Headache Awareness: Menstrual Migraines

Migraine headaches are not life threatening but can be so disabling you sometimes feel you are dwelling in a twilight state between life and death. The pain is so crippling you can not participate in your every day life. My first experience with migraine headaches was in high school. An intelligent and talented friend of mine, William, lost days of school at a time due to migraine headache pain. He described how light and noise bothered him - he had to hide the telephone under a pillow while confining himself to a dark room until the pain subsided. I winced at his description of suffering, never dreaming I too would fall prey to this malady - my weak spot. Prepubescent boys and girls experience migraines with the same prevalence. Women, however, are 3 times more likely than men to have migraine headaches.

Menstrually related migraine (MRM) are more severe, last longer and are less responsive to pain medication than other migraine headaches. MRM occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles as well as other times during a woman's cycle. Menstrual migraine (MM) occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles and at no other time of the month. 8% of all women have MRM, but 50% of women who report headaches have MRM (me too). The theory is that falling estrogen levels in the late luteal phase of a woman's cycle trigger migraines.

Treatment of MRM and MM is two pronged - treat the migraine itself once it starts and short-term prevention taken perimenstrually. The April 2008 issue of Neurology published the following recommendations as a result of evidence-based research:

• Perimenstrual short term prevention:
• transcutaneous estrogen 1.5 mg
• frovatriptan 2.5 mg twice daily,
• naratriptan 1 mg twice daily
• Treatment of acute MRM/MM:
• sumatriptan 50 and 100 mg
• mefenamic acid 500 mg
• rizatriptan 10 mg

All recommendations, of course, depend on your clinical situation, but if you suffer from menstrual migraines and are not getting adequate relief, be sure to discuss these findings with your doctor.

Thank you AxisGrid for use of photo Last Night.

Labels: menstrual migraine, migraine

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Thank You Dr. Emer For Grand Rounds 4.36

Dr. Emer writes the fascinating blog, Parallel Universes from the Philippines. He hosted Grand Rounds, a compilation of the best writing in the medical blogosphere for the week, for the 5th time this week. Thanks for including my post, Rice Wars, in such great company.

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NIH Back to Sleep Campaign Successful in Reducing SIDS Deaths

The rate of SIDS has decreased 50% since the NIH started the Back to Sleep campaign 13 years ago. Other tips for promoting safe sleep for babies:

• avoid soft bedding (extra blankets and quilts)
• don't let babies sleep with adults (roll over deaths)
• no stuffed animals in babies bed

The peak age of danger for babies is age 2-3 months. The American Academy of Pediatrics (AAP) advises putting babies bassinet or crib in a room with adults until they are older than 10 months of age. Pacifiers at bed time also have a protective effect in preventing SIDS. Keep your baby safe - back to sleep!

Labels: infant mortality, SIDS

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Ted Kennedy Diagnosed with a Glioma (Malignant BrainTumor)

I was only twelve at the time, but I’ve always remembered Senator Ted Kennedy’s concession speech from the 1980 Democratic Convention in NYC. He had entered the hall trailing incumbent Jimmy Carter’s number of pledged delegate votes by a whopping 40%, and had he been successful in his attempt to allow pledged delegates to change their votes at the last minute, those memorable words could have morphed into an acceptance speech for the party’s nomination. What struck me then, and has always stayed with me, was the odds were irrelevant. Meaningless. Incidental. My guess is that’s how he’ll face his next great fight.

Sighs of relief were common as many of us heard that a stroke was not the cause of a seizure he experienced over the weekend. But then news broke with that terrifying combination of words…”diagnosed” and “brain tumor.”

What’s the Diagnosis?
Doctors located a tumor in Senator Kennedy’s left parietal lobe. A biopsy reveled that the tumor was a malignant glioma.

What is a Malignant Glioma?
Of the close to 20,000 brain tumors diagnosed every year, malignant glioma is the most common type and frequently occurs in older Americans. They can be located in the cerebrum as is the case with Senator Kennedy and most adults, or in the cerebellum, much more common in children.

What are the Typical Symptoms?
In Senator Kennedy’s case, a seizure led to the diagnosis. Other common symptoms include headaches, difficulty with speech, walking or other motor functions, numbness or vomiting.

What are the Treatment Options?
Depending on the size of the tumor, surgery could be the first option, albeit a risky one. If the tumor’s size or location eliminates surgical options, as appears to be the case with Senator Kennedy, chemotherapy and/or radiation therapy may be utilized.

What’s the Prognosis?
Malignant gliomas are extremely aggressive tumors and the outlook is typically grim. For the most severe grade gliomas (a “4” on a 1 to 4 scale) the average survival time is less than 12 months. Very few diagnosed with any giloma survive more than three years.

