Coping, Society

Working With Migraines & Headaches

Working with migraines or a headache disorder — any misunderstood chronic illness, really — can be grueling and humiliating. If you’re lucky, co-workers who lack compassion and are resentful is the worst you’ll face. Often, though, supervisors and higher ups don’t understand the severity of your illness, your performance suffers and you’re a major topic of gossip.

Migraines in the Workplace is the subject of Wednesday’s HealthTalk webcast. With headache specialist Christina Peterson the expert guest, you’ll learn how to educate your coworkers and protect yourself legally. Migraine sufferer Cynthia M. will also participate in the discussion.

The program starts at 7 p.m. EST Wednesday, May 16. Starting about 10 minutes before the webcast, go to the program’s description page and look for a link that says “Join the Program.”

Symptoms

Tenderness on Thigh Related to Headaches?

When you have a headache, is the area on your thighs tender when you push on in the area where your arms hit? How about when you don’t?

Your responses to my completely unscientific experiment gave mixed results. According to my acupuncturist, this area is more tender during a headache than when you’re headache free. This is true for some of you, the opposite for others, and irrelevant for those who have a tender spot all the time or none of the time.

I was disappointed that I couldn’t give you any conclusions, but my yoga teacher inadvertently saved the day. She mentioned in class that the ilio-tibial band, which happens to correspond with the exact area that you pushed on, is sore in many people.

Whether or not it’s related to headaches is up for debate. That’s no reason to ignore the soreness. Kelly, being an anatomy geek and yoga therapist, has written up a great description of the IT band and suggestions for reducing the tenderness.

By Kelly M. Pretlow
Certified Purna Yoga Instructor
The ilio-tibial band, commonly referred to as the IT Band, is a long segment of fibrous tissue that runs down the outer thigh. It originates in portions of the gluteus maximus, gluteus medius, and tensor fascia latae. It attaches to the tibia, just below the knee joint. [larger image available here]

Many people feel tenderness or even pain along the IT band, and there are a number of explanations for it. Because this length of tissue starts in the muscles of the hip, tightness and imbalance in those muscles can lead to irritation of the IT band. For example, one of the major functions of the gluteus maximus is to externally rotate the hip/thigh (it has other functions — this is just one example).

If a person has a habit of standing and walking with their legs turned out, like a ballerina, then the gluteus maximus is in an almost constant state of contraction. The tighter that muscle becomes, the more it pulls the IT band toward it, causing strain along the band itself, or perhaps pain in the outer knee.

Runners often have pain along the IT band, but as a Purna Yoga teacher I have observed that much of the population has some degree of tenderness there. Whether it is due to activities, tightness, stress or muscular imbalances, there are a number of ways to find relief:

  1. First and foremost, posture must be addressed. No matter how much a person stretches, if they are often sitting with crossed legs, which externally rotates the hip/thigh, then they are still aggravating this tissue. Pinpointing postural habits and correcting as needed is key.
  2. Secondly, stretching the muscles from which the IT band originates will slowly but surely relieve the underlying physical issue. In Purna Yoga, we have a sequence called the hip opening series, which stretches the muscles of the hip, in turn allowing greater range of motion and freedom of movement (this series should only be taught by a qualified instructor).
  3. Thirdly, it is important to remember the role that emotions, stress, and psychological challenges have on the body. The muscles of the hip provide stability to the pelvis. The pelvis holds the energy of creation, along with many of our more “animal” instincts, fears, passions and urges. Fear, for example, can create a sense of “falling apart.” The body responds to fear by tightening up in order to, literally, keep it together. If a person holds a lot of basic survival fear, then that should be addressed as one of the factors leading to tension in the muscles of the hip, and therefore pain down the outer thigh.
  4. Nutrition and hydration play a large role in how well the body functions. Dehydration makes the tissue sticky, if you will, which limits its ability to flush toxins and by-products. A diet rich in processed foods, sugar, caffeine, alcohol, dairy products and animal foods increases the overall level of acidity in the body. Internal acidity decreases healing rates, and increases the likelihood of disease. Remember, cells are constantly being “born” and need good nutrition in order to function well and be healthy.
  5. Hot baths with epsom salts, a muscle salve or other topical ointment with peppermint oil or similar can help one find short-term relief from the symptoms of IT band tenderness/pain.
  6. Regular practices that I have used which help immensely include: yoga (especially with a well-trained instructor who is familiar with this issue and its underlying causes), hip stretches, leg strengthening, massage therapy and physical therapy.

The IT band, while a source of discomfort for some, is a fabulous piece of bio-mechanical engineering. It provides stability to the leg, enabling humans to run. It is my hope that by learning some basic information about this tissue, readers can find ways to prevent or relieve discomfort. As with any physical pain, it may take some sleuthing to find the cause, but learning the tools to become or remain pain-free makes the detective work worthwhile.

News & Research

Evaluating News on Medical Study Findings

Much like you learned in kindergarten, findings of medical studies get distorted as they go along the telephone chain. A journal article gets to a journalist who interprets it, highlighting eye-catching findings. Then an editor steps in and may jazz it up some more. By the time you hear the news, it’s distilled to soundbites.

This happens with nearly every study that’s reported to the public. Headache specialist Christina Peterson‘s comments on Migraines Linked With Brain Damage are a recent example of the need to take a close look at the news.

