Both too much, too little weight tied to migraine

Both obesity and being underweight are associated with an increased risk for migraine, according to a meta-analysis published in the April 12, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The researchers looked at all available studies on body mass index (BMI) and migraine. “As obesity and being underweight are potentially modifiable risk factors for migraine, awareness of these risk factors is vital for both people with migraine and doctors,” said study author B. Lee Peterlin, DO, of Johns Hopkins University School of Medicine and a member of the American Academy of Neurology. “More research is needed to determine whether efforts to help people lose or gain weight could lower their risk for migraine.”

A total of 12 studies with 288,981 participants were included in the meta-analysis. When the researchers compiled all of the results and adjusted for age and sex, they found that obese people were 27 percent more likely to have migraine than people of normal weight. People who were underweight were 13 percent more likely to have migraine than people of normal weight.

Obesity was defined as a BMI of 30 or higher. Underweight was defined as a BMI of less than 18.5.

Peterlin said the risk between obesity and migraine was moderate and similar in size to the link between migraine and bipolar disorders and ischemic heart disease, a condition of recurring chest pain or discomfort when part of the heart does not receive enough blood.

According to Peterlin, age and sex were important variables in the relationship between body mass index and migraine. “This makes sense, as the risk entailed by obesity and the risk of migraine is different in women and men and in younger and older people,” she said. “Both obesity disease risk and the occurrence of migraine is more common in women and in younger people.”

She continued, “It’s not clear how body composition could affect migraine. Adipose tissue, or fatty tissue, secretes a wide range of molecules that could play a role in developing or triggering migraine. It’s also possible that other factors such as changes in physical activity, medications, or other conditions such as depression play a role in the relationship between migraine and body composition.”

Limitations of the meta-analysis include that for half of the studies people self-reported that they had migraine and for more than half of the studies people self-reported their body mass index.

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Dopamine levels fall during migraine attacks, brain scans show

Using PET scans of the brain, University of Michigan researchers showed that dopamine falls and fluctuates at different times during a migraine headache.

This could help scientists better understand dopamine-based therapies for migraines as well as a patient’s behavior during an attack.

The connection between dopamine and migraines has long been a poorly understood therapeutic and research area, says Alex DaSilva, assistant professor at the U-M School of Dentistry and Center for Human Growth and Development at the University of Michigan.

Dopamine — sometimes called the brain’s feel-good neurotransmitter — helps regulate emotion, motivation and sensory perception.

Physicians and emergency rooms often give migraine patients dopamine antagonists, drugs that block overactive dopamine receptors, to level off wild dopamine fluctuations and ease migraine attacks.

DaSilva and colleagues took various measurements of brain activity and dopamine levels of eight migraine sufferers and eight healthy patients during migraine attacks and between headaches. They compared study participants to each other with and without headaches, and also migraineurs to healthy patients.

When migraine patients were between headaches, their dopamine levels were as stable and even as the healthy patients, DaSilva said. But during an attack, the migraine patients’ dopamine levels fell significantly.

“Dopamine is one of the main neurotransmitters controlling sensory sensitivity,” said study co-author Kenneth Casey, U-M professor emeritus of neurology. “Therefore, a drop in dopamine could produce increased sensory sensitivity so that normally painless or imperceptible sensory signals from skin, muscle and blood vessels could become painful.”

This supports the hypothesis held by some researchers that migraines are a periodic disorder characterized by sensory hypersensitivity during which light, sound and odors may become abnormally intense, Casey says.

DaSilva says he was surprised when patients who were resting during their migraine attacks experienced a small dopamine spike and worsening symptoms when researchers applied warmth to their foreheads.

This condition in chronic pain patients is called allodynia — when a stimulus that normally wouldn’t cause pain does. DaSilva says the sudden small spike in dopamine was probably an aversive reaction to environmental stimulation.

This small fluctuation was only a partial recovery of dopamine, but it made the suffering worse because the dopamine receptors were highly sensitive by then, and even a small recovery would induce more nausea, vomiting and other symptoms related to migraine, he says.

In addition to the pain of migraines, DaSilva says the fall in dopamine in general could also explain some of the isolation and withdrawal that migraineurs exhibit during an attack.

“This dopamine reduction and fluctuation during the migraine attack is your brain telling you that something is not going well internally, and that you need time to heal by forcing you to slow down, go to a dark room and avoid any kind of stimulation,” he said.

