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Bad News For Coffee Drinkers Who Get Headaches

October 1st, 2009

From ScienceDaily.com:

People who consume high amounts of caffeine each day are more likely to suffer occasional headaches than those with low caffeine consumption, a team of researchers at the Norwegian University of Science and Technology (NTNU) reports in a study recently published in the Journal of Headache Pain.

But in findings that had “no obvious reason”, the researchers, led by Knut Hagen from NTNU’s Faculty of Medicine, also reported that low caffeine consumption was associated with a greater likelihood of chronic headaches, defined as headaches for 14 or more days each month.

The results are drawn from a large cross-sectional study of 50,483 people who answered a questionnaire about caffeine consumption and headache prevalence as a part of the Nord-Trøndelag Health Survey (HUNT 2), a county-wide health survey conducted in 1995-1997 on a wide range of health topics.

To drink or not to drink

Caffeine is the world’s most commonly consumed stimulant, and has long been known to have both positive and negative effects on headaches. For example, caffeine is a common ingredient in headache analgesics because it can help relieve headaches.

But research worldwide into the relationship between caffeine consumption and headache provides no relief to headache sufferers wondering whether they should drink more coffee or less. Some studies have shown that high caffeine consumption increases the prevalence of headaches and migraines, while other studies have shown no such relationship.

At the same time, headaches are costly to society, in work hours lost, and to individuals themselves. The World Health Organisation ranks migraine 19th in all causes of disability based on a measure called “years lived with disability”, as one example.

The issue is of particular interest in Scandinavia, because Scandinavians are heavy coffee drinkers, consuming on average about 400 mg of caffeine per day. That is roughly twice the average caffeine consumption in other European countries and in the US, and equates to roughly 4 cups of brewed coffee per day, although caffeine levels in coffee vary quite widely.

The power – and limitation — of numbers

The HUNT study is powerful because it is large-scale, population-based and cross-sectional, but when it comes to headaches, these characteristics make it difficult to establish cause-and-effect. For example, the frequency of non-migraine headache was found by researchers to be 18 per cent more likely in individuals with high caffeine consumption (500 mg per day or more) than among those with the lowest consumption (with mean levels at 125 mg per day).

But does that mean that all that caffeine causes headaches – or that people who are more likely to suffer from headaches drink caffeinated beverages in search of relief? “Since the study is cross-sectional, it cannot be concluded that high caffeine consumption causes infrequent headache,” the researchers write.

Even more difficult is explaining why chronic headache was less likely among individuals with moderate or high caffeine consumption, the researchers said. One possibility is that caffeine consumption helps change chronic headache into infrequent headache.

Cutting back may help

But it is equally possible that chronic headache sufferers had reduced their intake of caffeine because they had experienced its headache precipitating properties – and that individuals with infrequent headaches were unaware that high caffeine might be the cause.

In an interview, Hagen said that people should consider cutting back on their coffee consumption if headaches were a problem. “People who suffer from headaches should be focused on their caffeine use, because it can be a cause of their headaches,” he said.

Hutch researchers find women with migraines less likely to get breast cancer

July 10th, 2009

From seattlepi.com:

Women diagnosed with migraine headaches have a lower risk of developing breast cancer.

That’s the finding of a new study led by Fred Hutchinson Cancer Research Center researcher Dr. Christopher Li.

The research could lead to a new way of understanding how breast cancer works, Li said.

“If we can better understand what the biological mechanisms are, that could open new avenues for research into breast cancer prevention.”

The study appears in July issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research. It confirms work that Li published in the same journal in November. That study was the first to find that women with migraines have a lower risk of breast cancer.

This time Li and his team increased their sample size and looked at a wider range of ages. They looked at health data from more than 9,000 women in five American cities: Atlanta, Detroit, Los Angeles, Philadelphia and Seattle.

They also addressed this question: Could it be that migraine-prone women are less likely to do things that increase the risk of breast cancer?

Smoking, drinking alcohol and taking hormone-replacement therapy — all risk factors for breast cancer — are migraine triggers, so women with migraines have an interest in avoiding them. Also, the painkillers aspirin and ibuprofen — both likely choices of drugs to blunt the effects of a migraine — can lower breast cancer risk.

The researchers were able to show that behavior couldn’t explain the difference.

Whether or not they smoke, drank, popped Advil, or took hormone-replacement therapy, migraine sufferers still came down with breast cancer less often than they would if they behaved the same way, but had no migraines.

