Categories
News on Health & Science

High-Flow Oxygen Can Reduce Headaches

[amazon_link asins=’B004IJHHL4,0757004156,B00U1P3B1Y,0962052728,B000XTBHFK,1578266270,B00K70QDJA,1630060518,B005SUEVHU’ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’7337f99e-1cfa-11e8-b874-71b5798ca833′]

Fifteen minutes of treatment with high flow oxygen significantly eased cluster headaches, according to a new study:-

Cluster headache attacks, characterised by bouts of excruciating pain usually near the eye or temple, typically last for 15 minutes to three hours if untreated and have a frequency of up to eight attacks a day on alternate days.

High flow oxygen is given at a rate of six to seven litres per minute for 10 to 20 minutes at the start of a cluster headache.

Attacks usually occur in bouts, or clusters, lasting for weeks or months, separated by remissions lasting months or years, according to the study.

The current treatment for acute attacks of cluster headache is injection with the drug sumatriptan, but frequent dosing is not recommended because of adverse effects.

Another treatment option is the inhalation of high-dose, high-flow oxygen, but its use may be limited because of the lack of a good quality controlled trial.

Anna S. Cohen, of the National Hospital for Neurology and Neurosurgery, and colleagues conducted a randomised, placebo-controlled trial of high-flow oxygen for the treatment of acute attacks of cluster headache.

The study included 109 adults (aged 18-70 years). Patients treated four cluster headache episodes alternately with high-flow oxygen (inhaled oxygen at 100 percent, or 12 litres per minute, delivered by face mask, for 15 minutes at the start of an attack) or placebo (high-flow air).

Patients were recruited and followed up between 2002 and 2007. The final analysis included 57 patients with episodic cluster headache and 19 with chronic cluster headache.

The researchers found that 78 percent of the patients who received oxygen reported being pain-free or to have adequate relief within 15 minutes of treatment, compared to 20 percent of patients who received air.

For other outcomes, such as being pain-free at 30 minutes or a reduction in pain up to 60 minutes, treatment with oxygen was superior to air. There were no serious adverse events related to the treatments, says a National Hospital release.

“To our knowledge, this is the first adequately powered trial of high-flow oxygen compared with placebo, and it confirms clinical experience and current guidelines that inhaled oxygen can be used as an acute attack therapy for episodic and chronic cluster headache,” the authors write.

Source: The study appeared in the Wednesday issue of JAMA

Reblog this post [with Zemanta]
Categories
Featured

Oxygen Therapy for Migraine Headaches

[amazon_link asins=’B004IJHHL4,0757004156,B00U1P3B1Y,0962052728,B000XTBHFK,1578266270,B00K70QDJA,1630060518,B005SUEVHU’ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’2b587831-1cfa-11e8-858d-fbeffe8ee93e’]

Two types of oxygen therapy may offer relief to people who suffer from disabling migraine and cluster headaches.

A review of a number of studies evaluated normobaric oxygen therapy and hyperbaric oxygen therapy in the treatment of migraines and cluster headaches. Normobaric therapy consists of patients inhaling pure oxygen at normal room pressure, and hyperbaric therapy involves patients breathing oxygen at higher pressure in a specially designed chamber.

Three studies reported a significant increase in the proportion of patients who had relief with hyperbaric oxygen compared to sham therapy. For cluster headaches, two studies found that a significantly greater proportion of patients had relief of their headaches after 15 minutes of normobaric therapy compared to sham therapy.

About 6 percent to 7 percent of men and 15 percent to 18 percent of women suffer from severe migraine headaches, and cluster headaches affect about 0.2 percent of the population.

Sources:
Science Blog July 16, 2008
Cochrane Database of Systematic Reviews July 16, 2008, Issue 3

Zemanta Pixie
Categories
Ailmemts & Remedies

Cluster headache

Definition:
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are extremely rare.Cluster headaches are characterized by an intense one-sided pain centered by the eye or temple. The pain lasts for one to two hours on average and may recur several times in a day.

