Neurological Institute of the East Bay

So you had what seemed to be a migraine attack.  First migraine then bloodshot eye.  A bloodshot eye?  Is that a symptoms of migraine?

First I should ask what you mean by a "bloodshot eye".  You could mean that you actually have a large red patch in your eye.  That is what is called a subconjunctival hemorrhage.  This happens when one of the tiny blood vessels in the membrane covering your eye bursts.  Though it looks terrible, it’s usually harmless and goes away in a few days to a couple of weeks.  The hemorrhage itself is generally not painful (if it is, talk to your doctor).

A bloodshot eye from an infection

A subconjunctival hemorrhage is rarely associated with migraine.

On the other hand, some people talk about bloodshot eyes and are referring to inflammation.  When the blood vessels become inflamed, they become more red and prominent in the eye.  This type of bloodshot eye, or red eye, is actually very common in migraine.

This migraine attack may include not only red eyes but watery eyes.  The symptoms, along with the congestion that often comes along with migraine, lead many to believe they have a "sinus headache".

Why a Migraine then Bloodshot eye? Possible cause…

As a migraine attack progresses, it causes inflammation, especially around the head and facial area.  It’s this inflammation that may cause the symptoms around the eyes and nose, such as a runny nose, watery eyes, and congestion.  This part of the inflammation probably starts with the trigeminal nerve and spreads.

So what can be done?

If the bloodshot eye is simply part of the migraine attack, migraine treatment should resolve the red eyes along with everything else.  However, this brings us to a couple of warnings.

Are you sure it’s Migraine?

If you’re experiencing new symptoms, or your symptoms have changed, you should talk to a doctor who knows your medical history.  A bloodshot eye could be a sign of something else, and to treat it you need to know what you’re dealing with.  For example, glaucoma, which may also make you nauseous and sensitive to light.

A bloodshot eye is actually a much more common symptom of cluster headache.  Cluster headache pain is often localized around one eye, one side of the temple, or in the upper jaw.  Like migraine, symptoms may include congestion.  The eye may become red, and the eyelid may droop.

During a cluster headache, the person becomes agitated and may pace the floor, where migraine patients more commonly want to lie down in a dark room.

These are called "clusters" because they come in cycles of several weeks or months, then they disappear for months or even years.  The headaches generally last from 15 to 3 hours, and will repeat from every other day to several times a day.

If these symptoms sound like you, you may have cluster headache.  But either way, if you’re having new symptoms, or you’re not sure, talk to your doctor.

The migraine then bloodshot eye sequence is not unusual.  Read here for more on the strange symptoms of migraine.

These other posts might relate:

• Little Known Ways to Get to Sleep (even with a Headache)
• Trigger points - do they trigger headaches?
• Sleep apnea and migraine?

From the Headache and Migraine News Blog

First Migraine then Bloodshot Eye - What’s up?

Last week I spent way too many hours Driving Miss Daisy. Well, driving my wife and two children off on a family vacation. After 8 plus hours driving on two...

Last week I spent way too many hours Driving Miss Daisy. Well, driving my wife and two children off on a family vacation. After 8 plus hours driving on two...

Here are some of the posts that have been the most popular with visitors to this site over the last 3 months.  Go back and catch up on the ones you missed!  The most popular are last:

• Fight Migraine: Be nice to your Mitochondria: Migraine and mitochondrial disease - is there a connection?
• Doxycycline for daily headache?  New clues about chronic daily headache
• Little Known Ways to Get to Sleep (even with a Headache)  Some tips from around the internet that might be new to you
• Anti-seizure meds and Suicide  Confusion over side effects of medication used for migraine
• Migraine Nasal Spray - Should You Try One?  Why people are turning to nasal sprays for migraine
• Get a Headache after Working Out?  It’s a common problem, and there are solutions
• Our What is Migraine? series continues to be popular - all three: What is Migraine? (the scientific story), What is Migraine? (the Story of Symptoms) and What is Migraine? (The Life Impact Story)
• 5 Signs You have Retinal Migraine  The real story about this rare condition
• Is High Blood Pressure Causing My Headache?  The answer, and a surprising twist

