Migraine Rates Up For No Apparent Reason

Migraine rates in a comprehensive Norwegian health study have climbed by 1% in a decade -- that may not sound like much, but in the Norwegian context, it means 45,000 more migraine sufferers -- and if the trend were to hold for the European Union, that would be an additional 5 million more people plagued by migraines. Researchers at the Norwegian University of Science and Technology (NTNU) are baffled by the cause of this trend.

The findings, in which researchers compared data from a survey conducted in the mid-1990s to data collected in 2006-2008, shows that people aged 20-50 years are more prone to migraines now than in the mid 1990s.

The numbers are derived from the second and third phases of the Nord-Trøndelag Health Study, called HUNT 2 and 3 after their Norwegian acronyms, which represents one of the largest comprehensive health studies in the world. HUNT 2 involved the collection of a health history during 1995-1997 from 74,000 people, with the collection of blood samples from 65,000 people. The follow-up in 2006-2008, called HUNT 3, involved 48,289 people, many of whom were represented in the earlier study.

The findings showed that while 12 per cent of the population met the medical criteria for having migraine headaches in the HUNT 2 survey, 13 per cent of the HUNT 3 respondents 11 years later met the medical criteria for having migraines.

While that 1 per cent increase "may not sound dramatic, in the context of the population as a whole, that represents an increase of roughly 45 000 Norwegians," says Professor Knut Hagen, one of the NTNU researchers working with the data. "Those are real numbers and give some cause for concern. The increase has also occurred over a relatively short period of time."

The increase is most marked in the age group 20-50 years, but is also found in older age groups. Hagen does not have data for people younger than 20.

The most puzzling aspect of the finding is that it has no obvious scientific explanation, Hagen says. Diagnostic criteria were the same in the 1990s as they are today, and the level of self-reported migraine did not increase. The number of migraines caused by medicines has also not increased between the HUNT 2 and HUNT 3 databases, he said.

"This last finding is really good news because the use of pain relievers has risen sharply since these drugs have been available for sale in stores without a prescription," says Hagen.

A more likely explanation for the increase in migraines is a change in the external environment, Hagen says.

"From experience we know that visual impacts, such as flickering screens, can trigger migraines. Measurements of the neurophysiological activity in the brain with EEG shows that migraine patients are more susceptible to light stimulation. It is tempting to believe that the increase in migraines is due to the increase in these kinds of stimuli during the 11 years between the two HUNT surveys," Hagen says. "But this is speculation that we have no scientific evidence for."

But Hagen was clear that one possible candidate radiation from mobile devices was not a cause of the increase, based on the results of a previous NTNU study, which found no evidence that radiation from mobile phones contributed to an increase in headaches.

Sources: The Norwegian University of Science and Technology (NTNU), AlphaGalileo Foundation.

Nautilus Neurosciences And Tribute Pharmaceuticals Announce Exclusive Canadian License For CAMBIA™

 (diclofenac Potassium For Oral Solution)

Nautilus Neurosciences, Inc., a neurology-focused specialty pharmaceutical company, and Tribute Pharmaceuticals, a privately-held Canadian specialty pharmaceutical company, announced today their exclusive license agreement for the commercialization of CAMBIA™ (diclofenac potassium for oral solution) in Canada. CAMBIA™ is approved in the United States for the acute treatment of migraine with or without aura and was launched in the United States in June 2010.

"Canada is an important pharmaceutical market and opportunity for CAMBIA," said James Fares, Chairman and CEO, of Nautilus Neurosciences. "The management team at Tribute Pharmaceuticals has a wealth of experience in developing, launching and successfully commercializing new products in Canada. This partnership along with recent developments in the US has significantly enhanced our ability to market CAMBIA™ to the broader North American market and reach more people suffering from acute migraine headaches. We look forward to completing the expansion of our efforts through the addition of a partner for the family practice market in the United States in 2011."

Rob Harris, President & CEO of Tribute Pharmaceuticals points out that, "According to IMS, the prescription drug market in Canada for treating migraine headaches is valued at approximately one hundred and fifty million dollars." Many Canadians who suffer from migraines are dissatisfied with their current medication and hope for a better treatment. "Tribute Pharmaceuticals is very excited about the potential for CAMBIA™ in Canada and we look forward to building a strong partnership with Nautilus Neurosciences."

