Researchers at the University of California San Diego have found that the mouths of those who suffer from migraine headaches have significantly more microbes with the ability to modify nitrates than people who do not have headaches. Many of the millions of Americans who suffer from migraines report an association between consuming foods with nitrates and the intensity of their headaches. The researchers were interested in exploring the idea that foods can trigger migraines and in particular exploring the microbiome connection with migraines. In addition, four in five cardiac patients who take nitrate-containing drugs often report headaches as a side effect.

Nitrates are found in foods including processed meats and green leafy vegetables. Nitrite reducing bacteria found in the mouth can reduce the nitrates to nitrites. These nitrites can then be converted to nitric oxide when circulating in blood. Nitric oxide can help improve cardiovascular health by reducing blood pressure.

Using publicly available data from the American Gut Project, the researchers sequenced bacteria found in 172 oral samples and 1,996 fecal samples from healthy study participants. The people who the samples were obtained from had filled out surveys indicating whether they suffered from migraine headaches. The bacterial gene sequencing found that bacterial species were found in different abundances between people who have migraines when compared to those who don’t.

The team then used a bioinformatic tool called PICRUSt to analyze which genes were likely to be present in the two different sets of samples, given the bacterial species present. In fecal samples, they found a small statistically significant increase in the abundance of genes that encode nitrate, nitrite and nitric oxide-related enzymes in those who suffer from migraines. In oral samples, these genes were significantly more abundant in those who suffer from migraines.

The researchers feel that the conversion from nitrates to nitrites in the mouth is advantageous to cardiovascular health. However, now they know that more of this going on can result in migraine headaches or may be a cause of migraine headaches occurring. The researchers have plans to look at more patients and group by different types of migraines. The researchers can then better find out if oral microbes really do have nitrate-reducing genes and measure their levels of circulating nitric oxide allowing them to gain insight into migraine headaches.

This is interesting work and helps solidify the experience that many migraine sufferers have, that their diet can play a role in their headaches. See for example a prior blog post at http://blog.teethremoval.com/a-healthy-headache-diet/.

Source: Antonio Gonzalez and et al., Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort, mSystems, October 2016.

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Researchers have shown that survivors of a terror attack have an increased risk of frequent migraine and tension headaches developing after the attack. Therefore there are potential physical effects of violent incidents in addition to the better known psychological effects.

Source: Synne Øien Stensland, John-Anker Zwart, Tore Wentzel-Larsen, and Grete Dyb, The headache of terror, Neurology, 2017.

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A new study that attempted to find racial disparities in the treatment of migraine headaches found no differences and instead found that opioids are often overused for migraine headache treatment. As has been discussed on this blog and site before, the prescribing habits of opioids are under scrutiny for wisdom teeth surgery. See for example the article http://blog.teethremoval.com/what-can-a-surgeon-do-to-prevent-opioid-abuse/ and the article http://blog.teethremoval.com/painkiller-overdose-in-michigan-are-wisdom-teeth-extractions-contributing/. Now it appears that the prescribing habits of opiods for migraines should also be under scrutiny.

Existing research shows that African-Americans experience more frequent and severe migraine headaches than non-Hispanic whites. Researchers at the University of Michigan set out to explore if there was any evidence of racial disparities in treatment practices for migraines. However, instead of finding any disparities, they found opioids were being prescribed as frequently as medications that are more effective for migraine headaches.

In the study, results from 2,860 migraine visits in the U.S. between 2006 and 2013 were explored. A total of 65% of patients were non-Hispanic whites, while 10% were African-American, and another 10% Hispanic. African-Americans were 4% less likely to receive high-quality abortive agents and Hispanics were 5% less likely to receive high-quality prophylactic agents when compared with non-Hispanic whites (without any statistical significance).  A total of 15.3% of African-Americans, 19.4% of non-Hispanic whites, and 17.7% of Hispanics received a Level A abortive, an evidence-based medication intended for acute migraine treatment, such as dihydroergotamine or triptan. Overall, 38.9% of patients were not prescribed any abortive medication. Also 27% of patients being given an abortive medication were given a low-quality one instead of a high-quality one.