Random other posts:

• Invisible symptoms in pictures
• Probiotics for IBS - study review
• Hot/Cold Therapy:  cheap

From the Headache and Migraine News Blog

Highlights from the last 3 Months (February 2009 edition)

(Neurology News and Information) The Eyes of Wellness a unique 12month calendar for 2009 showcasing the artwork of ResidentNeighbors at Northeast Center for Special Care is now available as a free download Northeast Center for Special Care is a specialty rehabilitation program for traumatic brain injury neurobehavioral disorders spinal cord injury respiratory care and ventilator weaning located in the town of Lake Katrine in a stateofart......

(Neurology News and Information) Natural Horizons Wellness Center an integrated medical and wellness facility in Fairfax Virginia recently launched Horizons of Hope a unique and fullscale substance abuse treatment program located 20 miles outside Washington DC Horizons of Hope utilizes the best of traditional and alternative therapies in the treatment of chemical dependency combined into a protocol that facilitates biological psychological......

(Neurology News and Information) A paper published online today in Nature Neuroscience reveals the presence of methyl CpG binding protein 2 MeCP2 in glia MeCP2 is a protein associated with a variety of neurological disorders including Rett Syndrome the most physically disabling of the autism spectrum disorders The researchers show that MeCP2deficient astrocytes a subset of glia stunt the growth of neighboring neurons Remarkably these......

(Neurology News and Information) A paper published online today in Nature Neuroscience reveals the presence of methyl CpG binding protein 2 MeCP2 in glia MeCP2 is a protein associated with a variety of neurological disorders including Rett Syndrome the most physically disabling of the autism spectrum disorders The researchers show that MeCP2deficient astrocytes a subset of glia stunt the growth of neighboring neurons Remarkably these......

Dr. Bradley was puzzled.  These patients with heart and kidney failure often had something else in common.  Sleep apnea.  Why?

In the most recent edition of HeadWay, we were exploring the connection between sleep apnea (or sleep apnoea) and migraine, headaches and cluster headache.  There’s good evidence for a strong relationship.  It seems many people with headache and migraine also have sleep apnea, and we know that sleep patterns are closely related to an increase in these other attacks.

Sleep apnea interrupts sleep, and can make you drowsy during the day.  It can also lead to serious heart problems and diabetes.

But the underlying cause of sleep apnea is not easy to explain.  We know that, for example, obesity is a risk factor.  But many people with sleep apnea are not obese, and are otherwise fairly healthy.  So what’s the problem?

Dr. Douglas Bradley, who we mentioned earlier, noticed that his patients did have something else in common.  Fluid retention (oedema).

Could fluid retention be causing the sleep apnea?

Dr. Bradley and his team set out to study 23 non-obese men.  When these men got horizontal to sleep, the fluid shifted in their bodies, and the circumference of their necks actually increased.  For the control group, it was an increase of 1/2 a centimetre.  But for those with sleep apnea, it was double that, 1 centimetre.  Why?  You guessed it.  Fluid.

So what’s happening?  Dr Bradley explains:

Gravity forces fluid down to the bottom of the body when you are sitting and your legs are inactive.  Standing and walking cause the calf muscles to contract, pumping fluid from the legs up through the veins toward the heart.

When you lie down to sleep, that "extra" fluid gets redistributed, causing the increase in neck circumference, which may be causing blockage leading to some sleep apnea.  (Read the story at Groundbreaking study results could help reduce the incidence of obstructive sleep apnea)

This surprising turn of events leads to some interesting treatments for sleep apnea, and so for the headaches it causes.

The first, best, and most obvious?  Move around!

If you tend to sit or even stand a lot of the day, try changing position, going for walks, getting your leg muscles working.  This keeps the fluid moving through your body the way it’s supposed to.

Dr. Bradley also suggests that elevating your upper body while you sleep may help, interestingly enough something that was recently discussed in a blog carnival entry Sleeping off my headache….