Evaluating medical studies is not as complicated as it may seem. Determining accuracy of the reporting is only one part. It’s also important to evaluate the study as a professional would. This includes asking whether the study has been replicated, how many participants were in the study and what was the time period for the study. See Cleveland Clinic’s Health Extra article for good tips on interpreting studies.

(According to the tips, journals usually offer press releases reviewed by a medical professional. Press releases published by the institution that the lead author works for — usually a university — can be helpful.)

Diet, Triggers

Aw, Nuts! Another Migraine Trigger?

Post-peanut butter, nuts have become a go-to food for me. When I’m hungry and can’t think about food, I put almond butter on a bagel. If I’m going to be away from home for awhile, I bring a bag of trail mix along. Turns out these good-for-you snacks aren’t so smart for me.

Last Tuesday I noticed that I had a migraine about 30 minutes after lunch, which I was able to abort. Then I had another one come on within an hour after dinner. The similarity between these two meals? Almond butter. Hmm, could this spell migraine food trigger?

Finally heeding the signals, I stopped eating nuts. Here’s the rundown since then:

  • All my symptoms were present Wednesday at a moderate level, but there was no spike in pain or exhaustion.
  • Thursday I had little pain and spaciness until evening. It was a long, intense, busy day. I was worn out, a little “off” and slightly headachy when I got home around 4:30. The migraine that followed lasted through Friday night.
  • Saturday I woke up with lots of energy. After three hours at full speed, I felt spacey and tired. The pain came on in the late afternoon, but I was able to abort all the severe symptoms with a caffeine.
  • Sunday started with an energy surplus that lasted a couple hours. Then I was tired off and on, but other symptoms never popped up and my headache pain was low all day.
  • Monday, I went to a coffeehouse to work — and wound up writing for four hours! By 3 p.m. I was tired and my headache was moderate, so I rested between 3 and 6. After that, I was good to go until bedtime.

These are the highlights of course. I’ve still had moderate to severe head pain most nights, get spacey, feel tired, and need to rest every day. The nuts can’t hold all the blame, so I’m also being hypervigilant to not wear myself out. This morning started out slow, but I still went to yoga and the grocery store. I’m beginning to droop again, but I enjoyed my class and have gotten to enjoy some of this glorious Seattle day.

As wonderful as they are, nut can’t provide the same joy as not being chained to the couch nearly all day every day.

News & Research

Reinterpreting Study on Migraine & Brain Damage

Headache specialist Dr. Christina Peterson‘s comment on Migraines Linked With Brain Damage points out that one study never reveals absolute truth. Nor are articles written for the general public usually preceeded by the analysis necessary to critically evaluate research findings. As Dr. Peterson writes, it is “distressing and somewhat irresponsible that every finding in the medical literature becomes a sound bite for the media.”

“For anyone who thinks the information presented here is condescending–please note that most of what Kerrie has put forward here has been written by journalists, and
not by medical experts
. It has been paraphrased from the original medical studies. I personally find it distressing and somewhat irresponsible that every finding in the medical literature becomes a sound bite for the media.

“It is the unfortunate fact that not every study can be taken as absolute gospel truth. This is why we call our ideas “hypotheses,” and we set up studies to test our hypotheses. Generally speaking, we consider them to be working hypotheses until newer ideas are discovered to expand our understanding of the concept. And even then, we are not
fully comfortable until new findings are confirmed by several studies.

“A good chunk of what we are taught in the early part of medical school is how to interpret studies in the medical literature–how to analyze the validity of study design, how to be certain the statistical analysis was done correctly, and how to tell if a given study actually measured anything that matters.

“There are a number of issues presented here. White matter lesions (those white spots on MRI scans that some migraineurs get) may or may not reflect anything to do with brain damage. We do not know yet. However, there was a paper presented this past week in Boston at the Academy of Neurology meeting that suggests not. But I would want to see
further confirmation before I would be certain about anything. White matter lesions, however, are unlikely to cause cognitive damage, as it is the gray matter that does the thinking.

In the study that suggests “older” migraine sufferers have no cognitive decline–this was determined by conducting a 10 minute test called the Mini-Mental Status Exam, which is not particularly rigorous testing. Genetic material was also collected for a test called APOE4, which has been associated with Alzheimer’s. However, very recent research conducted at Yale has demonstrated that the APOE4 genetic allele is associated with psychosis in Alzheimer’s, and not with cognitive decline or loss of function. (The migraine researchers could not have known that when they began their study some years ago.)

“In Boston, I saw microscopy pictures of blood vessels, brain cells, and receptors specially stained to show what happens during cortical spreading depression. This was research done at Harvard-MIT. It was fairly clear that there is oxygen loss in the cellular areas in between the capillaries during cortical spreading depression (CSD). Does this
cause cognitive loss? We don’t know.
The type of researcher who looks at cellular and subcellular structures is generally not the same type of researcher who studies cognitive responses in a whole person.

“Research can be excruciatingly slow. We have, for example, known about CSD since the 1930s, but it took time before it was proven to be associated with migraine, and even longer before we have been able to more clearly understand its significance. We are only now learning exactly what happens chemically during CSD.

“The take-home message is that not everyone with migraine is the same, and that, NO–it’s NOT JUST A HEADACHE!