A clinical diagnosis of migraine meant a 26 percent lower risk of breast cancer.

“It was reassuring that we were able to confirm what we had published previously,” Li said. “We’re seeing a consistently reduced risk of breast cancer.”

Migraines and breast cancer are both related to the hormone estrogen.

Estrogen has a wide range of effects on the body. It is present in both men and women, but women have more of it. It promotes the development of breasts and other female body characteristics, and it helps build bones. Levels rise and fall through women’s menstrual cycles.

The more women are exposed to estrogen, the more likely they are to develop breast cancer. For example, if a woman starts menstruating before age 12 she has an increased risk of breast cancer.

Migraines, which are more common in women than in men, follow the flux of estrogen in the body. They’re often triggered by the onset of menstruation, when estrogen levels plummet. They also decrease during the second and third trimester of pregnancy, a time of high hormone levels.

Li’s team is onto the next step. They’re contacting some of the women from the previous studies and learning more about the effects of different kinds of migraine.

“We’re trying to understand what are the types of migraine that are most related to reduction in breast cancer risk,” Li says.

Avoiding the painkiller-overuse rut in migraines

December 26th, 2008

boston.com

Those pain pills you think help your migraines? Take too many and you could make them worse. Overusing painkillers can spin migraine patients into a rut, spurring more headaches that in turn require more pain medication. A very unlucky fraction even get what’s called chronic migraine, where they’re in pain more days than not, and new research suggests certain prescription painkillers, including narcotics, increase that risk.

Don’t misunderstand: Treating migraines, properly, is important. The bigger message is to try migraine-preventing medicines if the tenacious headaches strike regularly — so that you don’t fall into the painkiller rut like Rena Cerbone did.

“It was a double-edged sword,” Cerbone, 41, of Montclair, N.J., says of a period when only one pain reliever dulled her migraines and then invariably triggered rebound headaches a day or so later. “I was taking Fiorinal on a daily basis just to function.”

The caution is timely, as the estimated 30 million Americans who suffer migraines — migraineurs, they’re called — often find the holiday season a time of increased pain. Lack of sleep, tempting treats and the stress of travel are common triggers.

The head throbs, usually on one side, anywhere from a few hours to three days. Nausea and sensitivity to light and sound are common. Moving makes it worse. Some people can sense them coming with visual disturbances like seeing pinpoints of light, although lacking that classic “aura” doesn’t mean you don’t have a migraine.

Fortunately for most patients, migraines are every-so-often miseries. Studies suggest that about a third of migraine sufferers have them often enough to be candidates for prevention medications that can cut the frequency in half. Yet only about 10 percent use them.

And depending on acute painkillers more than a few days a week can signal overuse.

“Most people outside the specialty community are not aware of the concept,” said Dr. Stephen Silberstein of Thomas Jefferson University, a spokesman for the American Academy of Neurology. “I think there’s an epidemic in the U.S. of patients having frequent headaches, taking their pain pills over and over again,” and winding up in more pain.

Overusing any pain medication, over-the-counter or prescription, can cause a rebound headache once it’s stopped.

But occasionally in frequent migraine sufferers, the brain gradually becomes more sensitive to pain so they worsen even more. When they’re having pain a stunning 15 or more days a month, it’s called chronic migraine or “transformed migraine.” No one knows exactly how many people get that bad, although migraine specialist Dr. Richard Lipton of the Albert Einstein College of Medicine says some estimates suggest there could be as many as 5 million.

“Chronic migraine is a condition we should be trying to prevent,” says Lipton, who also heads New York’s Montefiore Headache Center and studied whether particular medicines are linked to this worst-case pain.

The study tracked 8,200 episodic migraine sufferers for a year, and found 2.5 percent worsened to a state of chronic migraine. Those who took two classes of prescription medications — drugs containing narcotics, such as Percocet, or drugs containing barbiturates, such as Fiorinal — were most likely to worsen, Lipton and colleagues reported in the journal Headache. Risk increased with higher doses.

Over-the-counter standbys, from plain acetaminophen to the anti-inflammatories called NSAIDS — ibuprofen, naproxen and their cousins — weren’t linked to chronic migraine. The NSAIDS even showed a hint of protection. Migraine-specific painkillers called triptans likewise showed no risk at low to moderate use, becoming a risk factor only after 10 pain days a month.

