Posts Tagged ‘migraines’

Headache Imaging Can Spot Brain Tumors

Reducing imaging tests for patients with headaches runs the risk of missing or delaying the diagnosis of brain tumors, according to a new study.

“Patients with brain tumors may present with isolated headaches in the absence of other neurological symptoms and signs.

Early diagnosis of brain tumors allows prompt treatment before more severe symptoms, reduced performance status, and worsened outcomes,” stated the researchers, led by neurosurgeon Ammar H. Hawasli, MD, from Washington University School of Medicine, St Louis.

“As physicians grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, they must carefully balance the costs and benefits of discretionary services, such as neuroimaging for headaches.”

Despite recently published guidelines to limit neuroimaging for headache, there has been a progressive increase in neuroimaging for headaches in the United States.

In most cases, diagnosis of migraine and other types of headache can be made in the doctor’s office, without any special tests.

“Nonetheless, neuroimaging in the United States between 2007 and 2010 for migraines and headaches approached $1.2 billion,” the researchers stated.

“Medical providers have likely continued high use of neuroimaging for headaches because of concerns about potential missed diagnoses and medical errors, which would adversely affect patient outcomes and, in turn, affect malpractice liability,” they said.


The recent guidelines seek to reduce the use of neuroimaging for patients with headaches to limit the use of unnecessary and costly medical tests.

For example, the “Choosing Wisely” guidelines developed by the American College of Radiology and Consumer Reports include the recommendation, “Don’t do imaging for uncomplicated headaches.”

“Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon’s experience with patients with brain tumor,” the investigators stated.

“Specifically, patients with brain tumors may present with isolated headaches in the absence of other neurological symptoms and signs.”


The researchers presented their analysis of a series of 95 patients with a confirmed diagnosis of brain tumor.

Nearly half of the patients had a combination of symptoms, such as seizures, cognitive and speech dysfunction, and other neurological abnormalities.

However, about one-fourth of the patients had isolated headaches, no symptoms, or nonspecific symptoms.

In 11 patients, headache was the only symptom of brain tumor; 4 of these patients had new-onset headaches that would have qualified them for neuroimaging under recently proposed guidelines.

The other 7 patients had migraine or other types of headache and would not have been chosen for neuroimaging.

Depending on which set of recent recommendations had been followed, neuroimaging would have been delayed or never performed in 3% to 7% of patients who had brain tumors.

“We support careful and sensible use of neuroimaging in which physicians exercise excellent clinical judgment to reduce waste in the medical system,” the researchers concluded.

“Although we do not recommend routine screening for the general population, we do contend that a substantial number of patients with brain tumors will present with isolated headaches.”

The researchers published their results in the January 2015 issue of Neurosurgery.

Chronic Migraine Burdens Whole Family

Chronic migraine has significant effects on family relationships and activities, according to the results of a new study.

“The effects of chronic migraine can be devastating and far-reaching.

The results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) study highlight the significant impact of chronic migraine not only on the person with migraine but on the entire family,” said Dawn Buse, PhD, Director of Behavioral Medicine, Montefiore Headache Center, and Associate Professor, Clinical Neurology, at Albert Einstein College of Medicine.

Dr. Buse led a study to assess the nature and extent of chronic migraine on family activities and relationships.

“Among 994 women and men who met criteria for chronic migraine, respondents reported missing both routine and special family events on a regular basis and feeling guilty and sad about how this affected their relationships with their spouses and children,” she said.


Almost three-fourths of respondents said they would be better spouses if they did not have chronic migraine.

Almost two-thirds felt guilty about being easily angered or annoyed by their partners because of headache, and at times two-thirds avoided sexual intimacy with their partners because of headache.

The majority of respondents also endorsed that they would be better parents if they did not have chronic migraine.

“About two-thirds of respondents reported that they became easily annoyed with their children due to headache,” Dr. Buse said.

“In addition, slightly more than half of respondents reported that they had reduced participation or enjoyment on a family vacation due to headache in the past year, and 20% cancelled or missed a family vacation altogether.”


