Adolescents With Migraines More At Risk of Pain Disorders

Adolescents With Migraines More At Risk of Pain Disorders

According to a new 2021 study which examines the development of psychiatric and pain disorders in the transition from adolescence to adulthood, adolescents who have a diagnosis of migraine are far more likely to develop additional psychiatric or pain disorders than adolescents who don’t suffer from migraines.

The study looked at the 2006 and following ten years of health insurance data from 56,597 German 15 year-olds to find out whether adolescents with a migraine diagnosis were more at risk of developing comorbid pain or psychiatric conditions.

The comorbid conditions which were looked for included; mood disorders, stress-related disorders, back pain, irritable bowel syndrome, and behavioural syndromes associated with physiological disturbances. Any patients who had headaches which were not variations of migraine, and patients who had already been diagnosed with one of the comorbid conditions, were excluded from the final study. 

The research showed that 88.4% of the patients with migraine developed at least one of the comorbid conditions during the ten-year period.

The likelihood of migraine patients developing a comorbid condition, when compared with non-migraine suffering adolescents was; a 2.1 times higher likelihood for affective or mood disorders, 1.8 times higher for stress-related disorders and also 1.8 times for behavioural syndromes, 1.6 times higher for back pain, and 1.5 times higher for irritable bowel syndrome. Overall, the migraine patients were 1.3 times more likely to develop one or more of the evaluated additional disorders.

The authors of the study suggested that the increased risk may also increase the impact which migraine had on a sufferer’s well-being, and they emphasized that early evaluation of risks for additional disorders was vital in the care of these patients, and might improve the long-term outcome significantly.

A Dislike of Strong Smells – A Childhood Migraine Indicator

childhood

Identifying migraines in childhood is a lot harder than diagnosing migraines in adults – and that can be hard enough as it is! In fact, nearly half of children with migraine never receive a diagnosis.

What makes childhood migraines so hard to recognise is that they don’t necessarily resemble your ‘typical’ (after all, all migraines are different so ‘typical’ is a slight misnomer) migraine.

For adults the most common migraine symptom is head pain on one side of the head, but for children the main symptom is not always head pain. If head pain is experienced, it typically affects the forehead and temple areas or whole head, rather than just one side of the head.

To make diagnosis even harder, some children don’t experience any head pain at all as part of their migraine attacks – hence why so many children with migraines go undiagnosed. Instead the main symptoms of migraine in children tend to be abdominal pain, cyclical vomiting, limb pain, and episodic dizziness. What may be one marker of migraine that could help to signal if a child is suffering from migraines though is osmophobia.

Osmophobia is an aversion to or dislike of strong smells. Many adult migraine sufferers report strong smells as being a migraine trigger – with the likes of perfumes and aftershaves, cigarette smoke, and some cleaning products all being particularly triggering.

However, since what is the case for adults with migraine is not necessarily the case for children with migraine, a study looking specifically at children’s reaction to smells in relation to migraines was needed.  

A 2020 study involving 300 child/adolescent patients, of whom 253 had migraine and 47 had a tension-type headache, found that 137 had osmophobia during their attacks. Those who did also had longer attacks which were more intense.

So, although not all of the patients had osmophobia or found strong smells to be a trigger for their attacks, it was concluded that osmophobia could be useful in diagnosing migraines in children. Especially as younger children may not be able to communicate exactly what symptoms they are feeling – making diagnosis of migraine that much more difficult.  

Migraines and Chills – Why Do Sufferers Get Cold?

Migraines and Chills – Why Do Sufferers Get Cold?

There are many different symptoms which can be part of a migraine attack. Nausea and an aversion to bright lights are two, but for some migraine sufferers chills can be another – and one which can happen days before the main headache phase of a migraine attack takes place.

Why is this?

Essentially it is down to the fact that when a migraine attack is experienced, the brain undergoes both structural and functional changes. One of the areas of the brain which experiences neurological changes during a migraine attack is the hypothalamus, and it’s this part of the brain that controls our body temperature.

If the hypothalamus is affected by unusual activity, it’s not surprising that that is experienced in some perceptible way in our bodies.

