Migraine

DIET, MIGRAINES, AND HEADACHES.

@Neuralgroover

 

For years, migraine and headache sufferers, at the advice of their physicians, have tried to keep track of the root triggers of their migraines and headaches. While there is no one cause for migraines or headaches, especially when it comes to diet, keeping track of what we eat can help lower the likelihood of the onset of migraine or headache. Let’s take a look at the different common food triggers for headaches and migraines, as well as some dietary tips that can help. There are a variety of different “migraine diets” that focus on a variety of known dietary triggers and tips.

 

How Can You Tell If a Certain Food Or Drink Is a Headache Trigger?

Typically, beverage or food that is a headache trigger will cause a headache within 10 to 12 hours, but no longer than 24 hours. One way that you can check to see if a food or beverage causes headaches and migraines is to limit your consumption of it for a period of time, such as 4 to 6 weeks. Charting your consumption of food and beverages over a month’s time frame can also help you see patterns with the onset of headaches and migraines.

 

How Do Sweeteners Impact Headaches and Migraines?

If you regularly drink diet soda, use sweetener in your tea or coffee, or eat foods that are sugar-free, but use sweeteners such as aspartame, you might have a slight increase in your level of headaches. In fact, monthly consumption of diet soda can contribute to an increased frequency of migraines and headaches. The mechanism behind sweetener-induced headaches is not entirely understood, but reducing it will help decrease the frequency of severe headaches.

 

Why Does MSG Cause Headaches?

Chinese food is a common source of MSG. MSG is a food additive that is commonly found in a wide variety of foods for added flavor. MSG has been linked with several different disorders, including obesity and metabolic disorders. MSG-triggered headaches are not totally understood, but it is believed that MSG can release nitric oxide, which dilates blood vessels within the brain. An MSG headache will be pulsing, often on both sides of the head and will frequently be agitated by physical activity, all of which fits into the criteria of migraine. If you want to avoid MSG, you can eat whole foods that have been flavored with natural herbs and spices. On food labels, MSG is often hidden as other names including glutamate, natural flavor, and partially hydrogenated vegetable protein.

 

What Are Some Other Foods That Will Cause Headaches?

Chocolate has been shown to cause headaches in some individuals and can also be a migraine trigger. Around 20% of people who have experienced a migraine or a headache might identify chocolate as a trigger. The headache and migraine inducing ingredient in chocolate is beta-phenylethylamine.

Cured meats, like the ham you get at the deli, can cause headaches because of the preserving agent used in them. Nitrates, the preserving agent, are used to preserve color and flavor. As with MSG, this agent can cause blood vessel dilation in the brain, which is believed to be one of the reasons cured meats can trigger headaches or migraines. Aged cheeses also have an ingredient that causes headaches. Tyramine forms in cheese as proteins break down and this agent can also cause headaches.

Additionally, salty foods, fermented foods, and pickled foods can contribute to headaches because of the preservatives they contain.

 

Foods That May Have a Positive Impact on Headaches and Migraines

If you are experiencing headaches or migraines, you might want to incorporate some healthier foods into your diet. Everything from leafy greens to fish can improve the headache and migraine cycle. Leafy greens contain several different ingredients, like iron, that enrich blood flow and can help with headaches. Fish contain omega 3 fatty acids, which can reduce the frequency of headaches and are discussed more here.

 

Why Are Headache Diets Helpful?

Keeping track of what you eat and linking it to your headache and migraine patterns can be helpful. Not only does it let you identify food and beverages that may contribute to headaches and migraines, but you are more likely able to track triggers if you can identify them within a 24 hour period.

Headache diets may also have a therapeutic effect. Identifying what causes headaches and migraines is a weapon in the arsenal that lets headache and migraine sufferers know that they have control over their headaches and migraines.

 

What Are Some Tips For Starting a Headache Diet?

There are some things that may help you if you wish to start a headache diet:

  • For a period of a few weeks, keep track of food and drink that is consumed right before the onset of a headache or migraine.
  • For a period of four to six weeks, eliminate the food and beverages of concern to see if they are triggering your headaches.
  • If no change happens or the change is minimal, the food may not be associated with your headache or migraine.
  • In addition to tracking foods and beverages, also track other factors in your life, such as sleep issues, your menstrual cycle, or other factors.
  • Once you feel as if you have identified the culprit from your headaches or migraines, eliminate that food over time.

What Are the Benefits of a Healthy Diet?

Not only will diet changes help with headaches and migraines, but they will also improve your overall health. Reducing fat intake will have a positive impact on your blood pressure and cholesterol levels. Additionally, a healthy diet can reduce the likelihood of other chronic diseases, such as diabetes, that can have headaches as a secondary effect.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

 

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Last updated on October 18th, 2021 at 03:26 pm

CAN ALLERGIES CAUSE MIGRAINES, SINUS HEADACHES, AND JAW PAIN?

@Neuralgroover

 

Allergies and Sinus Headache

Do you have a bad headache along with sinus pressure, facial pressure, facial pain, sinus pain, nasal congestion, nasal drainage, postnasal drip, or sore throat? It must be a sinus headache, right? Sure, it’s possible if there is a true sinus infection going on. However, the majority of the time it isn’t.

 

Now if these symptoms are associated with fevers, nasty colored drainage, and other infectious symptoms, there could certainly be a sinus infection and sinus related headache. However, without these infectious types of symptoms (fever, nasty colored drainage, signs of infection), the most likely cause is actually migraine.

 

Yes, those several monthly headaches you get with sinus pressure and congestion are probably not recurrent sinus headaches or sinus infections. They are most likely migraine, especially if there is a recurrent pattern such as monthly occurrence. Allergies (and associated sinus symptoms) are not felt to be a common cause of headache, and most of the time those symptoms actually represent migraine. If your sinus headache has features including throbbing, pounding, pulsating pain, nausea, or sensitivity to light and sound, it easily fits criteria for migraine, and should be treated as such. However, a discussion with your doctor is always recommended to ensure there is not an associated sinus infection or other cause of the headache. Your doctor should always be the one making treatment recommendations based on their assessment.

 

With that said, it is still possible that allergies can cause headaches for some patients due to the inflammation involved. The second half of this blog towards the end will address the connection between allergies, headaches, and jaw pain.

 

Sinus Headache and Migraine Misdiagnosis and Mistreatment

The bottom line is that migraine is commonly misdiagnosed as a “sinus headache” by patients, physicians, and other medical professionals when there are sinus symptoms present. Unfortunately, what we end up seeing in the headache clinic are patients with a history of excess unnecessary antibiotics, sinus procedures, and minimal to no relief. By the time patients see us, they have often had sinus surgeries, which surprise, don’t help them. Improvement usually doesn’t begin until the headaches and sinus symptoms are treated as migraine.

 

Sometimes patients report their “sinus headaches” improve with these repeated courses of antibiotics, but this doesn’t confirm a sinus infection. Many antibiotics have anti-inflammatory effects, and it is often this effect on the headache that is being felt rather than an infection being treated. In addition, unnecessary excess antibiotics lead to antibiotic resistance. So, when you actually do need that antibiotic for an infection it may no longer be effective against that bacteria (and remember, most upper respiratory infections are viral, which antibiotics will have no effect on anyway). C-difficile (C-diff) infection (which can be deadly) is another complication of antibiotic use in some patients, so the less unnecessary gamble of antibiotic use the better.

