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Spinal Tap (aka Lumbar Puncture) to Diagnose Headache Disorders

A common headache diagnostic tool, the thought of a lumbar puncture (often called a spinal tap) may terrify you. The length of the needle used is surprising, but the procedure is not that bad. At least, it wasn’t for me and I was needle-shy at the time. Many people have shared similar experiences with me.

Why Lumbar Punctures Are Used
Lumbar punctures are used to check for an underlying condition, like meningitis, hydrocephalus or subarachnoid hemorrhage. They can’t diagnose migraine or tension-type headache, but are used to rule out other possibilities.

What the Procedure is Like
Before the needle is put in, you are given local anesthetic. The anesthetic will sting or burn initially, but you’ll be grateful for it during the next step. After the anesthetic takes effect, the needle to draw the fluid will be inserted. You’ll feel a hard pressure in your back when the needle goes in and might have a few seconds of pain as it goes through the tissue. You may feel pressure while the fluid is being drawn.

The entire procedure takes about 30 minutes, but the part where the needle is in your back only takes a few minutes.

The Dreaded Lumbar Puncture Headache
I’d be lying if I said that spinal headaches following a lumbar puncture are uncommon. However, they are usually gone within 48 hours after the procedure. They are easily treated with pain relievers, lying flat, and drinking a little caffeine and lots of water and are usually gone within 48 hours.

If the headache lasts longer than 48 hours, most doctors will recommend a blood patch. For this, blood is drawn from your arm and then injected in the lumbar region. The blood then forms a clot to seal the puncture hole.

Nearly everyone has relief after a blood patch. Because I’m so special, I became a baseball fan during the three weeks following my lumbar puncture. The odds that you’ll have the same trouble are so low that I’ll spare you the details.

Tips For Your Lumbar Puncture

  • Schedule the procedure for a Friday so you can rest over the weekend.
    If you can send the kids to stay with Grandma and Grandpa, great!
  • If you can stomach it, ask the doctor to explain each step as you go along. Knowing what to expect relieves some of the fear.
  • Have someone drive you to your appointment so you don’t have to drive home. Even if you’re not in pain, you may feel woozy or “off” from nervousness.

Learn More About Lumbar Punctures

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American Council for Headache Education’s New Website

Wondering how migraine and tension-type headache differ? Or what the common migraine treatments are? The American Council for Headache Education (aka ACHE) has a new website that will answer these questions and more.

Particularly good stuff:

All headache organization and educational sites have similar information. How it’s presented is the difference. ACHE’s articles are brief, but don’t skimp on details. The vast amount of information is narrowed to key topics, so you’re not overwhelmed. Articles aren’t bogged down with confusing jargon and are well-written.

I was shocked that ACHE links to Wikipedia’s migraine page. Wikipedia is a wonderful pop culture and travel reference, but am I’m wary of it for serious topics. The migraine page used to be full of errors and misleading information. At 1:03 pm PST on July 22, the page is quite good. Just know it is ever-changing and that being wrong doesn’t preclude someone from editing it.

ACHE’s site is primarily focused on migraine, which is the case
with a lot of headache sites (including mine). Perhaps it’s because
migraine is so prevalent and underdiagnosed. The articles are helpful even if you aren’t a migraineur. You might find — like I did — that your headaches that aren’t migraines actually are.

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Recognizing & Treating Children’s Migraines

Up to 10% of school-age children have migraine. Think a child or teenager that you love might be one of them? Listen to Children’s Migraines: How to Recognize and Treat Them, today’s HealthTalk webcast, to learn more.

The hour-long show starts at 7 p.m. EST tonight, Wednesday, July 18. About 10 minutes before the webcast, go to the program’s description page and look for a link that says “Join the Program.” If you miss the live show, it will be available archived by the end of the week.

A. David Rothner, MD, and Donald W. Lewis, MD, will be guests on the show. Their impressive bios are available on the webcast program page.

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Does Harry Potter Have Migraine?

The excruciating pain in Harry Potter’s forehead when evil is present is one reason experts have diagnosed him with “probable migraine” in the latest issue of Headache, the journal of the American Headache Society.

“Come on” (said like an exasperated teenager) was my first reaction. But the argument is quite persuasive.

What makes the experts so convinced Harry is a migraine sufferer? Consider the facts:

  • Migraine headaches often start during adolescence (although they can appear much earlier): Harry started having excruciating headaches at age 11, soon after he found out he was a wizard.
  • Migraine headache pain is often (but not always) on one side of the head: the focal point of Harry’s headaches apparently is the lightning-shaped scar on the side of his forehead.
  • Nausea and vomiting are common symptoms of migraine, particularly in children: as he experienced more headaches, Harry increasingly developed these symptoms.
  • Migraine is disabling: there is no doubt that Harry was completely debilitated during his headache attacks, and on occasion was brought to his knees by them.

Harry’s headaches fulfill all but one of the criteria
for migraine diagnosis according to the gold-standard International Classification of Headache Disorders-Second Edition (ICHD-II): he’s had at least five attacks; they’re severely painful and one-sided; they’re disabling; they’re accompanied by nausea and vomiting and they can’t be
attributed to another disorder.

The only criterion that isn’t fulfilled is length of the headache. Harry’s headaches are excruciating, but typically end within minutes of starting, whereas in Muggle children and teens, a migraine headache typically lasts at least one to three hours. Without that last criterion, Harry gets the diagnosis of “probable migraine.”

Do you buy the argument? See Harry Potter and the Horrible Headache for the rest of the story and let me know what you think.

Hallie Thomas, a 17-year-old recent high school grad and migraineur, is third author on the study. I think that is so cool!

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What Kind of Headaches Do You Have?

Headache Central, an educational site sponsored by the Michigan Headache Treatment Network, has a new tool to help classify your headaches in medical terms. The web-based program asks questions about your headaches, determining which questions to ask based on your previous responses. After you’ve answered all the questions, you’re given a page with your responses and possible diagnoses summarized in a doctor-friendly format to print and take to your next appointment.

It’s not intended for you to diagnose yourself, but to provide your doctor with a more complete view of what you’re experiencing. It’s a guide from which your doc can ask you relevant questions to flesh out your diagnosis and find the appropriate treatment for you.

FYI: The program doesn’t work in Firefox.