing on early life origins of sex differences in mast cells represents a new area of investigation and will hopefully help us understand why females are more vulnerable to, or why males are protected from, mast-cell related diseases throughout life. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257816/original/file-20190207-174880-k7tt7a.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">Take the time to destress and meditate. Your immune system will thank you.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pretty-joyful-brunette-woman-meditating-553195012?src=AVyAn3yI6MnOzcacqZCbkw-1-8">Look Studio/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Don’t stress</h2>
<p>Right now, people with immune-triggered conditions can’t do much to change the effects of sex and genetics on their mast cells. But understanding which lifestyle factors invoke hyperactive mast cells, causing them to release the chemicals that make us miserable, is important for minimizing disease. </p>
<p>Stress is a potent activator of mast cells and thus, monitoring stress levels using management strategies may help mitigate some disease severity. Self-management strategies include practices like proper diet, exercise, and sleep regimens. It will be critical to understand the impact of stress on men and women as this can influence the vulnerability and severity of these immune diseases.</p><img src="https://counter.theconversation.com/content/111334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Moeser receives funding from The National Institutes of Health (NIH): National Institutes of Allergy and Infectious Disease (NIAID) and Child Health and Human Development (NICHD), and The United States Department of Agriculture. </span></em></p>
Women are more prone to immune-related diseases like allergies and irritable bowel syndrome. But this may be due to the fact that they have super-strong immune systems.
Adam Moeser, Matilda R. Wilson Endowed Chair, Associate Professor of Large Animal Clinical Sciences, Michigan State University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/90782
2018-03-06T09:38:07Z
2018-03-06T09:38:07Z
Drilling holes in the skull was never a migraine cure – here’s why it was long thought to be
<figure><img src="https://images.theconversation.com/files/208876/original/file-20180305-65541-34tup5.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">wellphoto/Shutterstock.com</span></span></figcaption></figure><p>Trepanation – the technique of removing bone from the skull by scraping, sawing, drilling or chiselling – has long fascinated those interested in the darker side of medical history. One stock <a href="http://mentalfloss.com/article/52689/5-bizarre-and-scary-historical-headache-cures">tale</a> is that <a href="http://scienceblogs.com/neurophilosophy/2008/01/24/an-illustrated-history-of-trep/">trepanning</a> is one of the most ancient treatments for migraines. As I study the history of the migraine, it certainly has always caught my attention.</p>
<p>The word trepanation comes from the Greek <em>trypanon</em>, meaning a borer. The earliest known trepanned skulls date from around 10,000 BCE, and come from North Africa. There are <a href="https://www.ncbi.nlm.nih.gov/pubmed/17961050">trepanation accounts</a> in the Hippocratic texts (5th century BCE), when it was used in cases of fracture, epilepsy or paralysis, and in the second century CE Galen wrote of his experiments with trepanation on animals in his clinical studies. </p>
<p>But the reasons for trepanning remain largely unknown. While the famous 17th-century physician William Harvey may have <a href="https://books.google.co.uk/books?id=iZ6Qnh_helkC&printsec=frontcover#v=onepage&q=trepand&f=false">suggested</a> that the procedure was used for migraines, <a href="https://books.google.co.uk/books?id=3Hp5AgAAQBAJ&printsec=frontcover#v=onepage&q&f=false">recent authors</a> have acknowledged that there is little evidence to suggest this. So where did this persistent idea come from?</p>
<h2>Migraines and fairies</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203612/original/file-20180126-100926-wcv3p9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inca skull showing trepanning.</span>
<span class="attribution"><span class="source">© Wellcome Collection</span></span>
</figcaption>
</figure>
<p>The real source of the myth seems to have come much later. In 1902, the Journal of Mental Science published a <a href="https://wellcomelibrary.org/item/b22430349#?c=0&m=0&s=0&cv=2&z=-0.7296%2C0%2C2.4592%2C1.5881">lecture by Sir Thomas Lauder Brunton</a>, a London physician well-known for his work on pharmacology and ideas about migraine pathology. The lecture mixed neurological theory and armchair anthropology, and ranged over subjects including premonitions, telepathy, hypnotism, hallucinations, and epileptic and migrainous aura. In one notable passage, Brunton proposed that visions of fairies and the sound of their jingling bells were “nothing more” than the zigzags of migraine aura, and the aural results of nerve centre stimulation. </p>
