Archive for the ‘migraine’ Category

by Philip Perry

Those who get migraines know how painful and debilitating they can be. In extreme cases, they can take you out of commission for days. One in seven suffer from them, making migraines the third most common illness in the world. Symptoms include a pounding headache, sometimes on one side of the head, nausea, vomiting, and sensitivity to light and sound.

A laundry list of causes and triggers have been implicated including genetics, eating certain foods, lack of sleep, hormonal changes, neurological issues, and much more. Though there have been lots of indicators, medical science has been stumped as to what causes them, which has made the development of new therapies difficult. Now, according to a group of scientists at the International Headache Genetics Consortium (IHGC), the cause has most likely been discovered. It all has to do with blood flow. Specifically, blood vessels within the brain becoming restricted may be what causes migraines.

There has been a long running debate as to whether migraines are caused by a neurological problem or a vascular one—having to do with circulation. This study, published in the journal Nature Genetics, is likely to put the controversy to rest, and help researchers develop novel approaches to treat the condition. 59,674 migraine sufferers and 316,078 controls, or those who didn’t get the headaches, participated. They hailed from 12 different countries. All participants were part of previous studies, where they had their DNA or genome scanned.


The part of the brain where migraines originate.

Researchers identified 38 specific genes or loci tied to migraines, 28 of which had never been implicated before. What’s interesting is these same genes are associated with other forms of illness, all in the realm of vascular disease. Due to this, researchers believe blood vessel problems are at the heart of migraines.

Aarno Palotie is the leader of the IHGC. He is also associated with the Center for Human Genome Research at Massachusetts General Hospital, in Boston, and at the Broad Institute of MIT and Harvard. Palotie hailed the discovery. He also said the IHGC’s approach was necessary in achieving it. “Because all of these variants modify the disease risk only slightly, the effect could only be seen when this large amount of samples became available.” Migraines have been difficult to treat. Symptoms and severity run the spectrum, and drugs effective in some patients, have been less potent, or even ineffective in others. Now, researchers have a place to start for developing new drugs, which must somehow target the “regulation of vascular tone.” John-Anker Zwart is another member of IHGC. He hails from the Oslo University Hospital in Norway.

Zwart said, “These genetic findings are the first concrete step towards developing personalized, evidence-based treatments for this very complex disease.” He added, “In the future, we hope this information can be utilized in dividing the patients into different genetic susceptibility groups for clinical drug trials, thus increasing the chances of identifying the best possible treatment for each subgroup.”

Previous studies implicated brain tissue genes. But researchers here say that those studies may not have used enough tissue samples. Another neurological theory was that it had something to do with ion channels in the central nervous system (CNS). This was thought to be an area that warranted more study, until now.

The authors of the IHGC study say that the widespread sharing of data played a critical role in this discovery. Palotie said, “We simply can’t overstate the importance of international collaboration when studying genetics of complex, common diseases.” More studies will now be conducted to understand the pathogenesis or development of migraines and what role each gene plays, in order to find entryways suitable for therapeutic intervention.

http://bigthink.com/philip-perry/scientists-discover-the-cause-of-migraines-and-a-path-toward-a-cure?utm_source=Big+Think+Weekly+Newsletter+Subscribers&utm_campaign=709f2481ff-Newsletter_072016&utm_medium=email&utm_term=0_6d098f42ff-709f2481ff-41106061

Marijuana may give relief to migraine sufferers, according to research published online in Pharmacotherapy.

The research included 121 patients diagnosed with migraines and treated with medical marijuana between January 2010 and September 2014. Patients in the study used both inhaled marijuana and edible marijuana. The researchers said inhaled marijuana seemed to be preferred for treating current headaches, and edibles seemed to be favored for headache prevention.

The researchers found that 103 study participants said they had a decrease in their monthly migraines. Fifteen patients said they had the same number of migraines, and 3 reported an increase in headaches. Overall, the patients’ number of migraines fell from 10.4 to 4.6 per month, which is statistically and clinically significant.

“There was a substantial improvement for patients in their ability to function and feel better,” senior author Laura Borgelt, PharmD, a professor in the School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus in Aurora, said in a university news release. “Like any drug, marijuana has potential benefits and potential risks. It’s important for people to be aware that using medical marijuana can also have adverse effects.”

Reference

Rhyne D, Anderson SL, Gedde M, Borgelt LM. Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population. Pharmacotherapy. 2016;



Jets linebacker Lorenzo Mauldin (55) wears special contact lenses and a helmet shade to prevent migraines.

