The American Headache Society completed their 54th Annual Scientific Meeting on Sunday June 24, 2012. I had the pleasure of being able to attend this conference with Teri Robert and Ellen Schnakenberg. Three women in a hotel room was a bit scary at first, but I think we made out absolutely fine. I just hope Teri and Ellen agree with me!
As usual, we were up early each morning and just about feel into bed in the evenings. There was so much to learn and see it made my head spin at times. The meeting started off with an informative session called The Fred Sheftell Post-Traumatic Headache Series: Military Traumatic Brain Injury and Post-Traumatic Headache in honor of Dr. Fred Sheftell who passed away last year. Helmet design in both the military and in sports was discussed, as was the need to screen for other headache disorders when a patient is dealing with post-traumatic headache. People whom suffer a mild to moderate traumatic brain injury (TBI) are more likely to suffer from headache than those who incur a more severe TBI.
In another session, Dr. Sarah K. Gibbons gave some startling statistics about soldiers who suffer a concussion and have headaches that do not improve (or are in fact worse) at 12 months. TBI was discussed frequently this past week, and the bottom line is that there is simply not enough research right now to have an idea about effective treatments. Now that it's in the forefront of everyone's mind, maybe the importance of concussion education can really begin.
Chronic Nicotine Promotes Expression of Proteins Implicated in the Development of Peripheral and Central Sensitization of Trigeminal Neurons proved to be a very interesting session. Jordan L. Hawkins reported that nicotine use increases pain sensitivity and sumatriptan (Imitrex) does not stop the stimulatory effects of nicotine. This could be the reason that Imitrex can be ineffective for some Migraineurs who smoke.
In Dr. Todd Schwedt's session, The Cerebral Cortex and Migraine, he explained that the brain is so complex, there are many different "regions" involved during the pain process. Some of these regions include the posterior insula, amygdala, prefrontal cortex and hippocampus. Dr. Schwedt also noted that "Migraineurs may have atypical pain perception/processing involving all domains" and that Migraineurs could experience a lower threshold of pain. Interestingly enough, when we are expecting pain, the pain may be worse than if we weren't expecting it. In this sense, some Migraineurs may create a self-fulfilling prophecy (a positive or negative expectation regarding events that may affect the outcome) of pain. Dr. Schwedt reported that about 50 percent of Migraineurs think about Migraine even on pain-free days. I found that distressing, and some of us may need to reassess our coping strategies.
Dr. Fabrizio Benedetti held an amazing session called Placebo Response: How Therapeutic Rituals Change the Patient's Brain. During this session, Dr. Benedetti described how, if a patient is given their first effective treatment and then given frequent placebo treatments, the placebo effect is keener. Positive reinforcement may be improve placebo response; however, if a patient receives positive reinforcement without a successful treatment first, the placebo response does not occur. Again, our minds may be more helpful than we realize in helping control our pain.