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Migraine Problems: Haircuts

Thanks to my extreme sensitivity to odors, getting a haircut often triggers a migraine. Here’s how I’ve learned to avoid salon-induced migraine attacks.

1. Avoid salons that do nails. Need I say more?

2. Go to an Aveda salon. While the scent of Aveda’s products is too strong for me to use on my hair, the scents don’t linger in the air of hair salons. Even the hair coloring chemicals don’t bother me (much). I did a sniff test of all the hair salons within a few miles of my house, none of which were Aveda. Most of them had such a strong odor that I didn’t even have to open the door to know it would trigger a migraine. After smelling all those, I decided the extra time to get to an Aveda salon was worth it.

3. Take your own products. Even though I go to Aveda salons (and think their products smell divine), the long-lasting product scents always trigger migraine attacks, so I always bring my own. Some stylists turn up their noses at my homemade products. They’re usually understanding when I explain why, but I recently broke up with a stylist who was snotty about my obviously inferior products.

4. Try to schedule at a time when the other appointments don’t involve hair color. This one can be difficult, but most salons try to accommodate me, especially if I explain the issue.

5. Shower immediately after the appointment. It’s disappointing to wash out a beautifully styled haircut, but my hair and body pick up product odors just from the stylist touching me.

6. Use a neti pot. This is the newest and most ridiculous thing I have to do after a haircut. My current stylist is incredible, but, even though she uses a modest amount, I can’t escape the smell of her perfume. The scent is pleasant and isn’t strong enough to trigger a migraine while I’m at the salon. Still, it stays with me for hours unless I use a neti pot after I shower. Last week, I had to wash my nose out with a washcloth to eradicate the smell! (But I didn’t get a migraine.)

Do you have any tips for migraine-free haircuts? Please share in a comment!

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Migraine Could Be the Source of Colic in Infants

Could colic be an early form of migraine? Quite possibly, according to an increasing body of evidence. The latest research, presented at the American Headache Society conference in June, reviewed published studies that either investigated migraine and colic specifically or had collected data on migraine and collect as part of other research.

This meta-analysis focused primarily on three studies and 891 participants in total. In one, infants whose mothers had migraine were 2.6 times more likely to experience colic than those with non-migraineur mothers. Another found that kids or teenagers who had migraine were 6.6 times more to have had colic than those without a later diagnosis of migraine. The third had similar findings to the second.

Colic is harrowing for parents. To be diagnosed with colic, a baby has to cry for at least three hours a day at least three days a week for three or more weeks. According to Amy Gelfand, MD, the lead researcher, 2.2% of parents of one-month-olds with colic said they had shaken, slapped or smothered their child to get them to stop crying. By the time a child with colic reaches six months old, 5.6% of parents admit to doing so.

Obviously, we can’t know what symptoms an infant experiences. There is some comfort in knowing that children often have migraine attacks without head pain and, for those who do have head pain, it generally lasts a much shorter time than for adults. Basically, many of us “grow into” the head pain that is the hallmark symptom of migraine. Nausea, digestive issues, sense hypersensitivity and autonomic symptoms aren’t minor, but at least there’s a decent chance most infants don’t have the excruciating head pain that adults get with migraine attacks.

Reading this research, I’m deluged by a variety of thoughts and questions. Here’s some of what’s running through my mind:

  • This research is fascinating!
  • If this research holds, it would be a tremendous relief for parents to finally have an explanation (that hopefully leads to a treatment) for colic.
  • Imagining an infant having a migraine attack is heartbreaking.
  • How awful that migraine attacks could begin in the earliest weeks of life.
  • What happens between the time colic resolves and a child starts having identifiable migraine attacks? Do they still experience symptoms?
  • Is there any connection between colic and prevalence of chronic migraine?
  • to imagine and infant with a migraine and to consider migraine attacks could begin in the earliest weeks of life.
  • Colic is widely regarded as awful for infants and their parents. If the general public equates colic with migraine, might they have more empathy for migraineurs?
  • Is it selfish and unfair to hope infants with colic will reduce the stigma of migraine? (Though reducing the stigma would benefit those infants throughout their lifetime with migraine.)

I’m sure I’m not the only one with tons of questions and expect lots more research on the topic in coming years.

Want to read more? Medscape has a good overview of the research and conference presentation: Infant Colic May Be Early Migraine.

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Predicting Botox Response for Chronic Migraine

When a patient asks if Botox will help them, the usual response is along the lines of, “Quite possibly, but you’ll have to try it to find out.” A patient’s blood levels of calcitonin gene-related peptide (CGRP) could predict whether a person with chronic migraine will respond to Botox, according to a study published in the journal Headache‘s June edition.

Researchers believe that a patient’s CGRP levels could predict whether Botox will be effective with 95% accuracy. In their study of 81 chronic migraineurs, those who had a CGRP level above a certain threshold were 28 times more likely to respond to Botox than those with CGRP levels below that threshold. (If CGRP sounds familiar, it’s probably because the research findings on migraine prevention drugs that made the news this spring are CGRP antibodies.) This is only one study and it was small. More studies will need to investigate and confirm a connection between Botox response and CGRP before doctors will begin checking CGRP levels before giving a patient Botox.

