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Migraines: Interview and Q&A

Migraines:  Interview and Q&A

Below is a portion of a ‘Web Extra’ with Dr. David Dodick, released after an exceptional one hour interview on NPR’s ‘The Diane Rehm Show’.
Both are found at the following link (definitely worth a listen/read) http://thedianerehmshow.org/shows/2012-08-16/living-migraine-and-search-new-treatments

 

Web Extra: Dr. David Dodick Answers Audience Questions
Is there a correlation between migraine and epilepsy? How are migraines diagnosed in children? Dr. David Dodick of the Mayo Clinic responded to these listener questions and more. Some questions have been edited for space and clarity.

Q: Is it common for children to experience migraines during puberty and then grow out of them? — From Twitter user @A_Fountain

A: Migraine tends to be begin during adolescence, peak in the 20’s-40’s, and diminish thereafter. While the clinical course is highly variable and migraine can go into remission at any time, it is not common for migraine to remit in adolescence. In addition, the predisposition to migraine is believed to be genetic and therefore, the predisposition is lifelong, though for a significant proportion of individuals, the attacks tend to diminish over time.

Q: What is the correlation between stroke, birth control and migraine? — From Twitter user @MigraineLand

A: The risk of stroke, particularly in women less than age 45, is increased two-fold in those who have migraine with aura. That risk is increased by up to 8-fold in women who have migraine with aura who also use an oral contraceptive pill. This risk is increased even further if the woman smokes. Therefore, all women with migraine with aura should be encouraged to quit smoking (if they smoke). In regards to the oral contraceptive pill, recommendations vary from never using the OCP in a woman with migraine with aura to using if aura is infrequent and limited to visual symptoms only. In general, for those young women with frequent migraine with aura, or aura that is prolonged (lasting longer than 60 minutes), or in those whose aura started or worsened after starting the OCP, it is recommended that alternative means of birth control be explored to minimize the risk of stroke.

Also, please keep in mind that while the relative risk of stroke is increased by a factor of 2 in those with migraine with aura, the baseline risk of stroke in young women without migraine with aura is very low (approximately 4 per 100,000 women). That means that while the risk is double, the risk of stroke is still very small (8 per 100,000 women) and even when the OCP is added, the risk is approximately 60 per 100,000. Those individuals with a family or personal history of blood clotting disorder (deep venous thrombosis, pulmonary embolus, should certainly avoid the OCP)

Q: Are there any studies that establish a correlation between fibromyalgia and migraines? — From Twitter user @araaajoooo

A: Yes, fibromyalgia and other chronic pain disorders are considered to be “comorbid” with migraine. That means that they are more often associated with migraine than one would expect to occur by change alone. This is likely due to abnormal function of the internal pain modulating networks in the brain in migraine, and this dysfunction leads migraine sufferers to be susceptible to other chronic pain conditions.

Q: I get cluster headaches which are often mistaken for migraines. Is it because I am female, or are they that similar? — From Twitter user @MJnTJ

A: Cluster headache does share some features with migraine. For example, cluster headaches are almost always unilateral (migraine is unilateral about 50% of the time), and cluster headaches may be associated with sensitivity to light (photophobia) and noise (phonophobia), and, less commonly, with nausea. However, cluster headache can usually be distinguished easily from migraine because cluster headache is almost always unilateral, side-locked (which means they occur on the same side), last a shorter period of time (30minutes to 3 hours; compared to the 4-72 hours of migraine), are associated with prominent tearing, reddening of the eye and …. see http://thedianerehmshow.org/shows/2012-08-16/living-migraine-and-search-new-treatments for more.

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