A
Publication of the East Bay Headache Support Group
A Member of the Americal Council for Headache Education (ACHE) Support Group
Network
VoLUME 9, ISSUE 1
JANUARY 2004
January 13th Meeting: A Survivor’s Guide to Visiting the ER for Headache Relief
Have you ever had a headache so bad that you sought relief at the hospital’s Emergency Room? Many of us have, but not always with satisfactory results. The East Bay Headache Support Group is pleased to invite Dr. Stuart B. Shikora back again to talk about what to expect when you arrive at an ER with the complaint of severe head pain. What treatment options are available to you, and what can you do prior to the visit to maximize your chances of finding quick relief for your pain? These and other questions will be explored during Dr. Shikora’s presentation on January 13, the 8th anniversary of the support group.
Dr.
Shikora practices Emergency Medicine at Mt. Diablo Medical Center in Concord and
Kaiser Medical Center in Walnut Creek. He
trained at Hahnemann Medical College in Philadelphia, and is board certified in
both Internal Medicine and Emergency Medicine.
Dr. Shikora’s practice of Emergency Medicine covers 28 years, during
which he served as Chairman of the Emergency Department and President of the
Medical Staff at Mt. Diablo Medical Center.
We
will meet in the Hanson Room (formerly called Monterey Room), downstairs at John
Muir Medical Center, from 7:30 to 9:00 p.m. on Tuesday, January 13.
For more information, call 925-685-8775.
Allergies,
Asthma, and Migraine: More Than a
Casual Relationship?
By Roger K. Cady, MD
In
order to survive, all living organisms must be able to separate themselves from
their environment. They must be
able to absorb nutrients from that environment, while at the same time protect
themselves from injury and contamination. To
ensure that we live safely within our environment, nature has evolved complex
safeguards involving the nervous system, endocrine (hormonal) system, and immune
system. As part of this defense
system, each portal of entry into the human body has a sophisticated mechanism
in place to provide this protection. While
most of the time these defense mechanisms function flawlessly, there is the
potential for problems; and several important disorders, including migraine,
asthma and allergies, may reflect disruptions of these mechanisms.
Disruption of the defense mechanisms designed to protect the lung can
result in asthma. If those in the
skin or sinus go awry, allergies can result, and if those involving the nervous
system are disrupted, migraine can result.
People
with migraine inherit a nervous system that is more sensitive to change than
those without migraine. This
nervous system evolved to be highly vigilant of its environment.
When the migrainous nervous system is functioning well, this vigilance is
often reflected in positive ways. For
example, people with migraine are often well-organized, perceptive, and
successful in school and artistic activities. This heightened vigilance may also be why migraine sufferers
tend to be light sleepers and more emotionally vulnerable. However, if the nervous system perceives a threat from either
the external or internal environment, the nervous system response can be an
attack of migraine.
People
born with asthma inherit a respiratory system that is more sensitive and
vigilant of its environment than those without asthma.
When the respiratory system of an asthmatic is threatened, it can respond
dramatically by constricting the airways and initiating an inflammatory response
in this defense perimeter. This results in wheezing and airway restrictions.
In
a similar fashion, people with allergies respond in a variety of ways when their
systems are threatened. The most
dramatic is an anaphylactic reaction. This
is the type of reaction noted rarely with a bee sting or an injection of
penicillin and can be fatal. More
commonly, allergic individuals develop sinus or skin symptoms that can vary
considerably in severity. Seasonal
allergies are likely the most common allergic condition.
Symptoms generally consist of nasal congestion and discharge, eye
irritation, and sometimes headache. Allergies
can also be closely associated with asthma.
Observations
that link these seemingly diverse disorders together include the fact that they
are common in the general population, genetic facts appear to be important for
all of them, each can be triggered by internal or external threats, and each
represents an over-response or exaggerated response of the very mechanisms that
nature designed to protect us. Given
these similarities, it is not surprising that if you inherit one of these
disorders, you have a greater likelihood of inheriting one or more of the
others. In the recent American
Migraine Study II, 40% - 70% of respondents with migraine reported having
allergies. Other studies have
reported that people with migraine are 2 to 3.5 times more likely to have
asthma, especially if they have a parent with migraine and asthma.