By ZACH SCHONBRUN

FWhen he woke last Sunday morning, Jeremy Kerley sensed trouble already coming on. Fitful sleep is often his trigger, he said. The migraine eventually hit him like an anvil late in last week’s game against the Giants.

His eyes grew blurry and he felt what he described as a “sharp, shooting, throbbing pain.” He wanted to sit down. He wanted to lie down. He knew he needed to leave the field.

Kerley, the Jets’ punt returner, departed to the locker room and did not return. As the Jets came from behind to beat the Giants in overtime, he was receiving intravenous fluids and oxygen to help relieve the anguish from a struggle that has afflicted him since high school.

For Kerley, migraines are the silent menace that constantly lurks. They ambush him almost once a month, even though he rarely talks about it. He knew his grandfather got them; only recently, he discovered that his dad did, too. He just never knows when they will affect him.

Though Kerley is one of approximately 38 million Americans who suffer from them, migraines are not something that is openly discussed in N.F.L. locker rooms. They are far more common in women, and often minimized as simply a headache, a stigma that Kerley acknowledged could make it difficult to pull himself out of a game.

But those who do struggle with migraines — which the Migraine Research Foundation considers a neurological disease, like epilepsy — understand the plight. When Kerley felt a severe headache coming on last season after a game at Minnesota, his teammate Percy Harvin patted him on the back.

“I know how you feel,” Harvin said quietly. He has struggled with migraines throughout his career.

Kerley did the same thing earlier this season, after linebacker Lorenzo Mauldin revealed that he had had migraines since adolescence. Kerley gave him recommendations about nutritional supplements that he found helpful, like fish oil and magnesium. Mauldin also now takes prescription medication to both relieve and prevent severe headaches.

He said that light could often trigger his migraine episodes, so Mauldin wears special contact lenses and a protective shade on his helmet.

“It hurts because it’s pulsating and you can’t really stop it,” Mauldin said. “With a bruise or something, you can put alcohol or peroxide over it and it’ll be fine. Or if you’ve hurt a muscle, you can ice it. But you can’t put ice over a migraine.”

In September, a migraine forced Ohio State quarterback Cardale Jones to the emergency room, something that is not uncommon, said Dr. Melissa Leber, the director of emergency department sports medicine at the Icahn School of Medicine at Mount Sinai. She typically treats patients intravenously. But that often cannot relieve the crippling symptoms right away.

“Some people can’t even get out of bed,” Leber said. “Others can function just while not feeling well. It really runs the gamut for how debilitating it can be.”

Migraines are thought to be related to the brain’s trigeminal nerve, which can grow hypersensitive and cause pain signals to fire throughout the brain, typically concentrated around the eyes or temples. Though migraines are strongly hereditary, showing up in people who have had no sports history, they are often clinically similar to post-traumatic headaches, like the headaches that arise after a concussion, according to Dr. Tad Seifert, a neurologist at Norton Healthcare in Louisville, Ky.

During the summer, Seifert led a study of 74 high school football players in the Louisville area and found that 33.8 percent of them suffered from migraines, a rate twice that of the normal population. The rate rose to 37.5 percent in players who reported having sustained a concussion once in their lives, and 40.7 percent in those who reported multiple concussions.

“The elephant in the room is whether there is some influence of contact sports and the development of frequent or chronic headache later in life,” Seifert said. “And if so, how much?”

Seifert, who also chairs an N.C.A.A. task force on headaches, said that he expected to publish a similar report involving 834 Division I athletes in the spring. Though he would not go into detail about the results, he said that it looked to be “very similar to what we’ve found in this sample of high school players.” Mauldin, it should be noted, sustained a concussion earlier this season.

There is no cure for migraines, and sufferers often go the rest of their lives “controlling” the issue, Seifert said, comparing it to those dealing with high blood pressure or diabetes. What concerns him, though, are the studies that have shown that people with migraines are more susceptible to concussions, and when they do sustain one, it takes them longer to recover.

“We know that the migraine brain is just wired differently,” Seifert said. “And we know that it’s a brain that is hypersensitive to external injury. And those pain receptors that are in overdrive — it takes that much longer to calm down and return to baseline.”

In the time it takes for the receptors to settle, though, the pain can bring a linebacker to his knees.

“When they pop up out of nowhere, you start to feel a sensation like in between the middle of your forehead,” Mauldin said. “But it’s in the back of your head as well. It’s like somebody’s punching you in the side of the head.”

Kerley said he had yet to receive a migraine disease diagnosis, but he thinks it could be related to difficulties he regularly has with sleeping, being someone who has sleep apnea. When he feels a headache coming on, he has a nasal spray that he said often cured his symptoms within a half-hour. But last Sunday, it was too late.

