Category: Headaches

Use of most electronic media is not associated with headaches, at least not in adolescents. A study of 1025 13-17 year olds, published in the open access journal BMC Neurology, found no association between the use of computer games, mobile phones or television and the occurrence of headaches or migraines. However, listening to one or two hours of music every day was associated with a pounding head.

Astrid Milde-Busch, from Ludwig-Maximilians-University Munich, Germany, worked with a team of researchers to study the links between exposure to electronics and the prevalence and type of headaches. She said, "Excessive use of electronic media is often reported to be associated with long-lasting adverse effects on health like obesity or lack of regular exercise, or unspecific symptoms like tiredness, stress, concentration difficulties and sleep disturbances. Studies into the occurrence of headaches have had mixed results and for some types of media, in particular computer games, are completely lacking."

The researchers interviewed 489 teenagers who claimed to suffer from headaches and 536 who said they did not. When the two groups were compared, no associations were found for television viewing, electronic gaming, mobile phone usage or computer usage. Daily consumption of music was significantly associated with suffering from any type of headache, although, as Milde-Busch points out, "It cannot be concluded whether the habit of listening to music is the cause of frequent headaches, or the consequence in the sense a self-therapy by relaxation."

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Journal Reference:

1. Astrid Milde-Busch, Rudiger von Kries, Silke Thomas, Sabine Heinrich, Andreas Straube and Katja Radon. The association between use of electronic media and prevalence of headache in adolescents: results from a population-based cross-sectional study. BMC Neurology, (in press) [link]

New research shows that migraine and depression may share a strong genetic component. The research is published in the January 13, 2010, online issue ofNeurology®, the medical journal of the American Academy of Neurology.

"Understanding the genetic factors that contribute to these disabling disorders could one day lead to better strategies to manage the course of these diseases when they occur together," said Andrew Ahn, MD, PhD, of the University of Florida in Gainesville, who wrote an editorial accompanying the study and is a member of the American Academy of Neurology. "In the meantime, people with migraine or depression should tell their doctors about any family history of either disease to help us better understand the link between the two."

The study involved 2,652 people who took part in the larger Erasmus Rucphen Family study. All of the participants are descendants of 22 couples who lived in Rucphen in the 1850s to 1900s.

"Genealogical information has shown them all to be part of a large extended family, which makes this type of genetic study possible," said study author Gisela M. Terwindt, MD, PhD, of Leiden University Medical Center in the Netherlands.

Of the participants, 360 had migraine. Of those, 151 had migraine with aura, which is when headaches are preceded by sensations that affect vision, such as seeing flashing lights, and 209 had migraine with no aura. A total of 977 people had depression, with 25 percent of those with migraine also having depression, compared to 13 percent of those without migraine.

The researchers then estimated the relative contribution of genetic factors for both of the disorders. They found that for both types of migraine, the heritability was estimated at 56 percent, i.e., 56 percent of the trait is explained by genetic effects. For migraine with aura, the estimate was 96 percent. "This finding shows that migraine with aura may be a promising avenue to search for migraine genes," Terwindt said.

Comparing the heritability scores for depression between those with migraine and those without showed a shared genetic component in the two disorders, particularly with migraine with aura. "This suggests that common genetic pathways may, at least partly, underlie both of these disorders, rather than that one is the consequence of the other," Terwindt said.

The study was supported by the Netherlands Organization for Scientific Research, the European Community, and the Centre for Medical Systems Biology in the framework of the Netherlands Genomics Initiative.

Ask anyone who suffers from migraine headaches what they do when they're having an attack, and you're likely to hear "go into a dark room." And although it's long been known that light makes migraines worse, the reason why has been unclear.

Now scientists at Beth Israel Deaconess Medical Center (BIDMC) have identified a new visual pathway that underlies sensitivity to light during migraine in both blind individuals and in individuals with normal eyesight. The findings, which appear January 10 in the advance online issue of Nature Neuroscience, help explain the mechanism behind this widespread condition.

A one-sided, throbbing headache associated with a number of symptoms, including nausea, vomiting, and fatigue, migraines are notoriously debilitating and surprisingly widespread, affecting more than 30 million individuals in the U.S. alone. Migraine pain is believed to develop when the meninges, the system of membranes surrounding the brain and central nervous system, becomes irritated, which stimulates pain receptors and triggers a series of events that lead to the prolonged activation of groups of sensory neurons.

