I had two no-shows yesterday, (which I find perplexing in itself), but that did give me the opportunity to catch up on reading three issues of Cephalalgia, the international journal of headache research.
While the journals were full of reports about important work, much if it would make no sense if I tried to share it here. It is work at a very fundamental biochemistry level and is very complex. Sometimes I don’t full grasp the studies myself and I’ve been reading these journals for over 30 years. Here is one such title (out of about 40) Meningeal transient receptor potential channel M8 activation causes cutaneous facial and hindpaw allodynia in a preclinical rodent model of headache. This work is very important and will eventually bear fruit. Basically it is making reference to the fact that the pain we interpret as headache may be playing out inside our skulls among the soft tissue surrounding the brain.
But I did try to cherry pick studies that would be easier to understand and have more value for the patient.
- The occipital lobes of the brains of people who have visual aura, seem to be different from the occipital lobes of patients who don’t have migraines.
- An experiment in burning the sphenopalatine ganglion (an autonomic nerve that rest behind the nose and is involved in many types of headache) of cluster headache patients seemed to decrease the frequency and severity of their attacks.
- When you are trying to “Detoxify” someone from rebounding medications (usually pain killers that are taken too often, making the headaches worse), if you add a nurse to make contact with the patient and help coach then through the process, it makes a big difference. Those patients did much better. While this is possible in the European model, it would not be possible in the US because insurance companies would not allow it.
- Doing a lumbar puncture with a Sprotte Spinal Needle reduces post-spinal headache. This needle has a special coating that is more gentle to the dura that surrounds the spinal fluid. If you have a lumbar puncture, make sure they are using this needle.
- While we now know that migraine aura is not caused by blood vessel constriction, there is evidence that in prolong migraine there are chemical markers that the brain cells are deprived of oxygen, probably as the result of the initial and continuing electrical disturbances.
- The autonomic (in other words, automatic, or nerves that we can’t directly control) nervous system in the head of cluster patients functions abnormally even when they are not having attacks.
- Patients who over use medications (pain killers, other symptomatic relief medications) also had unhealthy life styles and more stress than those who did not. This included smoking, lack of exercise, over eating and being in stress inducing social situations.
- People with chronic headaches (daily or near daily) have a much higher loss in their quality of life than previously appreciated. Insurance companies ( in America) governments and other agencies tend to down grade the importance of headache disorders, when they probably cause far more harm to someone’s quality of life than many other diseases, which are classified as much more important. This misunderstanding is having a direct interference for patients wanting good care.
Forgive the typos. I only had time to type this as fast as I could. I may come back to proof-read.
Michael Jones, MPAS-C