 

There is a rare and controversial type of facial pain called mucosal contact point headache. This type of pain is typically localized to a smaller area in the face, rather than a headache elsewhere. So it is more of a facial pain than a headache. It is suspected to be caused by a severe nasal septal deviation where part of the nasal septum contacts the nasal mucosa across from it. or pressure on the nasal walls and headache. This has also been called rhinogenic headache.

 

How Does Migraine Cause Sinus Symptoms?

The reason for this common misdiagnosis of “sinus headache” is because the trigeminal nerve (cranial nerve 5) is the root cause and central to migraine, and it also innervates the sinuses, teeth, TMJ (temporomandibular joint) area, and the face. So if the migraine is activated and turned on, not only does the pain of the headache turn on, but so does the discomfort in the sinus areas, TMJ, teeth, along with sinus symptoms. The bottom line, if you get recurrent episodic headaches that have any throbby, pulsating or pounding pain, any nausea, or sensitivity to light and sound during a bad “sinus headache”, consider it migraine.

 

How Often is Migraine Misdiagnosed as Sinus Headache?                       

A study of almost 3,000 patients with self-diagnosed or doctor diagnosed sinus headaches showed that 88% of the patients actually had migraine according to ICHD3 criteria, not sinus headaches! The most common sinus symptoms reported in that study were sinus pressure (84%), sinus pain (82%), and nasal congestion (63%).

 

Another study called the American Migraine Study II showed similar results. This was a study involving 30,000 patients. About 50% of patients who were eventually diagnosed with migraine had been previously misdiagnosed, and the most common prior misdiagnosis was sinus headache.

 

Yet another study that looked at 100 patients with self-diagnosed sinus headaches. After a detailed history and exam, patients were given headache diagnoses based on the ICHD3 criteria. Of the 100 patients with self-diagnosed headache, 86% were diagnosed with a migraine related headache disorder, rather than a sinus related headache.

 

Is There a Connection Between Allergies and Jaw Pain?

Occasionally, Virtual Headache Specialist will allow guest bloggers to write an article on a migraine related topic, or collaborate with another website or company to further disperse useful medical knowledge. Sinus headache, allergies, jaw and facial pain are very relevant migraine associated topics. So, the second half of today’s blog topic in the section below was written by a guest author, whereas I wrote the section above. I hope the following article provides additional useful information on allergies, sinuses, and how they may relate to jaw and facial pain. The article below is a collaboration with the Zyrtec website given their allergy expertise on this topic.

 

While many people are aware of the fact that allergies can lead to headaches and sinus pain, they may be surprised to learn that allergies can also cause jaw pain. This can present as tender cheeks, pain radiating to your jaw and teeth, or even discomfort on the top of your head, and often feels worse when you lay down and better when you’re upright.

 

But why?

 

Basically, it’s all about the sinuses. We have four pairs of sinuses (frontal, ethmoid, maxillary, and sphenoid), and sinus pressure and pain in any of them can radiate all over your face — including your jaw. That’s why keeping your sinuses healthy by using a nasal spray, treating your allergies, and rinsing your sinuses with a saline rinse can be so helpful. Eating a healthy diet, exercising, and catching some solid zzz’s each night will also benefit your sinus health. Learn more ways to show your sinuses some love in this infographic.

 

Can Allergies Cause Jaw Pain?**

By Kristen Stewart

 

When you experience jaw pain, your mind may jump to reasons such as teeth grinding or toothaches. By going for the obvious, however, you may overlook something as simple as allergies causing your jaw pain. Keep reading to uncover how allergies can cause jaw pain. First, to help you determine if you may be suffering from allergies, here’s a quick primer on what allergies are, what causes them, and who’s most at risk of getting them.

 

IS IT ALLERGIES OR A COLD?

Allergies affect more than 50 million people in the United States each year, with many individuals suffering from allergic rhinitis. Also known as hay fever, its symptoms are as common as they are annoying — sneezing, runny nose, and itchy, watering eyes to name a few.1

 

While some symptoms overlap between allergies and a cold, you may notice some key differences. Colds are contagious and people often unwittingly infect others for two days before symptoms appear. A low-grade fever and aches and pains may accompany them. This common illness may also develop gradually over a couple days.2

 

On the other hand, viruses don’t cause allergies, so you can’t pass allergies on to anyone else. They occur when the body initially encounters a normally harmless substance and creates antibodies to it. When the body encounters the substance again, the existing antibodies tell the immune system to send chemicals such as histamine into the bloodstream to fight the invader. The immune response causes unpleasant allergy symptoms, and they often come on suddenly rather than gradually.3 Take our allergies versus cold quiz to find out which one you have.

 

ALLERGY CAUSES AND RISK FACTORS

Allergic rhinitis typically comes in two forms:  seasonal and perennial. As its name suggests, seasonal allergies strike at predicted times of the year, most often in the spring, summer, or early fall. The main culprits tend to be pollens from grassestrees, and weeds as well as mold spores transported through the air.

 

People with perennial allergies suffer all year. Triggers tend to be exposures encountered during everyday life such as animal dander, dust mites, cockroaches, or mold spores rather than outdoor greenery or conditions.4

 

While allergies are more likely to strike during childhood, they can develop at any time during a person’s lifetime. Reactions can vary from minor to severe.5

 

Unfortunately, you can’t control most of the risk factors for developing hay fever. People with existing allergies, asthma, or eczema are more likely to have hay fever. And if a parent, sibling or other blood relative has allergies or asthma, your chance of getting hay fever increases. But you can control one risk factor by spending less time exposed to allergens like animal dander or dust mites.

 

ALLERGIES, SINUSES, AND HOW THEY CAN CAUSE JAW PAIN

As any sufferer knows, allergies can wreak havoc on your body. In addition to the well-known sneezing, sniffling, and red watering eyes, you may experience postnasal drip, coughing, and fatigue.6 Allergies can also clog the sinuses. Because of that, they could be the source of your nagging jaw pain.7

 

You probably identify sinus problems with nasal pressure. But allergies can cause lower jaw pain as well as the feeling of general pressure, especially if maxillary sinuses are obstructed. Inflamed and swollen sinuses can affect a number of areas of the face and head and result in issues ranging from headaches and earaches to facial tenderness near the eyes and nose that radiates to the jaw.8

 

It’s possible that seasonal allergies could cause jaw pain in other ways, although more research is needed on the subject. Frequent sneezing and coughing force the mouth open which could lead to muscle tension and overuse strain and create issues with the jaw. Similarly, a stuffy nose may make you breathe through your mouth at night. If your jaw is strained open all night, it makes sense that you could wake up with jaw discomfort.9

 

And for people who have a temporomandibular joint disorder (diagnosed or not), it’s possible that allergies could exacerbate it and cause increased jaw pain. However, the sinuses are the key way allergies cause jaw pain.

 

THE SINUSES EXPLAINED

Many parts of the body get a lot of love. We try to eat right and exercise for our hearts and stay engaged with life mentally and socially to keep our minds sharp as we age. But people often neglect their sinuses. The sinuses may only become your focus of attention if a problem occurs. But it’s worth understanding more about your sinuses, and that’s especially true if you experience jaw pain, because sinus pressure and pain can radiate all over the face.

 

Sinuses are also called paranasal sinuses. They’re air-filled pockets or cavities in the skull and facial bones that connect to the nose through an opening known as an ostium.

Usually when we hear about cavities, it’s when we get bad news at the dentist’s office, but sinus cavities are our allies. Check out our 6 Things to Know About Sinuses page to learn about the remarkable role they play to keep us well and healthy.