According to a survey published in the Journal of the American Board of Family Medicine, many people still hope to find a better treatment for their migraines, with more than a quarter dissatisfied with their treatment and fewer than a fifth of people who suffer migraines describing themselves as "very satisfied" with their treatment.

A novel, water-soluble, buffered diclofenac potassium powder, CAMBIA™ is the only prescription non - steroidal anti-inflammatory drug (NSAID) available for the acute treatment of migraine. Engineered using Dynamic Buffering Technology™ (DBT), a patented absorption-enhancing technology developed by APR Applied Pharma Research S.A., CAMBIA™ is specifically designed for fast, effective relief from the symptoms of migraine. CAMBIA™ enters the bloodstream quickly and readily achieves peak plasma concentrations, providing pain relief in fifteen minutes for some patients.

Unites States Indication

CAMBIA is a non-steroidal anti-inflammatory drug (NSAID) indicated for the acute treatment of migraine attacks with or without aura in adults 18 years of age or older.

CAMBIA is not indicated for prophylactic therapy or for cluster headache.

Important Safety Information (United States)

WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS NSAIDs, including CAMBIA, may increase the risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. Risk may increase with duration of use or in patients with CV disease or risk factors for CV disease. CAMBIA is contraindicated for peri-operative pain in coronary artery bypass graft surgery. NSAIDs increase the risk of gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk.

Use the lowest effective dose for the shortest possible duration. Long-term administration of NSAIDs can result in serious and potentially fatal events, including CV thrombotic events or GI reactions.

CAMBIA is contraindicated in patients with hypersensitivity to diclofenac or other NSAIDs, and in patients with preexisting asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic-like reactions have been reported in such patients. Anaphylactic reactions may also occur in patients with the aspirin triad or in patients without prior exposure to CAMBIA. CAMBIA is contraindicated in patients with the aspirin triad. Discontinue immediately if an anaphylactic reaction occurs.

Renal papillary necrosis and other renal injury may occur with long-term use of NSAIDs. Use CAMBIA with caution in patients at risk, including the elderly, those taking diuretics or ACE inhibitors, those with renal impairment, heart failure, or liver impairment. CAMBIA is not recommended in patients with advanced renal disease.

Use caution when prescribing CAMBIA with drugs known to be hepatotoxic (eg, acetaminophen, certain antibiotics, antiepileptics). Warn patients to avoid acetaminophen containing products while taking CAMBIA. The liver metabolizes almost 100% of diclofenac, and there is insufficient information to support dosing recommendations in patients with hepatic insufficiency. Hepatic effects range from transaminase elevations to liver failure. Discontinue CAMBIA immediately if abnormal liver tests persist or worsen.

NSAIDs can lead to new onset or worsening of preexisting hypertension. Monitor blood pressure closely during therapy. Patients taking ACE inhibitors, thiazides, or loop diuretics may have impaired response to these therapies when taking NSAIDs. Note that fluid retention and edema have been observed in some patients taking NSAIDs. Use CAMBIA with caution in patients with fluid retention or heart failure.

Using CAMBIA with other NSAIDs (eg, aspirin) or with anticoagulants (eg, warfarin) is not advised due to increased risk of serious adverse events, such as GI bleeding. Use with caution in patients with a history of ulcers or GI bleeding. Anemia may occur in patients on NSAIDs. In patients on long-term therapy, check hemoglobin or hematocrit upon any sign or symptom of anemia or blood loss.

NSAIDs, including CAMBIA, can cause serious skin reactions including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, which can be fatal. Discontinue use immediately if rash or other signs of local skin reaction occur.

CAMBIA can harm fetuses. Starting at 30 weeks' gestation, pregnant women should avoid CAMBIA and other NSAIDs as premature closure of the ductus arteriosus in the fetus may occur. Use with caution in nursing mothers as it is not known if diclofenac is excreted in human milk.

The most common adverse events in clinical trials with CAMBIA were nausea and dizziness.

Source: Nautilus Neurosciences, Inc

Blood Pressure, Glaucoma Links In Migraine Patients; Eye Care Goes Digital And Mobile

Data on glaucoma risk in people with migraine and on innovative uses of mobile, digital technology were featured in the Scientific Program yesterday (Oct.17), presented at the 2010 American Academy of Ophthalmology (AAO) - Middle East-Africa Council of Ophthalmology (MEACO) Joint Meeting. The AAO-MEACO meeting is in session October 16 through 19 at McCormick Place, Chicago. It is the largest, most comprehensive ophthalmic education conference in the world.