CLICK & SEE

Cluster headaches consist of brief periods of pain, often excruciating, in one part of the head. they occur in a characteristic pattern, usually between one and four times a day, and there may be gaps or months or years between each group of headaches. however, a small number of people have chronic cluster headaches that occur at regular intervals with very few remission periods between attacks. Like migraines, cluster headaches are likely to be related to an increase in blood flow as a result of widening of the blood vessels in the brain. Cluster headaches affect about 1 million people in the US, 9 in 10 of whom are men. Smoking cigarettes and drinking alcohol increase the risk. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and occasionally by taking medications.

While migraines are diagnosed more often in women, cluster headaches are diagnosed more often in men. The male-to-female ratio in cluster headache ranges from 4:1 to 7:1. It primarily occurs between the ages of 20 to 50 years. This gap between the sexes has narrowed over the past few decades, and it is not clear whether cluster headaches are becoming more frequent in women, or whether they are merely being better diagnosed. Limited epidemiological studies have suggested prevalence rates of between 56 and 326 people per 100,000. Latitude plays a role in the occurrence of cluster headaches, which are more common as one moves away from the equator towards the poles.

Cluster headache, nicknamed “suicide headache,” is a neurological disease that involves, as its most prominent feature, an immense degree of pain. “Cluster” refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions.

Causes:

The cause of the disease is currently unknown.Biochemical, hormonal, and vascular changes induce cluster headaches, but why these changes occur remains unclear. Episodic cluster headaches seem to be linked to changes in day length, possibly signaling a connection to the so-called biological clock. Alcohol, tobacco, histamine, or stress can trigger cluster headaches. Decreased blood oxygen levels (hypoxemia) can also act as a trigger, particularly during the night when an individual is sleeping. Interestingly, the triggers do not cause cluster headaches during remission periods.

Symptoms:
Cluster headaches often develop early in the morning. The major symptoms, which appear suddenly and affect one side of the head or face, include:

· severe pain around one eye or temple.
· watering and redness of the eye.
· drooping of the eyelid.
· stuffiness in the nostril and, sometimes, a runny nose on one side.
· flushing of one side of the face.

Individual episodes of pain may last from a few minutes to 3 hours. The average attack lasts 15-30 minutes. If you have a sudden, severe headache for the first time or if you have symptoms that are different from those of previous headaches, you should consult your doctors at once so that a more serious underlying cause can be excluded.

Cluster headaches are extremely painful, unilateral headaches of a piercing quality. The duration of the common attack is 15 minutes to three hours. Onset of an attack is rapid, and most often without the preliminary signs that are characteristic of a migraine. However, some sufferers report preliminary sensations of diverse description, often referred to as “shadows,” that may warn them an attack is imminent. Though the headaches are almost exclusively unilateral, there are many documented cases of “side-shifting” between cluster periods, or, even rarer, simultaneously (within the same cluster period) bilateral headache. They are often intially mistaken for brain tumors and Multiple Sclerosis often until patients are treated with corticosteroids and then imaged. Trigeminal neuralgia can also bring on headaches with similar qualities.

Pain
The degree of pain involved in cluster headaches is markedly greater than in other headache conditions, including migraine. It has been described by female patients as being more severe than childbirth. The pain is lancinating or boring in quality, and is located behind the eye or in the temple, sometimes radiating to the neck or shoulder. An analogy frequently used to describe the pain is that it is like a red-hot poker inserted into the eye. The condition was originally named Hortons Neuralgia after Dr. B.T Horton who postulated the first theory as to their pathologenesis. His original paper describes the severity of the headaches as being able to take normal men and force them to suicide.