 

Like many parts of the body, sinuses aren’t immune from issues. Allergic sinusitis typically comes with the usual allergy symptoms such as sneezing, nasal congestion, and itchy eyes, nose, and throat.10 Allergy headaches can also occur with facial discomfort in the sinus area. Pain can be located throughout the region or sometimes located on just one side.11

 

 

KEEPING SINUSES HEALTHY

The good news is you can take steps to keep your sinuses healthy, which may help alleviate and prevent jaw pain. One action you can take is to manage allergies to keep your symptoms under control. Allergies can cause inflammation of the nose and sinuses which in turn blocks mucus from draining and may lead to an infection.

 

In addition, consider using nasal saline sprays to keep your nose moist. This practice ensures the cilia will work at their optimum level to clear the airways and remove debris. You may also want to irrigate your sinuses with a saline sinus wash to add moisture and flush out dust, pollen, and other intruders. 12 13

 

Beware of irritants such as pollution and smoke. The chlorine found in chlorinated pools may also irritate and inflame your nasal passages and sinuses. If possible, opt to swim in saltwater pools or natural bodies of water to avoid excess exposure to chlorine.14

 

Maintaining good health overall can also help keep sinus issues at bay. Eat a healthy diet, exercise regularly, get enough sleep, and manage stress to boost the immune system and keep colds and flus at bay. Avoid taking antibiotics or steroids if possible as they disrupt the microbiota in the sinuses and may allow pathogens to proliferate.15Finally, it may sound obvious but don’t forget to wash your hands. Handwashing can play a large role in reducing illness and sinus issues.16

FIND THE RIGHT TREATMENT TO EASE YOUR JAW PAIN

If you have severe or long-lasting jaw pain, you may want to talk to a medical professional. But if you suffer from jaw discomfort and allergies, some simple precautions may help you smile — without pain — in no time.

________________________________________________________________________________________________________

Kristen Stewart is a freelance writer specializing in health and lifestyle topics. She lives in New Jersey with her husband, three kids and two very needy cats.

 

**The “Can Allergies Cause Jaw Pain?” section above originated on the Zyrtec website, was written by Kristen Stewart, and is being reshared here for an educational collaboration. The original version can be found here:

https://www.zyrtec.com/allergy-guide/understanding-allergies/symptoms/jaw-pain

 

[1]https://acaai.org/news/facts-statistics/allergies
[2]
https://www.zyrtec.com/allergy-guide/allergy-essentials/allergies-or-cold
[3]https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes…
[4]
https://acaai.org/news/facts-statistics/allergies
[5]
https://www.mayoclinic.org/diseases-conditions/allergies/symptoms-causes…
[6]
https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes…
[7]
https://acaai.org/allergies/symptoms/allergy-headaches
[8]
https://omfs.com.au/patient-information/news-updates/can-allergies-cause…
[9]
https://www.newsmile4u.com/blog/allergy-symptoms-can-hide-tmj/
[10]
https://www.cedars-sinai.edu/Patients/Health-Conditions/Allergic-Sinusit…
[11]
https://acaai.org/allergies/symptoms/allergy-headaches
[12]
https://blogs.bcm.edu/2014/06/25/ten-tips-to-avoid-sinus-infections/
[13]
https://medlineplus.gov/ency/patientinstructions/000801.htm
[14]
https://blogs.bcm.edu/2014/06/25/ten-tips-to-avoid-sinus-infections/
[15]
https://www.nature.com/articles/s41598-019-53975-9
[16]
https://www.cdc.gov/handwashing/why-handwashing.html

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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MIGRAINE AND HEADACHE DIETS.


Posted By on Sep 10, 2021

Last updated on October 14th, 2021 at 03:00 pm

MIGRAINE AND HEADACHE DIETS.

@Neuralgroover

The best migraine diet is…

 

Well first, there are many well established migraine triggers. The beverages and foods that we consume play a role in headaches and migraines for many patients. In fact, about 10% of headache and migraine sufferers can attribute at least a small part of their headaches to food and diet triggers. Often the trigger is a specific type of food or beverage. For example, in some studies (seen here and here) migraineurs reported their most common food triggers as chocolate (19-22%), cheese (9-18%), citrus fruit (11%), and alcohol (29-35%).

 

Certain types of diets may help reduce the likelihood and severity of headaches and migraines. Let’s take a look at some of the diets out there that may help with headaches and migraines.




How Does the Keto Diet Impact Headaches and Migraines?

The keto diet is unique in the sense that your body consumes more fat and protein while lowering the intake of carbohydrates. The idea is that your body is forced to burn fats rather than carbohydrates. Studies have shown that the keto diet was able to significantly reduce migraine frequency and abortive medication intake. It is thought that the keto diet can be particularly helpful for migraine sufferers on a twofold front:

  1. Ketone bodies produced by the liver can provide the brain with more energy than glucose.
  2. Additionally, ketones are thought to be anti-inflammatory. Since inflammation is a central piece of migraines, the keto diet can potentially help by reducing inflammation.

 

For those who are starting out fresh on the keto diet, there may be an occasional headache since the body is learning to burn fat instead of sugar. To avoid these headaches early on in the keto diet, the following suggestions will help:

  • Drink plenty of water.
  • Eat low-carb, water-rich vegetables.
  • Eat foods that are rich in electrolytes.
  • Avoid exercise on the opening days of your keto diet.

 

Can a Low-Histamine Diet Help With Headaches and Migraines?

Histamine can be a headache or a migraine trigger for certain individuals, even if they do not have allergies. The body makes a digestive enzyme called DAO (diamine oxidase) that processes histamine. About 25% of people have an issue with DAO production in their bodies. One study found that about 87% of people with migraines also had issues with DAO deficiencies. It was found that people who participated in a low-histamine diet had improved in their overall experiences with their migraines while a handful of people in the study had no migraines or headaches at all.

 

What can you eat on the low-histamine diet? You can eat fresh meat (especially chicken) and freshly caught fish. Some non-citrus fruits are low in histamine levels and include things like apples, raspberries, blueberries, melons, bananas, and kiwi. Eggs are also low in histamine. Gluten-free grains, such as rice and quinoa are also low in histamine. Fresh vegetables other than tomatoes, avocados, spinach, and eggplant are also low in histamine levels. Lastly, if you cook with oils, olive oil is low in histamine levels.

 

Elimination Diet, Headaches, and Migraines

From a dietary perspective, an elimination diet is any type of diet where you eliminate foods and beverages that you suspect your body does not tolerate well. On the elimination diet for headaches, there are some things that you might want to avoid:

  1. Caffeine and alcohol: These are known to dehydrate the body and cause headaches.
  2. Chocolate and cocoa: These are known to cause headaches. However, you may eat white chocolate.
  3. MSG: This is a flavor enhancing substance known to trigger headaches and migraines. If you want to avoid MSG, you can eat whole foods that have been flavored with natural herbs and spices. On food labels, it is often hidden as other names including glutamate, natural flavor, and partially hydrogenated vegetable protein.
  4. Processed meats: Anything like jerky, cold cuts, and lunch meats should be avoided. You can however eat fresh meats that you prepare yourself. Nitrates and nitrites are the migraine trigger culprits in these types of foods. These are vasodilating agents found in many foods, especially preserved and processed meats such as lunch meats, sausage, smoked foods, pork, bacon, salami, pastrami, hot dogs, corned beef, ham, and bratwurst. So if you have a child that is getting a lot of headaches and migraines, and eats lunch meat for lunch, you may want to look into nitrate and nitrite-free lunch meat options.
  5. Dairy: You should avoid certain dairy foods like aged cheese, buttermilk, sour cream, and yogurt. However, you can eat things like cottage cheese, cream cheese, and American varieties of cheese.
  6. Nuts: Try substituting seeds for nuts.
  7. Fruits: Avoid citrus fruits altogether. You can eat things like apples, peaches, pears, etc.
  8. Some vegetables, like onions, pea pods, and sauerkraut should be avoided. You can eat most leafy green vegetables and water-rich vegetables.
  9. Condiments: You should avoid things like ketchup, mustard, vinegar-based condiments, etc.
  10. Baked goods: Be careful to make sure that anything you eat is gluten-free while you are on the elimination diet for headaches and migraines.
  11. Avoid any artificial sweeteners altogether, like NutraSweet.
  12. Avoid Fermented foods such as sauerkraut, soy products, and pickled foods because they contain tyramine which is a migraine trigger for many patients. Brewer’s yeast also contains a large amount of tyramine. A low tyramine diet can be very helpful for some patients with migraine.