<p>Brunton proposed that openings bored into ancient Stone Age skulls during life had been made to cure migraine. His suggestion followed considerable excitement during the 1870s when the French physician and anthropologist <a href="http://www.nnce.org/Arquivos/Seminarios/2008.1/03-Marco/fabiano_castro_pdf_0801.1_2de2_mar.pdf">Paul Broca</a> claimed that ancient skulls discovered in Peru and France had not only been opened surgically during life in order to release evil spirits, but that the patients had survived. To Brunton, it seemed obvious that the holes would have been made at the request of migraine sufferers in order to “let the headache out”. He wrote: </p>
<blockquote>
<p>For when the pain of headache becomes almost unbearably severe, an instinctive desire sometimes arises either to strike the place violently in the hope of relieving the pain, or to wish that some operation could be done to remove the pain. </p>
</blockquote>
<p>The French surgeon <a href="https://archive.org/details/b29005668">Just Lucas-Champonnière</a> had claimed in 1878 that some South Sea islanders still performed a similar procedure but, essentially, Brunton’s ideas about trepanning were as imaginative as his thoughts on fairies. </p>
<p>Nevertheless, the theory gained traction. In 1913, the world-famous American physician <a href="https://archive.org/stream/evolutionofmoder00osleuoft#page/8/mode/2up/search/trephining">William Osler repeated</a> that trepanation operations had been used “for epilepsy, infantile convulsions, headache and various cerebral diseases believed to be caused by confined demons”. By 1931, T Wilson Parry (who was partial to the odd <a href="http://broughttolife.sciencemuseum.org.uk/broughttolife/objects/display?id=96064">experiment</a> of his own) <a href="https://www.sciencedirect.com/science/article/pii/S0140673600996752">reasoned in The Lancet</a> that as the large numbers of trepanned skulls found throughout France could not all be accounted for by epilepsy, the procedure must also have been used to cast out “other devils”. He proposed that this included disorders with “exasperating” head symptoms such as migraine, giddiness, “and distracting noises of the head”. </p>
<h2>A ‘burr hole’</h2>
<p>If Victorian theories about ancient trepanation for migraine were largely speculative, there is evidence of cutting holes in skulls for migraine somewhat closer to home. In 1936, Alfred Goltman, a physician from Tennessee, <a href="http://www.jacionline.org/article/S0021-8707(36)90320-9/pdf">observed something strange</a> about a woman with migraine that he was treating for allergies. </p>
<p>In the left frontal region of her skull, the woman had a depression, an inch in diameter, with a marked concentration of blood vessels. Four years earlier, she had been admitted to the care of Dr Raphael Eustace Semmes, the first neurosurgeon in Memphis, who had trained under Harvey Cushing, the American “father” of modern neurosurgery. Semmes had drilled a small circular opening known as a “burr hole” during one of the woman’s severe headaches, while she was under local anaesthetic. As he opened the thick membrane surrounding the brain, “a quantity of fluid escaped under increased pressure”. There was no evidence of a tumour. </p>
<p>This now seems a troubling era in experimental interventionist neurosurgery. Between the 1890s and the 1920s, some surgeons believed that brain surgery could “cure” inherited criminal tendencies. Children <a href="https://books.google.co.uk/books?id=oA3iDgAAQBAJ&pg=PA71&lpg=PA71&dq=gavrus+making+bad+boys+good&source=bl&ots=vAo5GBDhj_&sig=ph7dqs1VpCv5m368D4hZS9nRHrk&hl=en&sa=X&ved=0ahUKEwifzJKetvbYAhUGe8AKHQq3BKEQ6AEIQTAI#v=onepage&q=gavrus%20making%20bad%20boys%20good&f=false">referred by juvenile courts</a> were operated on in an attempt to release “pressure on the brain”, a procedure with a mortality rate of up to 42%. By the 1930s, <a href="https://academic.oup.com/neurosurgery/article-abstract/48/3/647/2751739">frontal lobotomy</a> was emerging as a treatment for mental illness. </p>
<p>Semmes’ patient survived the surgery, but her migraine headaches did not stop. Goltman noticed that during her headaches the depression left by the surgery began to fill up. As the migraine attack ended, the swelling would recede. Goltman’s observations helped influence the widespread acceptance of a theory that would dominate understanding of migraine until the 1970s: that the origin of migraine headache must be vascular, characterised by dilation of the blood vessels during the attack. </p>
<p>While we now see migraine as <a href="http://migraineresearchfoundation.org/about-migraine/what-is-migraine/">neurological</a>, much still remains to be discovered about its causes and mechanisms in the brain. In some ways, trepanning does seem a logical response to the intense pain of migraine. As Andrew Levy notes in his <a href="https://books.google.co.uk/books?id=42ixkES5V64C&pg=PT27&lpg=PT27&dq=levy+%22it+longs+to+be+cut+open%22&source=bl&ots=Apflp3Gk7c&sig=EIAmpFVelj0yWZKZdBfHvbygZc&hl=en&sa=X&ved=0ahUKEwix34r1tvbYAhUBB8AKHaR-Dg8Q6AEIKTAA#v=onepage&q=%22longs%20to%20be%20cut%20open%22&f=false">memoir</a>: “The migraining head wants to be cut open; it longs to be cut open.” This does not, of course, mean that it should be.</p><img src="https://counter.theconversation.com/content/90782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Foxhall has received funding from Wellcome Trust (Grant No. 091650/Z/10/Z)</span></em></p>
One stock history of medicine tale is that trepanning is one of the most ancient treatments for migraines.
