When Migraine Starts or Stays in Your Neck


Neck pain can be one of the most dreaded symptoms for those of us with migraine. For some, the arrival of neck pain marks the beginning of an attack; for others, it seems like there is always some degree of neck pain. It raises questions: Is the tense, sore neck a trigger for an attack? Is it a sign that an attack is already underway?

How do we know if there’s a structural component causing our pain?

Dr. Sait Ashina, MD, is an assistant professor of neurology and anesthesia at Harvard Medical School, as well as the director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center in Boston. He is a prolific researcher and is board certified in neurology and headache medicine.


How prevalent is neck pain for those with migraine?

Dr. Ashina:
Neck pain can be independent of migraine or it could be part of it. When it’s part of an attack, it can occur prior to its onset, during the headache itself, or may happen in the postdrome phase after the attack. There are studies showing that up to 70% of people with migraine report neck pain during their attack, while 48% describe neck pain beforehand. There are also conditions that are common with migraine that may result in neck pain, such as rheumatoid arthritis, herniated disc, arthritis in the neck or spine, fibromyalgia, concussion, whiplash injury, and, rarely, Ehlers-Danlos syndrome and hypermobility. All those conditions are very common in patients with migraine.
How do we know whether neck pain is a symptom of the attack, if it’s the trigger, or something else?
Dr. Ashina: What some think are triggers of a migraine attack are not really triggers, but symptoms of the prodromal phase of a migraine that happens before the actual attack occurs. Migraine has many symptoms, such as the headache itself, light and sound sensitivity, or nausea, all of which can respond to treatment. These treatments can also improve neck stiffness and pain. In terms of other conditions, there is cervicogenic headache, which is a secondary headache, in contrast to migraine, where the headache is a primary symptom. It’s a condition caused by a cervical spine problem or its bony component—a disc or tissue elements, and is usually accompanied by neck pain. Occipital neuralgia is another distinct headache condition involving the occipital nerves that run from the top of the spinal cord and through the skull. If injured or inflamed, a person with occipital neuralgia usually feels the pain in the back of the head and the base of the skull. The diagnostic criteria of the International Headache Society can help to distinguish between these different types of headaches. It’s essential to get the correct medical diagnosis.
How might the neck be treated if it’s aggravating or triggering migraine attacks?
Dr. Ashina: There are different treatments, such as physical therapy and massage, and self-care measures like applying hot or cold packs. There are trigger point injections, which are nerve blocks. If there are more structural problems in the cervical spine, like disc herniations or arthritis, then epidural steroid injections, facet joint blocks, and radiofrequency ablations, which use heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Some respond to acupuncture, acupressure and dry needling. Weight loss can help neck pain. Finally, many pain psychologists work with biofeedback, behavioral therapy, relaxation techniques, and meditation. In worst cases, surgeries can help the neck pain, as well.
Watch the full interview for answers to:

How prevalent is neck pain for those with migraine?What is the trigeminal cervical complex?What is the difference between primary and secondary headache?How do we know if neck pain is a symptom of a migraine attack or if it’s triggering the attack?What are trigger point injections?What is a cervicogenic headache?What is occipital neuralgia?How can we distinguish between occipital neuralgia and migraine with neck pain?Can Botox help relieve neck pain with migraine?How do we determine whether neck pain is a symptom of a migraine attack or caused by a structural or neurological issue apart from migraine?What types of imaging studies are done for neck pain?What are the treatments for neck pain that may be triggering a migraine attack?What is radiofrequency ablation (neurotomy)?How does posture affect the neck and migraine?Is it better to use heat or ice for neck pain?Which non-medical interventions are helpful for neck pain with migraine?
Watch Dr. Ashina’s interview preview here, or order it as part of the Migraine World Summit package from this page.


Migraines Headaches & Men


National Football League Hall of Famer and Superbowl MVP, Terrell Davis, is 5’ 11″, weighs 210 pounds and took more than his fair share of big hits during his career. He also has migraine, and said: “Migraine hits you harder than anything you can ever imagine.”