 

Overall, your doctor may advise you to try the elimination diet for a trial period to see if the foods you are eating are contributing to your headaches and migraines. When attempting to figure out what foods to try eliminating, sometimes IgG food testing against food allergens can assist in determining specific foods which may be associated with high IgG levels in the blood (meaning your immune system is reacting against them).




Inflammatory Foods, Headaches, Migraine, and the Anti-Inflammatory Diet

Another way to fight off headaches and migraines is to avoid foods that are known to cause inflammation. For example, sugar and high fructose corn syrup are found in most processed foods and sweets. In some studies, these sweet substances were known to counteract the effects of omega-3 fatty acids, which can help reduce inflammation. Artificial trans fat, vegetable oils, and seed oils can also cause inflammation, leading to headaches and migraines. Refined carbohydrates, prepared meats, and other processed foods can also cause inflammation. In addition to causing headaches and migraines, foods that cause inflammation can cause a wide variety of other issues including high cholesterol, heart disease, obesity, and diabetes.

 

There are other variations of the anti-inflammatory diet which focus on omega fatty acids including the high omega 3/low omega 6 (H3/L6) and low omega 6 (L6) diets. The thinking is based on the fact that omega 3 is anti-inflammatory, whereas omega 6 is more inflammatory and can increase pain. Fast food is often loaded with omega 6 fatty acids, along with many other chemical additives which are often migraine triggers. So the goal is to eat foods with a higher ratio of omega 3 as compared with omega 6. In fact, a recent study showed that eating fish with healthy omega ratios can help prevent migraines.

 

Fish with a healthy omega ratio include tuna (canned in water), wild salmon, swordfish, mackerel, herring, sea bass, anchovies, sardines, cod, and bluefish. Fish with a less healthy omega ratio include farm raised fish and fish canned in oil. Vegetables with a healthy omega ratio include green leafy vegetables, and those with a less healthy omega ratio include beats, carrotos, chard, and parsley. Nuts and seeds with a healthier omega ratio include walnuts, flax and chia seeds. Those with a less healthy omega ratio include almonds, pecans, cashews, and pistachios. Oils with a healthier omega ratio ratio include olive oil and canola oil, while those with a less healthy omega ratio include highly processed oils such as corn, soy, safflower, and peanut oil.

 

Gluten Free Diet (Celiac Sprue)

Celiac sprue is caused by inflammation in the digestive tract, caused by exposure to gluten. Gluten is a protein found in many grains, including barley, wheat, and rye. Thus it is a common ingredient in foods such as pizza, pasta, bread, and cereal. Patients often complain of abdominal bloating and pain, diarrhea, and headache when they eat these foods. Some patients can less commonly have additional neurological symptoms besides headaches, including unsteadiness/imbalance (ataxia), and peripheral neuropathy. Unexplained iron deficiency is common, and liver function tests are sometimes abnormal. 70% of patients with true gluten sensitivity and celiac sprue have been shown to have improved symptoms within 2 weeks of doing a gluten free diet. Many patients get loosely diagnosed or self diagnosed as “celiac disease” or “gluten sensitive”. However, the gold standard diagnosis is made by small bowel biopsy, along with supporting bloodwork. So if there are suspicious symptoms as discussed here, a gluten free diet for 2-4 weeks may be a good consideration to try.

 

Low Fat Diet

Low fat diets have been reported to decrease headache and migraines in some patients. One study looked at patients eating no more than 20 grams of fat per day. It reported significant differences in migraine frequency which went from 6 days to 1 day per month on average, along with significant decreases in migraine severity, duration, and medication intake.

 

Finding What Works Right For You

The various diets discussed above all have one principle in mind, eliminating certain foods from your diet that can cause headaches and migraines. Many of the foods that are mentioned in the diets above that are to be avoided contain Tyramine. This is the substance produced when the amino acid tyrosine breaks down and can cause headaches.

 

Not only will the right diet help you mitigate the frequency and severity of headaches and migraines, but a proper diet can also help avoid certain types of chronic health conditions. Good diet is only part of the formula that will help you reduce headaches and migraines in your daily life. Your physician will also counsel you on good diet and exercise practices to help you with your headache and migraines.

 

In summary, the answer to which diet is the best migraine diet is… there isn’t one. Finding dietary influences on migraine and headache will vary widely between patients and what their migraine may be susceptible to or what it responds to. However, if there are clues to when you get migraines in relation to any of the dietary factors discussed above when you eat meals, it may be worth trying that particular diet or dietary modification for at least 4 weeks. Any dietary changes should always be discussed and approved of with your regular medical doctor first though, to make sure it is safe to try depending on your particular medical history.

 

Regardless of dietary factors, keep in mind that having migraine means that you are wired in a way that migraines can be triggered easier as compared to someone without migraines. You may be able to identify triggers, but many times there may not be a trigger and migraines can just happen because that is the nature of the disorder, unfortunately. So you still want to ensure that you have a good migraine abortive option for when they do happen. Abortive treatments are taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack and associated symptoms. Some of these options include NSAIDs, ergots, triptans, neuromodulatory devices, the ditans (Reyvow (Lasmiditan)) and the gepants (Ubrelvy (Ubrogepant) and Nurtec ODT (orally dissolvable tablet) (Rimegepant)).

 

If the migraines are happening frequently enough, then a migraine preventive treatment should be considered. Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, CGRP monoclonal antibodies (mAbs) (Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), Vyepti (Eptinezumab)), neuromodulation devices, Botox, Nurtec ODT every other day (1st and only dually approved migraine abortive and preventive), herbal and natural supplements and vitamins, yoga and meditation, and acupuncture and acupressure.




IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 04:53 am

VESTIBULAR MIGRAINE, MIGRAINE VERTIGO, DIZZINESS, AND LIGHTHEADEDNESS.

@Neuralgroover

Vestibular migraine has also been called migraine-associated vertigo/dizziness, migraine-related vestibulopathy and migrainous vertigo. Vestibular migraines are not as common as other headache and migraine conditions, but they impact about 3% of the population. They happen five times more often in women than they do in men. One of the common themes among vestibular migraine sufferers is that this condition is often found in their family history, and often, these people have a history of migraines. An early clue can be that they may have gotten easily car sick as a child, and they may still as an adult.