Katherine Foxhall, Lecturer in History, University of Leicester
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/64497
2016-09-08T09:39:32Z
2016-09-08T09:39:32Z
Migraines were taken more seriously in medieval times – where did we go wrong?
<figure><img src="https://images.theconversation.com/files/136637/original/image-20160905-4795-1neeuil.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">Migraine Action</span></span></figcaption></figure><p>Have you ever experienced a migraine? If so, perhaps you recognise this:</p>
<blockquote>
<p>It feels as if there is hammering and pounding in the head. Sound or talking is unbearable, as is light or glare. The pain arises from hot, choleric fumes, together with windiness. And so one feels piercing, burning and ringing.</p>
</blockquote>
<p>Such a precise explanation of the pain and disorientation experienced during a migraine might have been written yesterday. In fact, it comes from <a href="https://books.google.co.uk/books?id=Yn11Ymj_1GIC&redir_esc=y">an encyclopedia</a>, compiled by the Franciscan monk Bartholomaeus Anglicus (Bartholomew the Englishman), in the 13th century. </p>
<p>There aren’t many ailments that have maintained so clear a course over so many centuries. And what’s more, looking at the history of migraines reveals that the ailment was actually taken more seriously in the past, something we can learn a lot from today.</p>
<h2>Hemicrania deciphered</h2>
<p>We can pinpoint the beginning of the history of migraine as a named disorder to <a href="http://www.sciencemuseum.org.uk/broughttolife/people/galen">Galen</a> (c. 129 – c. 216/17 CE), the most famous philosopher and physician in the Roman Empire. Galen set migraine, or <em>hemicrania</em> as he termed it, apart from other types of headache: as a painful disorder affecting only half the head, caused by the ascent of vapours from the stomach that were excessive, too hot, or too cold. </p>
<p>The 12th-century text of Causae et Curae, which scholars generally accept as the work of the the celebrated German abbess <a href="http://www.lulu.com/gb/en/shop/priscilla-throop/causes-and-cures-of-hildegard-of-bingen/paperback/product-20199717.html">Hildegard of Bingen</a> (1098-1179), gave a compelling explanation of why migraine seized only half the brain at a time: this was a bodily force so powerful, that if it seized the whole head, the pain would be unendurable. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=993&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=993&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=993&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1248&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1248&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136705/original/image-20160906-6124-12cpapi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1248&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An 18th-century portrait of Galen.</span>
</figcaption>
</figure>
<p>Although Galen’s writings were lost with the fall of the Roman Empire, Galen’s term, <em>hemicrania</em>, persisted, being adapted and adopted into various languages over the centuries. For example, in Middle English, we find <em>emigranea</em> and in medieval Wales the term <em>migran</em>. William Dunbar, writing in Middle Scots, used the term <em>magryme</em> in <a href="http://stylisticienne.com/medieval-migraine/">his poem describing the physical pain of migraine</a> as being like an arrow piercing his brow, a pain so bad that he couldn’t look at the light. Dunbar also captured the migraine aftermath, the “postdrome” that came with the new morning, when he sat down to write but was unable to find any words. His head “dulled in dullness”, his body was unrefreshed, his spirit asleep.</p>
<p>Throughout the 16th and 17th centuries, a wealth of remedies in manuscript and printed recipe collections suggest a sophisticated general knowledge about this disorder. For example, Jane Jackson’s recipe book, dating from 1642, gives six separate recipes for “Migrim in the Head”, requiring various amounts of effort to produce. The <a href="http://wellcomelibrary.org/item/b19335891#?asi=0&ai=19">simpler remedies</a> could be made in a few minutes from common garden ingredients (mix houseleek and earthworms with flour, spread it on a cloth and bind to the forehead), but the <a href="http://wellcomelibrary.org/item/b19335891#?asi=0&ai=104">most complex concoction</a> required equipment, planning and financial outlay to produce a medicine that would last 20 years. </p>
<p>As well as taking migraine seriously, Jackson’s recipe book suggests that people of the 17th century appreciated that migraine could occur on a spectrum, from the occasional acute attack to a chronic illness that could last for several days.</p>
