Lower income = more migraine?
July 3, 2007 5:13 pm
Here's a new study bound to stir up some discussion. Today's issue of Neurology reports on a study of adolescents with migraine. As it turns out, children in families with incomes over US$90,000 had 50% fewer migraines than children in families with incomes under US$22,500. Now, that didn't include children in families that had a history of migraine. In other words, if there was a known "hereditary factor", income didn't seem to make a lot of difference.
I could talk about this for several pages; it really is an interesting study, and interesting to think about. Why was there such a difference? Are we making another discovery about different types of migraine (one more hereditary, one not)?
This study isn't suggesting that there's actually an environmental cause to migraine. Likely there is something environmental that's triggering attacks, but what is it?
A few things to notice: First, we're talking about a huge income difference here. Second, similar studies have shown that lower-income adults have more migraine. Third, these were all households in the USA - perhaps there are factors in low income families there that wouldn't exist in other parts of the world. Fourth, a lot of related diseases and obvious factors were not taken into consideration (such as clinical depression, or substance abuse).
One more interesting note. This study does not support the "social selection" theory. This theory says that people with migraine are going to make less money because they don't tend to do as well at work. Since the study dealt with kids, they were not generally contributing to the family income. That's why the researchers are focusing on environmental factors now.
Dr A. Hershey from the University of Cincinnati sums up the limitations and strengths of the study well: expression of migraine clearly involves a complex interaction of genetics and environment. Bigal et al . . . have clearly demonstrated that the interplay between socioeconomic status and genetics contributes to this complexity. (quote from medpage article If No Genetic Link, Family Income Affects Migraine Risk)
In other words, no one's saying that migraine is simply "environmental". And, of course, lots of people with higher incomes had migraine too - just fewer. However, environment does contribute, and studies like this help us narrow down exactly what parts of our environment are causing problems.
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Splenda - migraine trigger?
July 14, 2007 8:35 am
Splenda is a newer artificial sweetener also known as Altern. Along with thousands of other food and beverage products, Splenda contains sucralose. It was approved as a food product in many countries through the 1990s.
Being newer, it hasn't taken the beating the aspertame has, when it comes to questions about its safety. And, being newer, that's part of the problem - there aren't a lot of long term studies showing just how safe it is. To get in on the controversy, check out Splenda's site (pro-Splenda), the discoverers of sucralose (pro-Splenda), website from the Sugar Association (anti-Spenda).
Of course Spenda isn't just sucralose - it also contains maltodextrin and dextrose. There's only a small amount of sucralose per teaspoon of Splenda because sucralose is incredibly sweet, and needs to be "diluted". Most of the calories in Splenda come from these added ingredients.
A report last September in Headache: The Journal of Head and Face Pain indicated that sucralose may trigger migraine attacks. What I want to know is, has this been a problem for you? Do you avoid Splenda?
And is this just about Splenda? Sucralose is in an increasing number of products - not all are "sugar free", and some even contain sucralose and aspertame.
What contains sucralose? Thousands of products including Diet RC Cola, Arm & Hammer Dental Gum for Kids, Atkins Diet shakes, Pedialyte Pops and Whitey's Ice Cream. Everything from milk products to juices to sauces to baked goods to formed meat chunks - and the number of products is growing.
Do you avoid Splenda? Why or why not?
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Back to brain lesions
July 16, 2007 9:13 pm
There has been concern over the past few years about the link between migraine and brain lesions. I wrote about the study back in early 2004 that demonstrated that people with migraine with aura had some damage to brain tissue, known as lesions. This is not uncommon damage, but the fact that there were more lesions in migraineurs was cause for concern. It may begin to explain the link between migraine and some other problems such as stroke. It may also indicate that migraine causes some kind of cumulative damage.
A recent study reported on by Dr. Todd Rozen in the June issue of Cephalalgia tells a more positive story. Brain lesions shown in one MRI scan were completely gone 16 days later. This is only one case, of course, but it's encouraging.
Brain lesions are normal and not usually a cause for concern. However, there are still a lot of questions - why do those with migraine with aura have more? And even if they are benign, that doesn't discount other evidence that damage from migraine may be cumulative - it may cause damage over time.
Thanks to Dr Alexander Mauskop of the New York Headache Center for pointing out this study. Dr Mauskop emailed me a few days ago to tell me about his new blog, which I will shortly add to our headache/migraine blog aggregator. We know Dr Mauskop from his book, a favourite of mine and of our visitors.
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What a way to get a headache
July 23, 2007 4:53 pm
The next time you find yourself with a headache, be thankful you didn't get it the way Michael did.
Michael Moylan (Florida, USA) woke up at 4:30am with a terrible headache. He thought maybe he had had an anuerysm, or that his wife had elbowed him in the head. He got his wife up, and she drove him to the hospital. In the emergency room, the nurse took a look.
"It appears that you've been shot", said the nurse.
"No way", he replied.
His wife went home to "look for clues", but later admitted that she had shot him. By mistake. It turns out she had in illegal firearm in the house.
The doctors removed the bullet from behind his right ear. The local sherrif, Ken Mascara, had this to say: "How can this guy be shot, not know that he was shot in bed and then walk into a hospital room. It was just amazing to all of us."
No kidding.
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Nitrates and Nitrites
July 31, 2007 7:54 pm
Nitrates and Nitrites. Migraine triggers? What are they and what's the difference?
Well now, that's a tricky question. The two words are tossed around and confused with one another, and really the "layperson" may not need to know all the details. They are two different things - nitrate is a salt of nitric acid, and nitrite is a salt of nitrous acid. Does that help?
Nitrates are found all over the place. It's found in some processed meats, many vegetables, and drinking water. It's naturally occurring, but there are concerns that too much can be a problem. This is why water needs to be tested for nitrate levels. Some heart medications also contain nitrates.
Nitrite is much more toxic, and is commonly used in cured meats for colour and to inhibit growth of bacteria. Though use of nitrites is strictly regulated around the world, there is less regulation on labeling. Meat may read "no nitrite added", for example, when in reality natural sources of nitrite were used (read more about nitrite labels here).
Photo courtesy of scottfeldstein
Nitrates and nitrites do seem to be migriane triggers for some people. The term "hot dog headache" has come in to use to refer to headaches that are triggered by meats like hot dog wieners.
It's tricky to know what is truly causing the headaches, because there's an intertwining of related triggers in many of these foods - MSG, tyramine and nitrites. But many people have found that avoiding foods with nitrates/nitrites has helped cut down their migraine attacks.
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