"This explains the throbbing headache and accompanying scalp and neck-muscle tenderness experienced by many migraine patients," explains the study's senior author Rami Burstein, PhD, Professor of Anesthesia and Critical Care Medicine at BIDMC and Harvard Medical School.

In addition, for reasons that were unknown, nearly 85 percent of migraine patients are also extremely sensitive to light, a condition known as photophobia.

"Migraine patients may wear sunglasses, even at night," he notes, adding that the dimmest of light can make migraine pain worse. Extremely disabling, photophobia prevents patients from such routine activities as reading, writing, working or driving.

It was the observation that even blind individuals who suffer from migraines were experiencing photophobia that led Burstein and first author Rodrigo Noseda, PhD, to hypothesize that signals transmitted from the retina via the optic nerve were somehow triggering the intensification of pain.

The investigators studied two groups of blind individuals who suffer migraine headaches. Patients in the first group were totally blind due to eye diseases such as retinal cancer and glaucoma; they were unable to see images or to sense light and therefore could not maintain normal sleep-wake cycles. Patients in the second group were legally blind due to retinal degenerative diseases such as retinitis pigmentosa; although they were unable to perceive images, they could detect the presence of light and maintain normal sleep-wake cycles.

"While the patients in the first group did not experience any worsening of their headaches from light exposure, the patients in the second group clearly described intensified pain when they were exposed to light, in particular blue or gray wavelengths," explains Burstein. "This suggested to us that the mechanism of photophobia must involve the optic nerve, because in totally blind individuals, the optic nerve does not carry light signals to the brain.

"We also suspected that a group of recently discovered retinal cells containing melanopsin photoreceptors [which help control biological functions including sleep and wakefulness] is critically involved in this process, because these are the only functioning light receptors left among patients who are legally blind."

The scientists took these ideas to the laboratory, where they performed a series of experiments in an animal model of migraine. After injecting dyes into the eye, they traced the path of the melanopsin retinal cells through the optic nerve to the brain, where they found a group of neurons that become electrically active during migraine.

"When small electrodes were inserted into these 'migraine neurons,' we discovered that light was triggering a flow of electrical signals that was converging on these very cells," says Burstein. "This increased their activity within seconds."

And even when the light was removed, he notes, these neurons remained activated. "This helps explain why patients say that their headache intensifies within seconds after exposure to light, and improves 20 to 30 minutes after being in the dark."

The discovery of this pathway provides scientists with a new avenue to follow in working to address the problem of photophobia.

"Clinically, this research sets the stage for identifying ways to block the pathway so that migraine patients can endure light without pain," adds Burstein.

In addition to Noseda and Burstein, coauthors include BIDMC investigators Vanessa Kainz, Moshe Jakubowski, Joshua Gooley, and Clifford B. Saper; and Kathleen Digre of the University of Utah.

This study was funded by grants from the National Institutes of Health and from the Research to Prevent Blindness.

If you're one of the millions of headache sufferers around the world, more effective relief might be on the way in years to come. That's because the International Headache Society has just published new research guidelines intended to stimulate more research into headache treatment, and to provide researchers with guidelines to cut health risks associated with treatment.

The guidelines appear in the latest issue of Cephalalgia, now published by SAGE.

Dr Lars Bendtsen and his team from the Clinical Trials Standing Committee of the International Headache Society in Copenhagen, Denmark developed new recommendations on how to improve the quality and safety of the research into treatments for episodic and chronic tension-type headaches. The guidelines will enhance clinical trial safety for patients, and will also allow researchers to determine if older drugs still used to treat tension-type headaches are as effective and safe as they should be.

The last research guidelines for tension-type headache research were published in 1995, but few novel or evidence-based treatment options have become available since that time. Focusing specifically on episodic tension-type headaches (ETTH) and chronic tension-type headaches (CTTH), Bendtsen's goal is to spur new research into the treatment of these commonly occurring headaches. This includes analgesics for episodic headaches as well as preventative treatments for chronic headache sufferers.

Millions of people suffer from ETTH, which can range in frequency from a few times a year to 14 times a month. Many people suffer from CTTH, which can be debilitating. The treatments for these can vary profoundly depending on the severity of the condition.

Over the years, research has found that analgesics — otherwise known as pain-relievers — are usually the most effective way of treating all but the most severe episodic headaches. However, severe episodic headaches and CTTH will often benefit from preventative treatments, which is usually the most effective way of providing lasting relief. Researchers have also found that chronic headache sufferers seldom benefit from analgesics.

