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Announcement of this awareness campaign has come out to post your art to help awareness of migraine.

Select submissions chosen by notable migraine experts will be displayed at the 59th Annual Scientific Meeting of the American Headache Society from June 8June 11, 2017 at the Westin Boston Waterfront in Boston, MA and other migraine-related events throughout the remainder of 2017. Additionally, art submissions will be displayed on the My Chronic Migraine Facebook Page.

 

Children and migraines

I do not have children but many of my migraineur friends do. Some of them are going through the gut-wrenching realization their children or teens are developing migraines. Some of those children severe migraines, like their parents. It is a horrible experience to feel knowing what you go through and then seeing your child experience the same thing. No parent wants that.

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What so we know about children and migraines? Here is a presentation by the Diamond Headache Clinic that goes over some important facts:

Common Types of Migraine Headaches and Symptoms: What Kind Does Your Child Have?

Abdominal Migraine

Abdominal migraine affects mainly children between 5 and 9 years of age. Many of these children go on to develop migraine headaches (with or without aura) later in life.

 

What Are the Symptoms of Abdominal Migraine?

Symptoms may include:

  • Midline abdominal pain of moderate to severe intensity that lasts 1 – 72 hours
  • Chronic or recurring pain severe enough to interfere with normal activities
  • Mild or no headache
  • Nausea, vomiting, loss of appetite
  • Pallor with dark shadows under the eyes or flushing
  • The absence of another illness, including a gastrointestinal disorder

 

How Is Abdominal Migraine Diagnosed?

No specific diagnostic test is available to confirm abdominal migraine. A diagnosis is made through a thorough evaluation of the patient’s medical history, incidence of migraine headache in the family, symptoms, and a physical exam and tests to rule out other conditions.

What Are the Treatment Options for Abdominal Migraine?

For children and teens, abdominal migraine treatment includes rest, plenty of fluids, over-the-counter pain relievers and relaxation/behavioral therapy techniques. For older children and adults with infrequent abdominal migraine attacks, physicians may prescribe medications used for other forms of migraine, such as NSAIDs, anti-nausea medication and triptans. Frequent abdominal migraines are treated with the same preventive therapies used for other migraines.

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Migraine Headache

The average age of onset for migraine is 7 years old for boys and 10 years old for girls, although symptoms may appear in much younger children. Up to age 12, equal numbers of boys and girls suffer from migraine; by the ages 21 – 24, up to 80% of migraineurs are woman. Children with migraine often have a family history of migraine. Migraine affects up to 5% of school-aged children. From 50% to 75% of children with migraine will cease having attacks between adolescence and early adulthood, but some will redevelop migraine later.

 

What Are the Symptoms of Migraine Headache?

Common symptoms of migraine in youngsters include:

 

  • Pain on one or both sides of the head, or a child may report pain “all over”
  • Pounding or throbbing pain, although children may not be able to articulate this
  • Abdominal upset, nausea and/or vomiting
  • Sensitivity to light and/or sound
  • Sweating
  • Becoming pale or quiet
  • Experiencing an aura, or a sense of flashing lights, funny smells and changes in vision

 

Tension-Type Headache

This common headache type is triggered by stress or emotional/mental conflict.

 

What Are the Symptoms of Tension-Type Headache?

  • Generally, symptoms include:
    • Headache that develops slowly
    • Pain usually present on both sides, and may involve the back of the head
    • Dull pain or pain that feels like a band around the head
    • Mild to moderate, not severe, pain
    • Change in sleep habits

 

Cluster Headache

More common in adolescent males, cluster headache usually begins in children over 10 years of age. This headache type occurs in a series, or “cluster,” that can last for weeks or months. This series of headaches may recur annually or every other year.

 

What Are the Symptoms of Cluster Headache?

  • Common symptoms in children and adolescents include:
    • Unilateral (one-sided) pain, often behind an eye
    • The affected eye may look droopy and have a small pupil, or the eyelid may be red and swollen.
    • Congestion or runny nose
    • Swollen forehead

 

Headache Associated With a Serious Issue

If your child shows these symptoms, consult a headache specialist to determine if there is a possible serious underlying cause:

 

  • Headache in a very young child
  • Headache pain that awakens a child
  • Headaches that begin very early in the day
  • Pain worsened by strain like a cough or sneeze
  • Recurrent vomiting episodes or other signs of a stomach virus
  • Child complaining about “the worst headache ever”
  • Increasing severity of headache, or one that continues
  • Personality changes
  • Weakness in limbs or problems with balance
  • Seizures or epilepsy

 

How Is Pediatric/Adolescent Headache Diagnosed?

