New York Headache Center

Unfair teachers can cause headaches in adolescents, according to an Italian study published in the journal Headache.  About 40% of 4,386 adolescents suffered from headaches at least once a week.  Girls were more likely to have headaches and kids who had better classmate social support had fewer headaches.  The researchers used an established  “Teacher and Classmate Support Scale” to measure these effects and also took into account other factors that could have skewed the data.  They looked at family and friend empowerment, bullying, school achievement, and trust in people, and none of those factors seemed to play a role in causing headaches.  Psychological stress worsens headaches in adults too, but it seems to have a more pronounced effect in adolescents.

Strokes in pregnant women who suffer from migraine headaches are very rare.  This is a letter I submitted to the British Medical Journal  in response to an article they just published on this topic:

The large amount of data and the statistical analyses in this paper look impressive and unfortunately may fool many readers into believing the conclusions made by the authors.  The authors do acknowledge that the discharge diagnostic codes miss many patients who suffer from migraine headaches.  This diagnosis is not only missed upon discharge, but it is an established fact that migraine is significantly underdiagnosed by the majority of primary care doctors.  Obstetricians are not likely to do a better job in distinguishing sinus and tension-type headaches from migraines, or diagnosing a migraine aura, particularly when managing a pregnant woman in the hospital.  It is true that migraines improve in pregnancy, but considering that about 18% of women suffer from migraine headaches, it is hard to believe that only one in 100 of these women will continue having migraines during pregnancy.  Obviously, when a complication, such as stroke occurs the diagnosis of migraine is much more likely to be recorded than when no complications occur. 
The authors provide many disclaimers and state that “On the basis of the select group of pregnant women with migraines coded during the hospital admission, this may not represent the population of women with migraine as a whole”.  Nevertheless, they go on to present and analyze this highly inaccurate data and even draw conclusions.  It is very unfortunate that the publicity associated with this paper (I first saw it reported on Yahoo.com) will cause unnecessary anxiety to millions of pregnant women. 

Smoking marijuana and taking its legal medicinal derivative, dronabinol helped one patient with cluster headaches, according to a report from the Montefiore Headache Clinic.  Dronabinol is approved for the treatment of nausea and loss of appetite.  The effectiveness of smoking marijuana or taking dronabinol for the relief of pain has been reported by many patients, but never proven in large trials.  I generally discourage patients trying marijuana for the relief of any symptoms, unless they have tried and failed traditional medications and they have already tried marijuana and it did help.  Marijuana not only has many negative effects on the body, but can be also contaminated by other harmful substances.  Cluster headaches can be extremely intense and at times lead patients to thoughts of suicide.  In view of this report it seems reasonable to try dronabinol in patients who failed Imitrex injections, oxygen and preventive drugs, such as high dose of verapamil, lithium, and topiramate.