Roughly just over 40% of patients for each of the three groups received no prophylactic treatment or preventive medication. For all three groups, 15.2% of patients studied received a prescription for an opioid, with no significant difference among groups of patients. Other medications have been show to be more effective for treating migraine headaches than opioods so the researchers were a bit surprised by the results. Futher, opioids carry additional problems including association with medication overuse headache and comorbidities such as anxiety and depression.

Source: Larry Charleston IV and James Francis Burke, Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia, 2017.

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Researchers have found why pain from the head and face can be more disruptive, and emotionally draining than pain in other parts of the body. The researchers found that sensory neurons from the head and face are wired directly into the brain’s principal emotional signaling hubs, while sensory neurons from elsewhere in the body are connected only indirectly to this hub. People consistently rate pain of the head and face as more disruptive and emotionally draining than pain in other parts of the body. The results may help lead toward more effective treatments for pain mediated by the craniofacial nerve, including chronic headaches and neuropathic face pain.

Usually doctors focus on treating the sensation of pain, but this work demonstrates that doctors need to also treat the emotional aspects of pain. Pain signals from the head and face compared to those from the body are carried to the brain through two different groups of sensory neurons, and it is possible that neurons from the head are simply more sensitive to pain than neurons from the body. Even so, differences in sensitivity would not explain the greater fear and emotional suffering that patients experience in response to head and face pain than pain in other parts of the body. Functional Magnetic Resonance Imaging (fMRI) shows greater activity in the amygdala, a region of the brain involved in emotional experiences, in response to head pain than in response to body pain. It has been observed in human studies that pain in the head and face seems to activate the emotional system more extensively.

Source: Erica Rodriguez and et al., A craniofacial-specific monosynaptic circuit enables heightened affective pain, Nature Neuroscience, 2017.

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An Illinois woman has filed a lawsuit against her dentist and dentist assistant in October, 2019, alleging that four wisdom teeth were extracted without informed consent. Just before the surgery occurring in September 2017, the woman alleges that she spoke with the dental assistant about concerns with going forward with the extraction. However, the surgery proceeded and the woman was given general anesthesia. The woman’s boyfriend at the time of the surgery signed of on the informed consent form although there was no legal right to do so.

The dentist was not aware that the woman had nerves that were too close to the wisdom tooth and thus should have required a more complex procedure. The suit says the dentist used an “overly aggressive, improper technique” and “negligently and carelessly failed to properly inform the plaintiff of all the risks.” As a result of the wisdom teeth surgery the woman has faced numerous medical bills from visiting doctors, dentists, neurologists, oral surgeons, medications, and having imaging studies performed. She has suffered permanent damage to her trigeminal nerve and suffers from “constant debilitating migraines, dizziness and vertigo.” The suit mentions that the woman has been diagnosed with trigeminal neuralgia by several doctors.

It is alleged that the dentist downplayed the extent of the nerve damage after the surgery and did not provide prompt referral to a specialist to treat nerve damage. The woman is hoping the suit can help prevent the same conduct dentists to other patients. She is seeking over $50,000 in damages which will be used to cover bills, lost wages, and legal fees.

While trigeminal neuralgia, persistent headaches, and dizziness are known risks of wisdom teeth removal, they are not generally disclosed as part of the informed consent process. Typically the lingual nerve and the inferior alveolar nerve are the ones mentioned and the possibility of headaches or dizziness is not mentioned. Such complications as these after wisdom teeth removal has been discussed on the wisdom teeth complications page. A recent post titled Wisdom Teeth Removal Leads to Trigeminal Neuralgia and Temporomandibular Joint Syndrome dysfunction describes another case of trigeminal neuralgia after wisdom teeth extraction. The post Vertigo and Dizziness After Wisdom Teeth Removal describes several cases of vertigo and dizziness after wisdom teeth extractions. Cases of headaches occuring after wisdom teeth surgery are also described elsewhere on this site. Cases of successful lawsuits and settlements after wisdom teeth surgery led to complications and/or were negligence was present are described at http://www.teethremoval.com/dental_malpractice.html.

Source:

John Breslin, “Patient alleges wisdom teeth extraction carried out without consent, caused major damage,” Madison – St. Clair Record, Oct. 23, 2019.

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