An accurate diagnosis is the first step to effective treatment in children and adolescents with headache. A pediatric headache specialist should evaluate your child thoroughly, including a physical exam, inquiries into medical and family history, and diagnostic tests. The child may be asked to describe the pain, its location, the duration of the headache and more. The specialist may ask parents about changes in behavior, personality, sleeping patterns, emotional stress and if physical trauma preceded the headache. If symptoms indicate migraine or tension headache, specialists may not recommend further testing. But sometimes, additional diagnostic tests may be necessary; these may include blood tests, an MRI or CT scan, or a polysomnogram to check for a sleep disorder.

 

What Is the Recommended Pediatric/Adolescent Headache Treatment?

Each child receives an individualized treatment regimen that may include these components:

  • Medication
    Specific therapeutic agents are prescribed, and patient response is closely monitored to evaluate efficacy and minimize side effects.

 

  • Lifestyle Modification
    Patients are instructed in the areas of diet, recreation, sleep patterns and other habits linked to headaches.

 

  • Biofeedback Training
    This is a non-drug therapy that enables patients to actively participate in their treatment while alleviating headache symptoms. About 70% of all patients, and especially children, benefit from this training. Biofeedback augments other therapies and is particularly useful for patients for whom stress is a major contributing factor to headaches, or for those patients who are unable to use standard headache agents.

 

Presentation courtesy of Diamond Headache Clinic.

The local ER experience

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On a local site they were complaining about the hospital and most of the complaints were invalid. Mine was not, but that is a side note. The one real complaint I have I didn’t mention because people wouldn’t get it. Because they have no idea how serious migraines can be.

I never go to the ER for a migraine unless it is a status migraine. An acute migraine that has lasted more than three days. Often I go on day 5. And I stopped even doing this long ago.

Here is what the treatment generally is:

Approximately 40% of all migraine attacks do not respond to a given triptan or any other substance. If all else fails, an intractable migraine attack (status migrainosus), that is, an attack lasting longer than 72 hours, should be addressed in an urgent care or emergency department. In rare cases, patients may need to be hospitalized for a short period and may need to be treated with intravenous valproate or dihydroergotamine (intravenously/subcutaneously/intramuscularly) for a few days Medscape

Here is a typical guideline

Or this treatment

The last time I went recently the doctor said we don’t see you often here for migraines and I said no and didn’t explain. But there are reasons. He treated me with morphine because I cannot take toradol anymore. By the way, the One doctor who Didn’t give me the stink eye because I can no longer take NSAIDs by the way. The nurse hooking me up for hydration literally said to me ‘we hydrate because sometimes a migraine can be caused by not enough fluids’. I wanted to tell her it just might… might… be the vomiting, lack of eating, and diarrhea that is to blame after five days of migraine straight. Maybe. Maybe that is why they do that. Just a thought.

Anyway, when I used to go for a status migraine I know for a fact they had no idea what a status migraine was. They always treated with toradol and nothing else. Sometimes with something for nausea, but not always. Sometimes hydrate you, but not always. And they didn’t particularly care if it didn’t work, which it just didn’t. So I stopped going because migraines are low on the list so it is always hours and hours in a very migraine adverse environment, for a treatment that does not work, to leave with a migraine anyway. No real point to it.

Then one day I had a status migraine to which I pushed through like always. Sick. Sleep deprived. On day five I woke up with a numb hand. Permanently numb and over time it spread over that hand. Until the whole hand was numb and had a sharp prickle sensation on it. Turns out it was nerve damage. One neuro says from the status migraine. Another says from a stroke in my sleep caused by the status migraine, causing the nerve damage. Either way, nerve damage. But would it have mattered? No. I would have went to the ER, gotten toradol after a 6 hour wait and left with the migraine and still had the nerve damage. Because they didn’t abort it. Because they don’t know how or care to know how. Or care that I leave that way. It is just a migraine after all. They just need the bed.

So that doctor wonders why I do not go? It never helps. I know I should. Stroke risk. Apparently nerve damage. Heart attack risk. Coma. Death. All higher risks when a migraine like that persists. But I gave up on them. People tell me, I should go to a different ER. Way out of my way and maybe, just maybe the treatment will be better. But to the people who say not to complain about that ER? Don’t even go there. I had one doctor ask Me if one of my symptoms was a migraine aura. Me. If he didn’t even know that, then I can guarantee you he didn’t know what a status migraine was. He gave me two Percocet’s. For a status migraine. Yeah, that did not work oddly enough. Because I knew that wouldn’t work I took one, drove home, and took the other praying for sleep. It failed.

