Migraines Linked to Stroke and Heart Attacks in Women

An interesting study in the January 2008 issue of Cephalagia revealed that women who had migraines more than once per week had nearly three times higher risk of ischemic stroke and 1.5 times more risk of heart attack as compared to women without migraines. Even having migraines once per month or less was associated with a 1.5 times increased risk of stroke or heart attack. The authors state that further research is needed to determine if migraine prevention reduces the risk of cardiovascular diseases. 

My feeling is that even if migraines were controlled with aggressive dietary modifications and pharmacologic agents, there will be minimal to no improvement in the incidence of the risk of heart attack or stroke. My logic is as follows: Migraine is a common feature in people with sleep-breathing disorders. It's especially more common in women (and men) who have upper airway resistance syndrome (UARS), which is a variation/precursor of obstructive sleep apnea (OSA). Obstructive sleep apnea is known to be linked to high blood pressure, heart disease and stroke. In my experience, allowing people to sleep better (by breathing better at night) usually improves migraines, as well as the effects of OSA. So covering up a migraine headache with medications will not address the cause, which is inefficient sleep due to breathing problems at night. I discuss the reasons for this in detail in my forthcoming book, Sleep, Interrupted.

When You Hear Ringing, and It's Not the Phone

Temporomandibular joint disease, or TMJD, is a very common disorder that affects millions of people in this country. The most common symptoms are ear pain and headaches. Other less common symptoms that are described are ringing, buzzing, ear fullness, sound sensitivity, popping and clicking. A paper published in April, 2008 issue of Archives of Otolaryngology - Head & Neck Surgery described a relatively high incidence of theses "aural" symptom in patients seen in an academic TMJ clinic. They reiterate and agree with other authors' hypothesis that local inflammation of the jaw joint, due to it's proximity to the ear structures, can aggravate all these problems. In the end, no one really knows why these symptoms occur. As in all scientific papers, they can only show association, but never prove cause and effect.

Let me propose one possible cause for these effects: People with sleep-breathing disorders (obstructive sleep apnea and upper airway resistance syndrome) all have various degrees of nasal inflammation with ear and sinus pressure problems, TMJD, and headaches. If you have nasal inflammation with partial blockage of the tube that connects the back of the nose to the middle ear (Eustachian tube), then you can imagine that you may feel ear fullness, hearing loss, popping or clicking. If your senses are heightened due to a physiologic stress response due to inefficient breathing during sleep, then you can hear noises in your ear or be sensitive to certain sounds or voices. Neurologic stimulation of the various structures can aggravate jaw muscle stimulation and spasm, or even ear or sinus fullness. This is similar to what occurs in a migraine attack. Various papers have suggested that a migraine attack can occur in any part of the body that has nerve endings, so in theory you can have a "migraine" attack anywhere in your body.

This is one of many papers that describe observations between one specific condition and it's symptoms. Their findings and observations are accurate, but when viewed from the more holistic perspective of the sleep-breathing paradigm, you may be able to make sense of all of these various interpretations all that much more. After all, there's really no point in looking at all this research without having an overall perspective to interpret it from.

Get Less Headaches – Raise Your Blood Pressure

A recent study published in the journal Neurology showed that the higher your blood pressure, the less likely you're going to have chronic daily headaches symptoms. This is an interesting finding since the authors conclude that headaches may result from stiffening of the arteries as one develops high blood pressure. In the end, the authors' weren't sure why this happened but were perplexed as to its paradoxical implications.

This finding is not surprising at all if looked at from the sleep-breathing paradigm which I describe in my forthcoming book, Sleep, Interrupted. People with upper airway resistance syndrome (UARS) are typically young, thin, don't snore, and are chronically tired, no matter how long they sleep. They also tend to have cold hands or feet, and have normal or low blood pressure with bouts of lightheadedness or dizziness when standing up suddenly. These people also tend to suffer from various headache syndromes, like tension, migraine, or TMJ associated headaches. They'll also have frequent sinus pain and pressure, usually misdiagnosed as a sinus infection. Typically, one or both parents will snore heavily, who frequently have high blood pressure, depression, or heart disease.

Later on in life, about 20-40 years later, UARS patients are more likely to be overweight, with no more cold extremities, dizziness or light-headedness, but now snore and have high blood pressure. At this stage, they are likely to have the classic features of obstructive sleep apnea (OSA).

We know that OSA is a major risk factor for high blood pressure, but patients with high blood pressure are almost never screened for OSA. Instead, they are treated for one of the signs of OSA, which is hypertension. One of the major root causes of high blood pressure is almost never addressed. There are even scientific thinkers that propose that OSA is the main reason for most cases of undiagnosed high blood pressure.

The study authors also commented on other studies that show that increasing blood pressure is linked to lower amounts of chronic pain throughout the body. In sleep research, sleep apnea patients are thought to have diminished autonomic nervous system sensitivity, thus the longer breathing pauses.

Unfortunately, in most cases, we wait for the end result of a disease process (high blood pressure) before starting treatment, rather than preventing it from happening in the first place. In the latter scenario, helping people breathe better at night so that they can sleep better can not only alleviate much of the headaches when they're young, but it can prevent progression into high blood pressure and other cardiovascular complications later in life.