Another part of the brain which is affected during a migraine attack is the brain’s cortex. The cerebral cortex part of our brain is involved in muscle movement, and chills are the result of involuntary muscle tightening and relaxing.

These two areas of the brain both being subject to neurological changes during a migraine attack, and in the prodrome phase before an attack, is why chills can be a symptom of a migraine – as can sweating and shivering.

Linked to these temperature migraine symptoms are the findings of one 2020 study, which found that women who experience chronic migraines were more likely to report having cold hands or feet – it is thought this is a result of blood vessel changes which occur with migraine.

So, although not the most common migraine symptom, experiencing chills is certainly one symptom to watch out for as a sign of an oncoming migraine attack. 

A Roller Coaster Ride Leads To Better Migraine Understanding

roller coaster

Not everyone enjoys roller coaster rides. For some people they just induce nausea and dizziness, and for those who suffer from migraines there’s a good reason for this – one which a new study from a team of university researchers in Germany can help to explain, and one which may prove to be helpful in developing new migraine treatments.

The team put twenty participants who experienced migraines, and twenty participants who didn’t, on a virtual roller coaster, and then monitored their brain activity using functional magnetic resonance imaging (fMRI) while they watched the videos to track their neurological activity. After the virtual rides the participants were also surveyed about their dizziness, motion sickness, and other symptom levels. No migraines were experienced during the virtual roller coaster rides.

The researchers found that 65% of the participants with migraines experienced dizziness, while only 30% of the participants without migraines did. For motion sickness, the questionnaires revealed that participants with migraines had an average score of 47 on the intensity scale of 1-180, while the non-migraine participants had an average score of 24. The feelings of nausea were also longer lasting for the migraine participants. 

Using the fMRI scans, the researchers were able to see changes in nerve cell activity based on blood flow to different areas of the brain. Participants with migraines had increased activity in five areas of the brain, and decreased activity in two other areas – all of which could relate to abnormal transmission of visual, auditory and sensory information within the brain.

While interesting to see the difference in experiences between migraine sufferers and non-sufferers, the main point of interest is why this study may be useful for helping to treat migraines.

Neurologist Arne May from the University of Hamburg had this to say:  “People with migraine often complain of dizziness, balance problems and misperception of their body’s place in space during migraine. By simulating a virtual roller coaster ride, our study found that some of these problems are not only magnified in people who experience migraine, but they are also associated with changes in various areas of the brain. By identifying and pinpointing these changes, our research could lead to a better understanding of migraine which could in turn lead to the development of better treatments.”

Migraines and Seizures – Telling The Difference

migraines and seizures

The connection between migraines and seizures is by no means a simple one, but what can be said is that there is some kind of connection. The number of children with epilepsy (which causes seizures) who also have migraine is estimated to be between 8% and 24%, which is approximately double the normal prevalence of migraine found in non-epileptic members of the population. Added to this is the fact that people who have migraine with aura are at a mildly increased risk of stroke.

Even with the increased risk, experiencing either migraine or seizures does not necessarily mean that you will have the other, but for those who do experience both it can be very complicated as it’s not always clear at first which has occurred – a migraine or a seizure. After all, both conditions are related to brain function, and both have similar symptoms. There are some things that help to diagnose which is being experienced however.

In seizures something called automatism occurs – this is essentially involuntary movements. Typically these are things like chewing movements or fidgety movements. This is not something which happens with migraines, so if automatism is present along with head pain it’s most likely a seizure-related headache.

Memory loss is another thing which is usually a seizure symptom rather than a migraine symptom. Confusion may occur with a migraine, but not being able to recall the headache having taken place suggests a seizure. 

Visual disturbances are something which can occur with both a seizure or a migraine, but with a migraine these disturbances emerge gradually over the course of a few minutes. With a seizure the visual disturbance will be of short duration and occur suddenly.

The time it takes to occur is another way you can differentiate between migraines and seizures more generally too – not just with the visual disturbances. Migraine pain usually increases gradually, while a headache which is related to seizure will come on very suddenly.

