Headache was a hot topic at the AAN Annual Meeting, and several studies have added to the literature. This slideshow summarizes the latest.
Her head felt like elephants were doing the merengue on her cerebellum.
âSusan Fanetti, Move the Sun
1. Headaches on the Rebound.
Medication overuse headaches affect ~1%-2% of the US population. In a meta-analysis, Mayo Clinic Arizona researchers found discontinuation of the overused medication and addition of preventive medication offers the best current treatment. Optimal strategy is unclear, however, and is the subject of considerable debate.
2. How to Predict Poor Response to Episodic Migraine Rx:
More than half of migraineurs do not achieve an adequate pain-free response at 2 hours, according to the American Migraine Prevalence and Prevention Study. The significant predictors of inadequate response included higher pain intensity, presence of allodynia, clinical depression, greater BMI, and not using preventive medication.
3. Revised Botulinum Toxin Guidelines:
The AAN updated its 2008 guidelines on the use of botulinum toxin for migraine headache. OnabotulinumtoxinA (onaBoNT-A) is established as effective and should be offered to increase headache-free days and is probably effective and should be considered to improve health-related quality of life in chronic migraine. OnaBoNT-A is established as ineffective and should not be offered for episodic migraine and is probably ineffective for chronic tension-type headaches.
4. Headaches and Irritable Bowel Syndrome Share Genes:
Migraine and tension-type headaches may share genetic links with IBS, which was twice as frequent in patients with migraine. Researchers found that IBS, migraine, and tension headache groups had at least 1 gene that differed from the genes of healthy participants.
5. Where There’s Smoke, There’s Headache:
Cigarette smoking is associated with headache in an exposure-response manner. In a study published in Headache, current smokers were more likely to have headache than never smokers. The likelihood of having headache increased significantly with increases in number of cigarettes smoked daily and pack-years of smoking. Subjects who smoked mentholated cigarettes were not more likely to have headache.
6. Migraine Flares in Adults Abused as Children:
Migraines may be more likely to occur in young adults who were abused as children. The link is stronger for emotional abuse than for physical or sexual abuse. Of patients with a diagnosis of migraines (aged 24-32 y), 61% said they had been abused as a child, compared with 49% of those who never had a migraine. Researchers noted that the study does not show cause and effect.
7. Slash Salt to Dash Headache:
Reduced intake of sodium, currently recommended for controlling blood pressure, was shown to reduce the occurrence of headaches in older persons with hypertension. The occurrence of headaches was significantly lower in an Na-reduction intervention group compared with controls. Results are from the Trial of Nonpharmacologic Interventions in the Elderly.
8. Progressive Muscle Relaxation Mitigates Migraine:
Progressive muscle relaxation (PMR) has been found clinically effective for migraine prophylaxis. A pre-treatment measure confirmed altered cortical information processing in patients with migraine. Central nervous system mechanisms of the PMR effect are proposed, which may be mediated by serotonin metabolism.
9. Brain Injury, Headache Hit Football Hard:
More than 40% of retired NFL players in a recent study had signs of traumatic brain injury-a rate significantly higher than in the general population. Now a federal appeals court has affirmed a $1 billion NFL settlement with more than 20,000 retired players, who listed a range of chronic traumatic encephalopathy effects: headaches, depression, increased suicide risk, memory loss, dementia, and language impairment.
10. Traumatic Brain Injury in Vets Predicts Headache:
TBI alone is a strong predictor of headache in the first year of VA care among Iraq and Afghanistan war veterans. Comorbid psychiatric diagnoses-eg, PTSD and depression-increase the likelihood of headache in these patients. Among those with baseline headache, only tinnitus, insomnia, and vertigo were baseline clinical predictors of headache persistence.
Tension-type headache is the second most common illness worldwide, and migraine ranks third. Up to 4% of the world’s adults have a headache or migraine on 15 or more days each month. In the United States, headache accounts for about 18 million office visits each year.Headache was a hot topic at the 68th American Academy of Neurology (AAN) Annual Meeting, held in Vancouver, BC, Canada (April 15-21, 2016), and several new studies have added to the literature in recent days.Click through the slides above for the latest research findings and developments on headache and migraine.