<h2>Losing legitimacy</h2>
<p>These historical descriptions of migraine reveal that we have lost something. In all of the sources from the medieval and early modern period that I have come across during the five years I have spent tracing the history of migraine, one thing is clear: these people took migraine seriously.</p>
<p>This is important. Migraine is now accepted as a “real” disorder which affects around one in seven people, two-thirds of whom are women, and is <a href="http://www.who.int/mediacentre/factsheets/fs277/en/">recognised by the WHO</a> as the sixth highest cause worldwide of years lost due to disability (YLD). But despite this, it (along with other headache disorders) is nevertheless <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2982.2007.01396.x/abstract">chronically under-funded</a>, its sufferers often ignored, dismissed or blamed, and their ailments <a href="http://www.tandfonline.com/doi/abs/10.1185/0300799019117017">under-diagnosed and under-treated</a>. In her recent book <a href="http://joannakempner.com/nottonight/">Not Tonight</a>, the sociologist Joanna Kempner has described this situation as migraine’s “legitimacy deficit”. </p>
<p>So what has happened? Historical sources suggest that the question we need to ask is not how we can begin to give migraine the legitimacy it needs, but when and why we stopped taking it seriously in the first place.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=666&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=666&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136634/original/image-20160905-4795-r37cbb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=666&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘La migraine’, 1823.</span>
</figcaption>
</figure>
<p>Over the course of the 18th century, something changed, as migraine became the stuff of ridicule. In May 1782, for instance, a flamboyant character graced the King’s Theatre Masquerade in London, and introduced himself to the gathering as “<a href="https://migrainehistories.wordpress.com/2015/08/14/how-migraine-lost-its-legitimacy/">Le Sieur Francois de Migraine, Docteur en Medicine</a>”. And in the summer heat of August 1787, the General Evening Post described how “half Paris had the migraine, and no lady of fashion could be prevailed upon to quit her boudoir”. Migraine was becoming something to joke about, a complaint that affected a particular kind of person, usually female. </p>
<p>By the 19th century, <a href="http://www.sciencedirect.com/science/article/pii/S0140673602402632">physicians routinely talked</a>
of young female “martyrs”, and of sick headache and megrim as a disorder of “mothers in the lower classes of life” whose minds and bodies had been weakened by daily toil, disturbed sleep, insufficient nourishment and constant lactation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136629/original/image-20160905-4760-1ax7kem.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ring any bells?</span>
<span class="attribution"><span class="source">Migraine Action</span></span>
</figcaption>
</figure>
<p>During the 1980s, many migraine sufferers took the opportunity to share their experiences of migraine by entering four international art competitions. The resulting collection, which includes over 500 pieces, reveals the powerful effect migraine has on people’s lives. Perhaps most striking is the frequency with which motifs such as arrows, hammering, pounding, light, glare and disorientation appear in this art – seemingly as familiar to sufferers today as they were to the medieval poets and physicians who discussed this disorder nearly 1,000 years ago. </p>
<p>For the first time, this collection is the subject of a <a href="http://www.migraineart.org.uk/">dedicated website</a>, which has now been launched by the charity <a href="http://www.migraine.org.uk/">Migraine Action</a> as part of <a href="http://www.migraine.org.uk/get-involved/migraine-awareness-week">Migraine Awareness Week</a>.</p>
<p>These paintings, backing up a thousand years of historical sources, make it clear that migraine is more than just a headache. It needs to be taken as seriously now as it was by Galen.</p><img src="https://counter.theconversation.com/content/64497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Foxhall received funding from the Wellcome Trust (Grant No. 091650/Z/10/Z) for her research into the history of migraine. She collaborated with Migraine Action to develop the Migraine Art Collection website, with funding from the University of Leicester Impact Award. </span></em></p>
A thousand years of historical sources make it clear that migraine is more than just a headache.
