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Identifying & Treating Sex- and Orgasm-Related Headaches

Posts about sex-related headaches are among the most frequently read and commented upon on The Daily Headache. Want more information about these headaches? Here are two must-read articles:

Preorgasmic and Orgasmic Headaches Are Not Migraine explains primary sexual headache (PSH), which are headaches that accompany sex but are not related to a headache disorder like migraine or cluster headaches, and describes treatment.

Sex as a “Cure” for Migraine or Cluster Headache? What’s the Deal? shares the statistics on sex decreasing or increasing migraine or cluster headache pain.

Only your doctor can determine whether your sex- or orgasm-related headaches are a primary disorder or part of another headache disorder. Whether you have experienced headaches in the past or not, it is important to see a doctor to get the correct diagnosis and treatment.

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Revamped Migraine Elimination Diet: Avoiding Histamine & Salicylates

“Immensely frustrating” sums up my experience with the migraine diet I began in January. It seemed to make no difference, but I haven’t known for sure because the high dose of magnesium I started a few weeks later did help. Reintroducing foods is nearly impossible as I can’t tell if any particular one is a migraine trigger or not since I still have a migraine nearly every day. About three weeks ago, a reader’s comment got me thinking and researching: Maybe I do have food triggers, but they aren’t the ones that are usually implicated in migraine.

It all started with this comment from reader Bibi on A Gluten Connection?:

My migraines get worse with wheat as well, but a gluten test at the doctor’s was negative. Genny Masterman (What HIT me?) writes, that there is histamine in yeast so that might cause migraines. I feel a lot better eating less histamine rich and histamine releasing foods.

This caught my eye because the only prescription migraine preventive that’s ever helped me is cyproheptadine, an antihistamine. And physicians don’t know exactly why it helps with migraine. Furthermore, my head often hurts worse after I eat, no matter the food — a phenomenon no doctor of any specialty has been able to explain to me. This pieces came together when I learned that that some foods contain histamine, that others cause histamine to be released in the body, and that the body releases histamine as part of digestion?

Researching histamine intolerance led me to discover that some people have a sensitivity to salicylate, a naturally occurring food chemical. More light bulbs turned on when I discovered that corn and olive oil, both of which have triggered migraines for me, are high in salicylates, as are some of my favorite vegetables. Vegetables that I have been consuming in mass quantities since starting the migraine diet.

There is so much to tell you and so much I have yet to learn and assimilate. Most of the information on histamine and salicylates is anecdotal and unscientific. The health ailments that people claim can be treated by eliminating these (and other) food chemicals from one’s diet range from rashes to ADD and ADHD to migraine to anxiety and depression. It is precisely the kind of topic I would normally dismiss as pseudo-scientific babble. Except that it makes logical sense given the years of unsuccessful treatments and medications I have tried and that I seem to feel worse the more healthful my diet is.

I started the elimination diet last week and felt better than I have in literally a decade, even though the weather was stormy. I’m not doing so well this week, whether it is because I’m in the “withdrawal symptom” phase of the diet, still eating forbidden foods while trying to sort out the details of the diet, or being worn out by Saturday’s party, I’m not sure. Possibly all of the above — or that my good spell last week was a blip completely unrelated to the diet. There’s always that infuriating explanation.

I honestly believe I’m onto something here. I’m looking forward to telling you all about it, but I’ve reached my limit of ability with this current migraine. Here are a few links to get you started:

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The Everlasting Search to Pinpoint Migraine Triggers

It never fails. I return home from a trip* and a migraine hits within a few hours. As always, there’s the urge to figure out what went wrong, what triggered the migraine. I could blame it on insufficient protein in my breakfast and lunch, restless sleep, not drinking enough water, or the mere fact that I was on an airplane for three hours. Or I could use the commonly cited trigger of stress — the stress of travel, the stress of returning to the demands of normal life, the stress of leaving friends, or the stress release upon being home. (Whether stress is actually a trigger is debatable.)