Some patients will need the stronger narcotics or barbiturates, especially for severe attacks, Lipton acknowledges. But, “the reality is they’re overused” in migraines, he says, advising that patients who truly need them limit weekly doses.

Chronic migraine aside, getting out of the medication-overuse rut is hard. In New Jersey, it took Cerbone several tries before she found a migraine specialist who cut her prescription painkiller cold turkey and found a daily prevention medication that has worked since August.

Headache specialists advise:

–Ask about migraine-prevention drugs. Choices range from blood pressure-lowering drugs called beta-blockers to epilepsy drugs and certain antidepressants, all of which have side effects to be considered. Some patients even try Botox injections, to quiet overactive nerve endings.

–Quit the overused medication, but brace for painful withdrawal. A doctor may advise different short-term medications to help.

–Use a headache diary to pinpoint migraine triggers and learn to minimize them.

Teens With Migraine At Greater Risk Of Suicide

July 12th, 2007

From Science Daily

Teens who have chronic daily headache, especially those with migraine headaches, are at greater risk for suicide than teens who don’t have migraines, according to a study published in the May 1, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology. Teens with migraine are also more likely to have other psychiatric disorders such as depression and panic disorder.

“Teens with chronic daily headache should be screened for psychiatric disorders so they can get the treatment and help they need,” said study author Shuu-Jiun Wang, MD, of the Taipei Veterans General Hospital and National Yang-Ming University School of Medicine in Taipei, Taiwan.

For the study, the researchers surveyed 7,900 students age 12 to 14 at five middle schools in Taiwan. Those who reported frequent headaches were interviewed by a neurologist and their headache type was diagnosed. A total of 121 teens with chronic daily headaches were then screened for psychiatric disorders. Chronic daily headache was defined as headaches 15 or more days per month for two or more hours per days, lasting for more than three months. Chronic migraine is a type of chronic daily headache.

Nearly 50 percent of those with chronic daily headaches had one or more psychiatric disorder, with 21 percent having major depression and 19 percent having panic disorder. Twenty percent were at high risk of suicide. “These numbers are much higher than those reported among the general population of teens of the same ages in Taiwan,” Wang said.

Those with migraine headaches were most likely to have a psychiatric disorder. They were 3.5 times more likely to have a psychiatric disorder than those without migraine. And teens whose migraines came with an aura, or a warning sensation that comes before the headache, were even more likely to have psychiatric disorders. Teens with migraine with aura were six times more likely to be at high suicide risk than those without migraine.

Researchers don’t exactly know how underlying mechanisms may link migraine and psychiatric disorders, although they do know that migraine, depression and the tendency toward suicide are all related to problems with the levels of serotonin in the brain.

The study was supported by grants from the Taiwan National Science Council and the Taipei Veterans General Hospital.

Celiac Disease a Possible Cause of Migraines

May 24th, 2007

From Web MD

In a nifty piece of detective work, doctors at Catholic and La Sapienza universities, Rome, identified a hidden gut problem as a potential cause of migraine headaches. The gut problem is called celiac disease or gluten intolerance. Celiac disease can cause severe symptoms — but sometimes the symptoms are hard to detect. Even in people with no obvious symptoms, it has been associated with many kinds of nerve and brain problems. Might celiac disease also cause migraine? Maurizio Gabrielli, MD, and colleagues compared 90 migraine patients with 236 healthy blood donors. They found that the migraine sufferers were 10 times more likely to have celiac disease than the healthy donors.

“Our results suggest that a significant proportion of patients with migraine may have celiac disease,” Gabrielli and colleagues write in the March issue of The American Journal of Gastroenterology. The cause of celiac disease is sensitivity to gluten. Gluten is the protein in grains that lets bread rise. A gluten-free diet cures the disease. Could it cure migraine? Of the 90 migraine patients in the study, four had previously undiagnosed celiac disease. All four went on a gluten-free diet. It cured migraines in one patient. The other three had fewer headaches — and when they got migraines they were shorter and less intense. This might have been the famous placebo effect. But Gabrielli’s team used SPECT scans to look at the patients’ brains blood flow. The gluten-free diet improved blood flow in the brains of all four patients. If larger trials confirm these preliminary findings, the researchers suggest, people with migraines should be tested for celiac disease. For those found to have the problem, it may be a cause of their migraines and a gluten-free diet could help — or even cure — them.

Dr. Perlmutter’s comment:

Simply stated, all headache patients should have a simple blood test, antigliadin antibody, to check for gluten sensitivity.