In the meantime, if you’re looking to figure out if Botox will help you, something called pain directionality is the best current predictor. Pain directionality is whether your pain feels like it is exploding, imploding or ocular. People with imploding or ocular pain are more likely to find relief from Botox than those with exploding pain.

Multiple studies have explored the connection between pain directionality and Botox response; here’s one you can read for free. However, headache specialist Alexander Mauskop warns that pain directionality “is not a very reliable predictor because some people have difficulty categorizing their pain in that way and because even if they do describe it clearly one way or another, this predictor is far from 100% accurate.”

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The Stress Caused by Illness

We all know that stress can be a cause or a trigger of illness, but we rarely hear about the inverse — that illness itself is a major stressor. In a national poll by the Harvard School of Public Health, the Robert Wood Johnson foundation and NPR, illness, whether one’s own illness or that of a loved one, stands out as huge source of stress.

When asked what their biggest source of stress was in the previous year, 43% of respondents to this open-ended question said health-related problems.

Respondents who were ill or disabled were most likely to have experienced a lot of stress in the month prior to being polled. The top three groups experiencing high stress in the previous month were all health-related:

  • Poor health condition: 60%
  • Disabled: 46%
  • Has a chronic illness: 36%

(The next most common stressor was income less than $20,000, which applied to 36% of respondents.)

Illness is stressful in so many ways: not being able to participate in your normal life, grief and identity loss, not being able to work and financial concerns, being cut off socially, fearing for your quality of life (or life itself), and many, many other issues. There’s also the physical stress of illness itself. Episodes of a illness, like a migraine or cluster headache attack, physically stress the body, as does the daily grind of a chronic disorder.

And, as this poll shows, our most important self-care mechanisms — the ones that are likely to make our bodies and spirits more resilient — go out the window when we’re stressed. The top four things that change when people are stressed? Sleep, proper nutrition, exercise and spiritual practice (listed in descending order).

Stress definitely can be a trigger for a lot of illnesses, but the fact that illness itself is a stressor is too often overlooked. People with chronic illness are told they’d feel better if they reduced their stress. Those who offer such advice are rarely aware that illness itself is responsible for a large part of our stress.

Fortunately, there are programs that specifically teach people how to cope with illness-based (and other) stress. Mindfulness-based stress reduction (MBSR) was a major help for me. Unfortunately, these programs can be expensive in terms of money, time and energy. You can get a decent approximation of the course for less than $30 by reading Full Catastrophe Living and listening to Jon Kabat-Zinn’s Guided Mindfulness Meditation Series 1 CD set. (A lot of libraries carry the book and CDs, so you may be able to introduce yourself to the concepts for no charge). There’s also a $199 interactive online MBSR course offered by the UMass medical school, which developed the program.

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New Daily Persistent Headache Research News

New daily persistent headache (NDPH) is “rare” and “poorly understood;” there is “no known treatment for NDPH.” These statements, which are from abstracts of two studies that were presented at the American Headache Society’s conference in June, succinctly capture the frustrations of people living with NDPH. These studies provide some insight into NDPH.

Characteristics & Precipitating Factors of NDPH

An examination of patients with NDPH at Stanford’s headache clinic revealed some interesting details about the characteristics of NDPH:

  • Patients most often described the pain as pressure-like and in the front of the head
  • 75% said the pain was on both sides of the head (not one-sided, like migraine commonly is)
  • 69% had migraine-like features to their headaches (46% of those had photophobia, 46% had phonophobia, 37% had nausea)
  • 17% had a history of episodic migraine or another headache disorder prior to the NDPH diagnosis
  • 53% had a family history of headaches

In addition, 75% of patients could identify an event or illness that immediately preceded the headache’s onset:

  • 48% had an infection (usually viral)
  • 26% had undergone recent surgery
  • 7.4% had physical trauma
  • 7.4% had psychological stress
  • 11% had another precipitating event

This research is important to both understand NDPH better and to help classify whether it is a primary or secondary headache disorder, which can influence how it is treated.

Botox for NDPH

Perhaps more interesting for people with NDPH is a study of Botox as an NDPH treatment. In this study, 22 patients received Botox injections and 95.4% percent had multiple rounds of injections. Following the injections:

  • 4.6% of patients had 21-30 headache-free days a month
  • 18.1% had 11-20 headache-free days a month
  • 9.1% had 0-10 headache-free days a month
  • 68.2% had no decrease in headache days

Researchers also looked at a reduction in pain severity.

  • 13.6% had a greater than 50% decrease in headache severity
  • 54.6% had less than a 50% decrease in headache severity
  • 31.8% had no change in headache severity

The numbers aren’t staggering, but 32% of patients did have at least some headache-free days with Botox. That’s not trivial for people who have received no other relief.

This was a small retrospective study. It’s results point to the need for more research on Botox for NDPH.