A Publication of the East Bay Headache Support Group
A Member of the Americal Council for Headache Education (ACHE) Support Group Network  

VoLUME 10, ISSUE 3  
MAY 2005

May 10th Meeting:  Do Your Headaches Cause Relationship Headaches?

Do you ever have to miss a family or social event because    of a painful headache?  Do headaches keep you from being a cheerful member of your family, able to carry your end of the give and take in a marriage/partnership?  Do your children have to play quietly while you keep to yourself in a darkened room?  Let’s face it.  Debilitating and/or frequent headaches affect more than just the person with the pain—your family  or friends can get frustrated also with having to deal with your headache condition.  

Janeece M. Dagen, M.S., L.M.F.T., is a psychotherapist in private practice in Walnut Creek and San Francisco.  As a clinician and consultant, she has over 25 years of experience in the area of couples and family therapy.  In addition, she  has done extensive work with individuals who have traumatic histories and has integrated this specialty into her work with couples.

Ms. Dagen will be giving a presentation on the impact of headaches on intimate relationships.  Partners are encouraged to attend.  Discussion will include topics of communication and understanding between partners; issues of trust and dependency; and how to create a more nurturing, caring environment to absorb the impact of chronic pain on the couple’s life.

Join us in the Sterns Conference Room at John Muir Medical Center from 7:30 to 9:00 pm on Tuesday,  May 10.  Take the stairs or elevator to the lower level and follow the signs.   Call Leslie Davis at 925-685-8775 for more information.

National Headache
Awareness Week
June 5-11

Join with the National Headache Foundation as it promotes National Headache Awareness Week June 5-11 to educate the public about the impact and severity of headache, and support the more than 45 million sufferers of this legitimate biological disease.

 The goals of National Headache Awareness Week are:

 ·  to gain recognition of headache pain as a real and legitimate condition,  

·  to encourage sufferers to see a physician for proper diagnosis and treatment, and

·  to let sufferers know that there are new treatments available.

This year’s theme, Stop Migraines Before They Stop You, communicates the importance of recognizing that migraine is a treatable, neuro-biologic disease which affects nearly 30 million Americans.  By effectively managing migraine with the acute and preventive medications currently available, migraine does not have to be a quality-of-life altering condition.  Get diagnosed, get treated and get on with your life.

Visit the Web site of the National Headache Foundation at www.headaches.org or call 1-888-NHF-5552 for more information.

 Future Meetings:

 July 12, 2005:  Duncan Macdonald, L.Ac.

 “Relieving Headaches With Acupuncture”

 September 13, 2005:  Michael Stein, M.D.

 “Talk It Over Night”

Mending Migraines, By Ben Harder

A year and a half ago, Nancy Buie’s cardiologist carefully threaded a patch of mesh through a vein and into her heart, using it to block a small tunnel between the organ’s two upper chambers.  The opening shouldn’t have been there—it was a defect—and it had caused the 57-year-old Eugene, Oregon, woman’s stroke.  When the procedure was over, Buie looked at her physician and asked, “No more strokes?”  “No,” he said. 

“No more.”

Within a few months, Buie realized the heart repair had banished something else.  Her agonizing migraines had stopped their monthly, miserable appearances.  “I haven’t had a migraine since September 2003,” she says.

New therapy.  Several recent studies suggest that Buie’s experience is no fluke.  Exactly what links a hole in the heart to migraines, devastating headaches that plague some 28 million Americans, “is still an enigma.  But it looks like there’s a definite relationship,” says neurologist Stephen Landy of the Wesley Headache Clinic in Memphis.  More than one quarter of the people who struggle with migraines have the heart defect.  If fixing it works, this could be a new treatment for millions

of sufferers.  And companies that make these mesh plugs would benefit to the tune of billions of dollars.

That is still a large “if,” cautions neurologist David Dodick of the Mayo Clinic in Scottsdale, Arizona.  Migraines may have many triggers, and the mere presence of a heart defect in some sufferers does not make it one of  them.  As far as treating it goes, the repair may only appear effective because people’s memories of past headache pain are not reliable.  But the connection is interesting enough that many neurologists and cardiologists are anxiously awaiting the results of a new trial, now underway in England, that is testing the heart intervention head to head against a mock procedure to eliminate any confusion.

“If the trial in England is positive, it’s going to be huge,” says cardiologist Mark Reisman of Seattle’s Swedish Medical Center.

The defect under scrutiny, called patent foramen ovale or PFO, arises when two overlapping curtains of heart tissue never fully join, allowing some blood to go directly from the heart’s intake side to its outflow side, bypassing the normal route through the lungs.  Doctors regard PFOs as generally harmless, although in a small number of people who have strokes for no other apparent cause, they suspect a clot passing through a PFO may be to blame.

It was stroke victims who first alerted Reisman to the migraine connection, after he started treating some of them by closing their PFOs.  On follow-up visits, patients mentioned that their migraines had gone.  Intrigued, Reisman and his colleagues did a systematic survey of 162 stroke patients with PFOs.

More than a third of them had had migraines.  Of those, more than half—Buie among them—were completely cured after PFO closure.  Others experienced headaches less frequently than before.