Other common treatments for fluid retention?  Don’t eat too much salt.  Drink plenty of water.  And how about this - one treatment for decreasing fluid retention that comes with the menstrual cycle is magnesium.  We keep coming back to that, don’t we?

One more interesting note.  Some drugs can increase fluid retention, such as NSAIDs (ie naproxen, oxaprozin and ibuprofen), and calcium channel and beta blockers, all commonly used for migraine, and often various types of headache.

Often sleep apnea is treated with special masks worn at night, implants, and even surgery.  But for many, this discovery may lead to solutions that are much less drastic.  And that means a lot less headaches.

These other posts might relate:

• Sleep apnea and migraine?
• Little Known Ways to Get to Sleep (even with a Headache)
• Is High Blood Pressure Causing My Headache?

From the Headache and Migraine News Blog

A Sleep Apnea Mystery Solved?

To get some background on DHE migraine treatment, we need to go back to the days before DHE, or dihydroergotamine, was used.  It was actually in 1925 that the first migraine patient got an injection of ergotamine tartrate.  It worked - stopping the migraine that just wasn’t going away.

In 1943 came the next step for "ergot treatment" - DHE, the long name being dihydroergotamine.  It was first used at the Mayo Clinic.

Yes, 1943.

Since then, our understanding of migraine has been completely transformed.  And yet, some people are still using DHE to stop migraine attacks.  Why?

Earlier this week I asked on Twitter who had used DHE lately, and got a helpful response from @maxjerz, who had used IV treatment to stop a migraine that, again, was not going away - 24/7 pain.

Photo courtesy of BlueGoa

That answer is actually typical - DHE is often given for migraine attacks that aren’t being stopped using more common medication.  DHE IV therapy isn’t the only way to go - it can also be injected intramuscularly or subcutaneously.  I’ve used it myself, and let me tell you sticking a needle in your body when you’re more sensitive to pain than ever isn’t fun (and for me wasn’t any help) (read Robert’s experience with DHE).

Just last month a report came out of the Cincinnati Children’s Hospital Medical Center in Ohio, USA about using DHE migraine treatment on children and adolescents with status migraine (again, migraine that ain’t going away - an attack lasting more than 3 days).  The results were encouraging - almost 3/4 of the patients became pain-free (excellent considering their normal medication wasn’t working).  Read the study on DHE migraine treatment for children and adolescents.

So DHE (sold as DHE-45 and Migranal) is still given to patients who aren’t being helped by other medications, and because it’s an injection it can be used for patients who have nausea.  It also may help with allodynia (sensitive/painful skin - a common symptom of migraine).

So - why don’t MORE people use it?

So maybe our question should be - why isn’t DHE migraine treatment used more often?  Here’s why dihydroergotamine is no longer at the top of most doctor’s lists:

• Side effects:  Serious side effects are rare, but they’re serious enough to make one cautious.  Possible problems include cardiac events, increase in blood pressure, and spasms of blood vessels.
• Drug interactions:  There are a large number of drug interactions that you need to worry about with DHE, such as certain antibiotics, triptan drugs, and protease inhibitors.  It’s recommended you carefully go through any drugs you’re taking or may take and let your doctor know before using DHE migraine treatment.
• Other cautions:  Like many drugs for migraine, DHE can’t be used by pregnant or nursing mothers.  There’s also concern about patients with hypertension, certain types of migraine, and patients with peripheral arterial disease (to name a few).
• Rebound headache:  Taking DHE may lead to rebound headache, where the migraine attacks start coming stronger and faster because of the medication itself.

Obviously other drugs have many side effects, and other cautions, but the concerns with DHE may be higher compared to the benefit, depending on the patient.  For most people, other treatments will work better.  But a doctor who knows your medical history may suggest DHE for your case individually.

So, although your doctor will have good reasons for recommending other medications first, DHE may still be the perfect thing to end the migraine symptoms in certain patients.

Read more technical details about dihydroergotamine msylate here.

These other posts might relate:

• Migraine Nasal Spray - Should You Try One?

From the Headache and Migraine News Blog

DHE Migraine Treatment: Why some people still use it