Today, we are bringing to you a topic rarely discussed in the world of headache: men with headache diseases. But equally, this is also for the partners, wives, mothers, and children because men fundamentally need your help. Why? Men are less likely to get diagnosed, seek treatment or even speak to someone about their headache disorder.

This interview has been specially recorded and released on Father’s Day to honor the role that many men have in their family during Migraine and Headache Awareness Month.

Watch the full interview for answers to:

  • Which headache disorders affect men the most? 
  • Cluster headache may affect more men than women, but are there actually more men who have migraine than cluster headache?
  • Are there any other headache conditions that are prominent in men?
  • How well do men cope with a headache disease?
  • What do men do instead?
  • Why is “manning up” the wrong approach?
  • 80% of men have declared that they would seek professional help for backache or insomnia but only 40% would seek medical help for headache (Kluwer-Trotter and Lian, 2012). Why should men care about getting diagnosed?
  • How might someone be putting their child at risk if they aren’t getting diagnosed or treated?
  • Do we know the likelihood that a child will inherit migraine from their father? (i.e. 50%, 25%?)
  • According to Migraine Buddy data, men are 43% more at risk than women of progression from episodic to chronic.
  • Are men who experience frequent headache or migraine attacks likely to have other health issues?
  • What has the research found about men with migraine and heart attack and stroke risk? What’s the level of absolute risk?
  • How can headache disease affect men in their careers and as a parent?
  • Can children and men who have had one or more concussions be at a greater risk for migraine?
  • How should we evaluate whether to let our children play high-contact sports?
  • What’s the bottom line? Final thoughts?

Watch the full interview now, no login or Access Pass required >>


Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com

International Headache Society

Migraine is an invisible disability!

People with migraine lose on average 10 work days/year causing £ £ £ in each country’s economy! Spread the word! Visit our website for more info!

https://ihs-headache.org/en/resources/migraine-awareness-month/ #migraineawareness2021 #migraineawareness #mham #mham2021 #neurology

Vestibular Migraine


Severe headache is the symptom many think of first with migraine, but for some, there may be other symptoms, like vertigo, that are the most disabling and prominent. While vestibular migraine can have a devastating impact on quality of life, it’s often challenging for people to receive a correct diagnosis or effective treatment. How do we know the difference between vestibular migraine and other forms of migraine with vertigo or dizziness, as well as the other conditions that share this prominent symptom? Dr. Shin Beh is an assistant professor of Neurology at the UT Southwestern Medical Center and the founding director of its Vestibular Neurology and Visual Disorders Clinic. He is a member of the American Academy of Neurology, the North American Neuro-Ophthalmology Society, and the American Headache Society.



What is vestibular migraine?


Dr. Beh: Many symptoms are similar to those of people with migraine: vertigo, light, sound and smell sensitivity. However, there may be no headache phase at all, just the full-blown vertigo symptoms. Many can also have a lot of constant lightheadedness and dizziness—a disequilibrium that’s present all the time and that’s aggravated by busy visual scenes or moving too quickly. Patients often tell me that this type of dizziness is, in fact, even more disabling. As an example, going to the grocery store can be unpleasant because of the overwhelming visual scenes, fluorescent lights, shiny floors and crowds, even if you’re not having an attack, and work on a computer can be difficult or impossible. Other disabling symptoms might occur during menstruation or when eating certain foods, and many get vestibular issues accompanied by cognitive difficulties, often referred to as brain fog. Vestibular migraine is more common as people age, and especially for women, after menopause.

What other conditions share these vestibular symptoms, making it difficult to diagnose?


Dr. Beh: Three conditions that can have some of the same symptoms are Meniere’s disease, benign paroxysmal positional vertigo (BPPV) and persistent-postural perceptual dizziness (PPPD). Meniere’s disease is a condition of the inner ear causing attacks of ear pressure and roaring tinnitus, followed by vertigo. Meniere’s disease patients tend to have hearing loss, usually asynchronous, while those with vestibular migraine don’t. Half of Meniere’s patients also have migraine, though we don’t know why. In BPPV, a loose crystal breaks off from one part of the ear and then wanders into a different part of the ear. Vertigo attacks are very short, generally measured in seconds (unlike vestibular migraine), and can usually be mitigated simply by changing the head angle. PPPD is a condition with constant, ongoing persistent dizziness, unsteadiness, and disequilibrium that can be triggered by any condition that causes vertigo, such as vestibular migraine. The two conditions can coexist, but PPPD can also be caused by conditions other than vestibular migraine.