The data suggest that women with chronic migraine appear less impaired and burdened by the condition than men.

“However, it is not clear whether there is truly a qualitative difference between the sexes in the nature and severity of attacks or differences in responses and resiliency to migraine attacks,” Dr. Buse said.

“We could hypothesize that males may have a smaller number of family and parenting responsibilities and commitments than females, making their percentage of missed events higher than the percentage for females.

It is also possible that mothers and wives feel that they cannot miss a family event or drop a responsibility.

In this case they may continue their activities despite debilitating pain and associated symptoms.”

The study highlights the point that chronic migraine is a debilitating disease that can affect all aspects of life, including roles, responsibilities, and relationships within the family.

“We hope that these data will help health care professionals further realize the scope of the burden of this condition and be diligent in providing accurate diagnoses and thorough treatment plans,” Dr. Buse said.

Those treatment plans should include both appropriate pharmacologic and nonpharmacologic (cognitive behavioral therapy, biofeedback, and relaxation training) interventions, she noted.

In addition, Dr. Buse advises health care professionals to encourage and facilitate patients in seeking help from mental health care professionals when these feelings become overwhelming.

Dr. Buse presented the results of the study on June 27, 2014 at the 56th Annual Scientific Meeting of the American Headache Society in Los Angeles.

Headaches Associated With Sex Are No Joke

Comedians have long joked about spouses avoiding sex by claiming to have a headache, but headaches associated with sex are no laughing matter, according to a headache specialist.

“Many people who experience headaches during sexual activity are too embarrassed to tell their physicians, and doctors often don’t ask,” said José Biller, MD, Chair of the Department of Neurology with the Loyola University Chicago Stritch School of Medicine and certified in Headache Medicine by the United Council for Neurologic Subspecialties.

Sexual activity is comparable to mild- to moderate-intensity exercise, he noted.

“Headaches associated with sexual activity can be extremely painful and scary,” Dr. Biller said.

“They also can be very frustrating, both to the individual suffering the headache and to the partner.”

About 1% of adults report that they have experienced headaches associated with sexual activity and that such headaches can be severe.

But the actual incidence is certainly higher, Dr. Biller noted.

Headaches usually are caused by disorders such as migraines or tension, and the vast majority of headaches associated with sexual activity are benign.

But headaches also can be secondary to other life-threatening conditions.

In a small percentage of cases, these headaches can result from a serious underlying condition, such as a hemorrhage, brain aneurysm, stroke, cervical artery dissection, or subdural hematoma.

“We recommend that patients undergo a thorough neurological evaluation to rule out secondary causes, which can be life-threatening,” Dr. Biller said.

“This is especially important when the headache is a first occurrence.”


In 2004, the International Headache Society classified headaches associated with sexual activity as a distinct form of primary headache.

The following are the 3 main types of sex-related headaches:

• A dull ache in the head and neck that begins before orgasm and gets worse as sexual arousal increases.

It is similar to a tension headache.

• An intensely painful headache that begins during orgasm and can last for hours.

This so-called thunderclap headache grabs attention because it comes on like a clap of thunder.

Dr. Biller said patients describe this headache as “all of a sudden, there was a terrific pain in the back of my head. It was like someone hit me with a hammer.”

• A headache that occurs after sex and can range from mild to extremely painful.

This headache gets worse when the patient stands and lessens when the patient lies back down.

The cause is an internal leak of spinal fluid, which extends down from the skull into the spine.

When there is a leak in the fluid, the brain sags downward when the patient stands, causing pain, he explained.

Dr. Biller said men are 3 to 4 times more likely to get headaches associated with sexual activity than women.

Depending on the type of headache, medications can help relieve the pain or even prevent the headache, he said.

To reduce the risk of headaches associated with sexual activity, exercise regularly, avoid excessive alcohol intake, maintain a healthy weight and, if necessary, seek counseling, Dr. Biller said.