The Blood Pressure-Glaucoma Connection in People with Migraine

Yury S Astakhov, MD, PhD, of Pavlov Medical University, St. Petersburg, Russian Federation, studied how day- and at night-time blood pressure levels may be related to the development of glaucoma in people with migraine. Understanding such effects is important for doctors in determining how to treat patients with multiple diseases.

Migraine is a known risk factor for open-angle glaucoma, a disease that can cause blindness due to damage to the optic nerve. The association between the two is stronger for people with "normal tension" glaucoma (NTG), in which the pressure within the eye is normal but optic nerve damage occurs nonetheless. It is also known that glaucoma patients who have low blood pressure at night are more likely to develop visual field loss (reduction of the full range of vision, which occurs first in the peripheral vision).

Dr. Astakhov's team compared day- and night-time systolic and diastolic blood pressures in 12 patients who had migraine and glaucoma (8 with NTG) against 16 patients with migraine but no glaucoma. The only significant difference between the groups was in night time diastolic pressure: migraine patients with glaucoma had excessive decreases - more than 20 percent - in their diastolic pressure levels.

"We conclude that low diastolic blood pressure at night is a possible risk factor for glaucoma in patients with migraine," Dr. Astakhov said.

iPhone Images: Good Enough for Medical Use?

Like the rest of society, medicine increasingly relies on digital systems and mobile devices to manage work flow and enhance communications. Eye M.D.s (ophthalmologists) routinely evaluate internet-transmitted images of patients' eyes as part of diagnosis and treatment. Usually images are viewed at computer workstations with standard display screens. University of Pittsburg School of Medicine researchers wondered whether handheld devices like the iPhone would work equally well.

In the study, Eye M.D.s from the University of Pittsburg Eye Center evaluated three aspects of diabetic retinopathy, a potentially blinding disease that affects many people with diabetes, by reviewing both the standard computer monitor and iPhone images for 55 patients (110 eyes). The doctors then made recommendations for follow up treatment.

"We found high consistency - more than 85 percent agreement - between evaluations based on the standard computer monitor and on the iPhone for all image sections tested," said Dr. Michael J. Pokabla. "There were no significant differences between evaluations and recommendations using the two systems, and the doctors rated the iPhone images as excellent. We conclude that mobile devices like the iPhone can be used to evaluate ophthalmic images," he added.

No Eye M.D. in the House? Videoconferencing Brings the Expert to the Outback When no ophthalmologist is available on site, some emergency rooms (ERs) in remote medical centers in rural Australia now use videoconferencing to receive diagnosis and treatment advice for their eye injury and ophthalmic illness patients.

A telecommunication link at a major metropolitan teaching eye hospital, the Royal Victorian Eye and Ear Hospital (RVEEH), is connected with four ERs that serve large regions of rural Australia. Dr. Christolyn Raj and her team studied the effectiveness of this approach by reviewing the initial six months of RVEEH videoconference interactions with the regional ERs.

Diagnoses were altered in approximately 60 percent of cases and management plans were changed in about 70 percent of cases following videoconference consultations, study results show. The average consultation time was 10 minutes.

"Videoconferencing is a sustainable, effective way of providing prompt eye management advice to rural emergency doctors," Dr. Raj said. "Although it can never replace face to face clinical care, it is a useful tool to have at one's fingertips and its use will undoubtedly increase in coming years," she added.

Source:
Mary Wade
American Academy of Ophthalmology

Painful Summer: Migraine Triggers Bring a Season of Misery for Many

By KIM CAROLLO (@kimcarollo)

July 5, 2011

It's a difficult time of year for frequent migraine sufferer Nancy Scuri. Certain weather and atmospheric factors affect her sinuses, which, in turn, trigger her debilitating headaches. "If a storm comes in where barometric pressure changes, that can affect me and set off a migraine," she said. "I also have an allergy to tree pollen, which affects my sinuses and breathing." The tree pollen season has nearly ended but summer still brings plenty of storms that can come at any time. "I constantly watch the Weather Channel," Scuri, 43, said.