The doctor who gave me morphine, and hydration and a boat-ton of anti nausea meds, well it sort of handled my nausea and it knocked the pain down to a 4… which by the way is so very low that I was one happy camper when I left. I consider him ranked one of the best damn doctors I have ever seen there. At least he had some good bedside manners and didn’t treat me horribly just because I can’t tolerate toradol. Right up there with the fellow who actually did know what a status migraine was and gave me DHE.

So I don’t go to the ER here for status migraines. When I am working, I get them quite frequently and they are a serious problem. But, I do nothing but suffer with them, because there is nothing to do with them apparently but that.

The comorbids

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Several chronic pain disorders were reported to be associated with migraine. The Nord-Trøndelag Health Study (Hagen et al., 2002) noted that subjects with headache reported more musculoskeletal pain than those without. The risk was similar between migraine and non-migraine headache patients (OR = 1.9 vs. 1.8). However, headache frequency was a strong predictor for musculoskeletal pain. Von Korff et al. (2005) also found that patients with self-reported chronic spine pain were associated with migraine with an OR of 5.2. Fibromyalgia was very common in patients with migraine with frequencies between 22 and 40%. (Peres et al., 2001; Ifergane et al., 2006; de Tommaso et al., 2009) The development of fibromyalgia was highly associated with migraine frequency. Patients who suffered from both migraine and fibromyalgia reported a higher prevalence of insomnia, lower quality of life and more mental stress (Peres et al., 2001; de Tommaso et al., 2009). It is interesting that the fibromyalgia was more frequent in female migraine patients than male patients (Ifergane et al., 2006; de Tommaso et al., 2009).

Fibromyalgia as you see is associated with higher frequency of migraines, higher prevalence of insomnia, lower quality of life and more mental stress. Therefore a comorbidity like this can have a major impact on coping with the migraines, with both. Certainly I have found this to be true. My frequency is daily, my insomnia severe and difficult to treat and both have impacted my quality of life and I do experience a great deal of stress due to the pain. Not to mention FM is chronic pain itself. I have been so insanely sore lately it is hard to sit down, hard to lay down for too long, hard to get up and walk… pain levels have been high. Add the migraines in and that is a whole lot of Overall pain we are talking about and Low level of functionality. There is times when the migraine is severe and I need to lie down… but I can’t lay down long because it causes me significant FM pain.

Depression

 In another study, which used data from an adult US population to look at the cross-sectional associations between three pain conditions (migraine, arthritis and back pain) and three psychiatric disorders [depression, generalized anxiety disorder (GAD) and panic attacks] (McWilliams et al., 2004), the associations between the three psychiatric disorders were roughly similar. In this population, 28.5% of the migraine subjects were considered clinically depressed, while only 12.3% of subjects without migraine fit the same criteria (OR 2.8). Comorbidity with psychological distress was related to a poorer health-related quality of life in patients with migraine (Wang et al., 2001). In a recent study, patients with disabling chronic headache had high frequencies of somatic complaints (OR 8.6) and major depressive disorder (OR 25.1) (Tietjen et al., 2007). We used a 30-item version of the Chinese Health Questionnaire (CHQ-30) to screen minor psychiatric morbidity if the score was > 10 in a Taiwan population. The study showed that subjects with chronic migraine had a higher chance to have a positive screening result in the CHQ-30 score (>10) than those with chronic tension-type headache (CTTH) (66% vs. 36%) (Lu et al., 2001). In clinic-based studies, patients with chronic daily headache, especially chronic migraine, had high frequencies of major depression and panic disorders (Juang et al., 2000). In addition, the presence of major depression was a poor outcome predictor in patients with chronic daily headache (RR = 1.8) (Lu et al., 2000).

Comorbidity with psychological distress was related to poorer  health outcomes and poorer health-related quality of life. Depression makes all pain harder to cope with and takes away the will to fight it as well.

When it comes to comorbids I have many. I have fibromyalgia, depression, suicidal thoughts and actions, allodynia (which can be extremely painful), asthma and I believe thought not in this article Hypothyroidism is a comorbid and I have that one as well. Under CVD is our white matter brain lesions, and I have those as well. That would be these:

Sub-clinical vascular brain lesions

Sub-clinical cerebral lesions, especially in the posterior circulation or white matter, were reported to be more frequent in patients with migraine (especially migraine with aura) in a case-controlled MRI study (CAMERA) (Kruit et al., 2004). The same group also demonstrated that most (88%) infratentorial infarct-like lesions had a vascular border zone location in the cerebellum and, further, that a combination of hypoperfusion (possibly migraine attack-related) and embolism is the most likely mechanism for posterior circulation infarction in migraine (Kruit et al., 2005). Recently, MRI was performed in participants of the AGES-Reykjavik Study, more than 26 years after the initial headache diagnosis. Women, but not men, with migraine with aura in midlife were associated with increased cerebellar infarct-like lesions in late life (Scher et al., 2009).

