JAMA: Equipment Ownership, Prior Imaging Behavior Predict High Rates of Low-Value Imaging for LBP, Headache

Despite evidence showing that imaging for low back pain (LBP) and uncomplicated headache is not necessary, too many health care providers still order these services for their patients, who incur greater financial costs. In a new study published in JAMA Internal Medicine, researchers identified several factors associated with higher rates of low-value imaging—including whether the providers owned the imaging equipment.

Using 4 years’ worth of claims data from 1 insurer, authors analyzed clinician characteristics as predictors for imaging for uncomplicated back pain and headache—2 low-value services identified by the Choosing Wisely campaign guidelines as inappropriate for imaging.

Full story at APTA

Yanni Anyone? Headbanging Linked to Brain Injury, Whiplash

It turns out that so-called heavy metal “headbangers” do just that, and violently enough to occasionally result in brain injury, whiplash, and other problems.

The July 5 issue of The Lancet includes a letter to the editor that describes treatment of a subdural hematoma in a 50-year-old man who presented with a worsening headache that had been going on for 2 weeks. He had an unremarkable medical history and denied substance abuse.

What he did mention was that just before his headache began, he attended a concert by Motorhead, a seminal speed metal band. And like many others in the audience, he spent much of the concert headbanging, which letter author Ariyan Pirayesh Islamian, MD, describes as “a contemporary dance form consisting of abrupt flexion-extension movements of the head to the rhythm of rock music, most commonly seen in the heavy metal genre.”

Full story of heavy metal headbanging and brain injury at Science Daily

Headache docs list top 5 tests and treatments to avoid

Doctors who specialize in treating head pain, such as chronic migraines, are out with a list of five procedures and treatments they think have risks or costs that may outweigh the benefits.

The American Headache Society’s list is part of the American Board of Internal Medicine’s Choosing Wisely campaign that has seen cancer doctors, eye doctors and chest surgeons naming the overused or unproven practices their peers should avoid and patients should question.

The newest Choosing Wisely list was published Thursday in the journal Headache.

“The article and recommendations identify situations that are felt by experts to be cases where patients and doctors should think very carefully before they decide to use that particular treatment or intervention,” said Dr. Elizabeth Loder, an author of the new recommendations.

Loder is the president of the American Headache Society, and chief of the Division of Headache and Pain at Brigham and Women’s Hospital in Boston.

Full story of headache treatments at NBC News

Learning to live with chronic pain

Chronic pain is a formidable foe. It’s invisible and can’t be measured by an X-ray or a blood test. Sometimes it has no identifiable cause and yet it can ruin lives, affecting everything from employment to family relationships.

“Pain Matters,” a new documentary airing on the Discovery Channel, illuminates what it’s like to be one of the millions of Americans suffering with chronic pain, often defined as recurrent pain that lasts more than three months.

In the documentary, we hear from six people living with the condition, including a Navy veteran who sustained debilitating injuries in Iraq, and a mother of two who is still hurting from a car accident more than 20 years ago. Their testimony will surely strike a chord with anyone who has struggled with a bad back, arthritis, carpal tunnel syndrome or recurrent headaches.

Clinicians also provide insight on the timely subject of pain management. Last month, the Food and Drug Administration recommended tighter controls on how physicians prescribe the most commonly used narcotic painkillers, such as Vicodin.

For more on this topic, we turned to Penney Cowan, 65, founder and executive director of the American Chronic Pain Association, one of the experts featured in the documentary. Here is an edited transcript of our interview:

Q: What is your personal connection to pain?

Full story of living with chronic pain at the Chicago Tribune

Painkillers May Worsen Headache After Concussion

Too much pain medication may have been part of the problem for teens reporting chronic headache months after suffering concussions, researchers reported here.

Nearly half of adolescents with post-concussion headaches lasting 3-12 months showed either complete resolution of symptoms or a reduction to pre-concussion levels after discontinuing their analgesics, according to Geoffrey Heyer, MD, and Syed Idris, MD, both of Nationwide Children’s Hospital in Columbus, Ohio.

Because withdrawal of painkillers alleviated these patients’ headaches, a diagnosis of medication overuse headache may be made under International Classification of Headache Disorders (ICHD) criteria, the researchers indicated in a poster presentation at the Child Neurology Society annual meeting.

The findings emerged from a retrospective chart review of 104 consecutive adolescent patients treated at Nationwide Children’s for concussion. Of these, 77 reported chronic headache after the injury, and 54 of this group were deemed to have “probable” medication overuse headache.

Under the ICHD, medication overuse headache may be diagnosed in patients with frequent headaches (at least 15 days per month) that either developed or worsened while using headache medications such as over-the-counter or prescription analgesics. The diagnosis is considered “probable” if either such medications have not yet been withdrawn or if the headaches continued for up to 2 months after medications were stopped.

Full story of painkillers and concussions at Med Page Today

When a Splitting Headache Is a Migraine (VIDEO)

It feels like “somebody stabbing me through the eyeball with a knife,” “pencils stabbing my ears,” or “explosions going off in my head.” These are some of the ways that Dr. Audrey Halpern’s patients have described the vascular headaches known as migraines. The pain is so severe that it can “cause disability,” said Dr. Halpern, a clinical assistant professor of neurology and migraine expert at NYU Langone Medical Center. “Even if you can make it to work or a social event with a migraine, most of the time you’re not going to be functioning at full capacity.”

