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Teenagers With Chronic Daily Headache or Migraine Have Greater Suicide Risk

Young teenagers with chronic daily headache, particularly migraine with aura, have a six times greater risk of suicide than teens without headache disorders. This is according to a study in Taipei of 7,900 teenagers between the ages of 12 and 14.

From Medscape (you can get a password from BugMeNot):

“Young adolescents with chronic daily headache (CDH), particularly those who have migraines with aura, are at 6 times greater risk for suicide than their headache-free peers, new research suggests.”

“Individuals with migraine headaches were 3.5 times more likely to have a psychiatric disorder than those without migraine. In addition, the investigators found those who had migraine with aura were at even greater risk for psychiatric disorders and higher suicide risk.”

“Age and sex effects were also associated with increased risk for depressive disorders, but not anxiety disorders. Female subjects were more likely to have major depression than male participants (26% vs 7%). They were also much more likely than their male counterparts to have any type of depressive disorder (37% vs 10%).”

It’s scary news, but as someone who had migraine and chronic daily headache and depression as a teenager, I’m not surprised. If you have a child with a headache disorder or are an adult with one, please take a look at these important notes:

Chronic daily headache is defined as 15 or more headache days per month. Even if your child doesn’t have a headache or migraine every single day, he or she could have chronic daily headache.

While being sad, frustrated or anxious are common emotions for people with chronic illness, they can also be indicators of a psychiatric disorder. Depression or anxiety are real, serious physiological disorders that
many headache sufferers also have
. Psychiatric and headache disorders are often referred to as comorbid conditions.

Headaches and nausea are the most obvious symptoms of migraine, but migraines can also cause many other symptoms. These include mental confusion, trouble understanding and finding words, irritability, hyperactivity, sweating and sighing. Such little-known symptoms can be as debilitating and disturbing as the pain.

Adults with migraine also have a higher risk of suicide than people without
. This graph* is shocking.

If you are feeling suicidal, please call a hotline for help. In the US call 1-800-273-TALK (8255) or 1-800-SUICIDE (784-2433). If you live anywhere else, check this list of international suicide prevention hotlines.

*The site with the graph is no longer loading. I know it’s a reputable site, so I’m keeping the link in thinking that the site will magically regenerate.

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News to Noodle

I’m tired of complaining, so here’s some news and information.

Children May Outgrow Migraines

A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

Migraine Study Brings Men New Headaches

. . . [M]en who experience migraine attacks have a 24 percent increased risk of suffering from major cardiovascular problems and a 42 percent increased risk of suffering a heart attack.

Web Health Info Seekers Tend Not to Check Sources

Only one-fourth of Americans who search the Internet for health advice regularly check the source and date of the information they find to assess its quality. . . .

Just 15 percent of those surveyed said they always checked the source and date of the health information found online, while another 10 percent said they did so most of the time. Three-quarters of those surveyed said they checked the source and date sometimes, hardly ever or never, Pew said.

I’m appalled by these numbers. There’s too much bad information online to accept it at face value. I never use a source that I’m even slightly skeptical of.

[via Kevin, MD]

Oh, the pain of it all! Oh, the pain!

An ER doc’s take on distinguishing real pain patients from drug seekers:

I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain.

Now please don’t jump to conclusions here. Pain sucks, and in the common event that I know to a reasonable certainty that someone is suffering, I am quite free with the narcotics. That’s a big part of my raison d’etre. The problem is that increasingly, it seems that the chronic pain complaints far outnumber the acute pain complaints, and treating chronic (or recurrent) pain in the ED is fraught with difficulty to say the least. You don’t know the patient, they come to the ED over and over for the same thing, they are demanding (both in terms of time expended and emotional energy), some are dishonest, there always seems to be some barrier to treatment which requires ED therapy (“Doctor out of town,” “Lost prescription,” “Only a shot works,” “Threw up my pills,” etc), and there is never objective evidence of physical disease.

[via Kevin, MD]

Sensitivity to Pain Explained

Stabbing back pain or the aches of arthritis send some people to bed in misery while the same distress seems easily tolerated by others. Why does pain hurt some people more than others? Scientists finally have an answer.