Given the many kinds of headache medications available today, and the frequency with which these pain relievers and other treatments are used, new research into tension-related headache treatments will have a great impact on public health. Numerous studies have established that frequent use of analgesics for episodic headaches can increase the risk of side-effects, and can even lead to kidney and liver problems over time. Therefore, identifying more effective treatments for headache sufferers will allow physicians to be more targeted in their choice of drugs. Ultimately, this will translate into a more pain-free life for the tens of millions of people around the world suffering from occasional and chronic tension-type headaches.

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Journal Reference:

1. L Bendtsen, ME Bigal, R Cerbo, HC Diener, K Holroyd, C Lampl, DD Mitsikostas, TJ Steiner, and P Tfelt-Hansen on behalf of the International Headache Society Clinical Trials Subcommittee. Guidelines for controlled trials of drugs in tension-type headache: second edition. Cephalalgia, 2009; DOI: 10.1111/j.1468-2982.2009.01948.x

Researchers from the American Headache Society's Women's Issues Section Research Consortium found that incidence of childhood maltreatment, especially emotional abuse and neglect, are prevalent in migraine patients. The study also found that migraineurs reporting childhood emotional or physical abuse and/or neglect had a significantly higher number of comorbid pain conditions compared with those without a history of maltreatment.

Full findings of the study appear in the January issue of Headache: The Journal of Head and Face Pain, published on behalf of the American Headache Society by Wiley-Blackwell.

According to a report by the U.S. Department of Health and Human Services, state and local child protective services (CPS) investigated 3.2 million reports of child abuse or neglect in 2007. CPS classified 794,000 of these children as victims with 59% classified as child neglect; 4% were emotional abuse; 8% as sexual abuse; and 11% were physical abuse cases. Both population- and clinic-based studies, including the current study, have demonstrated an association between childhood maltreatment and an increased risk of migraine chronification years later.

To conduct this study, Gretchen E. Tietjen, M.D, from the University of Toledo Medical Center, and colleagues, recruited a cross-sectional survey of headache clinic patients with physician-diagnosed migraine at 11 outpatient headache centers. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), a 28-item self-reported quantitative measure of childhood abuse (physical, sexual, and emotional) and neglect (physical and emotional). Self-reported physician-diagnosed history of comorbid pain conditions such as irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia (FM), interstitial cystitis (IC), and arthritis was recorded on the survey.

A total of 1348 patients diagnosed with migraine completed the surveys. Researchers found migraineurs who reported childhood emotional abuse or physical neglect had a significantly higher incidence of comorbid pain conditions compared with those without a history of maltreatment. In the study population, 61% had at least 1 comorbid pain condition and 58% reported experiencing childhood trauma either by abuse or neglect. The number of different maltreatment types suffered in childhood correlated with the number of comorbid pain in adulthood.

Specifically, physical abuse was associated with a higher incidence of arthritis; emotional abuse was linked to a greater occurrence of IBS, CFS, FM, and arthritis; and physical neglect connected with more reports of IBS, CFS, IC, and arthritis. In women, physical abuse and physical neglect was associated with endometriosis (EM) and uterine fibroids, emotional abuse with EM, and emotional neglect with uterine fibroids.

"Our study found that while childhood maltreatment is associated with depression, the child abuse-adult pain relationship is not fully mediated by depression," explained Dr. Tietjen. Results from this study, as well as three recent population-based studies, indicate that associations of maltreatment and pain were independent of depression and anxiety, both of which are highly prevalent in this population.

Researchers suggest that for persons presenting for migraine treatment, childhood maltreatment may be an important risk factor for development of comorbid pain disorders. "Since migraine onset preceded onset of the comorbid pain conditions in our population, treatment strategies such as cognitive behavioral therapy may be particularly well suited in these cases," concluded Dr. Tietjen.

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Journal References:

1. Tietjen et al. Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey. Headache The Journal of Head and Face Pain, 2010; 50 (1): 20 DOI: 10.1111/j.1526-4610.2009.01556.x
2. Tietjen et al. Childhood Maltreatment and Migraine (Part II). Emotional Abuse as a Risk Factor for Headache Chronification. Headache The Journal of Head and Face Pain, 2010; 50 (1): 32 DOI: 10.1111/j.1526-4610.2009.01557.x
3. Tietjen et al. Childhood Maltreatment and Migraine (Part III). Association With Comorbid Pain Conditions. Headache The Journal of Head and Face Pain, 2010; 50 (1): 42 DOI: 10.1111/j.1526-4610.2009.01558.x

Patients with a cluster headache, which is characterized by bouts of excruciating pain usually near the eye or temple, were more likely to report being pain-free within 15 minutes of treatment with high-flow oxygen than patients who received a placebo treatment, according to a study in the December 9 issue of JAMA.

