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HeadWay, Issue #115 -- Migraine, Chiari 1 Malformation, and Ginger
February 21, 2014

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In this issue:

More Questions: Changes in Migraine, Chiari malformation, and Ginger

Say what?!  Valsalva Maneuver

More Questions: Changes in Migraine, Chiari malformation, and Ginger

Why do migraine symptoms change over time?  Do I actually have chiari 1 malformation?  Ginger as a migraine treatment?  More questions from HeadWay readers...

Why does migraine change over time?

Karen Lee Johnson from the USA was asking this excellent question - why do migraine attacks change so much over time?  The symptoms change, they almost disappear, and later return - they're more severe, less severe - what's going on?

There's no one answer to this question, but we can answer it in part based on what we've learned about migraine attacks.

People with migraine do seem to have a genetic issue, but that doesn't mean that there's a genetic switch that turns on an exact pattern of migraine attacks (see Migraine: Why Genetic Studies haven't Solved all our Problems..  Even the genetic connection is very complex, and it varies by type of migraine disease.

The symptoms, frequency and severity of your attacks are influences by a very complex web of factors (I talked about the spider web analogy in Is anyone else like me?).

If we knew exactly why attacks changed over time in every individual case, we would be a lot closer to perfectly customized effective treatments.  But every case has to be examined individually.

So what factors are involved?  Well, in many cases we're simply talking about internal and external migraine triggers.  Internal changes could include hormonal levels, a heart condition, or muscle injuries.  External includes the foods we eat, chemicals we're exposed to, and even weather patterns.  (more on migraine triggers)

Not only do these things change day to day, they change year to year.

The most important take-away is this:  Recognize that symptoms will change over time.  The combination of how your body works and what is triggering attacks will change over time.  Continue to evaluate, and don't be afraid to change your strategy over time.


This isn't a question, but it is good news.  Last year there were two articles at Headache and Migraine News about a study on ginger supplements as a migraine abortive.  Cathy from the UK reports that ginger has been a help for her and her son:
Just wanted to report that it has been amazingly effective in stopping an attack both for me as a replacement for sumatriptan and for my 25 year old son who can't take it.  He has never been able to abort a migraine before but has just reported success from taking root ginger!  The brilliant thing is also that I have no concerns about taking it if I even think I may have an attack coming on.  I didn't like doing this with sumatriptan for fear of overuse so I am now treating migraines earlier which of course is more effective.  Since trying root ginger a couple of months ago, I haven't yet had to reach for the sumatriptan.  I know it's only anecdotal support for the research that's already been done but this is a huge step forward for me but more especially for my son so I wanted to share it.  Thank you so much!
Thanks for sharing, Cathy!

Here are the two articles on ginger, in case you missed them:

Misdiagnosis: Migraine or Chiari Malformation?

Sally from Canada asked for more information about migraine and Chiari malformation.

Chiari malformation is a rare condition in which the brain tissue protrudes into the spinal canal.  This is due to an issue with the shape of the skull.  It often shows up as growth occurs, and so symptoms may start in the teen years or even adulthood.  In many cases, there are no symptoms at all.

(Note we're talking mainly about the more common Chiari 1 malformation - there are other types usually diagnosed in childhood or in pregnancy)

There can be many similarities with migraine - the fact that symptoms may start in adolescence, headache, vision problems and dizziness.

Because CM1 doesn't always cause symptoms, some patients actually have surgery and discover that their headaches are being cause by something else.

To avoid this, researchers are trying to recommend strict procedures to diagnose and treat CM1.

There are symptoms that are very typical with CM1 - headaches centred in the back of the head, headaches precipited by coughing, headaches that last 5 minutes or less.  If this is the case, you should see a specialist who will do a couple of important things.

First, she will look for other symptoms that are common with brainstem and spinal cord issues.  Second, she will look at your symptoms overall and see if there is a better explanation.

If CM1 is suspected, a specific MRI done by a specialist will allow a diagnosis.

If your doctor confirms CM1, and if it seems to be the cause of your symptoms, surgery may be recommended.  However, for many patients with CM1, surgery is not the best treatment.

For more information, including links to doctors, see Chiari 1 Malformation: description, symptoms and treatment.

Say what?!  Valsalva Maneuver

If you're reading about CM1, you may notice that headache symptoms may be brought on by coughing, or by a Valsalva maneuver.  A what?

The name comes from Antonio Valsalva, an italian researcher who died in 1723.  The maneuver is performed by attempting to forcibly exhale with your mouth and nose closed.  It is sometimes used as a diagnostic tool.

Basically, the CM1 headache can be brought on by anything from sneezing to coughing to straining.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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