Scuri of Hauppauge, N.Y., isn't the only one who gets more frequent migraines during the summer. Experts say there are numerous triggers that can make summer an especially painful time of year for many people prone to migraines. Some research has suggested that summer is the worst time of year, but experts say it really depends on what factors set off migraines.

"Some people do experience more migraines in the summer but, for others, the winter is worse," said Dr. Joel Saper, founder and director of the Michigan Headache and Neurological Institute in Ann Arbor.
Those who suffer in the summer might experience a migraine when exposed to some of these common triggers:

Dehydration
Losing a lot of water and sodium through sweating can trigger migraines. "If a lot of sodium is lost when sweating, it can dilute the bloodstream a bit and when sodium goes down to a certain point, it can be very headache-provoking," Saper said.

 

A similar effect can happen if people drink too much water. Over-hydration can also throw off the balance of electrolytes, which can lead to a migraine.

Dehydration often occurs during extended periods of exercise, but physical exertion on its own can also trigger migraines.

Lazy Days of Summer
"Migraines can happen at a time of a let down from stress. When a person has a chance to relax, it may be the time for headaches to happen," said Dr. Andrew Charles, director of the Headache Research and Treatment Program at UCLA's Geffen School of Medicine in Los Angeles. "The first days of vacation or the start of the weekend are common times for migraines to occur."

Changes in sleep patterns can also cause migraines in some people. The longer days often cause people to go to sleep later than usual.

"People stay out later and sleeping patterns tend to change," Saper said. "People with migraines don't shift time zones well on vacation or tolerate different sleeping patterns well."
Migraines can also be caused when people don't eat at their normal times, which tends to happen in the summer. Maintaining consistent sleeping and eating patterns is key, he said.

Environmental Factors
Summer allergens, such as grass pollen, can also trigger migraines.
"There are also some studies suggesting that differences in the levels of pollutants may be correlated with frequences in migraines," Charles said. Humidity can increase the levels of some allergens in the environment and can also cause migraines in other ways. "Humidity can trigger migraines because when it's humid, you can pick up odors you wouldn't smell on a less humid day," Saper said.

Other summer migraine triggers include the heat, which can cause changes in body temperature; alcoholic beverages and higher altitudes some people might experience when they go camping.

Experts recommend that migraine sufferers know what their triggers are and avoid them if possible, but say even when all precautions are followed, migraines might still strike.

That's a painful reality Scuri experiences on a regular basis.
"As long as I stay on top of things, I'm OK," she said. "But I still get migraines one or two times a month."

Common Forms Of Neck Pain Not Cured By Botulinum Toxin

There is no evidence that Botulinum toxin injections reduce chronic neck pain or associated headaches, says a group of scientists who reviewed nine trials involving a total of 503 participants. Their findings are published in the latest update of The Cochrane Library.

The Botulinum toxin (BoNT) operates by temporarily stopping muscles contracting. This reduces muscle tightness or spasm. It is best known for its use in cosmetic treatments where commercially available products such as Botox, Dysport, Xeomin, Myobloc or Neurobloc are used to reduce wrinkles. Effects begin within three to eight days of an injection and may last up to four months. When the effect wears off, it can be repeated.

Having an injection of a very small volume of BoNT is not risk free, and patients may experience muscle tenderness or pain, weakness, or a general sense of being unwell. A few have anaphylactic reactions and there are reports that some have died.

"It's always important to look carefully at evidence from clinical trials to see whether a treatment is more effective than a placebo, and this is particularly important when treatments have known adverse effects," says the study's spokesperson, Dr Paul Michael Peloso, who works as a director of clinical research at Merck, in New Jersey, USA.

Some of the trials specifically compared the effects of either giving the toxin or a placebo injection of saline to two different groups of people with neck pain. The researchers could see no difference between the two groups either at 4 weeks or 6 months. Similarly adding BoNT to physiotherapy was no more effective than adding either an anaesthetic or saline.

"It is possible that BoNT did give some benefits that were not measured in the trials, or that it could help highly particular types of neck pain, but we would need some much more carefully conducted trials to reveal this," says Peloso.

"Based on current evidence we have no reason for supporting the use of BoNT as a stand-alone therapy for neck pain, but we do suggest that researchers consider further study to clarify whether the dose can be optimized for neck pain" says Peloso. The researchers also believe that trials should be run that look at other symptoms than pain, such as function, to see if there is any reason for believing that BoNT can provide some benefit.