Practically anything, whether it is positive, negative or neutral, could be a trigger. Eating a particular food? Not eating enough? Eating too much? Inadequate sleep? Excessive sleep? Weather changes? Schedule disruption? Flying? Any of these could be a trigger. This is the trouble with migraine. (Well, actually, there are many troubles with migraine, but this is the one that ignites most of my fruitless worry and unfounded self-flagellation.)

Not only is the field of potential triggers wide open, they are additive. Something might not be a trigger in isolation, but add on a couple more triggers and the attack begins.

What most triggers have in common is that the migraineur can be blamed for causing them to happen. “You have a migraine? Well, if you had taken care of yourself by sleeping/eating/breathing correctly, you wouldn’t have gotten it.” This seems to be the attitude of the general public. And we migraineurs are pretty quick to judge ourselves, too. Of course we don’t want to have migraine attacks and changing our behaviors or diets is one potential way to feel like we have some control over this illness. More importantly, it could reduce the frequency of attacks, which must be a universal goal among migraineurs.

Triggers are absolutely real. But they are also different for everyone. And sometimes you can follow all the rules and still have a migraine attack. That’s the case for me 95% of the time, yet I still have a migraine nearly every day. I feel like I must be doing something wrong, but have no idea what it is.

*I wrote this last week after returning from a wedding in Minneapolis. It devolved into a rant, so I let it sit a while before editing and posting.

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Chronic Migraine Defined (A Correction)

In All Migraineurs Are Different — So Stop Judging Me!, I wrote “…losing two days a week to migraine does not meet the clinical definition of chronic migraine, which is 15 or more migraine days a month.” Leora delicately pointed out that this is incorrect. Chronic migraine is actually defined as 15 or more headache days a month, eight of which are migraine. That’s my summary at least.

Verbatim, the current criteria for chronic migraine according to the International Headache Society follows. I’ve left out the footnotes; check the link for details.

A)    Headache (tension-type and/or migraine) on ≥15 days per month for at least 3 months*

B)     Occurring in a patient who has had at least five attacks fulfilling criteria for 1.1 Migraine without aura

C)    On ≥8 days per month for at least 3 months headache has fulfilled C1 and/or C2 below, that is, has fulfilled criteria for pain and associated symptoms of migraine without aura

1)     Has at least two of a-d

a)      unilateral location

b)     pulsating quality

c)      moderate or severe pain intensity

d)      aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

and at least one of a or b

a)      nausea and/or vomiting

b)     photophobia and phonophobia

2)     Treated and relieved by triptan(s) or ergot before the expected development of C1 above

D)    No medication overuse† and not attributed to another causative disorder‡

I’m not sure if my initial statement was outdated or just outright wrong, but it doesn’t really matter. I appreciate readers who are willing to point out my mistakes without calling me an idiot! Thanks, Leora.

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The Physiology of Migraine Mood Swings

With a range including euphoria, high sexual interest, high energy, depression, irritability and lethargy, mood swings are among migraine’s more bizarre symptoms. I knew they were related to serotonin, but never really understood the physiology until I read this fantastic post by Pam Curtis on Make This Look Awesome. In addition to describing the biology of migraine mood swings, she provides excellent ideas for coping with them.

Pam explains that following an initial surge in serotonin (responsible for a pre-migraine “high” or panic attacks), “the body loses all serotonin. It loses it’s supply in the blood, it loses it’s supply in the brain,” thus downshifting the brain into more troubling emotions. After providing further detail and citations, she points out that:

“It’s completely normal to expect with all this wacky brain chemistry going off, that besides the pain, there’s going to be an emotional component. (Pain, itself, provides its own emotional components, triggering “fight or flight” emotions such as aggression or apologizing.) There are going to be mood swings as there are brain chemical swings. And since all this also kicks off the autonomic nervous system by causing physical stress on the body, the migraineur’s ability to handle external stress is taxed.”

This brief excerpt is an insufficient glimpse at Pam’s post. Do yourself a favor by reading the entire piece.