Unraveling
the relationships these disorders have to each other poses many interesting
questions. For example, can
allergies or asthma trigger migraine? Clearly,
these associations appear to be popular beliefs.
For example, it has long been assumed that allergies are part of sinus
disease and that sinus disease, in turn, results in “sinus headache.”
In fact, most participants in the American Migraine Study II who had
diagnosed migraine also reported having “sinus headaches.”
However, whether sinus headache and migraine are distinct headache
disorders or related to one another is a matter of debate.
This
debate was the topic of a recent study presented at the American Academy of
Neurology meeting in May of this year (2001).
Dr. Curtis Schreiber evaluated a group of people who reported they had
recurrent attacks of sinus headaches. These
individuals were self-diagnosed and had never been evaluated by a physician as
having either sinus headaches or migraine.
They reported headaches that were frequently one-sided and usually
located in the area of the sinuses (around the eye or in the face). In addition, they often experienced nasal congestion and a
clear nasal discharge during their headaches.
Finally, many reported that changes in the weather could trigger attacks.
It appeared that these factors are what made them believe their headaches
were sinus-related.
After
a careful history and examination, Dr. Schreiber asked this group of patients to
keep diary records of their “sinus” headaches.
After evaluating these diaries, he concluded that over 95% of these
headaches actually met the criteria of the International Headache Society for
the diagnosis of migraine. However,
these headaches were also frequently accompanied by nasal symptoms and the pain
was located in the sinus area.
In
this group of self-diagnosed sinus headache patients, two other important
observations were noted. First,
these individuals experienced significant headache-related disability. In fact, the average score on the Headache Impact Test was
62, which is as high as the scores seen for many migraine patients who are
receiving medical care. This
indicates that these “sinus” headaches are not trivial or insignificant.
Second, this population was using many different medications including
sinus medications to treat their headaches, but most were dissatisfied with the
effectiveness of their medications. Dr.
Schreiber expressed concern that analgesic overuse could be a problem for these
people, especially if these headaches are in fact migraine. Ongoing studies are now underway to look at the treatment
needs for these headaches and to see if many of the headaches diagnosed as sinus
headaches by physicians and the general public are really migraine.
The
importance of this study is that it suggests a more than casual relationship may
exist between migraine and “sinus” symptoms such as face pain and nasal
symptoms. The nerve that conducts
the pain impulses from blood vessels during migraine also has branches that go
into the sinus cavities. It is
possible that an allergic response activates this nerve system (the trigeminal
nerve) that in turn develops into migraine.
Conversely, it may be that in some migraine attacks the sinus branch of
the trigeminal nerve is activated in the same manner as the trigeminal branches
that supply blood vessels are activated. This
activation could result in nasal symptoms being observed during migraine.
Clearly further research is needed in this area.
The
relationship between migraine and asthma is equally confusing.
Clearly, there is some overlap in the risk or triggering factors for
asthma and migraine—for example, stress and certain environmental exposures.
Often migraine sufferers with asthma report that both asthma and migraine
can worsen at the same time, and occasionally one seems to lead to the other.
Dr. Fred Sheftell recently observed that a group of migraine patients who
were given an asthma medication from a class of drugs known as leukotriene
inhibitors to prevent asthma also had a reduction in the frequency of their
migraine attacks. Consequently, he
conducted a small research study using this asthma medication as a migraine
preventive and reported it to be effective.
Further studies are underway.
It
is apparent that much more research is needed to fully understand the
relationships existing among migraine, asthma, and allergies.
Living with any or all of these disorders can be challenging.
Management goals for migraine, asthma, and allergy are the same: minimize
the frequency of attacks, rapidly control attacks once they have begun, preserve
normal function as much as possible, and prevent the evolution from the episodic
or intermittent form of these disorders into the chronic form.
There are no cures, but there are many effective therapies available for
each of these conditions. However,
they work best when an individual understands the unique way his or her system
interacts with its environment and is willing to develop a self-care lifestyle.
By
Roger K. Cady, MD. Primary Care
Network, Springfield, MO.
Excerpted from Headache, the Newsletter of ACHE, Summer 2001, vol. 12, no. 2.
“No,
you’re not crazy—you’re having a cluster headache” By
Christine Lay, MD, FRCP(C)
The
pain of cluster headache has been described as an excruciating, deep, boring
pain, like a hot poker in the eye. The
pain is like no other. Male
sufferers who have passed kidney stones say that they would rather pass another
stone, without pain medication, than have a cluster attack.