How important is it to get a diagnosis?


Dr. Beh: In general, an accurate diagnosis can take away a lot of uncertainty. Even if the person doesn’t meet the full criteria of vestibular migraine, if a clinician is fairly certain that the symptoms are coming from migraine, appropriate treatment can be started. And like the progression of chronic migraine from untreated episodic migraine, a person with vestibular migraine who has many attacks of vertigo can develop worsening symptoms. The brain doesn’t recover immediately after a vertigo attack; you may be disoriented and dizzy, and then even before you can become normal again, you get another attack of vertigo. It becomes a downward spiral of dizziness and vertigo that just gets worse and worse. As with chronic migraine, there is an inability to fully recover from one attack before starting another. Finding the right treatments can make a real difference.


Watch the full interview for answers to:

What is vestibular migraine?

To what extent can the symptoms of vestibular migraine cause disability?Are vestibular symptoms more likely to happen at a certain stage of an attack?

What is the difference between vestibular migraine, and migraine with dizziness or vertigo as part of the attack?

Are there any triggers specific to vestibular migraine attacks?

What is the difference between vestibular migraine and other conditions that cause vestibular symptoms, like Meniere’s disease, BBPV, or PPPD?

What is the relationship of tinnitus to vestibular migraine?

Why is the diagnosis of vestibular migraine so complicated, and does having an accurate diagnosis matter?

Can vestibular migraine symptoms get worse over time if untreated?

How can people who suspect they have vestibular migraine find help?

How can vestibular migraine be treated, either therapeutically or with alternative approaches?What does the future hold for those living with vestibular migraine?


Watch Dr. Beh’s interview here, or order it as part of the Migraine World Summit package from this page.

June is Migraine & Headache Awareness Month (#MHAM)


In the US, June is National Migraine & Headache Awareness Month (#MHAM), and the headache, migraine and cluster communities are working together for our diseases to be recognized. Our community has over 100 countries represented. If you’re not someone living in the US, there may be some valuable lessons that can be drawn about the awareness effort. A disease awareness month or week plays a vital role in raising public knowledge, addressing stigma and building a stronger community of patient advocates. 

The activities planned for the month are geared towards those living with headache diseases, their caregivers and the general public. 

Observance Days

For 2021, the following seven days are recognized as special Observance Days within the month of June. Each one represents a significant topic within our community. Help us spread awareness and recognition on these days by posting the information below on your social media accounts:

  • June 1: Headache at Work
  • June 6: Veterans with Headache Disease
  • June 7: Remembrance Day
  • June 19: Disparities in Headache
  • June 20: Headache Diseases and Men (Father’s Day)
  • June 21: Shades for Migraine
  • June 29: Chronic Migraine Awareness Day

Find more information about these days and articles from advocates (including several team members from the Migraine World Summit) on the MHAM event website.

Many of the activities taking place are online and if English is a common language for those outside the US, then you can still participate and support initiatives. You may even see others from your country doing the same.

Invisible and stigmatized conditions like chronic migraine, cluster headache and others need advocates and a public voice to improve research funding towards a cure and to increase support and care for patients and their families.

Many people on the Migraine World Summit team have migraine themselves and in the family. Many are also parents. The same may be true for you. If we want a better future for family, our children and the next generation, the time to act is now.

Whether you want to educate yourself through webinars and training sessions, participate in a race, share on social media, wear shades on June 21 or rally against Chronic Migraine on June 29, it’s up to you.

Join us in advocating and spreading awareness!