Katherine Foxhall, Lecturer in History, University of Leicester
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/60712
2016-07-20T20:05:10Z
2016-07-20T20:05:10Z
Migraines in childhood and adolescence: more than just a headache
<figure><img src="https://images.theconversation.com/files/131170/original/image-20160720-7910-13e4qch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Childhood migraine has been found to be associated with early stress. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This is part of our series on kids’ health. Read the other articles in our series <a href="https://theconversation.com/au/topics/kids-health">here</a>.</em></p>
<hr>
<p>Headaches are uncommon in toddlers. But between the ages of three and seven, around 5% to 50% of children experience headaches of some type. From seven to 15 years, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24641507">headache prevalence peaks at up to 75%</a>. The vast majority of headaches experienced are tension-type headaches that don’t need specific treatment. But a quarter of these troublesome headaches are migraines.</p>
<p>Migraine headaches are the most common type of severe headache. They occur when networks of sensory and regulatory nerves deep in the brain are disordered. The details of exactly how migraines work are not yet fully understood but research in this area has made <a href="http://www.ncbi.nlm.nih.gov/pubmed/25926442">rapid progress</a>, especially in the last decade.</p>
<p>Many adults who have a lifelong problem with migraines first experience them in childhood or adolescence. Migraine headaches occur in 15% to 18% of children, and the prevalence peaks between the ages of 11 and 13. </p>
<p>These figures are <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2003.00568.x/abstract;jsessionid=FD02A127FD1AA7945BFA23D52E93FF69.f02t02?userIsAuthenticated=false&deniedAccessCustomisedMessage=">similar in adults</a>. The worst 10% of adult sufferers account for 85% of the overall time lost to headaches. This suggests that if you don’t get effectively treated or grow out of your adolescent migraines, they <a href="http://link.springer.com/article/10.1007/s10194-009-0133-3">may get progressively worse</a>.</p>
<p>Much of <a href="http://www.ncbi.nlm.nih.gov/pubmed/27322543">the risk of having migraines is genetic</a> so it is no surprise that two-thirds of childhood migraine sufferers have a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25304765">family history of disabling migraine</a>.</p>
<h2>What causes childhood migraine?</h2>
<p>There are some significant differences between migraines that occur early in life and those that occur later. A clear link between <a href="https://www.sciencedaily.com/releases/2010/01/100106003608.htm">childhood adversity</a> and migraine predisposition throughout life is <a href="https://consumer.healthday.com/head-and-neck-information-17/migraine-news-477/emotional-abuse-during-childhood-linked-to-migraine-risk-708301.html">emerging from current research</a>. </p>
<p>The <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2009.01558.x/full">influence is likely to be complex</a> and is currently poorly understood. It may well be that prolonged exposure of a developing brain to excessive stress causes neuroplastic changes or altered biochemistry that create a migraine-prone brain forever after.</p>
<p>Early onset of migraine symptoms indicates a child is at increased risk of a number of other conditions characterised by severe episodes of symptoms that occur in a cyclical fashion, such as abdominal pain, vertigo and <a href="https://en.wikipedia.org/wiki/Torticollis">torticollis</a> (where the position of the head or neck is abnormal or asymmetrical). These “<a href="http://bit.ly/29PldsO">episodic syndromes</a>” are highly distressing and disabling. They may reflect a common disorder of pain processing and are considered variants of migraine.</p>
<p>There are documented associations of early-onset migraine with <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1468-2982.2003.00486.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=">emotional and behavioural difficulties</a>. Understanding these relationships better will contribute enormously to potential prevention strategies but also perhaps to new treatment approaches. </p>
<p>The most <a href="http://www.ncbi.nlm.nih.gov/pubmed/21044280">common triggers</a> for childhood migraine are similar to adults: emotional stress, sleep deprivation, skipping food, menstruation and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19545255">weather</a>. </p>