From Horton’s 1939 original paper on cluster headache:

“Our patients were disabled by the disorder and suffered from bouts of pain from two to twenty times a week. They had found no relief from the usual methods of treatment. Their pain was so severe that several of them had to be constantly watched for fear of suicide. Most of them were willing to submit to any operation which might bring relief”

Other symptoms
The cardinal symptoms of the cluster headache attack are ptosis (drooping eyelid), conjunctival injection (red-eye), lacrimation (tearing), rhinorrhea (runny nose), and, less commonly, facial blushing, swelling, or sweating. These features are known as the autonomic symptoms. The attack is also associated with restlessness, the sufferer often pacing the room or rocking back and forth. Less frequently, he or she will have an aversion to bright lights and loud noise during the attack. Nausea is not typical of cluster headache, though it has been reported. The neck is often stiff or tender in the aftermath of a headache, with jaw or tooth pain sometimes present.


Cyclical recurrence and regular timing

Cluster headaches are occasionally referred to as “alarm clock headaches”, because of the regularity of its timing and its ability to wake a person from sleep. Thus it has been known to strike at the same time each night or morning, often at precisely the same time during the day a week later. This has prompted researchers to speculate an involvement of the brain’s “biological clock” or circadian rhythm. In some cases, cluster headaches remain “steady” without cyclical ups and downs for days.


Episodic or chronic

In episodic cluster headache, these attacks occur once or more daily, often at the same times each day, for a period of several weeks, followed by a headache-free period lasting weeks, months, or years. Approximately 10–15% of cluster headache sufferers are chronic; they can experience multiple headaches every day for years.

Cluster headaches occurring in two or more cluster periods lasting from 7 to 365 days with a pain-free remission of one month or longer between the clusters are considered episodic. If the attacks occur for more than a year without a pain-free remission of at least one month, the condition is considered chronic.[1] Chronic clusters run continuously without any “remission” periods between cycles. The condition may change from chronic to episodic and from episodic to chronic. Remission periods lasting for decades before the resumption of clusters have been known to occur.

Pathophysiology:
Cluster headaches are classified as vascular headaches. The intense pain is caused by the dilation of blood vessels which creates pressure on the trigeminal nerve. While this process is the immediate cause of the pain, the etiology (underlying cause or causes) is not fully understood.

Hypothalamus:
Among the most widely accepted theories is that cluster headaches are due to an abnormality in the hypothalamus; a British specialist of the disease, Dr. Goadsby has developed this theory. This can explain why cluster headaches frequently strike around the same time each day, and during a particular season, since one of the functions the hypothalamus performs is regulation of the biological clock. Metabolic abnormalities have also been reported in patients.

The hypothalamus is responsive to light—daylength and photoperiod; olfactory stimuli, including pheromones; steroids, including sex steroids and corticosteroids; neurally transmitted information arising in particular from the heart, the stomach, and the reproductive system; autonomic inputs; blood-borne stimuli, including leptin, ghrelin, angiotensin, insulin, pituitary hormones, cytokines, blood plasma concentrations of glucose and osmolarity, etc.; and stress. These particular sensitivities may underlay the causes, triggers, and methods of treatment of cluster headache.

Genetics
There is a genetic component to cluster headaches, although no single gene has been identified as the cause. First-degree relatives of sufferers are more likely to have the condition than the population at large. However, genetics appears to play a much smaller role in cluster headache than in some other types of headaches.

Diagnosis
Cluster headache symptoms guide the diagnosis. A medical examination includes recording headache details, such as frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This history allows other potential problems to be discounted.

Treatment:
Cluster headaches often go undiagnosed for many years, being confused with migraine or other causes of headache.

Medically, cluster headaches are considered benign, but because of the extreme and often debilitating pain associated with them, a severe attack is nevertheless treated as a medical emergency by doctors who are familiar with the condition. Because of the relative rareness of the condition and ambiguity of the symptoms, some sufferers may not receive treatment in the emergency room and patients may even be mistaken as exhibiting drug-seeking behavior.

Over-the-counter pain medications (such as aspirin, paracetamol, and ibuprofen) typically have no effect on the pain from a cluster headache. Unlike other headaches such as migraines and tension headaches, cluster headaches do not respond to biofeedback.

