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Posts Tagged ‘migraine disease’

headacheblogcarnivallogoI am late (as usual) with this month’s Blog Carnival post. I have been pondering the original title, What Keeps You Going and came up with many answers: ice, dark room, good drugs, knowing someone else understands, but all of these seemed to fall short. And then it hit me; there is no “what” that keeps me going, but a “who” (not the Horton kind).

God keeps me going, even when I want to throw in the towel. He was there when I lost my job, when I wished I had cancer instead because that would kill me, and when I had given up hope of ever feeling good again. For years I prayed that the Migraines would go away forever, but because that has not happened, I thought He wasn’t listening. So I prayed LOUDER: ARE YOU THERE? DO YOU CARE? 

Years passed without a miracle and without even an effective preventative. I was resigned to a life of pain. Where was God? I don’t know. Absent? Distant? Then I heard these words from How Firm a Foundation

Fear not, I am with thee, O be not dismayed,
For I am thy God and will still give thee aid;
I’ll strengthen and help thee, and cause thee to stand
Upheld by My righteous, omnipotent hand.

Then I realized that He was there and cared very much about my pain. So in the middle of the night with my ice pack on my head, I sing or think those words. I know He is there and will get me through the night.

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This post is in response to Arabella’s post regarding the difference between medication overuse headache (MOH) and addiction. We are both responding to redOrbit’s article Migraine Meds Can Become Addictive  (BTW, the original AP article is better. Thanks, Parin). What followed was not on addiction, but on medication overuse headaches (MOH) or rebound headaches. These headaches occur when the culprit medication wears off and a severe headache occurs.

RedOrbit’s headline conjures images of Migraineurs sneaking out at night in dark alleys looking for their next fix. This is unfortunate because there is some truth to it. Anyone who takes a medication runs a risk in becoming addicted or dependent. This is NOT the same as abusing the drug. That is a whole other ball of wax.

In the medical community addiction or drug dependence means

is a state in which the body relies on a substance for normal functioning and develops physical dependence, as in drug addiction. When the drug or substance on which someone is dependent is suddenly removed, it will cause withdrawal, a characteristic set of signs and symptoms

It doesn’t mean that the person is liable to engage in dangerous behaviors to get another “fix”. That is drug abuse. Indeed, for most patients on pain medication, the fix is not necessarily just euphoria, but pain relief. And that certainly brings a sense of well-being.

There are many pain relievers that have the potential to cause drug dependence. Two of these are mentioned in the redOrbit article: Fiorial and Percocet. Fiorinal is a combination of three drugs: butalbital, aspirin, and caffeine. Butalbital is a sedative barbiturate that slows down the central nervous system. Patients can become dependent on butalbital and may find themselves taking Fiorinal more frequently just to function.

There is a double whammy in Fiorinal in that the butalbital can cause dependence; the aspirin and the caffeine can cause medication overuse headaches. So the woman highlighted in the article may have had both drug dependence and MOHs.

The same is true for Percocet. It is a similar drug prescribed for pain. It contains oxycodone and acetominephin. Oxycodone is an opoid narcotic pain reliever, similar to morphine. Acetominephin (Tylenol®) is a milder analgesic and enhances the pain relieving properties of oxycodone. Like butalbital, oxycodone can cause drug dependence, especially if taken more frequently than prescribed. The acetominephin can be the culprit in medication overuse headaches.

So it appears that drugs that combine a barbiturate or an opioid analgesic with aspirin, caffeine, or acetominephin carries the risk of both drug dependence (addiction) and medication overuse headaches. It does NOT necessarily lead to drug abuse.

Have an AWAP day,

Debbie

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Catchy title isn’t it. News releases, magazine articles, books, lectures and Sunday sermons all have one thing in common: catchy titles. They serve two purposes: one to get readers or listeners, the other to make the content believable. Sometimes, more believable than it really is.

Mathes, Malone, Davis, Lucas, Porter, and Li [1] released their findings in an article entitled, Migraine in Postmenopausal Women and the Risk of Invasive Breast Cancer, in the journal Cancer Epidemiology, Biomarkers, and Prevention earlier this month. Ever since, such reputable sites as Scientific American and MSNBC and the National Headache Foundation Newsletter have carried the news story. Is this finding worth all the media hype?   