Cluster headache attacks typically last for 15 minutes to 3 hours untreated and have a frequency of 1 every other day for up to 8 attacks a day. Attacks usually occur in bouts, or clusters, lasting for weeks or months, separated by remissions lasting months or years, according to background information in the article. The current treatment for acute attacks of cluster headache is injection with the drug sumatriptan, but frequent dosing is not recommended because of adverse effects. Another treatment option is the inhalation of high-dose, high-flow oxygen, but its use may be limited because of the lack of a good quality controlled trial.

Anna S. Cohen, Ph.D., M.R.C.P., of the National Hospital for Neurology and Neurosurgery, London, and colleagues conducted a randomized, placebo-controlled trial of high-flow oxygen for the treatment of acute attacks of cluster headache. The study included 109 adults (ages 18-70 years). Patients treated four cluster headache episodes alternately with high-flow oxygen (inhaled oxygen at 100 percent, 12 L/min, delivered by face mask, for 15 minutes at the start of an attack) or placebo (high-flow air). Patients were recruited and followed up between 2002 and 2007. The final analysis included 57 patients with episodic cluster headache and 19 with chronic cluster headache.

The researchers found that 78 percent of the patients who received oxygen reported being pain-free or to have adequate relief within 15 minutes of treatment, compared to 20 percent of patients who received air. For other outcomes, such as being pain-free at 30 minutes or a reduction in pain up to 60 minutes, treatment with oxygen was superior to air. There were no serious adverse events related to the treatments.

"To our knowledge, this is the first adequately powered trial of high-flow oxygen compared with placebo, and it confirms clinical experience and current guidelines that inhaled oxygen can be used as an acute attack therapy for episodic and chronic cluster headache," the authors write.

"This work paves the way for further studies to optimize the administration of oxygen and its more widespread use as an acute attack treatment in cluster headache, offering an evidence-based alternative to those who cannot take triptan agents."

Pooling results from 21 studies, involving 622,381 men and women, researchers at Johns Hopkins have affirmed that migraine headaches are associated with more than twofold higher chances of the most common kind of stroke: those occurring when blood supply to the brain is suddenly cut off by the buildup of plaque or a blood clot.

The risk for those with migraines is 2.3 times those without, according to calculations from the Johns Hopkins team, to be presented Nov. 16 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando. For those who experience aura, the sighting of flashing lights, zigzag lines and blurred side vision along with migraines, the risk of so-called ischemic stroke is 2.5 times higher, and in women, 2.9 times as high.

Study participants, mostly in North America and Europe, were between the ages 18 and 70, and none had suffered a stroke prior to enrollment.

Senior study investigator and cardiologist Saman Nazarian, M.D., says the team's latest analysis, believed to be the largest study of its kind on the topic, reinforces the relationship between migraine and stroke while correcting some discrepancies in previous analyses. For examples, a smaller combination study in 2005 by researchers in Montreal showed a bare doubling of risk, yet mixed together different mathematical measures of risk, while the Hopkins study kept them separate, pooling together only like measures. As well, another half dozen recent and smaller studies from Harvard University yielded mixed results, some showing a link between migraines and ischemic stroke, while one did not show a tie-in.

Nazarian says that while nearly 1,800 articles have been written about the relationship between migraine and ischemic stroke, the Hopkins review was more selective, combining only studies with similar designs and similar groups of people, and more comprehensive, including analysis of unpublished data.

"Identifying people at highest risk is crucial to preventing disabling strokes," says Nazarian, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. "Based on this data, physicians should consider addressing stroke risk factors in patients with a history or signs of light flashes and blurry vision associated with severe headaches."

Prevention and treatment options for migraine, he says, range from smoking cessation and taking anti-blood pressure or blood-thinning medications, such as aspirin. In women with migraines, stopping use of oral contraceptives or hormone replacement therapy may be recommended.

Such widespread use of hormone-controlling drugs is what Nazarian says may explain why women with migraines have such high risk of ischemic stroke. Contraceptives and other estrogen therapies are both known to contribute to long-term risk factors for cardiovascular diseases and stroke, such as high blood pressure and increased reactivity by clot-forming blood platelets.