It involves a single molecule under control of a gene that acts like a dimmer switch. A “bright” or high setting excites sensory nerves to produce more of a chemical called BH4. For scientists, BH4 has one meaning, but for sufferers, it might as well mean “Big Hurt.” Lower settings block BH4, protecting people from the wrench and bite of chronic pain.

New Report Finds Pain Affects Millions of Americans

One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government’s annual, comprehensive report of Americans’ health. . . .

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Second Thoughts on Second Thoughts

Hart had a migraine this morning. So did I. We both slept until 1:30 p.m. and are still in the headache hangover phase. I am so thankful that we don’t have a child to get out of bed, make breakfast for and get to school. I’m even glad we don’t have a dog to feed and take out to potty.

Of course we’d make it work if we had to, but it’s a blessing that we don’t when we have days like this.

Sure, we have second thoughts. We’re 30 and 31 and are watching the joy our friends’ babies bring them. The overwhelming love they feel for their children is beautiful. Even from the outside I know that it’s an astounding experience that is impossible to match by any other.

I am reading Why Do I Love These People? by Po Bronson. I picked it up as a tool to help my own writing, an example of telling other people’s stories without losing their essence. A passage on page 47 almost made me give up on it. It’s about young men and women who choose to not have children.

“They go around saying things like ‘I’m too selfish to be a mother,’ or ‘I’m not a baby person,’ or my favorite, ‘I love my life too much to do that.’ A friend of mine calls them the Petrified Forest — people who would freeze their life in time if they could. . . . When the Petrified Forest imagines parenthood, their hearts are flooded with the feeling of doors closing, not opening. . . . Every account is weighed — every account of sleep deprivation, diminished sex life, a promotion passed over, and social events missed. The Petrified Forest sits like a jury, considering the facts, making their calculations, collecting more evidence. . . .”

“But can those calculations ever truly account for the experience between a parent and a child?”

Who was he to discount the importance of such a decision? Just because he changed his mind didn’t mean I was going to. Besides, he can’t speak for me — my circumstances are special. Hmm, could this be an issue that’s too close to my heart?

Then there’s what happened this morning. In the comments of On Having Kids, my previous post on the topic, someone described having a child with such a severe form of illness as tantamount to “planned neglect.” I identified with that. It’s certainly not the case for everyone, but that’s how it feels in my life.

As I’ve said before, we’ll see what time tells. It’s a choice we have years to make, especially when adoption is an option. You can be sure that I’ll spend those next 15 years second guessing my decision and then second guessing my second thoughts. Maybe our decision will remain the same, maybe I’ll be posting pictures of my baby for you all to see.

By the way, the book is turning out to be terrific, both as an example of storytelling and as a member of a family. It’s a reminder of the capacity of the human heart to forgive transgressions or make excruciatingly painful decisions.

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On Having Kids

By now you’ve probably noticed that I’ve never mentioned having kids. That’s because we don’t plan to.

I decided before I met Hart that I didn’t want to and, fortunately, he was indifferent. Everyone told me that I’d change my mind when I got older. There’s a good chance I would have if circumstances were different.

But they aren’t. My head hurts all the time, some days worse than others. Hart works long hours. It’s hard enough to find time to spend together when I feel good and he’s not at the office. Where would the time be to spend with — or even care for — kids?

I worry about the physical effects too: Hormonal changes during pregnancy and their potential to change my future headaches. Headaches triggered by never getting enough sleep. Stress.

Our most important concern is how it would affect the child. My inability to function for some part of most days. Days or weeks that I can’t get out of bed at all, much less feed a child or take him or her to school. There would be canceled play dates, missed practices, and times I couldn’t go to the school talent show.

When I’ve asked on forums how people cope with having kids and headache, they all tell me it’s worth it. They never tell me how it affects their children. If the topic comes up spontaneously, parents talk about the activities their children miss out on, how much time the kids spend playing alone while their parents lie in bed. And how awful this is for kids and parents.

Some may say that all parents feel guilty for something they’ve done to “damage” their children. I’ll buy that, but our eyes are wide open to the potential for my headaches (and also Hart’s infrequent migraines) to harm a child.