Source:
Jennifer Beal
Wiley-Blackwell

View drug information on Botox; Myobloc; Xeomin.

Behavioral Treatment For Migraines A Cost-Effective Alternative To Meds

06 Jul 2011  

Treating chronic migraines with behavioral approaches - such as relaxation training, hypnosis and biofeedback - can make financial sense compared to prescription-drug treatment, especially after a year or more, a new study found.

Longtime behavioral therapy researcher and practitioner Dr. Donald Penzien, University of Mississippi Medical Center professor of psychiatry, coauthored the study. He said the costs of prescription prophylactic drugs - the kind chronic migraine sufferers take every day to prevent onset - may not seem much even at several dollars a day.

"But those costs keep adding up with additional doctor visits and more prescriptions," Penzien said. "The cost of behavioral treatment is front-loaded. You go to a number of treatment sessions but then that's it. And the benefits last for years."

Published in the June issue of the journal Headache, the study compared the costs over time of several types of behavioral treatments with prescription-drug treatments. The research team included investigators from Wake Forest University, UMMC and the University of Mississippi.

The researchers found that after six months, the cost of minimal-contact behavioral treatment was competitive with pharmacologic treatments using drugs costing 50 cents or less a day. Minimal-contact treatment is when a patient sees a therapist a few times but largely practices the behavioral techniques at home, aided by literature or audio recordings.

After one year, the minimal-contact method was nearly $500 cheaper than pharmacologic treatment.

"We have a whole armamentarium of behavioral treatments and their efficacy has been proven. But headache sufferers are only getting a tip of these options," said Dr. Timothy Houle, associate professor of anesthesiology and neurology at Wake Forest University, and the study's principal investigator.

"One reason is people think behavioral treatment costs a lot. Now with this study, we know that the costs are actually comparable, if not cheaper, in the long run."

At a time when health-care costs are under national scrutiny, the study offers a framework for comparing costs that researchers can update and use for years to come.

"We thought, 'Wouldn't it be fun to model this and see how it comes out over time?'" Penzien said. "All the figures are there so if someone disagrees with it, they can plug in their own numbers."

The researchers didn't compare the effectiveness of methods, nor did they calculate the costs over time of individual drugs, since dosages and prices vary widely. Rather, they figured the per-day costs of each method based on fees of physicians and psychologists. For the physician group, they added in the cost of prescription beta-blocker drugs at various prices.

For instance, among the psychologists surveyed, one-on-one behavioral sessions cost between $70 and $250 for the intake visit and $65 and $200 for follow-up visits. That put the median intake cost at $175 and median follow-up cost at $125 for a median 10 visits.

The researchers calculated the median cost of pharmacologic approaches at $250 for the intake session and a professional fee of $140 per session. Median time to the first follow-up was 52.2 days, rising to 60 for the second with a median five visits per year.

To get information on behavioral treatments, the researchers surveyed members of the Behavioral Issues Group of the American Headache Society. For figures on pharmacologic treatments, the researchers surveyed a group of Headache Society-member physicians they knew treated substantial numbers of headache sufferers.

The most expensive behavioral treatment method - individual sessions with a psychologist in clinic - cost more than pharmacologic treatment with $6-a-day drugs in the first months. But at about five months, individual sessions become competitive. After a year, they are cheaper than all methods except treatment with drugs costing 50 cents or less a day.

Overall, group therapy and minimal-contact behavioral treatment were cost-competitive with even the cheapest medication treatment in the initial months. At one year, they become the least-expensive headache treatment choice.

Grant funding from the National Institute of Neurological Disorders and Stroke supported the research.

Source:
Jack Mazurak
University of Mississippi Medical Center

"Not tonight, dear, I have a headache"

Types of Headaches

by Dr. Nor Ashikin Mokhtar

There's a reason why the clichéd phrase, "Not tonight, dear, I have a headache", always appears in the speech bubble above a woman's head, instead of a man's.

It is not sexist to say that women suffer from headaches more often than men. It's simply a biological truth. Women's fluctuating hormone levels are the main reason for this, as the hormone levels can cause chemicals in the brain to rise and fall, leading to headaches during certain times.

This is not to say that all women constantly suffer headaches and men do not. Environmental and social factors like stress can contribute to headaches in both men and women.

Not all headaches are the same. Different types of headaches have different causative factors. If you know what type of headache you are prone to, you can learn how to prevent or treat them when they occur.