<p>Hormonal fluctuations during <a href="http://www.ncbi.nlm.nih.gov/pubmed/27017029">young women’s periods</a> are one of the most consistently disabling trigger factors and many sufferers may need oral contraceptives to regulate hormone levels. It seems these common triggers may all <a href="http://www.ncbi.nlm.nih.gov/pubmed/26639834?log$=activity">increase oxidative stress</a> (chemical not emotional stress) in the brain. </p>
<p>It will no doubt be welcome news that while chocolate remains a common scapegoat in headache causation, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25567457">scientific evidence for this belief is thin</a>.</p>
<h2>How to treat childhood migraines</h2>
<p>It’s important to accurately evaluate frequent or severe childhood headaches given these children’s quality of life is <a href="http://pediatrics.aappublications.org/content/112/1/e1.short">severely impaired</a> and the long-term impacts may be substantial. </p>
<p>The doctor needs to thoroughly explore psychological and social factors, which may require tact and time for trust to develop. School absences must be prevented or mitigated so the child does not fall behind her peers either academically or socially. Having a <a href="https://www.migrainetrust.org/wp-content/uploads/2015/12/CIRC_School-Policy-Guideline-Headache-FINAL-10Oct11.pdf">formal plan</a> may help the school accommodate young headache sufferers. </p>
<p>The Royal Australian College of General Practitioners has published <a href="http://www.racgp.org.au/afp/2015/june/managing-childhood-migraine/#15">recommendations for GPs</a> to use analgesics or migraine drugs (known as triptans) to treat migraine, but to also focus on addressing possible environmental, social, and psychological factors that could be at play. </p>
<p>Treatment of migraines in childhood support the idea that it is virtually a different disorder compared to adults. Thankfully, simple pain relief such as non-steroidal anti-inflammatories (NSAIDs) including aspirin and ibuprofen are more effective than in adults. Allowing the child to sleep if they want to is also very effective. </p>
<p>The triptans – standard drugs for aborting attacks in adults – <a href="http://www.neurology.org/content/48/4/1100.short">do not seem to work</a> as well in children. The response to medication becomes more <a href="http://www.ncbi.nlm.nih.gov/pubmed/27316535">“adult-like”</a> after puberty. </p>
<p>First-line preventive treatments used in adults, such as propranolol (a heart medication), amitriptyline (an antidepressant) and sodium valproate (usually used to treat epilepsy) have <a href="http://www.ncbi.nlm.nih.gov/pubmed/15012660">not been thoroughly studied</a> for efficacy in children, though they do appear safe for short- to medium-term use. </p>
<p>Decisions about prevention against frequent, disabling attacks require careful thought and are probably best done in conjunction with a paediatrician or paediatric neurologist. Treatment plans for preventing frequent and severe headaches may need to include input from a multidisciplinary team to ensure triggers are addressed by all available means, not just pharmacological ones.</p>
<p>In general, while migraine remains a lifelong predisposition when it starts in childhood or adolescence, the outlook is pretty positive. From the peak of the mid-teenage years, both the frequency and average severity of acute migraine attacks tends to drop off the older you get until a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20713557">second peak in the 50s</a>. </p>
<p>For such a common and disruptive condition, it is perhaps a bit surprising we don’t know more. Effective early intervention and well-organised diagnosis and treatment of childhood migraines may save severe adult sufferers from decades of underachievement and frustration.</p>
<hr>
<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p>
<p><em><a href="https://theconversation.com/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal-60257">Nightmares and night terrors in kids: when do they stop being normal?</a></em></p>
<p><a href="https://theconversation.com/bed-wetting-in-older-children-and-young-adults-is-common-and-treatable-60248"><em>Bed-wetting in older children and young adults is common and treatable</em></a></p><img src="https://counter.theconversation.com/content/60712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Vagg 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>
Many adults who have a lifelong problem with migraines first experience them in childhood or adolescence.
Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon Health
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/59226
2016-07-12T02:22:50Z
2016-07-12T02:22:50Z
Why emotional abuse in childhood may lead to migraines in adulthood
<figure><img src="https://images.theconversation.com/files/125393/original/image-20160606-13070-h02qfr.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="http://www.shutterstock.com/pic-225460837/stock-photo-woman-suffers-from-pain-headache-sickness-migraine-stress-insomnia-hangover-in-casual-dress.html?src=_ycJXgQsKNjRMXELGPo-kw-1-15">Migraine image via www.shutterstock.com.</a></span></figcaption></figure><p>Child abuse and neglect are, sadly, more common than you might think. According to a 2011 study in <a href="http://dx.doi.org/10.1001/jamapediatrics.2014.410">JAMA Pediatrics</a>, more than five million U.S. children experienced confirmed cases of maltreatment between 2004 and 2011. The effects of abuse can linger beyond childhood – and migraine headaches might be one of them.</p>
<p>Previous research, including our own, has found a link between experiencing migraine headaches in adulthood and experiencing emotional abuse in childhood. So how strong is the link? What is it about childhood emotional abuse that could lead to a physical problem, like migraines, in adulthood?</p>
<h2>What is emotional abuse?</h2>
<p>The Centers for Disease Control and Prevention <a href="https://www.cdc.gov/violenceprevention/pdf/cm_surveillance-a.pdf">defines childhood maltreatment as</a>:</p>
<blockquote>
<p>Any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.</p>
</blockquote>
<p>Data suggest that up to <a href="http://dx.doi.org/10.1001/jamapediatrics.2014.410">12.5 percent of U.S. children</a> will experience maltreatment by their 18th birthday. However, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20882586">studies using self-reported data</a> suggest that as many as 25-45 percent adults in the U.S. report experiencing emotional, physical or sexual abuse as a child.</p>
<p>The discrepancy may be because so many cases of childhood abuse, particularly cases of <a href="https://www.cdc.gov/violenceprevention/pdf/cm_surveillance-a.pdf">emotional or psychological abuse</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/27194425">are unreported</a>. This specific type of abuse may occur within a family over the course of years without recognition or detection. </p>
<h2>The link between emotional abuse and migraines</h2>
<p>Migraine is a type of <a href="http://ihs-classification.org/en/02_klassifikation/02_teil1/01.00.00_migraine.html">chronic, recurrent moderate to severe headache</a> affecting about <a href="http://dx.doi.org/10.1111/head.12150">12-17 percent</a> of the people in the U.S. Headaches, including migraine, are the fifth leading cause of <a href="http://dx.doi.org/10.1111/head.12074">emergency department visits</a> and the sixth highest cause of <a href="http://www.who.int/mediacentre/factsheets/fs277/en/">years lost due to disability</a>. Headaches are about three times more common in women than men.</p>
<p>While all forms of childhood maltreatment have been shown to be linked to migraines, the strongest and most significant link is with emotional abuse. Two studies, one using a nationally representative sample of adults with <a href="http://dx.doi.org/10.1212/WNL.0000000000001120">a median age of 50</a> and one using a large sample of adults in California with <a href="http://www.ncbi.nlm.nih.gov/pubmed/20958295">a median age of 56</a>, have found a link to migraine and frequent headaches, respectively.</p>
<p>We have also examined the emotional abuse-migraine link in young adults. In our <a href="http://www.abstractsonline.com/pp8/#!/4046/presentation/8663">study</a>, we found that those recalling emotional abuse in childhood and adolescence were over 50 percent more likely to report being diagnosed with migraine. We also found that if a person reported experiencing all three types of abuse (physical, emotional and sexual), the risk of being diagnosed with migraine doubled.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=590&fit=crop&dpr=1 600w, https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=590&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=590&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=742&fit=crop&dpr=1 754w, https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=742&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/129897/original/image-20160708-24071-4u61z0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=742&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stress can cause changes in the brain.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-228208372/stock-photo-imaging-of-the-brain-on-x-ray.html?src=cpF1A2KyFchmN8MhB9OZ8Q-1-15">Brain image via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<h2>Why would emotional abuse in childhood lead to migraines in adulthood?</h2>
<p>The fact that the risk goes up in response to increased exposure is what indicates that abuse may cause biological changes that can lead to migraine later in life. While the <a href="http://dx.doi.org/10.1007/s11940-016-0415-4">exact mechanism</a> between migraine and childhood maltreatment is not yet established, research has deepened our understanding of what might be going on in the body and brain.</p>
