Migraine Doctors in Short Supply Across U.S.

Only 416 specialists available nationwide, study found

By Robert Preidt

HealthDay Reporter

FRIDAY, June 28 (HealthDay News) -- There are too few migraine headache specialists in the United States, a new study finds.

Migraines affect about 36 million Americans over age 12 (more than 11 percent of the population). That's more than the number affected by asthma and diabetes combined. However, only 416 specialists nationwide are certified by the United Council for Neurologic Subspecialties to diagnose and treat migraine, according to researchers.

States with the highest number of migraine specialists include New York (56), California and Ohio (29 each), Texas (25), Florida (24) and Pennsylvania (23). Six states have no migraine specialists, according to the study presented this week at the International Headache Congress meeting in Boston.

States with the worst specialist-to-patient ratios include Oregon, Mississippi, Arkansas and Kansas. The District of Columbia has the best ratio, followed by New Hampshire, New York and Nebraska.

"This is a troubling picture," study leader Dr. Noah Rosen, of the Pain and Headache Center of the North Shore-Long Island Jewish Health System, said in a congress news release. "Migraine is a highly disabling disorder -- the seventh most disabling in the world and the fourth most disabling among women. It's clear that many more specialists need to be trained and certified to meet the need."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Migraine costs the United States more than $29 billion a year in direct medical expenses such as doctor visits and medications, and indirect expenses such as missed work and lost productivity, the release noted.

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Migraine Sufferers Face Significant Stigma, Study Finds

Equal to that for epilepsy, panic disorder, researchers say, with impact of the disability discounted

By Kathleen Doheny

HealthDay Reporter

THURSDAY, June 27 (HealthDay News) -- Those who get migraines have to deal not only with the pain, which can be disabling, but the stigma caused by others who tend to discount the impact of the debilitating headaches, a new study shows.

"We were able to validate that people who have migraine are not mistaken that they feel they are stigmatized," said lead researcher Dr. Robert Shapiro, a professor of neurological sciences at the University of Vermont College of Medicine. "We have found those perceptions are well-grounded, and that the stigma that people with migraine experience is of a similar magnitude to the stigma people with epilepsy and panic attack experience," he noted.

"The general attitude is that migraine is not a serious or valid condition," he said. In the study, those with asthma experienced the least amount of stigma of the four conditions studied. Epilepsy patients can experience unpredictable seizures and the condition is known to carry a stigma. Panic attacks, where sufferers experience bouts of intense fear, are also unpredictable.

Shapiro is due to present the findings Sunday at the International Headache Congress in Boston.

About 29.5 million Americans are affected by migraine pain and symptoms, according to the U.S. Department of Health and Human Services. Symptoms can include severe headache, light sensitivity and nausea. Those who are affected may need bed rest and may be unable to work while they are experiencing a migraine.

Shapiro polled 765 people online. All were U.S. residents, with an average age of 28. When presented with vignettes that described people with asthma, migraine, panic attack and epilepsy, the survey participants answered questions on a well-known test used to assess stigma towards illness.

The questionnaire, Shapiro explained, "just provides insight into how someone wants to be associated with someone else." For instance, respondents told how likely they were to want to work with someone with one of the four conditions, and how comfortable they would be inviting them to a dinner party.

The lowest stigma score was for those with asthma. "What we found was the score for migraine versus epilepsy versus panic attack were quite close together and quite similar," Shapiro said.

The study was funded by the Canadian Institutes of Health Research. Peter Reiner, of the University of British Columbia, also conducted the research.

Some of Shapiro's findings echo those from another study, published earlier this year, in which researchers from Thomas Jefferson University Hospital's Headache Center found that chronic migraine patients experienced more stigma than did those with epilepsy, while those with episodic migraines experienced less stigma than those with chronic migraines.

The latest finding did not surprise Dr. Randall Berliner, a neurologist and psychiatrist specializing in headache disorders at Lenox Hill Hospital in New York City.

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Migraine With Aura May Be Linked to All Stroke Types

Study of women identifies important risk factor

By Robert Preidt

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- Women who have migraine headaches with aura are at increased risk for stroke, a new study indicates.

Migraine with aura is a migraine that's preceded or accompanied by visual effects such as flashes of light or blind spots, or by tingling in the hand or face.

A study of almost 28,000 women in the United States found those who had migraine with aura were at greater risk for all types of strokes, according to the researchers, who are scheduled to present the findings Wednesday at a meeting of the International Headache Congress in Boston.