Nazarian says the researchers' next steps are to evaluate if preventive therapies, especially aspirin, offset the risk of ischemic stroke in people with migraines.

Funding support for the study, performed entirely at Hopkins, was provided by the National Institutes of Health Clinical Research Scholars Program.

Other researchers involved in this study were Susan Kahn, M.D.,M. Sc.; Miranda Jones, M.P.H.; Monisha Jayakumar, M.P.H.; and Deepan Dalal, M.P.H. The lead study investigator was June Spector, M.D., M.P.H., a former postdoctoral research fellow at Hopkins, now in Seattle.

Presentation title: Migraine headache and the risk of ischemic stroke, a systemic review and meta-analysis of observational studies.

Inflammatory response of brain cells — as indicated by a molecular imaging technique — could tell researchers more about why certain neurologic disorders, such as migraine headaches and psychosis in schizophrenic patients, occur and provide insight into how to best treat them, according to two studies published in the November issue of The Journal of Nuclear Medicine.

By using positron emission tomography (PET) — a noninvasive molecular imaging technique — researchers were to able to identify neuroinflammation, which is marked by activated microglia cells (brain cells that are responsive to injury or infection of brain tissue) in patients with schizophrenia and in animal models with migraines. Although neuroinflammation has been shown to play a major role in many neurodegenerative disorders–such as multiple sclerosis, Parkinson's disease and Alzheimer's disease–only limited data exists about the role of neuroinflammation in schizophrenia and migraines. The two studies in The Journal of Nuclear Medicine are the first to identify neuroinflammation in specific regions of the brain — a development which could be used to effectively evaluate the treatment response to anti-inflammatory drugs and become transformative for diagnosis and care.

"This study shows that molecular imaging can play an important role in better understanding the processes involving psychiatric and other neurological disorders," said Janine Doorduin, M.Sc.,a researcher at the University Medical Center Groningen in the Netherlands and lead author of "Neuroinflammation in Schizophrenia-Related Psychosis: A PET Study." Doorduin added: "Without molecular imaging, the only way to look at inflammation in the brain, as well as other molecular processes, would be to use post-mortem brains."

Not much is known about the cause of schizophrenia — a chronic and disabling brain disease characterized by psychotic episodes of delusions and hallucinations. Previously, evidence from post-mortem studies suggested the presence of activated microglia cells in the brain. However, the results of those studies were inconsistent. Using PET imaging to noninvasively image the living brains of schizophrenic patients, researchers in the Netherlands were able to pinpoint the neuroinflammation to an exact location in the brain, called the hippocampus. Now, researchers can target the hippocampus for further study and evaluate therapeutic treatments that could improve the quality of life for patients living with schizophrenia.

Likewise, PET imaging is also useful for identifying neuroinflammation associated with migraines. In the article, "¹¹C-PK11195 PET for the In Vivo Evaluation of Neuroinflammation in the Rat Brain After Cortical Spreading Depression," researchers in Japan were the first to noninvasively visualize neuroinflammation in an animal model of migraine using a PET technique. Neuroinflammation is thought to be a key factor in the generation of pain sensation in migraine headaches. Observations from the study suggest that an inflammatory process may be involved in the pathologic state of migraines and that PET is a useful tool for evaluating the neurogenic inflammation in vivo.

"For physicians and patients, it is important to develop an objective method for the diagnosis of migraines and monitor therapeutic efficacy," said Yi-Long Cui, Ph.D., a researcher at the RIKEN Center for Molecular Imaging Science in Kobe, Japan, and lead author of the study. "The present study will bring about these possibilities to us since the PET probe used in the paper has already been applied to patients in other diseases."

Co-authors of "¹¹C-PK11195 PET for the In Vivo Evaluation of Neuroinflammation in the Rat Brain After Cortical Spreading Depression" include Yilong Cui, Yosky Kataoka, Yasuhisa Tamura, Cellular Function Imaging, RIKEN Center for Molecular Imaging Science, Kobe, Hyogo, Japan; Tadayuki Takashima, Yasuhiro Wada, Yasuyoshi Watanabe, Molecular Probe Dynamics, RIKEN Center for Molecular Imaging Science, Kobe, Hyogo, Japan; Misato Takashima-Hirano, Hisashi Doi, Molecular Imaging Labeling Chemistry, RIKEN Center for Molecular Imaging Science, Kobe, Hyogo, Japan; and Miho Shukuri, Hirotaka Onoe, Functional Probe Research Laboratories, RIKEN Center for Molecular Imaging Science, Kobe, Hyogo, Japan.