Some have reported partial relief from narcotic pain killers. Anecdotal evidence indicates that cluster headaches can be so excruciating that even morphine does little to ease the pain. However, some newer medications like fentanyl (and Percocet) have shown promise in early studies and use.

Medications to treat cluster headaches are classified as either abortives or prophylactics (preventatives). In addition, short-term transitional medications (such as steroids) may be used while prophylactic treatment is instituted and adjusted. With abortive treatments often only decreasing the duration of the headache and preventing it from reaching its peak rather than eliminating it entirely, preventive treatment is always indicated for cluster headaches, to be started at the first sign of a new cluster cycle.

In many cases, some doctors have tried the use of beta blockers as a treatment.

Prophylactic treatment
A wide variety of prophylactic medicines are in use, and patient response to these is highly variable. Current European guidelines suggest the use of the calcium channel blocker verapamil at a dose of at least 240 mg daily. Steroids, such as prednisolone, are also effective, with a high dose given for the first five days before tapering down. Methysergide, lithium and the anticonvulsant topiramate are recommended as alternative treatments.

Muscle relaxants and atypical anti-psychotics have also been used.

Magnesium supplements have been shown to be of some benefit in about 40% of patients. Melatonin has also been reported to help some.

Other neuropathic pain alleviating agents can also be used such as amyltryptaline

Non-established and research approaches
There is substantial anecdotal evidence that serotonergic psychedelics such as psilocybin (mushrooms) and LSD and LSA d-Lysergic acid amide (Rivea corymbosa seeds) abort cluster periods and extend remission periods. Melatonin, psilocybin, serotonin, and the triptan abortive drugs are closely-related tryptamines.

Dr. Andrew Sewell and Dr. John Halpern at McLean Hospital in Boston have investigated the ability of low doses of psilocybin (“magic mushrooms”) to treat cluster headaches. Dr. Sewell examined medical records of 53 patients who had taken hallucinogenic mushrooms and reported in Neurology that the majority of them found partial or complete relief from cluster attacks. A clinical study of these treatments under the auspices of MAPS is being developed by researchers at Harvard Medical School, McLean Hospital.

Within the United States, the Controlled Substances Act (CSA) of 1970 makes it illegal to possess hallucinogens (including psilocybin and LSD), classifying them as Schedule I drugs with no legitimate medical use. Patients who use psilocybin to treat their symptoms face legal prosecution, although there are no known convictions.

What might be done?
Your doctor may prescribe an anti-migraine drug, which will help reduce the length of a cluster attack and decrease the severity of the headaches. anti-migraine drugs should be taken as soon as possible after the headache starts. If these drugs do not help, lithium is some effective.

If the cluster is prolonged, a short course of corticosteroids may help prevent the headaches from recurring. These drugs should be gradually reduced in dose, as advised by your doctor, as the headaches disappear.

If you have cluster headaches, you should not smoke cigarettes or drink even small amounts of alcohol because both increase the risk of an attack.

Cluster headaches may continue for the rest of your life, but you may have prolonged periods of remission.

Home Care
Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye’s syndrome.

Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.

If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.

Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax), almotriptan (Axert), and zolmitriptan (Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.

If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. Examples of these include:

Antidepressants such as nortriptyline (Pamelor), amitriptyline (Elavil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), or paroxetine (Paxil) for tension or migraine headache
Beta-blockers such as propranolol (Inderal) for frequent migraine headaches
Calcium channel blockers such as verapamil for frequent migraine headaches
Anti-epileptic medicines such as topiramate (Topamax)
If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.

All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Cluster_headache
http://www.charak.com/DiseasePage.asp?thx=1&id=4
www.healthline.com/adamcontent/headache?
http://www.healthatoz.com/

Categories
Ailmemts & Remedies

Headaches

I have a headache.   Everyone   from children, teenagers and adults to the elderly   has said this at some time or the other. The statement may be true, or it may simply be an excuse to avoid an unwelcome conversation, person or venture. After all, the pain is in the  head  (no pun intended) and it cannot be objectively verified or measured.