Having an electroencephalogram (EEG) is the best way to distinguish between migraine and seizure, but in more general terms if a person is having migraine symptoms along with neurological symptoms, and the person isn’t responding to any migraine treatments, then it’s worth asking whether it’s definitely migraines which the person is having. 

Why Does Throwing Up Relieve Migraines?

There are many migraine sufferers who find that feeling nauseous forms part of their migraine attacks. In fact 90% of people with migraine have reported feeling nausea as part of their migraine attacks. Not all migraine sufferers who feel nauseous during their migraine attacks then go on to throw up, but many who do find that once they have thrown up their migraine attack becomes less severe, and for some, stops completely.

There has been plenty of research into migraines and their symptoms, but even so experts still aren’t sure why throwing up can help to relieve migraine symptoms. There are theories though.

The first theory is that vomiting may happen at the end of a migraine attack because the attack has slowed down the gastrointestinal tract. With the slowed or even paused function of your stomach comes food which can have sat in your stomach for too long. Throwing up occurs as the gastrointestinal tract begins to function normally again and the normal stomach function returns.

Another theory is that the act of throwing up relieves some of the neurotransmitter imbalance that is part of a migraine episode. To get more technical – the chemoreceptor trigger zone (CTZ) in the brain works with the vomiting centre to trigger vomiting. The CTZ also releases the neurotransmitters dopamine and serotonin, which are both endorphins that can help you to feel better.

Next comes the theory that vomiting stimulates the vagus nerve, and this can help to calm the migraine. After all, the FDA has approved a migraine treatment that involves stimulating the vagus nerve electrically – so it’s certainly the case that vagus nerve stimulation in some form helps to bring relief.

Essentially, there are plausible theories as to why vomiting can signal the end of a migraine attack, but there’s no one definite reason that can be pointed to as the reason why. More than that – doctors aren’t sure if vomiting triggers the bodily responses that bring migraine relief, or if vomiting is something that occurs naturally when the migraine is ending anyway and is a symptom of the end of the attack rather than the cause of the end.

Fibromyalgia and Migraines

fibromyalgia

Migraine, as most migraine sufferers know all too well, is one condition which is commonly linked with other medical conditions such as depression, asthma and hypertension (high blood pressure). One condition which is less often mentioned in relation to migraine is fibromyalgia.

Fibromyalgia is a long-term condition which causes pain all over the body alongside extreme tiredness. Researchers believe that fibromyalgia amplifies feelings of pain by affecting the way the nervous system processes painful and non-painful signals. With this in mind, it’s hardly surprising that fibromyalgia has been linked to migraine.

In one past study a high co-occurrence of fibromyalgia and migraine was reported at over 30%, while another large epidemiologic study from 2015 found the prevalence of migraine among fibromyalgia patents to be 55.8%. Migraine headaches can lead to the development of fibromyalgia pain, while the hypersensitivity which comes as part of fibromyalgia can lead to more migraine attacks.

Unfortunately having both migraine and fibromyalgia means that the likelihood of having depressive symptoms is higher, as is the likelihood of more intense migraine pain and more severe migraine related disability. 

Fibromyalgia, like migraine, does not have a cure, but there are good treatment options available. These include painkillers and antidepressants, talking therapies (CBT and counselling), exercise programmes, and learning relaxation techniques.

As the co-morbidity rate for fibromyalgia and migraine is so high, and the impact of suffering from both conditions at once is so great, it has been suggested that clinicians who care for migraine patients should consider screening for comorbid fibromyalgia, especially in those patients who have moderate to severe depressive symptoms.

Eating More Oily Fish Found to Reduce Migraines

A new study has found that eating a diet which contains a lot of oily fish can help to reduce the number of migraines which sufferers experience – in particular female migraine sufferers.

The study was published in the British Medical Journal and conducted by the National Institute on Aging in Baltimore, US, by Dr Christopher Ramsden and his team. They wished to test whether increasing the percentage of Omega-3 fatty acids (found in oily fish, nuts, seeds and supplements) which are associated with pain-reduction, and Omega-6 fatty acids (commonly found in refined vegetable oils) which may worsen pain and provoke migraines, would impact on the severity or frequency of migraines.