So there is a long list of comorbids under each group I listed on my graphic. And other miscellaneous ones like asthma and even narcolepsy. I have 7 of them so that should show how easily it is to get these comobids once you have one. Although FM came first for me. Nevertheless you end up with a cluster of conditions all working against each other than need to be treated. Like FM making the migraines worse, and migraines making the FM worse. And then the hypothyroid needing to be treated well but it mimics some symptoms of the FM so hard to know if you are getting the right amount of meds. Then asthma springs up from god knows where. So there is another med, which by the way may trigger a migraine when you take that.

The picture becomes complicated. The pain becomes very complicated.

 

Source: Comorbidities of Migraine

Migraine: The Postdrome

The Postdrome is called a `migraine hangover`for a reason… it is the hangover without having it drink it get it. Yay us. It can last for hours to days. Yay us.

The postdrome is a constellation of symptoms that persist beyond the resolution of headache. Many of these symptoms appear initially during the prodrome or with the headache phase. Commonly, patients report anorexia, nausea, muscle tension, fatigue, and cognitive impairment. This phase has been termed the migraine hangover and can last and produce disability up to 1 to 2 days beyond the headache phase. The pathophysiology of the postdrome is unknown, but likely represents a gradual recovery phase from the extreme neurologic disruption that occurs during migraine — Understanding the Patient With Migraine: The Evolution From Episodic Headache to Chronic Neurologic Disease. A Proposed Classification of Patients With Headache, Medscape

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Not much happens with the Postdrome but we feel Cruddy with it. So fatigued. And with brainfog like nuts. Once the pain is gone it is like the body and brain don`t turn back on yet… they are left lagging behind with no energy to run.

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And then, again, we get the mood symptoms back for a show. I have Never experience the euphoria… but that would be nice for sure. I have experienced the depressed mood though

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You can also feel sore all over with muscle tenderness. Just feeling uhg all over.

Here are the results of a study on 893 migraineurs:

RESULTS:

A total of 32.9% of IHS migraine 1.1-1.6 patients reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migrainereported 29.7% and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these symptoms were present together in 17% of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15.0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 patients showed similar findings. IHS 1.1-1.6 patients with prodrome differed from patients without prodrome in having more triggers as a whole (P <.01), more individual triggers including alcohol (P <.01), hormones (P <.01), light (P <.001), not eating (P <.05), perfume (P <.01), stress (P <.01), and weather changes (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <.05), longer time to peak of headache (P <.05), longer time to respond to triptan (P <.05), longer maximum duration of headache (P <.05), and more headache associated nausea (P <.05), more headache associated running of the nose or tearing of the eyes (P <.05), more postdrome syndrome (P <.05), and longer duration of postdrome syndrome (P <.001).

So symptoms vary as does that duration by quite a bit.

 

So now we are at the end of the migraine stages. But it is good to note these stages last for different durations. Sometimes you even skip a stage, assuming you even get the auras or the headaches. And sometimes you go from the headache stage right into another prodrome of another migraine. The stages are what a standard attack looks like, but every attack is different. You may not get a prodrome one time and have a long prodrome the next. Same with the postrome. It may be not there or last days. There is a lot of variability in there and it is good to know the symptoms to know what stage you are in. First it helps with immediately treating the migraine. Secondly it can indicate when a migraine is nearing its end… but is in still in effect.

Migraine: Headache stage

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We are all aware of the headache stage. Many people thing it is the only stage which is why we need to raise awareness of the neurological processes to the disease.

It lasts anyway from 4 hours to 72 hours. Yeah. It can in fact last that long. And it certainly does. When it lasts longer it is a different, called a status migraine which is important due to the risks associated with it. It is mild to severe in intensity.

It is pulsating and throbbing. Definitely made worse by movement.

Generally migraines are diagnosed as one-sided pain. But they can in fact be bilateral from the get go. They can become bilateral into the attack. They can also switch sides during an attack.

It is not necessary to a migraine attack. Silent migraines have no headache stage.

In this stage is the migraine symptoms that are most familiar to someone who does not suffer from a migraine. Such as the sensitivity factor: To Sound. To Light. To Odours.

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And it can include:

 

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Not to mention jaw pain, facial pain, vertigo and dizziness and more.

The pain is hard to describe in its intensity. It is hard to think through pain. Hard to want to move pain. Constantly distracting pain. With your senses all heightened making your environment quite unpleasant and aggravating.