Dizziness, lightheadedness, and wooziness are very common symptoms associated with regular migraine attacks. Vestibular migraines cause severe dizziness, vertigo, imbalance, and disequilibrium in people with migraines. The severity of these symptoms in vestibular migraine are much more severe and pronounced as compared with the more commonly associated milder dizziness type of symptoms often seen with normal migraine attacks. In addition, with vestibular migraine, you might not always have a headache with the symptoms, which can make diagnosis even more tricky. So, let’s dissect the specifics and symptoms of vestibular migraine a bit more below…




What Types of Symptoms Might I Experience With a Vestibular Migraine?

As mentioned above, vestibular migraines don’t always coincide with a headache. They include dizziness that lasts for a few moments or more, nausea, vomiting, balance problems, sensitivity to motion when you move your body, disorientation, and sensitivity to light or sound. Vestibular migraines are connected to the inner ear, so a person experiencing this type of migraine will have significant issues with their balance and equilibrium during an attack.

 

The International Classification of Migraine 3rd Edition (ICHD3) has specific criteria that must be met to fit the diagnosis. Other causes of vestibular symptoms such as inner ear problems and other causes must have been tested for and excluded. The person must have a history of migraine without aura or migraine with aura. They must have at least 5 episodes of moderate to severe vestibular symptoms lasting between 5 minutes to 72 hours. Vestibular symptoms can include vertigo, spinning sensation, sensation of self-motion, disequilibrium, positional vertigo such as following a change in head position or head motion, dizziness with nausea, and visually induced vertigo triggered by a moving visual stimulus. At least half of these vestibular symptom episodes must be associated with 1 of the following 3 migrainous features:

1. Headache with at least 2 of the following 4 features:

  1. One sided location
  2. Pulsating, throbbing, or pounding pain
  3. Moderate to severe intensity
  4. Worsening by physical activity

2. Sensitivity to light (photophobia) and sound (phonophobia)

3. Visual aura

 

Approximately 1/3rd of patients can have vestibular symptoms lasting minutes, 1/3rd can last hours, and 1/3rd can last several days. A small fraction of patients have vestibular attacks which can last seconds only, but occur repeatedly during head motion, changes in head position, or visual stimulation. In these patients, episode duration is defined as the total period during which short attacks are recurring with these triggers. An even smaller fraction of patients can have attacks that can last several weeks to a month. Overall, attacks last 72 hours or less for the vast majority of patients.

 

What Causes Migraines With Vertigo?

The exact cause of vestibular migraines is not clearly understood. However, many researchers believe that there is overlap and erroneous connections between pain signals and vestibular signals that come in from the inner ear and the electrical migraine pathways. Some contributing factors to vestibular migraines include many of the commonly recognized migraine triggers such as lack of sleep, consumption of MSG and certain other foods, and dehydration.

 

How Long Does a Vestibular Migraine Last?

Vestibular migraines can last for a period as short as 5 minutes or up to 72 hours, as detailed above. Some patients have reported this type of migraine lasting for up to 4 weeks, with the intensity of the symptoms coming and going.

 

What Types of Treatments Will Help Alleviate Vestibular Migraines?

Different types of abortive therapies are available for vestibular migraines. Abortive migraine medications are medications taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack and associated symptoms. Some of these options include NSAIDs, ergots, triptans, neuromodulatory devices, and the gepants (Ubrelvy (Ubrogepant) and Nurtec ODT (orally dissolvable tablet) (Rimegepant)). Triptans and abortives are particularly helpful if they are taken at the first sign of symptoms. Your doctor might prescribe something like Ativan, Valium or another vestibular suppressant to correct the balance on your inner ear, but these should preferably not be taken frequently or daily because they can form dependency and addiction.

 

Calcium blockers and beta blockers can also work to reduce the severity and intensity of your vestibular migraine, but there are many other migraine preventive options as well. Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, CGRP monoclonal antibodies (mAbs) (Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), Vyepti (Eptinezumab)),  neuromodulation devices, Botox, Nurtec ODT every other day (1st and only dually approved migraine abortive and preventive),  herbal and natural supplements and vitamins, yoga and meditation, and acupuncture and acupressure.

 

Some of the typical migraine pill preventive medications include antiseizure, blood pressure, and antidepressant drugs. These traditional migraine medications can also be very helpful in treating more severe occurrences of vestibular migraines.




Could My Vestibular Migraine Be Something Else?

Vestibular migraines have symptoms that overlap with other medical conditions. In fact, at least 20% of vestibular migraine cases are misdiagnosed. A condition called Meniere’s disease causes dizziness. This disease, however, will often be accompanied by a stuffed ear sensation or ear ringing. Referral to an ENT doctor (ear nose and throat) to evaluate for inner ear disorders should always be part of the evaluation plan, along with possible neuroimaging with brain MRI or CT, and possibly some blood work. A brainstem stroke can also cause dizziness before more severe symptoms set in. MRIs and other medical tests can help rule conditions like these out. Therefore, vestibular migraine should always be a “diagnosis of exclusion”, meaning it can be considered only after other causes of dizziness and vertigo have been tested for and ruled out.

 

How Will My Doctor Manage My Vestibular Migraines?

In addition to some of the medications suggested above, there are ways to manage your vestibular migraines. Your doctor will probably do a full medical examination to understand any comorbidities and also see what medications you are currently taking. Dizziness is one of the most commonly reported side effects of many medications, so make sure to trace onset of symptoms back to any medication adjustments as well.

Depression, lack of sleep, and anxiety are some of the issues that may be exacerbated by your vestibular migraines. If these conditions are left untreated, the vestibular migraine will not get better. Depression and anxiety do not cause vestibular migraines, but the migraines can lead to anxiety and depression and these issues can all begin to feed into and fuel one another.

Another thing to keep in mind is that traditional medicinal approaches to headaches may not be the best approach to vestibular migraines for everyone. Vestibular migraines can sometimes be sensitive to Advil, Tylenol, and other NSAIDs. However, most patients will not respond as well to these over the counter medications and will need more migraine specific therapies. If you use triptans or NSAIDs daily or with a high frequency of more than 10 days per month on average, you may be more prone to rebound vestibular migraines. Vestibular physical therapy can also be helpful for some patients if they suffer from a high frequency of symptoms.

 

What Is the Outlook for Vestibular Migraines?

Overall, the outlook for Vestibular migraines is good. An NIH study found that vestibular migraines in a pool of patients from a period of 10 years decreased in about 56% of cases, increased in only about 30% of people, and stayed the same in about 16 percent of cases.




IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 04:53 am

WHAT ARE THE CGRP MIGRAINE MEDICATIONS AND HOW ARE THEY USED?

@Neuralgroover

What is CGRP (Calcitonin Gene Related Peptide)?

During a migraine attack, the trigeminal nerves release a variety of inflammatory proteins. One of the main proteins is called CGRP (calcitonin gene related peptide). CGRP has been studied since the early 1980s when it was discovered. It was found throughout the trigeminovascular system and trigeminal cranial nerves which transmit pain in the head and face. Therefore, a role in migraine was suspected. The trigeminal nerves are central to causing migraine as explained here. The trigeminal nerves and their associated electrical circuitry throughout the brain, brainstem, and arteries in the brain is called the trigeminovascular system. This system is the basis and an “on switch” for migraine.

In the early 1990s it was shown that CGRP was released by the trigeminal nerves and levels increased during an acute migraine attack. In 2004, a CGRP antagonist (blocks the binding of CGRP to its receptor) was shown to abort (stop) an acute migraine attack, and decrease CGRP levels. Subsequent preventive migraine studies done since 2014 with a CGRP antibody to block the effects of CGRP continued to show reduction in migraine frequency and severity.