CLICK & SEE

The brain itself is actually devoid of nerves and cannot feel pain. The sensations arise from receptors in the nerves in the surrounding structures such as the eyes, teeth, sinuses, facial muscles, scalp and the meninges (covering of the brain).

Acute pain may be due to an infection in any of these structures. If the headache is chronic and recurrent, it is probably due to tension or migraine, with an overlap between the two conditions.

During such a headache, biochemical analysis of the blood shows a drop in the levels of a neurochemical called serotonin and the trace element magnesium. This, in turn, stimulates the trigeminal nerve (one of the cranial nerves) and results in the release of substances called neuropeptides. Their action is dilatation and inflammation of the blood vessels of the covering of the brain. The result is a throbbing or dull, aching sensation in the head.

Tension headaches may not be confined to the head. There may be pain in the scalp, neck, jaw or shoulder. It may be associated with non-headache symptoms like insomnia, fatigue, irritability, loss of appetite or lack of concentration.

Migraines are the other type of recurrent headaches. They occur in 12 per cent of the population and are three times commoner in women. The headache may be familial, with many members of the family complaining of a similar indisposition. A typical migraine may be preceded for a few days by vague symptoms of drowsiness, irritability, depression, craving for sweets or increased thirst. A few hours before the onset of the headache, there is usually a typical aura with flashing lights, a feeling of lightening bolts in the head, tingling and numbness. (This differentiates migraines from tension headaches, which typically do not have an aura.) The headache that follows is throbbing and unbearable. It may last for a couple of hours or a whole day. It usually subsides with vomiting, leaving a physically and emotionally drained individual who has effectively lost a full working day.

CLICK & SEE

Migraine attacks are usually preceded by a typical aura with flashing lights, lightning bolts in the head, numbness, etc.

Devastated by the ailment, most sufferers learn to recognise and avoid triggers which precipitate the headache. Migraine may be due to  hormones, especially fluctuating levels of oestrogen and progesterone. This is the reason why migraines are commoner in women. They are also aggravated at the time of hormonal surges and changes like menarche, pregnancy and menopause.

Foods containing monosodium glutamate (an additive in Chinese food) and tryptophan (found in chocolates, oats, bananas, poultry and red meat) and some preservatives. This has lead to the coining of the term   Chinese restaurant headache.

Stress at home or at work, which can cause the release of chemicals.

Scents and perfumes or even the smell of paint.

Insomnia as well as excessive sleep.

Change in the weather.

Headaches are a source of anxiety, especially if they are severe and recurrent. There may also be the persistent nagging fear of a sinister diagnosis like a brain tumour. If you are worried,

Keep a   headache calendar, so that when you consult the physician you have precise documentation of the type, frequency and duration of the ailment.

Have an ENT (ear, nose and throat) evaluation to rule out sinusitis and an eye check-up for refractory errors or glaucoma.

If these are normal and the headache is still worrying, you need to consult a physician. You may require further tests like a CT scan or an MRI, especially if the headache is non-typical.

A physician needs to be consulted if :

The onset of the headache is abrupt and severe,

If it is associated with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties,

If it has occurred after a head injury or has suddenly appeared after the age of 50 years.

Most headaches respond well to a simple paracetamol or an NSAID (non-steroidal anti-inflammatory drug) like ibubrufen or tolfenamic acid preceded by an antiemetic like domperidone or stemetil. Lying in a darkened room also helps. Anecdotal evidence suggests that acupuncture or pressure are helpful.

CLICK & SEE:  Some Natural Remedies For Headache and Migraine

Lifestyle modifications help to reduce the severity and frequency of attacks. Triggers should be avoided. Aerobic exercise for 40 minutes a day like walking, jogging, running or stair climbing releases protective mood-boosting chemicals from the calf muscles in the leg. Regular yoga, Tai-Chi, meditation and relaxation also lessen the levels of tension causing chemicals, thus reducing attacks and improving the quality of life.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Source:The Telegraph (Kolkata,India)