The National Headache Foundation (NHF) estimates that more than 37 million Americans suffer from migraines. Women are three times more likely than men to have migraines, which usually strike people between the ages of 15 and 55. While research continues to shed new light on what causes migraines and what they do to the brain, many people don’t understand how debilitating a migraine can be or what makes it different from a bad headache.

According to the NHF, a migraine is generally diagnosed after a patient has had at least five previous headaches that lasted between four and 72 hours. Migraine-related pain is usually felt on one side of the head, and it can be accompanied by nausea and sensitivity to light (photophobia) or sound (phonophobia).

A number of things can trigger migraines including lack of sleep, sunlight, certain foods, hormone levels, noises, staring at a screen, and stress. Brain cells set off the release of chemicals that cause blood vessels around the brain to swell and transmit pain signals.

Full story of headaches and migraines at Everyday Health

Best treatment of your headache varies with the cause

Life can be a pain at times, literally. Every day, one in 20 adults suffers a headache. Stress is usually to blame, but headaches can be caused by a number of things such as dehydration, hormones or environmental factors.

Treatments for Different Headaches and CausesThere are many different types of headaches, and while most are nothing to worry about, you should be aware of symptoms that could signal a serious problem.

Sinus headaches are common and typically accompany allergy symptoms (sneezing, runny nose). Pressure behind the eyes and in the forehead worsens when the head is tilted forward. Over-the-counter medications will relieve symptoms, but the underlying allergy needs to be treated along with any resulting sinus infection.

Tension headaches are the most common. Dull pressure or tightness is felt in a band around the head, resulting from tension in scalp and neck muscles. Over-the-counter medications are a quick fix, but finding ways to relax and avoid stress is recommended. Patients sometimes will need preventive medications to help reduce frequency and severity of these headaches.

Full story of treatments for different headaches at TB 10 News

Photos courtesy of and copyright PhotoPin, http://photopin.com/

Why you should take headaches more seriously

Taking Headaches More SeriouslyA headache can be caused by localised conditions like a toothache, infection in the ear, problems or infections within the nose and other structures on the face, intracranial problems (problems within the skull) which are the major contributors of headaches and vascular causes – popularly known as a migraines. Other causes include high blood pressure, strokes, aneurysms etc. It is the commonest cause for worry amongst patients and often causes so much discomfort that in severe cases it may hamper a person’s day to day activities. (Read: Headaches – why you should take them more seriously)

The symptoms provide clues

The type of headache often indicates the cause for the headache. Headaches, with vomiting and weakness of the limbs often signify a space occupying lesion in the head. Those that are shifting in nature and with an aura are can indicate a migrainous headache and those that occur in the front of the head, and increases on bending would indicate frontal sinusitis (infection of the frontal sinus). (Read: Migraine: Facts you should know)

They affect children too

Headaches were earlier the prerogative of adults. We now find that a larger number of children suffering from  headaches. In most cases they suffer from stress headaches, that are usually due to emotional issues at home, problems with friends at school, tension to perform and the peer pressure syndrome. Other factors include, problems in proper visual acuity or being able to see things clearly, squinting (or slight squint in the eyes) etc. Here is where it is important that the child get his/her eyes tested.  Another startling fact is that there is a marked increase in the number of children suffering from migraines. The positive aspect is that headaches in children are usually without a brain disorder, and can be taken care of fairly easily.

Full story of taking headaches seriously at Health India

Photos courtesy of and copyright PhotoPin, http://photopin.com/

10 stroke symptoms everyone should know

Stroke Symptoms Everyone Should KnowA stroke—a decrease in blood flow to the brain due to a clot or bleeding—is a medical emergency. And doctors often say “time is brain,” meaning the quicker you get treatment, the less likely it is that your brain tissue will be permanently damaged. About 80 percent of strokes are due to a clot (ischemic strokes) and the rest are due to bleeding in the brain (hemorrhagic stroke).

“There are treatments available for stroke that need to be provided within the first 3-4 hours, such as clot-busting medications. That is why urgent attention is critical,” Dr. Seemant Chaturvedi, professor of neurology at Wayne State University School of Medicine, said. So don’t waste time wondering if you should go to the hospital. If you or someone you know has the following symptoms, call 911.

Trouble seeing or blurry vision
Stroke can cause double vision, blurred vision or loss of vision in one eye.

But it may not be as well recognized as facial weakness, arm weakness, and speech problems.

When 1,300 people in the U.K. were asked what symptoms occur in stroke, only 44 percent knew vision loss is a strong indicator.

Full story of stroke symptoms at Fox News

Photos courtesy of and copyright PhotoPin, http://photopin.com/

Headaches are common, but they are not all alike

Headaches Are Not All The SameThere’s no escaping the headache. At one point in your life, you will have one — probably more than one.

“Headache is a very common thing,” says Dr. Heidi Nicola, who added she has seen a multitude of patients for headaches.

But not all headaches are created equal and some can be a sign of something more serious. We talked to Nicola, an internal medicine specialist with Advocate Good Samaritan Hospital in Downers Grove, for more information. Here is an edited transcript of our interview.

Q: What are some common causes for headaches?

A: For me, when I think of headaches, I think about headaches as two main causes — the headache that is the symptom and the headache that is the diagnosis.

Tension headache, migraine headache, cluster headache and over-medication headache are the four most common types of headaches. When the headache is a symptom it might be more dangerous (it could be a brain bleed or a tumor in the brain) and it has different characteristics.

Full story of headache differences at the Chicago Tribune

Photos courtesy of and copyright PhotoPin, http://photopin.com/