 

CGRP causes inflammation around the brain and cerebral arteries (“sterile inflammation”) in the dural membrane surrounding the brain, intensifies pain signals, enhances transmission of pain signals through the trigeminal nerves into the brainstem and into the brain, and causes dilation of the cerebral arteries through the dural membrane. Trigeminal nerve endings surround these arteries. The dilation of these arteries triggers these trigeminal nerve endings and this leads to further increasing pain signals. Think of the process like a painful meningitis, minus the infection.

 

The result of these steps is intense migraine pain (as you are unfortunately very familiar with). So, if we can block these steps of migraine pain, the attack should be aborted quickly, and not as severe. That’s the thinking here, and that’s where the CGRP medications (gepants and CGRP monoclonal antibodies) come into play, as discussed below.

 

CGRP MEDICATIONS USED TO ABORT MIGRAINE (TAKEN AS NEEDED)

Abortive migraine medications are medications taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack. Historically, the options have included NSAIDs, ergots, triptans, and neuromodulatory devices.

 

The gepants were the first new medicine class to emerge as new migraine abortive options (FINALLY!!!) since the triptans became available in 1992. There are currently 2 oral pill gepant abortive options available. They are Ubrelvy (Ubrogepant), and Nurtec ODT (orally dissolvable tablet) (Rimegepant). These 2 gepants are discussed and compared in much greater detail here. Zazegepant will be the 3rd abortive gepant, and will be the 1st nasal spray gepant option available. It is in ongoing clinical trials currently.

 

How does Nurtec ODT and Ubrelvy (gepants) work?

Gepants work as CGRP receptor antagonists, which means they directly block (antagonist) the CGRP receptor. This results in the medication “blocking” the CGRP inflammatory protein from sticking to the CGRP receptor to activate it, and thus prevents it from “turning on” the pathways of pain described above.

 

So, you get reversal of cerebral vasodilation, which decreases the firing off of the trigeminal nerves. Notably, the gepants do this in a way that does not cause vasconstriction, in contrast to the triptans. Thus, they are felt to be safe in those with cardiovascular or cerebrovascular disease (as opposed to the triptans).

 

By blocking the CGRP receptor, you also get reversal of the neurogenic inflammation going on through the brain and around the arteries, and you block the electrical transmission of migraine pain from traveling from the trigeminal nerves into the brainstem, and ultimately into the brain.

 

The other huge benefit of the triptans compared to all other abortive options is that they do not cause medication overuse headache (rebound headache)!

 

What are the side effects of Nurtec ODT and Ubrelvy?

The side effect profile of the gepants is minimal and similar to placebo. The most common side effects of gepants are very low risk of nausea for Nurtec ODT and low risk of nausea and mild sedation with the higher dose of Ubrelvy. Side effects are discussed in more detail here.

 

In addition, there is no interaction with using them and triptans, NSAIDs, or other acute meds in case they happen to be taken close together.

 

Compared to other abortive medications such as the triptans and NSAIDS, these medications are not associated with medication overuse headache (rebound headache), which is great! They also have no addiction potential.

 

Compared to the triptans and ergots, these medications are NOT contraindicated in patients with stable cardiovascular or peripheral vascular disease or risk factors because they do not cause vasoconstriction (narrowing) of the arteries, which is a HUGE benefit.

 

Triptans are also contraindicated in patients with visual snow, persistent migraine aura, and migrainous stroke (infarction). However, gepants are felt to be safe for these patients, as well as those with hemiplegic migraine and migraine with brainstem aura (previously called basilar migraine). There are many patients who have been stuck without safe options since they have been unable to use standard therapies such as triptans due to other medical problems such as heart disease. So, we finally have a safe alternative for them, which is a highlight of these medications.

 

Can Nurtec ODT and Ubrelvy be used in pregnancy and breastfeeding?

Safety of these medications in pregnancy or breastfeeding is unknown because they haven’t been studied, and therefore are not recommended.

 

Are there drug interactions with Nurtec ODT and Ubrelvy (gepants) and other medications?

The primary drug interactions to be aware of with these medications are when used with other medications that are metabolized by the liver enzyme system called CYP3A4. Many commonly used medications are metabolized by this system. Strong or moderate inhibitors of CYP3A4 (which slow down the metabolic drug breakdown) will cause an increase in gepant blood levels. Strong or moderate inducers of CYP3A4 (which increase the metabolic drug breakdown) will cause a decrease in gepant blood levels and possibly decreased effectiveness. These medications should be avoided in patients with severe liver disease or end stage kidney disease such as those on dialysis.

CGRP MEDICATIONS USED TO PREVENT MIGRAINE

Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, neuromodulatory devices, herbal and natural supplements and vitamins, yoga and meditation, acupuncture and acupressure. All of the medications used for migraine prevention have always been “adopted” from other specialties. In other words, these were medicines made for other purposes (such as antidepressants, antiseizure, anti-blood pressure meds), but eventually some were also found to be useful for migraine prevention.

 

There has never been a medicine engineered and created purely and only for migraine prevention. However, that changed in 2018 when the migraine preventive landscape changed abruptly and significantly. The 1st medication class designed purely and only for migraine prevention become available, called the CGRP monoclonal antibodies (mAbs). There are currently 4 CGRP mAb treatment options. They are Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), and Vyepti (Eptinezumab).

 

These medications either target the CGRP receptor (Aimovig), or the CGRP protein (Emgality, Ajovy, Vyepti). The result of “blocking” the CGRP protein or CGRP receptor prevents the CGRP pathways of pain from “turning on”, as discussed above and here. Clinically, some patients tend to respond better to the CGRP receptor blockade, whereas others tend to do better with binding the CGRP protein itself. There is not really any data on this in terms of who may respond to which type of CGRP mAb target, but I’m sure it will be studied further eventually.

 

Aimovig, Emgality, and Ajovy are all once monthly self-injections (push button autoinjection), although Ajovy also has the option of quarterly injections (3 injections every 3 months). Vyepti is the only IV (intravenous form) and is done by 30-minute IV treatment every 3 months. These individual CGRP mAbs are discussed and compared in much greater detail here.

 

What are the side effects of the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti)?

Compared to most other medications used for migraine prevention historically, the side effects of the CGRP mAbs are very low. The most common side effects reported (at a very low rate) are mild upper respiratory infections and minor injection site reactions. Aimovig has a slightly increased risk of constipation and possible mild increase in high blood pressure for some patients. These have little to no drug interactions and do not affect the liver or kidneys. Data show no immunological (they do not suppress or alter the immune system because they do not have a target within the immune system), cardiovascular, or neurological safety concerns of significance.

 

Can the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used in pregnancy and breastfeeding?

There is no data to answer this question yet. However, CGRP is suspected to play a possible role in regulating uteroplacental blood flow, myometrial and uterine relaxation, and in maintaining normal gestational blood pressure. Since the mAbs have a long half-life and can last in the system for 5 months, it is recommended to stop it about 6 months prior to pregnancy planning. The CGRP mAbs are also not recommended to use during breast-feeding since we do not have enough safety data at this time.

 

Nurtec ODT and gepants for migraine prevention.

The CGRP mAbs have been a major step forward for migraine prevention. However, up to this point, we still have not had an oral pill that has been engineered and created purely and only for migraine prevention (not “adopted” from a different medicine class as mentioned above).