Maybe not.
Unfortunately, for most of us, news reporters do just that: report the news. I guess it isn’t up to them to interpret it or analyze it, just report it. That leaves interpretation to those for whom it is important. Watchdogs and Migraine bloggers. I am one of the latter, although I hope, one day to be both. I have several questions and I will address them in turn.

Why is this big news?
     I have to admit it, but when I first read the article, I told my DH, “Ok, that’s interesting, but so what? What is the big deal? This doesn’t necessarily help manage or explain Migraine disease and women can’t “catch” Migraine disease to lower their risk of breast cancer. It doesn’t help women who already have breast cancer. Why is everyone so excited??” I don’t find this kind of research very helpful.

Why did this story hit the mainstream papers before the ink was dry on the journal article?
     I asked my DH this question and he answered, “Follow the money.” Good idea; no, a great idea. This is what I found.
     The researchers received a grant from National Cancer Institute, which is under the umbrella of the National Institutes of Health. I remember that, in March, Teri Robert and the Alliance for Headache Disorders were encouraging Migraineurs to send email to our represetatives to press the NIH for research funding for Migraine Disease. Well, it seems that they have granted our request. Not only that, but research on breast cancer, too. Two with one blow. If this is what the NIH considers valuable research, I am disappointed.
In addtion, the authors suggested hormone treatments for Migraineurs:
Although not typically used as a first-line treatment for menstrual-associated migraine, hormonal treatments, particularly those administered during the hormone-free week of oral contraceptive users, may have a beneficial effect on female migraineurs unless there is a contraindication for estrogen supplementation.

In light of this statement, it is important to note that Lucas, one of the authors, has a connection to GlaxoSmithKline, Merck, Pfizer, Ortho-McNeil. Each of these drug manufacturers make either medications for Migraine (GlaxoSmithKline, Merk, and Pfizer) or oral contraceptives (Ortho-McNeil). Interesting association. Readers can form their own conclusions.

 Study results

Mathes et al. stated:

 

Our results suggest that a history of diagnosed migraine may be associated with a reduced risk of breast cancer in postmenopausal women and particularly with a reduced risk of ER+ tumors. These reductions were observed in women with either IDC or ILC tumors and did not vary by history of prescription migraine medication use or age at migraine diagnosis.

The big question is as to the reason why there is an association between Migraine disease and lowered risk of breast cancer.  The authors first established that incidence of migraine attacks is associated with changes in estrogen levels (menses, pregnancy and menopause). They then noted “the well established postive association between endogenous circulating hormones and risk of hormone receptor positive breast cancer.  Therefore,

…it is plausible that migraine is associated with a reduced risk of IDC [invasive ductal carcinoma] and ILC [invasive lobular carcinoma] through hormonal pathways. Several studies have observed an association between hormonally associated events (i.e., menarche, menses, pregnancy, and menopause) and migraine frequency and severity.

What do the statistics mean?  

Statistics are peculiar. It all depends on how they are portrayed. Researchers can make a smal number look big. For example, 30 is a pretty big number, but .3 is a small number. Researchers can make .3 look big by changing it to 30%. Now the number looks big, but it really is small.
Now, what does 30% less risk mean? Thirty percent less than what? I have to know my baseline. My current lifetime risk of breast cancer is 10%. Now that I have Migraine Disease, I can lower it by 30% to 7%. Not a huge decline, in my book.

Are the results believable?

To me, this line of reasoning is not believable. For this line of reasoning to be accurate, the incidence and frequency of migraine attacks must be associated with lower circulating endogenous hormones. The authors do not show that this is the case. In fact, in the introduction, they stated that rather the withdrawl of estrogen precipitated a migraine attack and that stable estrogen levels are “inversely associated with migraine frequency.

In addition, every woman experiences these types of estrogen fluctuations. But not all have Migraines nor do all get breast cancer.