One of three different diets were assigned for a period of 16 weeks to each of the 182 patients who took part – each suffering from between 5 and 20 days of migraine a month. One diet kept Omega-6 fatty acids the same but increased Omega-3 acids, one increased Omega-3 acids but lowered Omega-6 acids, and the control diet kept the levels of both fatty acids to a typical level.

The results showed that both of the diets which raised Omega-3 acid levels increased the levels of a pain-reducing substance in the body called oxylipin. These diets also reduced the frequency of the patient’s migraines.

For the high Omega-3 but normal Omega-6 diet there was an average reduction of 1.3 hours of pain duration on headache days and two fewer migraine days a month. For the high Omega-3 but lower Omega-6 group there was a 1.7 hour reduction in pain duration on headache days and four fewer migraine days a month.

This study did have a few limitations however. The majority of the participants were women and so the increase of Omega-3 fatty acids may not be so beneficial to children or men. It’s also unknown whether the reduction in pain duration was entirely down to an increase in the Omega-3 fatty acids, or whether other micronutrients played a role since eating more oily fish such as salmon increases the amount of vitamin D and selenium you are eating too.

Whether or not it’s entirely due to an increase in Omega-3 fatty acids, or a combination of nutrients, this study has shown that eating a diet which contains more oily fish can be of help to migraine sufferers.   

Which Forms Of Psychotherapy Can Bring Migraine Relief?

psychotherapy

There are plenty of different types of psychotherapy that can be effective in reducing the frequency and/or intensity of migraines. Some of these include:

Muscle Relaxation

This relaxation can slow down the nervous system, regulate the heart rate, blood pressure, and blood vessel dilation and contraction. One 2016 study found that after a six-week course in progressive muscle relaxation the participants had a significant reduction in migraine frequency.

Mindful Meditation

A small-scale pilot study gave participants who suffered from episodic migraine an eight-week mindfulness-based intervention course in which they were taught how to practise mindful meditation. The study leaders then compared the migraines of these participants with those of people who had not learned the meditation practice and found that those who hadn’t learned the practice had longer migraines and that they impacted more on their lives.

Cognitive Behavioural Therapy

CBT for migraine examines the thoughts and actions which could be maintaining or exacerbating the condition, and then works to change these in a systematic way. Investigators of one 2019 study found that eight weeks of a mindfulness-based CBT intervention reduced migraine disability when compared with a “usual treatment” group.

These are just a few of the options which come under psychotherapy. Other options include the likes of Biofeedback and Acceptance and Commitment Therapy (ACT).

If you suffer from migraines you might find it helpful to incorporate psychotherapy treatments alongside pharmaceutical options. Alternatively, if you’re unable or unwilling to take pharmaceutical drugs to help combat your migraines, with psychotherapy there are still avenues to explore.

How Psychotherapy Can Help Migraine Sufferers

psychotherapy

Tablets are good, but they aren’t the be-all and end-all when it comes to treating medical conditions. Alternative treatments such as acupuncture, physiotherapy, and much more can be effective in relieving certain conditions.

One thing which has proved helpful with some migraine sufferers is psychotherapy.

Psychotherapy is a term which encompasses a few different treatments such as mindfulness-based stress reduction for migraine (MBSR-M), cognitive behavioural therapy (CBT), biofeedback, and relaxation training. These not only help by managing how the sufferer responds to pain, but there is also evidence to suggest that some of these treatments can reduce the frequency, duration and intensity of migraine attacks, as well as lowering the overall burden of migraine.

Part of the reason that psychotherapy can be effective is down to neuroplasticity. This is the theory that the brain can change the response it has to what is practised and what is experienced.

Another reason why psychotherapy can help is because it can reduce stress. Up to 80% of migraine patients say that stress is a trigger for their attacks.

Unlike with traditional pharmaceutical options, psychotherapy is far less likely to result in any adverse side effects, and this is one reason why it might be the preferred treatment option for some migraine sufferers. Alternatively, it can also be a path to go down for migraine sufferers who have other medical conditions which make taking medication for their migraines impossible due to dangerous interactions between drugs.