 

That was until now, with development of the gepants (discussed above). On 5/27/21, Nurtec ODT (Rimegepant) made history as the first and only FDA approved medication for BOTH abortive and preventive migraine treatment simultaneously, and the only option with this flexibility and is discussed in greater detail here!

 

The perspective behind this is that migraine is a fluid and variable disease, fluctuating between periods of episodic migraine (1-14 headache days per month), and other periods of chronic migraine (15 or more headache days per month). So, having a medicine that can function as both types of treatment, depending on what type of phase the migraine is in (episodic or chronic) opens up an entirely new flexible treatment paradigm and approach which we have never had up to this point.

 

So essentially, taking Nurtec ODT every other day could be used as an ongoing daily preventive strategy (the long half-life of 11 hours allows for this spread-out dosing) when the migraine is in a high frequency to chronic migraine phase. If it evolves back into a lower frequency episodic migraine pattern, it can then just be used abortively only when needed for a migraine attack.

 

This new flexible dosing option of Nurtec ODT could also be used as a “mini-prophylaxis” within the month. For example, if patients know they are approaching a predictable migraine trigger, such as menstrual migraine, barometric trigger from an airplane trip, upcoming stressful event such as an exam, etc., the medication could possibly be taken daily or every other day starting a few days before the anticipated trigger, and stopping it a day or so after the trigger is no longer present. Unlike other migraine preventive pill treatments which take 4-6 weeks to start working and 2-3 months to see full effect, the gepants work fast and this would allow this potential treatment option to begin working immediately. In fact, studies show that migraine frequency dropped by 30% within the first week alone of preventive use.

 

Atogepant is the 2nd gepant that will be used as a daily preventive pill only and is pending FDA approval, but is anticipated soon.

 

Can the preventive CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used with the CGRP abortive gepant medications (Nurtec ODT, Ubrelvy)?

Can I use Aimovig with Nurtec ODT? Can I use Aimovig with Ubrelvy? Can I use Emgality with Nurtec ODT? Can I use Emgality with Ubrelvy? Can I use Ajovy with Nurtec ODT? Can I use Ajovy with Ubrelvy? Can I use Vyepti with Nurtec ODT? Can I use Vyepti with Ubrelvy? These are very common questions. Unfortunately, there aren’t many studies so far to clarify this, although I’m sure these questions will be studied and clarified in the near future. The gepants and the CGRP mAbs have much different structures, molecule sizes, and metabolism.

 

So theoretically, it would make sense that using an abortive CGRP medication (gepant) on top of a CGRP preventive medication (CGRP mAb) would give synergistic (working together) benefit. Using a CGRP preventive medication targeting the CGRP protein (Emgality, Ajovy, Vyepti) and a CGRP abortive medication targeting the CGRP receptor (Nurtec ODT, Ubrelvy) seems like a very sensible idea. Similarly, using a CGRP preventive medication targeting the CGRP receptor (Aimovig) combined with a CGRP abortive medication also targeting the CGRP receptor (Nurtec ODT, Ubrelvy) would make a lot of sense too. In fact, there are some limited studies which provide evidence that these medications used together do work better and are safe.

 

There was a publication of data from only a 2-patient cohort showing that the use of these acute and preventive CGRP migraine therapies together can be successful and safe. These two patients had been using Rimegepant (Nurtec ODT) in a long-term safety study and they had added Erenumab (Aimovig) once monthly injection as a preventive treatment. After Aimovig was added, patient 1 had 100% relief for 7 of 7 acute migraine attacks treated with Nurtec. Patient 2 had 100% relief for 9 of 9 acute migraine attacks treated with Nurtec. So, the combination of using Nurtec abortively in addition to using Aimovig preventively appeared to provide an even more effective acute migraine response. Larger studies to confirm the suspicion that they likely work together synergistically will be helpful.

 

There was a larger safety study publication which evaluated the acute treatment of migraine with Rimegepant while using a CGRP monoclonal antibody for the prevention of migraine. The CGRP mAbs used were Erenumab (Aimovig) (7 patients), Fremanezumab (Ajovy) (4 patients), and Galcanezumab (Emgality) (2 patients). The study determined that Rimegepant used as an acute migraine treatment in combination with CGRP mAbs for migraine prevention was well tolerated with no safety issues identified. The researchers concluded that the probability between these 2 classes (gepants and CGRP mAbs) was low, especially because they have entirely different pathways of drug metabolism. The gepants are metabolized in the liver, while the CGRP mAbs are metabolized and cleared in the reticuloendothelial system. They also concluded that existing evidence supports the safety of combined use, although further larger research was warranted.

 

Can the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used with Botox (Onabotulinumtoxin A) for chronic migraine?

The answer is yes. Insurance companies often present various hurdles to using preferred treatment options (the bane of my existence). One common issue for patients with chronic migraine who are receiving Botox injections is that most insurance companies will now make the patient choose between Botox or the CGRP mAb. There is of course no good scientific basis for this, other than the company doesn’t want to pay for both.

 

Actually, there is evidence that using Botox with the CGRP mAbs works better together than with either individually. An abstract presented at the American Headache Society Annual Scientific meeting in June 2020 showed that in patients with chronic migraine and a baseline frequency of 25.7 days per month, the frequency dropped to 14.8 days with Botox, and 9.1 days with Botox plus a CGRP mAb.

 

Can I still use my CGRP mAb (Aimovig, Ajovy, Emgality, Vyepti) with the Covid-19 vaccine?

This hasn’t been a reported issue thus far. There is no current evidence for an interaction between the Covid-19 vaccine and CGRP mAbs, the same as any other vaccine. This has also been stated by the American Migraine Foundation. Patients receiving CGRP mAbs were not excluded from the Covid-19 vaccine trials. There is no evidence at this time that these treatments cannot be used along with receiving Covid-19 vaccination, nor do they need to be delayed or timed any differently in relation to receiving Covid-19 vaccination.

 

Most physicians feel that there should theoretically be no interaction or contraindication to receiving either of these treatments in relation to Covid-19 vaccination because they are entirely different proteins with different mechanisms of action. The Covid-19 vaccine stimulates the immune system to form antibodies against the virus, should you encounter it. The CGRP mAbs do not have any significant influence on the immune system (they do not cause immunosuppression, etc.).

 

Rarely, the immune system of some patients can form neutralizing antibodies against the CGRP mAbs, and this can weaken the effectiveness of these treatments in their ability to decrease migraine frequency and severity. However, this rarity really has nothing to do with the mechanism and how the Covid-19 vaccine works. So, it is not felt that the Covid-19 vaccine will lessen the effectiveness of these treatments, nor will these treatments lessen the effectiveness of the Covid-19 vaccine.

 

Notably, there have been just a few isolated reports of dermal fillers used in dermatology causing some facial swelling in association with Covid-19 vaccination, but not with Botox or the CGRP mAbs. These reports were with the Moderna Covid vaccine and resolved with steroids and/or antihistamines. The topic of Covid-19 headache and Covid-19 vaccination is discussed further here.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

Read More

Last updated on September 17th, 2021 at 06:48 am

HEADACHES THAT OCCUR DURING PREGNANCY.

@Neuralgroover

Many women experience headaches during their pregnancy. In fact, some research has shown that 39% of women may experience some sort of headache or migraine during their pregnancy during their postpartum. The sensation and type of headaches that women experience during their pregnancy may be different, but generally, pregnancy headaches should not raise too much alarm. Generally speaking, many women who suffer from frequent headaches before pregnancy often note that these decrease in severity and intensity because of increased estrogen throughout the body. Menstrual migraines are typically caused by the drop in estrogen prior to the menstrual cycle. So if with a sustained level of estrogen, that trigger is eliminated during pregnancy.

