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.

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 >>

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

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/

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

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

Background: In late December 2019, a new pandemic caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection began to spread around the world. The new situation gave rise to severe health threats, economic uncertainty, and social isolation, causing potential deleterious effects on people’s physical and mental health. These effects are capable of influencing oral and maxillofacial conditions, such as temporomandibular disorders (TMD) and bruxism, which could further aggravate the orofacial pain. Two concomitant studies aimed to evaluate the effect of the current pandemic on the possible prevalence and worsening of TMD and bruxism symptoms among subjects selected from two culturally different countries: Israel and Poland.

Materials and methods: Studies were conducted as cross-sectional online surveys using similar anonymous questionnaires during the lockdown practiced in both countries. The authors obtained 700 complete responses from Israel and 1092 from Poland. In the first step, data concerning TMDs and bruxism were compared between the two countries. In the second step, univariate analyses (Chi2) were performed to investigate the effects of anxiety, depression, and personal concerns of the Coronavirus pandemic, on the symptoms of TMD, and bruxism symptoms and their possible aggravation. Finally, multivariate analyses (logistic regression models) were carried out to identify the study variables that had a predictive value on TMD, bruxism, and symptom aggravation in the two countries.

Results: The results showed that the Coronavirus pandemic has caused significant adverse effects on the psychoemotional status of both Israeli and Polish populations, resulting in the intensification of their bruxism and TMD symptoms.

Conclusions: The aggravation of the psychoemotional status caused by the Coronavirus pandemic can result in bruxism and TMD symptoms intensification and thus lead to increased orofacial pain.

Osteopaths are open for treatment of Bruxism

Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

• What does a cluster attack feel like?
• What is the difference between migraine and cluster headache?
• What is the difference between episodic and chronic cluster headache?
• Does cluster headache typically decline in occurrence or stop altogether as you age?
• What are the latest treatments approved for cluster headache?
• How does oxygen work as a treatment for cluster headache?
• How are psychedelics used to treat cluster headache?
• Do triptans, ditans and gepants work for cluster headache?
• What are the biggest advocacy challenges currently facing those with cluster headache?
• How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..

Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

• What does a cluster attack feel like?
• What is the difference between migraine and cluster headache?
• What is the difference between episodic and chronic cluster headache?
• Does cluster headache typically decline in occurrence or stop altogether as you age?
• What are the latest treatments approved for cluster headache?
• How does oxygen work as a treatment for cluster headache?
• How are psychedelics used to treat cluster headache?
• Do triptans, ditans and gepants work for cluster headache?
• What are the biggest advocacy challenges currently facing those with cluster headache?
• How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..