It’s always hard to come up with the right words at times like this, so I’ll borrow from Senator Kennedy’s own inspirational speech from 1980 which ended with some seemingly relevant words…
“For me, a few hours ago, this campaign came to an end. For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

By Jerry Gulley
Director of Content, Healthline.com

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Thank You David E. Williams for Grand Rounds 4.34

Our good friend David E. Williams of Health Business Blog hosted Grand Rounds this week. He gathered up some fabulous tales from the medical blogosphere and included my post about HBO's Hear and Now: The Joy of Communication. David writes one of my favorite blogs - he is a strategy consultant to pharma, biotech and other healthcare services industries. Expand your brain with Grand Rounds.

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Medical Records Vulnerable Targets

Last month I wrote about wide spread data theft from medical centers. Security authorities have been busy offering reassurances that data wasn't compromised and other "reassurances" that some how wasn't very reassuring. US Today reports that identity thieves have been busy preying on medical records, finding them a rich treasure trove of social security numbers and credit information. Sophisticated crime rings use insiders - people who work in medical centers - to help gain access to data and commit ignoble crimes like submitting false claims to Medicare. California and Arkansas are the only states which require a patient be notified when medical records are accessed illegally.

A study commissioned by Kroll Fraud Solutions risk consultants finds that medical centers have focused on medical privacy and compliance while neglecting patient identity theft and other data breaches. HIPPAA compliance measures do nothing to prevent fraud or protect against hackers - they do a great job at preventing patients from getting access to their own records. Medical centers are not required to report or disclose security breaches. It is not even clear that any agency is monitoring this problem but it is clear that health IT experts are ignorant about the costs ($200 per record and $6.3 per incident).

Meanwhile, while the rush is on to implement electronic medical records (EMR) your data may be sold to pharma and other advertisers who underwrite the implementation of EMR. Doctors have been resisting this data mining in which patient information is aggregated and cleansed of identifying features. They are concerned about their prescribing habits being sold back to pharma. Hey, shouldn't we get a discount if our data is sold?

Thank you gayan job for use of image Yathura.

Labels: health IT, identity theft

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HBO's Hear & Now: The Joy of Communication

HBO premiered the documentary film Hear and Now last night. It is a love story of a fascinating, quirky, intelligent, loving couple who happen to be deaf and the parents of three hearing children. One of the children, award winning filmmaker Irene Taylor Brodsky decided to document her parents journey through cochlear implant surgery.

Paul and Sally Taylor have been deaf all their lives - they are well adapted, happy people - successful, good parents. They are about to retire. Still, what are they missing out on, not being able to hear? Paul Taylor is one of the inventors of the TTY - the telecommunications system that revolutionized communications for the hearing impaired. Brodsky captures the vulnerability of the deaf - of anyone with disabilities. She captures the rejection the Taylors felt as teens trying to fit in to an uncaring world. She captures the youthful hope the Taylors feel at 65, wanting to try new things - have a conversation, go to a concert, listen to music. One thing they remind us is that communication is a joy we take for granted.

Their surgeon proclaims that cochlear implants are the #1 medical advance of the 21st century - because hearing is the only sense that can be restored. The filmmaker/daughter makes it obvious that just the thought of being able to hear for the first time is emotionally overwhelming for the 65 year old Sally, but the surgeon seems to have as much difficulty processing her emotional reactions as she seems to have processing sound.

The surgery is successful - both Paul and Sally can hear sounds. Language acquisition and understanding the spoken word is a different matter. I admit to being an emotional person but I was crying like a baby watching this deeply personal story. The technology is still new and maybe counseling and language classes are imperative adjunctive therapies to help recipients adapt to the world of sound.

Hear and Now airs frequently on HBO in English and in Spanish through June 22. Be sure to watch it exclusively on HBO.

Labels: cochlear implants, HBO, Hear and Now

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Study Proves Parents Don't Understand Kids

A University of Rochester Medical Center study proves what kids have long suspected - parents have unreasonable expectations of them. No matter what parents income and education level, they don't know the basics of child development and often misinterpret their behavior. Here are some helpful tips for understanding your kids:

• 1 year olds can't tell the difference between right and wrong
• 1 year olds don't play well with others
• 18 month olds are incapable of sitting still for a doctor's appointment
• kids are naturally curious - not being defiant so avoid:
• harsh discipline
• withdrawal of affection

Pediatricians are encouraged to use well child visits to educate parents about child development. Parents might enjoy their children more if they understood where they are on the "evolutionary timeline" a little better. I have to laugh when I see parents "negotiating" with two year olds. But I cringe when I see little ones out in a jogging stroller with no blankets, jackets or covering - exposed to the elements while mom or dad is working up a sweat. It's great that you are getting exercise and taking care of your health - but your little one needs swaddling and protection from the sun and wind.

Thank you sesame ellis for use of photo Then the toddler got a "talking to".

Labels: child development, parenting

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Thank You Doc Gurley for Grand Rounds Smack Down!

Doc Gurley writes Posts from an Insane Health Care System for his blog. He hosted Grand Rounds this week and included my post, Diogenes Syndrome: Living In Extreme Squalor
in the Smack Down. (Hey, did anybody catch Dr. Phil's show Secret Inside: Extreme Hoarding on the same topic this week?) Thanks for a take-the-rings off entertaining reading - my head in spinning!

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