"Migraine with aura has been consistently linked with increased risk of ischemic stroke and there is also some evidence that it increases risk of hemorrhagic stroke," lead author Dr. Tobias Kurth, of Brigham and Women's Hospital in Boston, said in a congress news release.

An ischemic stroke is caused by blocked blood flow to the brain while a hemorrhagic stroke is caused by bleeding in the brain.

"In this study we sought to determine the importance of migraine with aura in stroke occurrence relative to other stroke risk factors," Kurth added.

The study included 1,435 women who had migraine with aura. None of the patients had heart disease at the start of the study.

During 15 years of follow-up, there were 528 strokes overall -- 430 ischemic strokes, 96 hemorrhagic strokes and two unknown types of strokes.

"For total, ischemic and hemorrhagic stroke, migraine with aura was a strong relative contributor," Kurth said in the news release.

About 36 million Americans suffer from migraine, more than the total number of Americans who have asthma or diabetes combined. Migraine costs the United States more than $20 billion in direct medical expenses, such as doctor visits and medications, and indirect expenses, such as missed work and lost productivity.

The data and conclusions of research presented at medical meetings are typically considered preliminary until published in a peer-reviewed medical journal.

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FDA Warns Pregnant Women About Migraine Drugs

Medicines containing valproate linked to lower IQs in children, agency says

By Robert Preidt

HealthDay Reporter

MONDAY, May 6 (HealthDay News) -- Pregnant women who struggle with migraine headaches should never use medicines containing the ingredient valproate because they can lower the IQ scores of their children, the U.S. Food and Drug Administration said Monday.

The new warning will be included on the labels of medicines that contain valproate. These medicines already carry a boxed warning about fetal risk, including birth defects. Valproate products include valproate sodium (Depacon); divalproex sodium (Depakote, Depakote CP, and Depakote ER); valproic acid (Depakene and Stavzor); and their generic versions.

"Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that show the risks to the children outweigh any treatment benefits for this use," Dr. Russell Katz, director of the division of neurology products in the FDA's Center for Drug Evaluation and Research, said in an agency news release.

Valproate medicines have several FDA-approved uses including: prevention of migraines, treatment of epileptic seizures and treatment of bipolar disorder.

This new warning was issued after a study found that children whose mothers took valproate drugs to protect against epilepsy during pregnancy scored eight to 11 points lower on IQ tests at age 6 than children who were exposed to other antiepileptic drugs in the womb.

It's not known if there's a specific time during pregnancy when valproate can result in decreased IQ in children. The women in the study took the antiepileptic valproate drugs throughout their pregnancies, the FDA said.

Valproate may have some value in treating bipolar disorder and epileptic seizures in pregnant women, but should only be taken if other medications have failed to control the symptoms or are otherwise unacceptable, according to the agency.

The FDA also said that:

Women who can become pregnant should not use valproate unless it is essential to managing their medical condition.Women of childbearing age taking valproate products should use effective birth control.Women who are pregnant or who become pregnant while taking valproate medications should talk to their health-care professional immediately. Women should not stop taking their medication without talking to their health-care professional because stopping treatment suddenly can cause serious and life-threatening medical problems for the woman or the fetus.

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Colic May Be Linked to Childhood Migraine, Study Says

Expert suspects disrupted sleep cycles might play a role in both disorders

By Serena Gordon

HealthDay Reporter

TUESDAY, April 16 (HealthDay News) -- Although colic has always been considered a gastrointestinal illness, new research suggests that migraines might be to blame.

The study, published April 17 in the Journal of the American Medical Association, found the odds were nearly seven times higher that children with migraine were colicky babies than were not.

"It is already known that migraine can show with intestinal pain in childhood," said study senior author Dr. Luigi Titomanlio, head of the pediatric migraine and neurovascular diseases clinic at APHP Hospital Robert Debre in Paris, France. That is termed abdominal migraine.

"Our results suggest that infantile colic could represent a form of migraine with age-specific expression," Titomanlio said.

As a colicky child gets older, be aware that he or she may be more likely to have migraine headaches, he added. "By extrapolation [from the study's findings], having had colic could be a risk factor of migraine in teens with recurrent headaches," said Titomanlio.

Colic affects as many as one in five infants, according to the U.S. National Library of Medicine. Babies with colic cry for more than three hours a day, usually at the same time each day, at least three days a week. The exact cause of infant colic is unknown, but it usually gets better by 12 weeks of age.