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Innovative treatment offers relief to children with frequent migraine headaches

A minimally invasive treatment for migraine headaches used for adults is also proving to be a safe and effective treatment for children and teenagers, and only takes minutes for a child to feel relief, according to new research being presented today at the Society of Interventional Radiology’s 2017 Annual Scientific Meeting.

Migraines are a common medical condition among youth and adults, affecting 12 percent of people ages 12 and older. They can be especially debilitating in teenagers and often disrupt everyday activities, such as school, music and sports. The innovative treatment — sphenopalatine ganglion (SPG) block — does not involve needles touching the patient. Instead, a small flexible catheter is inserted into each nostril and local anesthetic is administered to the SPG, a nerve bundle thought to be associated with migraines, located at the back of the nose. Briefly disabling the SPG can disrupt and reset the headache circuit, breaking a cycle of severe migraines and reducing the need for medication. The minimally invasive SPG block takes almost immediate effect with relief potentially lasting for months, researchers said. SPG blocks are not a frontline treatment. A child only qualifies for the therapy if he/she has been diagnosed with a severe migraine that has not responded to first-line treatments.

“This treatment, performed in an outpatient setting by an interventional radiologist, can safely relieve a child’s migraine quickly,” said Robin Kaye, MD, section chief of interventional radiology in the department of medical imaging at Phoenix Children’s Hospital and a co-author of the study. “By reducing the need for medications that come with serious side effects or intravenous therapies that may require hospital stays, children don’t have to miss as much school and can get back to being a kid sooner.”

Kaye and her team conducted 310 treatments in 200 patients ages 7 to 18 at Phoenix Children’s Hospital. Patients’ pain levels before the intervention were recorded on a scale of 1-10. Ten minutes after the treatment, patients were asked to compare their pain level, using the same scale. The researchers saw a statistically significant decrease in the headache scores, with average pain score reduction of just more than 2 points on the 10-point scale.

“While it isn’t a cure for migraines, this treatment has the potential to really improve the quality of life for many children,” said Kaye. “It can be performed easily, without complications, and gives quick pain relief, which is important to parents who want to see their children happy, healthy and pain free again. If needed, we can also repeat the treatment if or when the migraine returns.”

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Researchers aim to cure headache during flight

Many people suffer from pain when they fly but that may soon be a thing of the past. A new study from Aalborg University may have discovered the mechanisms responsible, opening the door to developing a cure.

A getaway to the southern sunshine should be a treat but according to a study done at Aalborg University last year, for one out of twelve people a flight means a severe headache. Now, the same research group is the first in the world to investigate the cause of the problem, and they have a preliminary explanation.

“The major changes in cabin pressure at take-off and landing may cause tissue damage and inflammation in the sinuses. This releases the substance PGE2, which can make the blood vessels in the brain expand and thus cause head pain,” says Master’s student Sebastian Bao Dinh Bui.

Torben Petersen and Sebastian Bao Dinh Bui conducted the study as part of their studies in Medicine with Industrial Specialization (MedIS) at Aalborg University along with their supervisor, Parisa Gazerani, Associate Professor. The group’s results have just been published in The Journal of Headache and Pain.

Tests in flight simulator

The two Master’s students put subjects in a pressure chamber that simulates the pressure changes during a flight. During the “trip” they took regular saliva samples to measure the levels of PGE2 and the stress hormone cortisol. Both substances were prominent in people who suffer from headaches when flying.

“The elevated cortisol level indicates that these people are very stressed when they fly. We have already seen that some airline passengers develop anxiety and stress when they travel, which may also trigger a headache. It is a vicious cycle.” says Master’s student Sebastian Bao Dinh Bui.

The research group at Aalborg University has identified PGE2 and cortisol as causes of airplane headache, but the case is far from closed. Although the study examines airline passengers, it is still only a pilot project and the results are not written in stone.

“Clearly there is more work to be done. Our study is the first of its kind in the world on airplane headache, and that is why we need more and larger studies that can repeat the experiment and see if our conclusions are accurate,” says Sebastian Bao Dinh Bui, AAU.

Treatment on the way

“We are presenting the first finding on the cause of airplane headache, and thus we are also taking the first step towards being able to develop a treatment,” says Master’s student Sebastian Bao Dinh Bui.

Although more data is still needed, Sebastian Bao Dinh Bui is moving forward to the final stage of his three-stage research project. After having first mapped the extent of airplane headache, and then investigated the cause of the problem, he has more clues to work with. He is now starting on his Master’s thesis at AAU where he will examine potential treatments for airplane headache.