Here’s how you can get involved >>

International Headache Society

Several publications have shown headache as a common symptom of COVID19, and it may be caused by different etiologies. Systemic viral infection is one possible source of headache. The ICHD3 criteria for Headache attributed to systemic viral infection are:

A. Headache of any duration fulfilling criterion C
B. Both of the following:
1. systemic viral infection has been diagnosed
2. no evidence of meningitic or encephalitic involvement
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed in temporal relation to onset of the systemic viral infection
2. headache has significantly worsened in parallel with worsening of the systemic viral infection
3. headache has significantly improved or resolved in parallel with improvement in or resolution of the systemic viral infection
4. headache has either or both of the following characteristics:
a) diffuse pain
b) moderate or severe intensity
D. Not better accounted for by another ICHD-3 diagnosis.

https://ihs-headache.org/

headache #headaches #ichd3matters #virus #covid_19

World Meningitis Day

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WORLD MENINGITIS DAY

In November 2020, following years of campaigning made possible by your support, the World Health Organization (WHO) approved the first ever Global Roadmap to Defeat Meningitis by 2030. Now, we need your help once again to ensure that governments around the world act on the plan.

Meningitis is a global disease. It travels from person to person without respect for national borders. You have the power to take action and defeat meningitis by helping us raise vital awareness and life saving funds, to finally rid the world of this deadly and devastating disease.

This World Meningitis Day (April 24th 2021) we need you to take action and defeat meningitis.

The second-largest infectious killer of under 5s

According to new research, meningitis is not being prioritised appropriately in key global and regional health plans despite it being a leading killer of children.

Among preventable diseases, meningitis has one of the highest fatality rates and can cause devastating epidemics. Whilst deaths from measles and tetanus in children under five years of age are estimated to have decreased by 86% and 92%, respectively, between 1990 and 2017, deaths from meningitis decreased by just 51%.

Personal stories told for the very first time

Meningitis can happen to anyone, of any age, at any time. To mark World Meningitis Day, three brave people have told their stories of personally experiencing meningitis to raise life-saving awareness.

Paula Donnelly (pictured) was just 21 when she fell ill and, like many young people, brushed her illness off until it was almost too late. Rebecca Jones Leslie became very ill very quickly and, in her words, “knew [she] was dying”. Martin Fletcher forced himself into work despite feeling terrible – a decision which likely saved his life.

Write to your representative with a pre-written template

The World Health Organizaiton (WHO) might have endorsed the Global Roadmap to Defeat Meningitis by 2030, but nothing will change unless governments all over the world act on it.

A letter written to your local political representative can make a massive difference. Not sure what to say? Our friends at the Confederation of Meningitis Organisations (CoMO) have created a personalised template letter to your local representative, highlighting the issues that matter most to you.

Donate to help fund life saving research and help defeat meningitis
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Join #TeamMRF and run, walk, cycle or swim for a world free from meningitis
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Working from home – The Migraine Trust

Working from home
Many people with migraine work from home. For some people it helps them to manage their migraines. However, it can also present challenges. This page has more information on managing migraine when working from home.
Migraine and working from home

Many people with migraine work from home at least some of the time, and with covid-19 many people have had to take up working from home indefinitely. While some people find working from home can help with their migraines, others find it can contribute to or make them worse.

For many people working from home means improvising or adapting their living space. This can mean that their ‘workstation’ isn’t set up in a migraine friendly way. Some people find themselves working longer hours and spending more time looking at a screen which can trigger migraine.

You may want to consult with your company’s occupational health or health and safety team for more information about how to work safely from home.

If you have adapted or ‘special’ equipment for work, you should be provided with appropriate equipment to help you work from home safely. Speak to your manager, HR or Occupational Health team for further advice.

Take time off if you need to
It’s important to take time off work if you need to. Many people feel they should try to ‘push through’ a migraine when they’re working from home. However, it’s better to take the time off you need to feel better and then return to work. Otherwise you may find your migraines last longer or bounce back.

Routine
Keeping a routine when working from home is important. It can be even more important for people with migraine, especially if changes to routine act as a trigger.

Try to stick to your normal routine as much as possible including going to bed, getting up and eating at your usual times.