Headache experts are also dubious of these results. Dr. Ellen Drexler is one of them. The associate director of the Division of Neurology at Maimonides Medical Center explains:
 Migraine brains are more sensitive to many exogenous and endogenous factors, of which falling estrogen levels are an important one for many female migraineurs. However, female migraineurs are not known to have consistently lower levels of estrogen than are non-migraineurs. [as cited in 2]
Conclusion

Authors Mathes et al. have established that there is some kind of relationship between Migraine disease and breast cancer. Despite what they claim, hormones are probably not the cause. What is the bottom line? Is this information helpful to women who are at high risk for hormone sensitive cancer? Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, says no. He stated:

There is a decreased risk for women with migraines to develop breast cancer. But in practical implications — what should a woman do differently — there is no action a woman or her health-care professional would take as a result of this report.

[1] Mathes, R. W., Malone, K. E., Daling, J. R., Davis, S., Lucas, S., Porter, P., & Li, C. (2008). Migraine in postmanopausal women and the risk of invasive breast cancer. Cancer Epidemiology, Biomarkers, and Prevention, 17, 3116-3122.
[2] Reinberg, S. (2008, November 6). Migraine might lower breast cancer risk. HealthDay. Retrieved December 4, 2008 from http://www.healthday.com/Article.asp?AID=621050
 

 

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I just did a Google search for migraine +cure and in a split second I got 268,000 hits. It boggles my mind to think there are that many people hawking a cure for what is known to be a manageable, neurological, genetic disease with NO known cure. Now only that, but the articles contain outdated information, unsubstantiated claims, and downright lies.
Take this one, for example. Thomas Coffman’s article was published on November 5th in Albert Lea Tribune.com. The title, You Might Discover Your Own Migraine Cure, is a bit refreshing only because he isn’t trying to sell me something. However, he should brush up on his statistics and the latest Migraine research.
Let’s take him on step, by painful step:
  1. “an episodic, paroxysmal, headache with debilitating pain” Migraines are NOT headaches. Headache does not define Migraine. Migraines are not always episodic. Migraines are not always sudden; mine creep up on me. Yes, the pain can be and usually is debilitating. OK he got one out of four.
  2. “They may be the result of tension, or stretching of the membranes around the brain and of the blood vessels and muscles of the scalp” Migraines are not vascular in origin as once thought. This idea is at least 10 years behind current research.
  3. “23 million Americans… suffer from m [M]igraines…” old stats. Magnum cites 32 million Americans with Migraine. The American Headache Foundation cites 29.5 million.
  4. “there are some common trigger factors associated with behavior, which gives us a psychosomatic origin. ” I almost lost my dinner after reading this. Patent lie. This needs no comment.
  5. “Of all the things that affect the migraine patient, I try to identify what the patient may be doing to them selves first.” OK. Blame the patient.

The article goes from bad to worse. I think I have made my point. Thomas, get your facts straight.

photo courtesy of Apolline Fishing Tackle Co.,Ltd.

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Bright Light invades brain piercing right eye

hammering pain; I’d rather die

Dark Room don’t move

Hours pass

I see pretty flowers under glass

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I’m participating in a Virtual Book Tour with other popular bloggers to bring attention to this important new book: Women, Work and Autoimmune Disease: Keep Working, Girlfriend! Along with the other bloggers, I will be interviewing the author and bringing attention to this important issue. Join us Nov. 3 – Nov. 24. I will be interviewing Rosalind.

My post will include a give-away. I will be giving a copy of her book to the person who can best answer the question: What is your biggest challenge at work and how would reading this book assist in solving that problem? Rosalind and I will select the winner. The deadline is December 4th (wow, where did the time go?).

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I intended to post this a while back, but something got in the way :O!

Megan Oltman’s post about this was music to my ears. I have been looking for an answer to my friends’ inquiries about my health that would be upbeat, but wouldn’t dismiss or invalidate my illness. I usually swing from one extreme or another: “I am fine”, which is a lie or by saying, “Terrible” or “Yuckky” even if that is not entirely the truth. So, as well as possible fits like a glove!
As well as possible: My garden is beautiful (even if I didn’t pull any weeds today); movies make me laugh (Ledgend of Bagger Vance); my hubby is very understanding; I am making progress on the socks I am knitting (I LOVE to knit socks, but that’s another show); and I got some editing work done. That is a long list! So, be as well as possible (AWAP).

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