Co-authors of "Neuroinflammation in Schizophrenia-Related Psychosis: A PET Study" include: Janine Doorduin, Erik F.J. de Vries, Antoon T.M. Willemsen, Rudi A. Dierckx, Hans C. Klein, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Jan Cees de Groot, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and Hans C. Klein, University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

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Journal References:

1. Cui et al. 11C-PK11195 PET for the In Vivo Evaluation of Neuroinflammation in the Rat Brain After Cortical Spreading Depression. Journal of Nuclear Medicine, 2009; 50 (11): 1904 DOI: 10.2967/jnumed.109.066498
2. Doorduin et al. Neuroinflammation in Schizophrenia-Related Psychosis: A PET Study. Journal of Nuclear Medicine, 2009; 50 (11): 1801 DOI: 10.2967/jnumed.109.066647

Migraine with aura (temporary visual or sensory disturbances before or during a migraine headache) is associated with a twofold increased risk of stroke, finds a study published on the British Medical Journal website. Further risk factors for stroke among patients with migraine are being a woman, being young, being a smoker, and using estrogen containing contraceptives.

The risk was highest among young women with migraine with aura who smoke and use estrogen containing contraceptives.

Migraine is a common, chronic disorder that affects up to 20% of the population. Women are affected up to four times more often than men. Up to one third of sufferers also experience an aura prior to or during a migraine headache (often described as the perception of a strange light, an unpleasant smell or confusing thoughts or experiences).

Doctors have long suspected a connection between migraine and vascular events such as stroke. So to investigate this further, an international team of researchers analysed the results of nine studies on the association between any migraine (with and without aura) and cardiovascular disease. Differences in study design and quality were taken into account to minimise bias.

They show that migraine with aura is associated with a twofold increased risk of ischemic stroke. This risk is further increased by being female, age less than 45 years, smoking, and estrogen containing contraceptive use.

There was no association between migraine and heart attack or death due to cardiovascular disease.

In light of these findings, the authors recommend that young women who have migraine with aura should be strongly advised to stop smoking, and methods of birth control other than estrogen containing contraceptives should be considered. They also call for additional research to investigate the association between migraine and cardiovascular disease in more detail.

The absolute risk of stroke for most migraine patients is low, so a doubling of risk is not cause for panic, explains Elizabeth Loder from Brigham and Women's Hospital, Boston, in an accompanying editorial. However, at a population level, this risk deserves attention because the prevalence of migraine is so high. She suggests that patients who have migraine with aura should be followed closely and treated aggressively for modifiable cardiovascular risk factors.

She was only 30 years old, but she was experiencing the classic symptoms of a stroke. Her speech suddenly became slurred, and her left hand became clumsy while eating.

What triggered her stroke, at such a young age, may have been the birth control pills she was taking. Oral contraceptives nearly double the risk of stroke, according to a review article in MedLink Neurology by three Loyola University Health System neurologists.

Nearly 100 million women worldwide use birth control pills. Pills now in use contain much lower concentrations of estrogens than older preparations. The relationship between oral contraceptives and stroke has been studied and debated for decades, and studies have yielded conflicting results.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed "meta-analysis" cited in the article. (A meta-analysis combines the results of multiple studies.) This is still a small risk; there's one additional stroke for every 25,000 women who take birth control pills, according to the article.

But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher.

"When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient," said senior author Dr. Jose Biller. "For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives."

The 30-year-old woman was one of two patients described in the article. She had suffered migraine headaches since she was 15 years old, which further increased her stroke risk. Doctors took her off birth control pills and gave her medication for her migraines.

Authors also described a 27-year-old woman who suffered severe right-sided headaches, nausea, vomiting and unsteadiness while on oral contraceptives. She stopped taking birth control pills and was treated with a blood thinner for six months. On a follow up visit, she was doing well except for occasional headaches.

"These observations obviously need to be considered in the proper context of a careful understanding of possible risks and benefits associated with the use of oral contraceptives, as well as those associated with other forms of contraception," Biller said.

How oral contraceptives might cause strokes is not completely understood. But two possible mechanisms are the increased risks of blood clots and high blood pressure associated with oral contraceptives, authors wrote.