“There has already been success with using the migraine medication triptans for airplane headache as these prevent the blood vessels in the brain from expanding. In my thesis I will measure the biological effects of triptans using saliva samples from passengers while they are traveling,” says Sebastian Bao Dinh Bui.

The project begins this spring where passengers from Aalborg Airport initially serve as the test group.

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Wireless stimulation may ease migraine pain as well as drugs

A preliminary study suggests that a new, wireless patch that you wear on your arm may help reduce migraine pain as well as drugs. The study is published in the March 1, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These results need to be confirmed with additional studies, but they are exciting,” said study author David Yarnitsky, MD, of Technion Faculty of Medicine in Haifa, Israel, and a member of the Medical Advisory Board for Theranica, maker of the stimulation device. “People with migraine are looking for non-drug treatments, and this new device is easy to use, has no side effects and can be conveniently used in work or social settings.”

The device uses electrical stimulation to block the pain signals from reaching the brain. The patch uses rubber electrodes and a chip on an armband. The device can be controlled by a smartphone app. In the past when stimulation has been tested for people with migraine, devices needed wires and were attached to the head.

The study involved 71 people with episodic migraine who had two to eight attacks per month and had not taken any preventive medication for migraine for at least two months. Participants were asked to apply the device to their upper arm soon after the start of a migraine and use it for 20 minutes. They were not supposed to take any medications for migraine for two hours.

The devices were programmed to randomly give either a placebo, or sham, stimulation at a very low frequency or one of four levels of active stimulation. The stimulation was designed to not be painful.

A total of 299 migraines were treated with the device during the study. During the active stimulation at the three highest levels, 64 percent of people had a reduction in their pain by at least 50 percent two hours after the treatment, compared to 26 percent of people during the sham stimulation.

For those who started with moderate to severe pain, their pain was reduced to mild or no pain in 58 percent of people at the highest level of stimulation, compared to 24 percent of those during the sham stimulation. In the same group, 30 percent said they had no pain after receiving the highest level of stimulation, compared to 6 percent of those receiving the sham stimulation.

“These results are similar to those seen for the triptan medications for migraine,” Yarnitsky said.

The researchers also found that starting the stimulation within 20 minutes of the start of a migraine was more effective, with 47 percent reducing pain when starting early, compared to 25 percent who started after 20 minutes.

Yarnitsky said one limitation of the study was that during the sham stimulation participants often stopped the treatment before the 20-minute period was done. “This may indicate that they knew the stimulation was not active, and thus they were no longer blinded to the study, which is a challenge in any sham stimulation study,” he said.

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Vitamin D deficiency increases risk of chronic headache

Vitamin D deficiency may increase the risk of chronic headache, according to a new study from the University of Eastern Finland. The findings were published in Scientific Reports.

The Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, analysed the serum vitamin D levels and occurrence of headache in approximately 2,600 men aged between 42 and 60 years in 1984-1989. In 68% of these men, the serum vitamin D level was below 50 nmol/l, which is generally considered the threshold for vitamin D deficiency. Chronic headache occurring at least on a weekly basis was reported by 250 men, and men reporting chronic headache had lower serum vitamin D levels than others.

When the study population was divided into four groups based on their serum vitamin D levels, the group with the lowest levels had over a twofold risk of chronic headache in comparison to the group with the highest levels. Chronic headache was also more frequently reported by men who were examined outside the summer months of June through September. Thanks to UVB radiation from the sun, the average serum vitamin D levels are higher during the summer months.

The study adds to the accumulating body of evidence linking a low intake of vitamin D to an increased risk of chronic diseases. Low vitamin D levels have been associated with the risk of headache also by some earlier, mainly considerably smaller studies.

In Finland and in other countries far from the Equator, UVB radiation from the sun is a sufficient source of vitamin D during the summer months, but outside the summer season, people need to make sure that they get sufficient vitamin D from food or from vitamin D supplements.

No scientific evidence relating to the benefits and possible adverse effects of long-term use in higher doses yet exists. The Finnish Vitamin D Trial, FIND, currently ongoing at the University of Eastern Finland will shed light on the question, as the five-year trial analyses the effects of high daily doses of vitamin D on the risk factors and development of diseases. The trial participants are taking a vitamin D supplement of 40 or 80 micrograms per day. The trial also investigates the effects of vitamin D supplementation on various pain conditions.

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