Reisman’s team published their observations in February 2005 in the Journal of the American College of Cardiology, alongside similar data from a separate investigation of 89 patients by University of California-Los Angeles researchers.  A third medical team, from LDS Hospital in Salt Lake City,  has found the same connection in an additional 200 patients.  And in Europe, researchers have published five studies pointing to the same phenomenon.  (The procedure seemed most effective for sufferers who had migraines with auras—visual flashes that go along with attacks in some people.)

Why?  Researchers suspect that some substance that migraine sufferers are sensitive to—perhaps a hormone or minute particles of debris—is taking the PFO detour around the lungs and going directly to the brain, where it disturbs blood vessels and triggers a migraine. Normally the lungs filter such  things out.
 

The evidence has mounted to a point where one device manufacturer, Boston-based NMT Medical, started the trial in England this January in which some migraine patients will get PFO closure but other volunteers, unknowingly, will get a fake treatment.  The results should indicate whether the operation actually does stop migraines or—if the sham treatment group also improves—if the procedure is simply producing an illusory effect.  It will be next year before results are known.  Another company, AGA Medical Corp. of  Minneapolis, has requested permission from the Food and Drug Administration to undertake a similar study in the United States.

Desperate patients.  If the treatment clears the scientific bar, insurance companies might cover it for migraine.  So it’s not surprising that mesh manufacturers are pursuing it.  “It would be a huge market,” says cardiologist Sotirios Tsimikas of the University of California-San Diego.  “But we have to be careful not to oversell this until we have better data.”

Demand for the procedure is already racing ahead of the evidence.  When NMT sought fewer than 200 volunteers for its British trial, thousands of interested—and desperate—people overwhelmed its Web site and jammed phone lines with inquiries.  One of them was Jacquelyn Compton, 56, a Williamsburg, Massachusetts resident, who suffers migraines on as many as 23 days per month.

Compton doesn’t even know if she has a PFO, and if she gets into a trial also won’t know whether she gets the mesh plug or a sham procedure.

None of that deters her.  She plans to get tested for the defect—usually a small probe is pushed down the throat to image heart structure with ultrasound—as soon as possible.  “If I have the PFO,” she says, “I'll get the repair by hook or by crook.  It’s just too alluring to think of being free of this.”

Source:  U.S. News & World Report, April 11, 2005  v138 i13 p40.

Headaches in the Over-50 Crowd, By Barbara J. Mitchell, April 1, 2001

As my husband keeps reminding me, there are advantages to being over 50.  Sometimes you pay a lower price for tickets, or get a discount at a store or motel, but best of all, you most likely suffer fewer headaches.  In fact, by the time we get to 70, only about 10% of women and 5% of men have chronic severe headaches.

Truth is, that probably isn’t much consolation to all you baby boomers who are now in your 50s, though.  Remember when you didn’t trust anyone over 30?  However, although senior citizens are less prone to migraines and clusters, they are more prone to headaches due to disease or medications.  As you get older, your body responds to medicine differently so you are more susceptible to drug toxicity.  You’ve no doubt known an elderly person who appeared to be senile, but it turned out he was simply over-medicated.  Once all the drugs were stopped, he was like a new person.

Drugs which often cause headaches include those for high blood pressure, chest pain, lung disease, stomach problems, estrogen replacement, Parkinson’s, and depression.  They may also make existing chronic headaches worse.  Doctors don’t have an easy time diagnosing the cause of headaches in older people.  There is more likelihood of a chronic illness for one thing, along with the drugs used as treatment for that illness.  Older people are more likely to have degenerative disc disease or past trauma which can cause referred pain to the head.

Headaches that occur with exertion and improve with rest can be an indicator of heart disease or of poor circulation of blood to the brain.  Morning headaches can indicate sleep apnea.  Headaches in the elderly can indicate eye problems such as glaucoma, or perhaps temporal arteritis.  They also experience subdural hemorrhages.  In an elderly person the injury causing a subdural hematoma may be a seemingly trivial one.  The symptoms are continuing headaches, drowsiness, and some confusion, but again this isn’t easy to diagnose when the trauma wasn’t serious enough to cause immediate suspicion.

Even though migraine decreases with age (to 5% of women and 2% of men by age 70) and only 2% of migraineurs have their first one after 65, there is a phenomenon called late life migraine. My husband has them, after suffering regular migraines from the age of 17 until he was in his 50s.  Now he gets symptoms of lightheadedness, difficulty speaking, and a mild aura, but no headache.  I’ve learned that this is not at all uncommon.

Drug treatment of headaches for seniors is another problem.  For instance, triptans are the drug of choice for younger people but aren’t the best thing for older people because of the risks with existing, but perhaps unsuspected, cardiac, cerebral, or vascular disease.  Aspirin and NSAIDs aren’t the best treatment either because as we get older we’re more susceptible to ulcers and internal bleeding.  And any medication given to young or old can result in rebound headaches.

Of course, it all depends on your general health and sensitivity to drugs. Since no one wants to have headaches or take expensive drugs, preventive measures are best.  Sufficient sleep, proper nutrition, and regular exercise appropriate for your physical condition can go a long way toward nipping a headache problem in the bud.  With care, perhaps you won’t need to have a discussion with your doctor about a lot of tests to find out what’s causing headaches.  

Found on the Internet at www.suite101.com
 

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.