In this article, six common types of headaches will be described.


1. Tension Headaches

This type of headache is the most common in both women and men. It results in a dull ache on both sides of your head, triggered by stress, fatigue, or hunger.

A tension headache is different from a migraine because it does not cause nausea or sensitivity to light, sound or smells, neither does it get worse with regular activities like walking.

The triggers of tension headaches are sometimes unavoidable, but fortunately, this type of headache can be treated with over-the-counter painkillers.


2. Migraines

Women are believed to be more prone to migraines than men because hormonal changes are one of the triggers of migraines, which is why it can occur more frequently during menstruation.

The vast range of other triggers includes certain types of food and drink (e.g. aged cheeses, red wine, and coffee), nicotine and cigarette smoke, sudden changes in weather, over-sleeping, strong smells and, for some, even sex.

Like tension headaches, migraines can also be triggered by stress, lack of sleep, and emotional upsets. But the difference with migraines lies in the symptoms – the pain is sometimes only on one side of the head, it causes nausea and/or vomiting, and there is sensitivity to light, sounds, and motion.

Some people with migraines notice a warning 'aura' before the migraine occurs, while others don't. The aura takes the form of flashing lights, or spots and lines floating in front of the eyes.

As the migraine triggers are very specific for each person, you can prevent them or reduce the severity by identifying the triggers and avoiding them. You can also see your doctor for specific pain-prevention medications.


3. Sinus Headaches

The sinuses are air-filled cavities in the skull that help insulate the skull. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head.

Sinus headaches are treated with decongestants that contain painkillers. Sometimes, your doctor may prescribe antibiotics if there is an infection present.

Sometimes, sinus headaches can be mistaken for migraines, and vice versa. One way to distinguish it is to see whether the headache is accompanied by a fever and thick greenish or yellow mucous. This distinction is important because if you take decongestants for what is actually a migraine, you could make your headache worse.


4. Cluster Headaches

This type of headache is actually more common in men than in women. It is called a cluster headache because it occurs in cluster periods, such as for several days, weeks, or months at a time, followed by a remission where the attacks stop completely.

Cluster headaches cause a sharp, penetrating or burning pain, generally located in or around the eye, that may radiate to other areas of the face, head, neck and shoulders, and is usually one-sided.

Unlike migraines, cluster headaches lead to restlessness, because the person may feel that lying down makes the pain worse.

Unfortunately, over-the-counter painkillers often do not work for cluster headaches. You should see a doctor for prescription medications, such as triptans, or other specific medications.


5. Rebound Headaches

Ironically, popping too many painkillers can set you up for a never-ending cycle of headaches. These are called rebound or medication-overuse headaches.

You may be getting rebound headaches if you're taking over-the-counter painkillers or sinus headache formulas with a decongestant at least 15 days a month, or prescription painkillers at least 10 days a month.

What happens is that your threshold for pain is lowered as your body's pain receptors become overly sensitive when the dose of painkiller wears off.

It won't be easy to wean yourself off the pain medications. But you have to, because the vicious cycle could go on and on, with no relief. Ask for your doctor for help, and explore other remedies for relieving pain, such as acupuncture, yoga, or medication.

Most importantly, do not self-medicate rebound headaches by trying other medications on your own.


6. Exercise Headaches

Some women suffer from headaches right after physical activity, particularly strenuous exercise. These are actually called exertional headaches, which are a group of headaches associated with some form of physical strain, such as exercise or even sex.

This type of headache is closely related to migraines, as it often occurs in those who have inherited a tendency for migraines. Most exercise or exertion headaches are harmless and can be treated with simple painkillers.

However, if it's a new, severe headache that occurs after exercise, especially if you're not prone to migraines, it could be a sign of something more serious, such as abnormalities in the brain or other diseases. It is better to be safe by seeing your doctor immediately.

This is no reason to stop exercising completely. Exercise reduces stress, helps you sleep, and increases endorphins (chemicals in your brain that act as natural painkillers).

What you can do is avoid activities that make your head bob up and down, such as jogging, and switch to cycling or swimming instead. Drink plenty of water before, during, and after your workout, warm up gradually, and exercise in a cool environment.

In Control

Headaches are no joking matter. They can make you want to curl up in bed and avoid the rest of the world. Learning to recognise the different types and their causes can help you to be in control of the pain.