Female sufferers describe the pain as worse than that of childbirth.
Not
surprisingly given the severity of pain, people with cluster headache have
demonstrated numerous and varied, often strange, patterns of behavior in their
attempts to lessen the pain. It’s
important to understand that these behavioral responses are a reaction to the
pain and not a sign of mental or physical abnormality.
As
a sufferer of cluster headache, you’ve no doubt been plagued with questions
from loved ones and well-meaning friends who ask, “What’s wrong with you? Why do you do that? That
doesn’t seem normal to me. Shouldn’t
you see someone about that?” While
your behavior during an attack may seem crazy or odd to you and those around
you, it’s unlikely that you’re behaving all that differently from other
sufferers before you.
Unlike
migraine sufferers who crave a dark quiet place in which to lie down, cluster
sufferers are restless, preferring to move.
In fact, they refuse to lie down as this intensifies the pain. People with cluster have been known to pace and rock to and
fro, often screaming out loud as they pound their fist against their head or
pull firmly on their hair. Some
sufferers cradle their head in their hands, pushing their thumb or finger deep
into the affected eye socket, as they kneel rocking back and forth.
Even the most reserved individual can, during an attack, be driven to
curse out loud or to kick and scream in pain.
Irrational and even violent behavior is not unheard of.
Even couch potatoes may be seen to run quickly in place or do vigorous
sit-ups or push-ups in an attempt to find relief.
Others describe sticking their heads in the freezer or running into a
cold snow bank to distract them from their pain.
A cluster sufferer’s walls or furniture may bear the scratches and
marks of having fists pounded against them in the dead of night.
Others find relief by rubbing the affected side of the head against a
rough carpet, upholstered furniture, or the side of a cold bathtub. At times, the pain may be so intense as to drive patients to
bang their head against the wall or to forcibly pinch, scratch or bite
themselves to distract from the pain.
As
attacks are often triggered by deep sleep—the rapid eye movement (REM)
stage—patients try to avoid sleep and stay awake for as long as possible. This sleep deprivation leads to rapid onset of REM sleep when
sleep eventually prevails, and with it the onset of an attack within minutes.
Without treatment, patients begin to fear sleep; the ensuing cycle of
excruciating pain and lack of sleep leads to depression and occasionally,
thoughts of suicide. During an attack, the sufferer may actually speak of suicide.
Despite this, suicide during an attack is very rare.
Most
cluster sufferers are surprised by their own actions and behavior but are
relieved to find that they are not alone and are not “going crazy.”
If you are a cluster sufferer or believe you may be one, it’s important
to discuss your actions and behavior during an attack with your doctor.
Often these descriptions help solidify the diagnosis and open the door to
treatment and relief from one of the most severe types of pain known to
mankind.0
By
Christine Lay, MD, FRCP(C). The
Headache Institute, Roosevelt Hospital, New York, NY.
Excerpted from Headache, the Newsletter of ACHE, Winter 2001-2002, vol. 12, no.
4.
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The East Bay Headache Support Group is a nonprofit organization dedicated to providing a forum for headache sufferers. The support group meets the second Tuesday every other month at John Muir Medical Center from 7:30 to 9:00 p.m. It is open to all headache sufferers and their families, and interested persons. The meetings are free (however, donations to cover printing, postage, and Web site
expenses are appreciated!). The support group meetings include lectures by guest speakers, question and answer sessions, and informational materials.
Directions to John Muir Medical Center: Take Highway 680 to the Ygnacio Valley Road exit in Walnut Creek; go East (toward Mt. Diablo) approximately 1-1/2 miles, and turn right onto La Casa Via. Turn left into the medical center parking lot, and enter at the main lobby. Take stairs or elevator to the lower level and follow signs to the meeting room.
We value your input! Call, fax, write, or e-mail us if you have any comments or suggestions, or would like to help. The planning committee meets occasionally in the evening and welcomes new members. Michael Stein, MD, Advisor; Leslie Davis, Editor; Dana Giese, Webmaster; Donna Johnson, Treasurer; Carol Bartlett, Reg Fong, Joan Kelley, Richard Tomchalk, Janet Young, Jean Tamayo.