“If you don’t catch it while it’s early, it could get pretty bad,” Kerley said. “Mine got there.”

http://www.nytimes.com/2015/12/13/sports/football/migraine-headaches-a-lurking-malady-in-the-nfl.html?emc=edit_th_20151213&nl=todaysheadlines&nlid=41412344&_r=0

brain

The many documented cases of strange delusions and neurological syndromes can offer a window into how bizarre the brain can be.

It may seem that hallucinations are random images that appear to some individuals, or that delusions are thoughts that arise without purpose. However, in some cases, a specific brain pathway may create a particular image or delusion, and different people may experience the same hallucination.

In recent decades, with advances in brain science, researchers have started to unravel the causes of some of these conditions, while others have remained a mystery.

Here is a look at seven odd hallucinations, which show that anything is possible when the brain takes a break from reality.

1. Alice-in-Wonderland syndrome
This neurological syndrome is characterized by bizarre, distorted perceptions of time and space, similar to what Alice experienced in Lewis Carroll’s “Alice’s Adventures in Wonderland.”

Patients with Alice-in-Wonderland syndrome describe seeing objects or parts of their bodies as smaller or bigger than their actual sizes, or in an altered shape. These individuals may also perceive time differently.

The rare syndrome seems to be caused by some viral infections, epilepsy, migraine headaches and brain tumors. Studies have also suggested that abnormal activity in parts of the visual cortex that handle information about the shape and size of objects might cause the hallucinations.

It’s also been suggested that Carroll himself experienced the condition during migraine headaches and used them as inspiration for writing the tale of Alice’s strange dream.

English psychiatrist John Todd first described the condition in an article published in the Canadian Medical Association Journal in 1955, and that’s why the condition is also called Todd’s syndrome. However, an earlier reference to the condition appears in a 1952 article by American neurologist Caro Lippman. The doctor describes a patient who reported feeling short and wide as she walked, and referenced “Alice’s Adventures in Wonderland” to explain her body image illusions.

2. Walking Corpse Syndrome
This delusion, also called Cotard’s Syndrome, is a rare mental illness in which patients believe they are dead, are dying or have lost their internal organs.

French neurologist Jules Cotard first described the condition in 1880, finding it in a woman who had depression and also symptoms of psychosis. The patient believed she didn’t have a brain or intestines, and didn’t need to eat. She died of starvation.

Other cases of Cotard’s syndrome have been reported in people with a range of psychiatric and neurological problems, including schizophrenia, traumatic brain injury and multiple sclerosis.

In a recent case report of Cotard’s syndrome, researchers described a previously healthy 73-year-old woman who went to the emergency room insisting that she was “going to die and going to hell.” Eventually, doctors found the patient had bleeding in her brain due to a stroke. After she received treatment in the hospital, her delusion resolved within a week, according to the report published in January 2014 in the journal of Neuropsychiatry.

3. Charles Bonnet syndrome
People who have lost their sight may develop Charles Bonnet syndrome, which involves having vivid, complex visual hallucinations of things that aren’t really there.

People with this syndrome usually hallucinate people’s faces, cartoons, colored patterns and objects. It is thought the condition occurs because the brain’s visual system is no longer receiving visual information from the eye or part of the retina, and begins making up its own images.

Charles Bonnet syndrome occurs in between 10 and 40% of older adults who have significant vision loss, according to studies.

4. Clinical lycanthropy
In this extremely rare psychiatric condition, patients believe they are turning into wolves or other animals. They may perceive their own bodies differently, and insist they are growing the fur, sharp teeth and claws of a wolf.

Cases have also been reported of people with delusional beliefs about turning into dogs, pigs, frogs and snakes.

The condition usually occurs in combination with another disorder, such as schizophrenia, bipolar disorder or severe depression, according to a review study published in the March issue of the journal History of Psychiatry in 2014.

5. Capgras delusion
Patients with Capgras delusion believe that an imposter has replaced a person they feel close to, such as a friend or spouse. The delusion has been reported in patients with schizophrenia, Alzheimer’s disease, advanced Parkinson’s disease, dementia and brain lesions.

One brain imaging study suggested the condition may involve reduced neural activity in the brain system that processes information about faces and emotional responses.

6. Othello syndrome
Named after Shakespeare’s character, Othello syndrome involves a paranoid belief that the sufferer’s partner is cheating. People with this condition experience strong obsessive thoughts and may show aggression and violence.