When babies with colic are crying, their abdomens often appear swollen and they may draw their legs up to their bellies. These symptoms appear to originate in the digestive tract, but treatments aimed at easing digestive system symptoms aren't very effective at making babies with colic calm down.

Migraine is a common cause of headaches in children, according to the study. Another type of headache in children is a tension-type headache, and children who have tension-type headaches are believed to have increased pain sensitivity. Links between these and other types of headaches and colic have been suggested, but they haven't been well-studied, the researchers noted.

This latest research includes more than 200 children 6 to 18 years old who were diagnosed with migraine headaches. The study also included 120 children who had tension-type headaches, and 471 control children who were treated for minor traumas.

The researchers found that nearly 73 percent of children who had migraines also had colic as babies, while just 26.5 percent of those without migraine reported colic. Slightly more children who had migraine without aura (without visual and other sensory disturbances) reported having had colic than those who had migraine with aura. Overall, the odds that someone with a migraine had colic as a child were 6.6 times higher than the odds they didn't have colic, the study found.

The researchers didn't find an association between tension-type headaches and colic.

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Migraine, Chronic Back Pain Tied to Higher Suicide Risk

Hopelessness, disability may play a role in feelings of despair, study finds

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, May 22 (HealthDay News) -- People who endure chronic migraines or back pain are more likely to attempt suicide, whether or not they also suffer from depression or another psychiatric condition, according to a new study.

"Clinicians who are seeing patients with certain pain conditions should be aware they are at increased risk of suicide," said study co-author Mark Ilgen, of the Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich.

"Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person's risk," Ilgen said. "There might be something about someone with significant pain that puts them at increased risk."

The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.

The research team then looked for associations between suicide death -- the 10th most common cause of death in the United States -- and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.

They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.

Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.

"It makes sense that pain is a risk factor for suicide," she said. "Often, suicide has several different things going on, but pain can be the straw that breaks the camel's back in terms of a person's decision not to go on."

Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.

"It's not a standard question: 'Are you in pain?'" Ritchie said. "I would ask, 'Are you in pain?,' or 'Is pain an issue for you?'"

Psychogenic pain increased people's risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.

"We think that's not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed," Ilgen said. "There's not a clear treatment plan for that type of pain. It's likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide."

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Migraine Triggers May Not Always Trigger Migraines

Jan. 23, 2013 -- Worrying about what may trigger a migraine attack adds to the discomfort of many people with migraines. But according to a new study from Denmark, much of that worry may be unfounded.

The researchers studied the effect of light and exercise -- both commonly believed by patients to trigger migraine with aura -- and demonstrated that neither caused attacks in most of the people enrolled in the study.

“There are a lot of things about headache and migraine that are accepted as true but that remain untested,” neurologist Peter Goadsby, MD, Dsc, says of triggers. “The results of this study may surprise some patients.”

Goadsby, director of the University of California, San Francisco Headache Center, co-authored an editorial that accompanied the Danish study. In his clinical practice, he sees many patients whose quality of life suffers as a result of both their migraines and their efforts to avoid triggers that they believe will lead to attacks. In addition to light and exercise, other proposed triggers include stress, emotions, and certain foods.

But there’s little evidence that any of these things really do trigger attacks, says Goadsby. He hopes that, in addition to the current study, there will be much more research on triggers.

“There are tens of millions of people with migraine,” says Goadsby, “and all they have to go on are tales handed down about what triggers them.”

To investigate the impact of light and exercise, researchers at the University of Copenhagen recruited 27 people who had migraine with aura, a condition in which headaches are preceded most often by other symptoms, such as blind spots and light flashes. Nausea, excessive yawning, and numbness are among the other possible aura symptoms. About 1 in 5 people with migraines has migraine with aura.

The study participants -- 17 women and 10 men whose average age was 40 -- all said that light or exercise, or a combination of the two, triggered their attacks. To test their claims, the researchers exposed each of the participants to their triggers.

In 30- to 40-minute sessions, one of three different types of stimulation was used to mimic the light that patients said triggered their migraines. The exercise portion of the study was also intense. Participants went running or pedaled on a stationary bicycle until they reached 80% of their maximum heart rate. Afterward, the researchers monitored the participants for three hours for symptoms.

Overall, only three of the 27 participants had an attack of migraine with aura: one after exercise alone and two following a combination of light and exercise. Another three participants had a migraine without aura. None of the participants had an attack after being exposed to light alone.

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