 

For the majority of women (60-70%), migraines improve during pregnancy, particularly in the 2nd and 3rd trimester. It is not uncommon to hear women mention that their migraines were gone during pregnancy. Unfortunately, it is also not uncommon to hear that the migraines come roaring back after delivery and hormonal shifts move back to normal. The women that tend to improve during pregnancy are those that have migraine without aura, migraines related to menstrual cycles, and migraines that began with menarche (when menstrual cycles began). With that said, 4-8% of women have worsening migraines during pregnancy.

 

What Types of Headaches Are Common During Pregnancy and Postpartum?

Primary headaches are the most common type of pregnancy and postpartum headaches. These are primarily migraine and tension-type headache. Some of the symptoms that you may experience as a result of a pregnancy headache or migraine include a dull ache or pressure (tension type headache), a pulsating or throbbing pain (migraine), and a sharp pain around one or both eyes (typically migraine).

 

About 25% of these headaches in pregnant women are tension headaches. Secondary headaches that occur during pregnancy are less common and may be related to circulatory issues such as high blood pressure (pre-eclampsia, eclampsia) and low iron levels. Idiopathic intracranial hypertension (IIH), previously called pseudotumor cerebri, can sometimes also occur or worsen during pregnancy. Less common but serious medical causes could also include cerebral venous thrombosis (blood clot in the large veins of the brain). Any change of headache pattern or new headache development during pregnancy requires an evaluation with your doctor.

 

Pregnancy Headaches By Trimester

Depending upon which trimester you are in, the cause of your headaches and the accompanying symptoms will be different. Hormonal changes, higher blood volume, and weight gain/loss are contributors to headaches during your first trimester. Some of the causes of these headaches might include dehydration, nausea, stress, vomiting, lack of nutrition, low blood sugar, and other issues.

 

During your second and third trimesters of pregnancy, you might have different causes of your headache. Weight gain, posture, lack of sleep, muscle strain and tightness, and other issues are the biggest causes of pregnancy headaches during this period.

 

Throughout your pregnancy there are certain foods that can also cause headaches and be migraine triggers. These include chocolate, dairy products (milk and cheese), anything with yeast, tomatoes, and certain other food items. Caffeine can also increase the likelihood of a headache during your pregnancy.

 

When Should You Worry About Headaches During Pregnancy?

More intense and frequent headaches that happen during your 2nd and 3rd trimesters could be indicative of high blood pressure. This condition is not common and impacts about 8 percent of pregnant women who are between 20 and 44. High blood pressure could cause serious complications for both the mother and child. Preeclampsia, stroke, premature delivery, low birth weight, and preeclampsia or eclampsia odds are higher for pregnant women with high blood pressure.

 

When you have a severe headache during pregnancy that causes dizziness, blurred vision, and other issues, you must see your doctor. If it comes on abruptly, you should see a doctor in the emergency room. Headaches during the 2nd and 3rd trimester with greater frequency and intensity could increase the risk of stroke if they are related to high blood pressure or cerebral venous thrombosis. As mentioned above, any change in your normal headache pattern, or development of new headaches during pregnancy, needs to be discussed and evaluated with your doctor. Some women can develop or exacerbate symptoms of idiopathic intracranial hypertension (IIH), which was previously called pseudotumor cerebri. This is caused by high pressures of the cerebrospinal fluid (CSF) around the brain. Symptoms consist of daily or frequent headaches along with visual disturbances such as blurred vision, persistent areas of lost vision, and frequent brief episodes of visual black outs, grey outs or blurring lasting 5-15 seconds called transient visual obscurations (TVOs).

 

Dealing With Headaches During Pregnancy

You should avoid any known headache triggers, especially certain types of foods. These include MSG, cured meats, strong cheeses, certain dairy products, anything with yeast, and caffeine. Avoid secondhand smoke, as this can cause headaches. Eat well and drink plenty of fluids, which will help reduce morning sickness. When you are pregnant, avoid stress. Massages and cold (or sometimes warm) presses will also help deal with headaches, especially tension headaches. Cool, dark rooms with no noise will help with migraines, as well as other conservative treatments.

 

Abortive (As-Needed) Medications for Headaches and Migraines During Pregnancy

Overall, acetaminophen is fairly safe to take for headaches during pregnancy. Up to the third trimester (32 weeks), NSAIDs are considered safe, as well. After the third trimester (after 32 weeks), ibuprofen and other NSAIDs can put the baby at risk. NSAIDs can cause a serious issue affecting the blood pressure in your baby’s lungs. Additionally, NSAIDs used late in pregnancy cause issues with amniotic fluid and make for an elongated labor.

 

Triptans have historically been avoided in pregnancy due to theoretical concern that their vasoconstrictive (blood vessel narrowing) effects may result in less blood flow to the placenta and baby. However, many physicians are increasingly using triptans during pregnancy now given some evidence suggesting they can be used safely and anecdotal evidence that they appear generally safe, although more research is needed. Some antiemetics are used during pregnancy for not only nausea, but also some abortive benefit. Metoclopramide has generally been felt to be the safest antiemetics and most often used in this scenario. Currently, it is recommended to avoid the gepants (Nurtec ODT and Ubrelvy) during pregnancy and breastfeeding because there is not enough safety data at this time.

 

Preventive Medications for Headaches and Migraines During Pregnancy

Magnesium supplementation is often recommended as a preventive migraine treatment both during pregnancy and outside of pregnancy. Other medications sometimes used for migraine prevention if needed include cyproheptadine (although it should be stopped when breastfeeding starts to avoid sedation in the baby), metoprolol, and some SSRI type antidepressants. Current recommendations are that CGRP monoclonal antibodies (Aimovig, Emgality, Ajovy, Vyepti) are not used during pregnancy or breastfeeding because there is not enough safety data at this time. In addition, CGRP is suspected to play a possible role in regulating uteroplacental blood flow, myometrial and uterine relaxation, and in maintaining normal gestational blood pressure. Since the CGRP mAbs have a long half-life and can last in the system for 5 months, it is recommended to stop it about 6 months prior to pregnancy planning. Historically, Botox has generally been avoided in pregnancy, although some physicians are increasingly using it during pregnancy for refractory chronic migraine.

 

Non-Medication Treatments For Headaches During Pregnancy

There are certain types of non-medication treatments that may also help with headaches and migraines during pregnancy. These include activities and therapies aimed at lowering stress such as mindfulness, relaxation,biofeedback, yoga and meditation, acupuncture, acupressure and pressure points. Sometimes exercise or physical therapy can be helpful. Neuromodulation devices, trigger point injections, or nerve blocks such as occipital nerve blocks can also be helpful. Essential oils are also a great way to help reduce headaches.

 

Outlook for Headaches During Pregnancy

If you are pregnant, your outlook is good in terms of headaches and migraines. These conditions happen because of the changes the body is going through in a relative short period of time. Always consult with a health professional during pregnancy if you are going to take medications for headaches and migraines because there are certain medications to avoid, especially during the later stages of pregnancy. Also, headaches further on in pregnancy might be indicative of a more serious health issue, like high blood pressure.

 

Generally speaking, consult with a doctor before taking any medications. Also, tell your provider if your headaches change in frequency or intensity. Also, check with your doctor if you are getting headaches that come with blurred vision, weight change, pain in the upper right abdomen, and swelling.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

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