Having something that you use as a prompt for starting and finishing work can help, such as having a coffee if you usually have one before work or going for a walk during the time you would usually commute.

Try not to work longer than your usual hours and try to ‘leave’ your workspace in some way at the end of the day (even if it’s just putting paperwork away).

Regular breaks
Taking regular breaks is important, especially taking breaks from the computer and getting up and moving around.

It’s also important to give your eyes a break from the screen regularly – fixing your gaze at a point in the distance can help.

Screens
Screens can trigger migraine for many people, and a lot of people find it more challenging working from home as they spend longer using a screen. There are some things that may help:

If possible use an anti-glare screen, or get an anti-glare screen cover. If you wear glasses speak to your optician about changes to glasses that may help – such as anti-glare lenses.
Adjust the brightness of the screen. Generally, it should be similar to the light around the screen. However, if the area is dark consider getting some desk lighting to even out the light distribution.
Adjust the screen refresh rate (how many times per second a computer screen refreshes its image) if you can. Usually a higher rate is better. How much of an issue the refresh rate is, and the difference it makes will depend on your screen. For help with this speak to your IT team.
Some people find changing the view mode based on what they’re using the computer for helps e.g. text for word-based activities.
Try not to sit too close to the screen – generally at least 2 feet is recommended.
Speak to your IT department (if you have one) about other adaptations that may help.
Video conferencing
A lot of people find themselves being expected to take part in more online and video conferences. This can be a good way of connecting with colleagues and maintaining social contact. However, some people with migraine find this triggers a migraine or makes it worse.

There are some things which may help:

Turn the video function off and use the audio only.
Ask colleagues to consider other methods for meetings and catch-ups such as telephone calls.
Try different views to see which one works best for you.
You could ask for participants to mute themselves when not speaking.
Ask colleagues to try and avoid sitting with bright light behind them.
Some platforms have a dark mode (which inverts colours to light text on a dark background) and some people find this helps.
Talk to colleagues about breaking up the number of zoom contacts in a day and making sure people are given enough time between meetings may help.
Environment
The environment you work in is really important. Although it’s not possible for everyone to have a separate space for working, where you can try to set a ‘work’ area.

Make sure you have access to everything you need, including water and snacks. Becoming dehydrated or hungry can trigger migraine in some people so it’s important to stay hydrated and eat regularly (getting up for a snack can be a good way to take a break).

Try to make sure the area is well lit, using as much natural light as possible. Try to avoid glare from light as much as you can. Desk lamps that direct the light evenly across the workstation can help.

Set your workspace up so it’s as supportive as possible.  NHS guidance can help with this.

Try to use a suitable desk and chair, if you need certain equipment speak to your manager or HR department.

If you don’t have access to a desk and office chair try to set up your environment using what you have around the house e.g. a cushion for your back or a box to rest your feet on.

Many people find that muscle tension in the head, neck and shoulder areas can trigger a migraine. Sitting comfortably  and regularly moving around can help.

You may find doing some sitting exercise can help. The Chartered Society of Physiotherapists have some exercises for people who sit at a desk.

Staying in touch
Working from home can be isolating, and can have a negative impact on your wellbeing, which can have a negative impact on your migraines.

Staying in touch with colleagues can help. Using video calls or phoning colleagues for a chat can help. If you find video calls difficult, speak to your colleagues and ask about alternatives such as conference calls.

Speak to your manager about any concerns you have about working from home, or if you’re finding working from home is making your migraines worse.

It’s also important to let your manager know if you’re having a migraine during work, and if you need to take time off.

If you have any suggestions that have worked for you – let us know.

Useful resources
NHS Every Mind Matters

Mental Health at Work

HSE Executive

— Read on www.migrainetrust.org/living-with-migraine/coping-managing/working-from-home/

Life with migraine during COVID

What is life like with migraine during the COVID crisis? We asked a man in his mid-70s:

I had successfully used preventives to control my migraine disease. But when the pandemic hit, my anxiety rose, especially considering my susceptible age group. I slept less well, struggled with broken routines, and had to stay distanced from many of my closest family members and friends. The frequency and intensity of my attacks increased, and I crossed the threshold into chronic migraine, my medication no longer effective. The hospital where my neurologist worked would not allow her to meet me in person. I felt the tools I had used to manage my migraines had slipped away.
Does this feel familiar? According to a study by the Headache and Migraine Policy Forum, 70% of people with migraine reported an increase in attacks during the pandemic.