I’m only 30, so we have plenty of time to change our minds. I just don’t think we will.

Please don’t think I’m passing judgment on headache sufferers who have or plan to have children. This is my decision for myself.

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News, News, News

There is never enough time for me to post about all that I want to write about. And there’s been a ton of headache news lately. Here are some highlights.

Detailed Results of Trexima Studies (the drug isn’t named in the study, but it looks like Trexima to me)

  • Neck pain and discomfort decreased significantly at two hours for the compound versus placebo in study 1 (35 and 44 percent) and study 2 (28 and 54 percent).
  • Sinus pain and pressure decreased significantly at two hours for the compound versus placebo in study 1 (19 and 33 percent) and study 2 (23 and 38 percent).(1)
  • More patients were pain free at two hours in both studies (52 and 51 percent) compared to placebo (17 and 15 percent) and sustained pain-free response was maintained for significantly more patients (45 and 40 percent), without the use of a rescue medication, to 24 hours, compared to placebo (12 and 14 percent).
  • The compound was effective in rapidly eliminating migraine pain, as measured by pain-free rates at 30 minutes, one hour, two hours and four hours.
  • Incidence of migraine associated symptoms (nausea, phonophobia (sensitivity to sound) and photophobia (sensitivity to light)) was lower with the compound than with placebo.
  • The compound was generally well-tolerated. In both studies, only nausea (3 and 4 percent) and dizziness (1 and 2 percent) were reported in at least 2 percent of patients who took the compound versus placebo (1 and 2 percent for nausea, 0 and < 1 percent for dizziness).

Confusion Over Safety Of NSAIDs For Pain Relief Leads Patients To Suffer In Silence
Almost two thirds of people surveyed (64%) said they were confused about what to take for pain relief because of conflicting information on drug safety that has emerged following the withdrawal of Vioxx (rofecoxib), a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) . Around 4 out of 5 (78%) said they didn’t know enough about the risks and benefits of medicines, whether prescribed or bought over-the-counter. Almost half (47%) said they weren’t using any painkiller medication at all for a number of reasons. Some were concerned about side effects, often after reading worrying news stories about painkillers, some had been advised to stop medication by their PCP and some thought they could manage without them.

Triple Therapy Synergy for Frequent Severe Migraine (registration may be required to read this)
The combination of behavioral migraine management, preventive medication, and optimal acute therapy appears to provide a superior reduction in migraine activity measures, functioning, and quality of life compared with any one alone, according to a study presented at the American Headache Society meeting here.

For these patients, “effective migraine management may require three components: a tailored acute therapy, preventive medication and behavioral migraine management to get the optimal results,” said Kenneth Holroyd, Ph.D., a professor of health psychology at Ohio University in Athens, Ohio, in an oral presentation.

Overweight Kids More Likely to Get Headaches
Children with headaches are 36 percent more likely to be overweight, results of the new research suggest.

“The numbers tell us that being overweight may contribute to kids having more headaches, most often migraines,” said Andrew D. Hershey, M.D., Ph.D., director of the Headache Center and a pediatric neurologist at Cincinnati Children’s Hospital Medical Center. “There likely are a number of causes, including poorer general health, body stress, lack of exercise and nutrition. It may not be that being overweight directly causes migraine, but that the reasons for being overweight cause these children to have worsening headaches.”

Magnetic Device Short-Circuits Migraine Headaches, Suggests Early Research
A hairdryer-sized magnetic device held briefly to the back of the head may short-circuit migraines before the pain starts, suggests preliminary research being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

People With Near-Daily Migraine Headaches Get Relief From Anti-Seizure Drug
An anti-seizure medication “quiets the brain,” providing relief to people with near-daily migraine headaches, suggest results of a randomized, multi-center study being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

FDA OKs the Pain Drug Opana
The drug, called Opana, is an opioid pain reliever taken by mouth. It will come in an extended-release form, called Opana ER, and an immediate-release version, simply called Opana.

The drugs contain oxymorphone hydrochloride, which was previously only available by injection. Endo Pharmaceuticals plans to relaunch the drug’s injected version for hospital use under the new trade name.

If you know of an article that I missed, please add it to the comments. Thanks!