In one recent case report, doctors described a 46-year-old married man in the African country Burkina Faso who had a stroke, which left him unable to communicate and paralyzed in half of his body. The patient gradually recovered from his paralysis and speaking problems, but developed a persistent delusional jealousy and aggression toward his wife, accusing her of cheating with an unidentified man.

7. Ekbom’s syndrome
Patients with Ekbom’s syndrome, also known as delusional parasitosis or delusional infestations, strongly believe they are infested with parasites that are crawling under their skin. Patients report sensations of itching and being bitten, and sometimes, in an effort to get rid of the pathogens, they may hurt themselves, which can result in wounds and actual infections.

It’s unknown what causes these delusions, but studies have linked the condition with structural changes in the brain, and some patients have improved when treated with antipsychotic medications.

http://www.livescience.com/46477-oddest-hallucinations.html

placebo-effect-one-a-day

Even when a medication works, half of its impact on a patient may be due to one aspect of the placebo effect: the positive message that a doctor provides when prescribing the treatment, according to a new study.

Researchers designed an elaborate study, in which 66 people suffering from migraine headaches were given either a placebo, or a common migraine drug called Maxalt. However, for each migraine attack the participants had during the study period, they were told something different. For example, they were told they were taking a placebo when they were actually taking Maxalt, or vice versa, and sometimes they were told the pill could be either Maxalt or a placebo.

The pain-relieving benefits of the migraine drug increased when patients were told they were taking an effective drug for the treatment of acute migraine. And when the identities of Maxalt tablets and placebo pills were switched, patients reported similar pain relief from placebo pills labeled as Maxalt as from Maxalt tablets labeled as a placebo, according to the study published January 8 in the journal Science Translational Medicine.

The results suggest that the information people have is as important as the effects of the drug in reducing pain, the researchers said.

“In many conditions, placebo effect is a big part of the effect of the drug,” said study researcher, Ted Kaptchuk, a professor of medicine at Harvard Medical School. In the new study, 50 percent of the drug’s effect could be attributed to the placebo effect, he said.

“Themore you give a positive message, the more a drug works. In this case, our message was just as important as the pharmacology of the drug,” Kaptchuk said.

In other words, patients may benefit from optimistic messages from their doctors, which may enhance the effectiveness of a good pharmaceutical, the researchers said.

“When doctors set patients’ expectations high, Maxalt [or, potentially, other migraine drugs] becomes more effective,” said study researcher Rami Burstein, a professor of anesthesia at Harvard Medical School. “Increased effectiveness means shorter migraine attacks and shorter migraine attacks mean that less medication is needed,” Burstein said.

However, physicians should be realistic when prescribing a treatment, Kaptchuk said.

“The medical community should consider what’s the positive message that is still accurate, and not an exaggeration that verges on deception,” he told LiveScience.

Migraine attacks are throbbing headaches, usually accompanied by nausea, vomiting and sensitivity to light and sound. The researchers decided to look at migraine, because it is a recurring condition, and responds well to medication, Kaptchuk said.

During the study, the participants had a total of 450 migraine attacks. Each time they were provided with one of the six available treatments: two were made with positive expectations (envelopes labeled “Maxalt”), two were made with negative expectations (envelopes labeled “placebo”), and two were made with neutral expectations (envelopes labeled “Maxalt or placebo”).

But within each of these conditions, the envelopes contained either the placebo or Maxalt. The patients then reported their pain experiences.

“When patients received Maxalt labeled as placebo, they were being treated by the medication — but without any positive expectation,” Burstein said.

For both placebo and Maxalt, patients reported great pain-relieving effects when the envelope was labeled “Maxalt.” This suggests that a positive message and a powerful medication are both important for effective clinical care, the researchers said.
The placebo effect is centered on the idea that a person’s expectations and beliefs drive changes in symptoms, even though they have received a sugar pill or a sham treatment with no effect. Knowing that they have received a placebo changes their expectations, which is expected to alter the placebo effect.

However, people in the study also reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all.

This finding “contradicts the medical beliefs,” Kaptchuk said. “Because in medicine, we think you have to think it’s a real drug for placebo to work. But apparently, the body has memories, or an embodied awareness, which operates below the level of consciousness.”

One possible mechanism for this effect could be that the body is conditioned to react positively in medical situations, Kaptchuk said.

“We know from other studies that the symbols, the rituals and the words of medicine activate the brain to release neurotransmitters that change the experience of illness. It activates centers in the brain that modulate many symptoms like pain and nausea and fatigue,” he said.

http://www.livescience.com/42430-placebo-effect-half-of-drug-efficacy.html