<p>Adverse <a href="http://www.sciencedirect.com/science/article/pii/S0031938411004045">childhood experiences</a> are known to upset the regulation of what is called the hypothalamic-pituitary-adrenal (HPA) axis, which controls the release of stress hormones. In plain English, that means experiencing an adverse event in childhood can disrupt the body’s response to stress. Stress isn’t just an emotion – it’s also a physical response than can have consequences for the body. </p>
<p>Prolonged elevation of these stress hormones can alter both the structure and function of the brain’s limbic system, which is the seat of emotion, behavior, motivation and memory. MRIs have found alterations in structures and connections within the limbic system both in people with a history of <a href="http://dx.doi.org/10.3389/fnhum.2012.00052">childhood maltreatment</a> and <a href="http://dx.doi.org/10.1007/s11940-016-0415-4">people diagnosed with migraine</a>. <a href="http://dx.doi.org/10.1038/nn.4086">Stressful experiences</a> also disrupt the immune, metabolic and autonomic nervous systems. </p>
<p>Both <a href="http://dx.doi.org/10.1111/acps.12217">childhood abuse</a> and <a href="http://dx.doi.org/10.1007/s11940-016-0415-4">migraine</a> have been associated with elevation of c-reactive protein, a measurable substance in the blood (also known as a biomarker), which indicates the degree of inflammation. This biomarker is a well-established predictor of cardiovascular disease and stroke. </p>
<p>Migraine is considered to be a <a href="http://dx.doi.org/10.1016/S1474-4422(14)70220-0">hereditary</a> condition. But, except in a small minority of cases, the genes responsible have not been identified. However, stress early in life induces alterations in gene expression without altering the DNA sequence. These are called <a href="http://dx.doi.org/10.1186/s13148-015-0156-3">epigenetic changes</a>, and they are long-lasting and may even be passed on to <a href="http://dx.doi.org/10.1007/s00702-016-1570-1">offspring</a>. The role of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584973/pdf/1741-7015-11-26.pdf">epigenetics in migraine</a> is in the early stages of investigation.</p>
<h2>What does this mean for doctors treating migraine patients?</h2>
<p>Childhood maltreatment probably contributes to only a small portion of the number of people with migraine. But because research indicates that there is a strong link between the two, clinicians may want to bear that in mind when evaluating patients. </p>
<p>Treatments such as cognitive behavioral therapy, which alter the neurophysiological response to stress, have been shown to be effective treatments for <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616982/pdf/10.1177_2049463715578291.pdf">migraine</a> and also for the psychological effects of <a href="http://dx.doi.org/10.1080/01612840500184012">abuse</a>. Therefore CBT may be particularly suited to persons with both. </p>
<p>Anti-epileptic drugs such as valproate and topiramate are FDA-approved for migraine treatment. These drugs are also both known to <a href="http://dx.doi.org/10.1111/j.0013-9580.2004.00104.x">reverse stress-induced epigenetic changes</a>. </p>
<p>Other therapies that <a href="http://www.ncbi.nlm.nih.gov/pubmed/24977967">decrease inflammation</a> are currently under <a href="http://dx.doi.org/10.1177/0333102415618615">investigation for migraine</a>. </p>
<p>Migraineurs with history of childhood abuse are also at higher risk for <a href="http://dx.doi.org/10.1111/j.1526-4610.2009.01557.x">psychiatric</a> conditions like depression and anxiety, as well as for medical disorders like <a href="http://www.ncbi.nlm.nih.gov/pubmed/19845780">fibromyalgia and irritable bowel syndrome</a>. This may affect the treatment strategy a clinician uses.</p>
<p>Within a migraine clinic population, clinicians should pay special attention to those who have been subjected to maltreatment in childhood, as they are at <a href="http://www.ncbi.nlm.nih.gov/pubmed/19845782">increased risk of being victims of domestic abuse and intimate partner violence as adults</a>. </p>
<p>That’s why clinicians should screen migraine patients, and particularly women, for current abuse. </p>
<hr>
<p><em>This article was updated on August 4, 2016 to clarify that one of the studies referred to was not nationally representative. It was based on California data that found a link between childhood maltreatment and frequent headaches.</em></p><img src="https://counter.theconversation.com/content/59226/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gretchen Tietjen received funding from the American Headache Society to conduct research on headache and abuse in the past. </span></em></p><p class="fine-print"><em><span>Monita Karmakar 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 has found a link between experiencing migraine headaches in adulthood and experiencing emotional abuse in childhood. So how strong is the link?
Gretchen Tietjen, Professor and Chair of Neurology, University of Toledo
Monita Karmakar, Ph.D. Candidate in Health Education, University of Toledo
Licensed as Creative Commons – attribution, no derivatives.