The study also found that:

84% of the 1,000 people surveyed experienced more stress in managing their disease.61% were afraid to seek care.74% hesitated to go to an emergency room during an acute attack, especially when they knew that emergency departments and hospitals were overburdened.
Added stress, worry about friends and loved ones, more time in front of a computer, job uncertainty and financial insecurity have all complicated the already complex challenge of living with migraine. Difficulty getting longer supplies of medications, increasing anxiety and depression among school-age children, and inability to seek in-person care and treatment have compounded what for many was already a debilitating disease.

Women, especially women of color, have borne a disproportionate brunt of the COVID fallout. The pandemic has shone a light on inequalities in health care, employment, and caregiving. And since women experience migraine at three times the rate of men, the 70% increase in attacks hardly feels surprising.

There are proven coping strategies, however. At an earlier Migraine World Summit, Dr. Amaal Starling spoke about SEEDS for Success. SEEDS reminds us of the key lifestyle changes we can make to control our migraine attacks, along with preventive or acute medications we may be taking. It stands for Sleep hygiene, Eating regular and healthy meals, Exercising regularly, keeping a headache Diary, and Stress management. What can be added in today’s pandemic world are finding alternate sources for social interaction and learning to adapt to the use of telemedicine.

The world has changed entirely in the past year. One thing that remains constant is the commitment of the Migraine World Summit to reduce the global burden of migraine. We hope you’ll join us from March 17 to 25 to learn about the latest advancements in migraine and headache medicine, and to brush up on strategies for migraine best practices.

Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com

Life with migraine during COVID

What is life like with migraine during the COVID crisis? We asked a man in his mid-70s:

I had successfully used preventives to control my migraine disease. But when the pandemic hit, my anxiety rose, especially considering my susceptible age group. I slept less well, struggled with broken routines, and had to stay distanced from many of my closest family members and friends. The frequency and intensity of my attacks increased, and I crossed the threshold into chronic migraine, my medication no longer effective. The hospital where my neurologist worked would not allow her to meet me in person. I felt the tools I had used to manage my migraines had slipped away.
Does this feel familiar? According to a study by the Headache and Migraine Policy Forum, 70% of people with migraine reported an increase in attacks during the pandemic.

The study also found that:

84% of the 1,000 people surveyed experienced more stress in managing their disease.61% were afraid to seek care.74% hesitated to go to an emergency room during an acute attack, especially when they knew that emergency departments and hospitals were overburdened.
Added stress, worry about friends and loved ones, more time in front of a computer, job uncertainty and financial insecurity have all complicated the already complex challenge of living with migraine. Difficulty getting longer supplies of medications, increasing anxiety and depression among school-age children, and inability to seek in-person care and treatment have compounded what for many was already a debilitating disease.

Women, especially women of color, have borne a disproportionate brunt of the COVID fallout. The pandemic has shone a light on inequalities in health care, employment, and caregiving. And since women experience migraine at three times the rate of men, the 70% increase in attacks hardly feels surprising.

There are proven coping strategies, however. At an earlier Migraine World Summit, Dr. Amaal Starling spoke about SEEDS for Success. SEEDS reminds us of the key lifestyle changes we can make to control our migraine attacks, along with preventive or acute medications we may be taking. It stands for Sleep hygiene, Eating regular and healthy meals, Exercising regularly, keeping a headache Diary, and Stress management. What can be added in today’s pandemic world are finding alternate sources for social interaction and learning to adapt to the use of telemedicine.

The world has changed entirely in the past year. One thing that remains constant is the commitment of the Migraine World Summit to reduce the global burden of migraine. We hope you’ll join us from March 17 to 25 to learn about the latest advancements in migraine and headache medicine, and to brush up on strategies for migraine best practices.

Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com