Caffeine Withdrawal: A Model for Migraine?
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Headache 561 reflected in your external appearance, the basis by which we talk about race, the answer seems to be in the range of .01%.” In spite of tired racist comments to the contrary, there are far more differences between migraineurs and nonmigraineurs than there are between people of different races. The differences between races, aside from melanin in the skin, would appear to in- volve minor orthopedic and muscular features. Ac- cording to the majority of writers and researchers, there are no significant differences in intelligence, or- gan systems, or cerebral neurons. Blacks are not more hypersensitive to visual stimuli, nor do they suf- fer more or less migraine. (Asians may or may not suffer more migraine, an issue which is yet to be set- tled.) The calcium channels of American minorities appear to be similar, as far as we know. It’s ironic, then, that the physical characteristics of being, say, white versus Asian, which are superfi- cial and immediately apparent have been given so much importance. In fact, if one insists on being a bigot, he or she should attack migraineurs for all of our numerous and sundry differences from the norm. We’re an insidious presence in their midst, prone to mutually inconvenient attacks of disabling headache, unable to sit in the backseats of their cars, and likely to tell them to quit smoking. We offend them because we don’t wish to try their homemade wine, and we don’t care for their perfume or aftershave lotion. In short, it can be a nuisance to have us around, damn fluorescent light-hating Homo sapiens migrainosums. Granted, it’s probably not an issue of paramount importance whether or not migraineurs receive desig- nation as a subspecies, but at least the argument in fa- vor might enable the citizen migraineurs to regard his or her malady more realistically. Migraine is an inher- ent part of us who are afflicted—not an acquired per- sonality defect. Whether to deny its existence save for the acute eruptions, to quail before it as a foreign in- truder, or to wear its presence as a badge of shame, all involve a misperception of self that can result in a life of needlessly reduced quality. It explains why just about everything in life can be affected by the disease. In closing, perhaps it would probably be better for all if the migrainous subspecies amidst us mated only with other members of the subspecies. Certainly, there would be more empathy for the condition within the home. Unfortunately, this would require polygamy, or elsewise two thirds of migrainous women would re- main single, searching in vain for another unattached male with recognized migraine. Robert Singer, MD Northwest Headache Clinic 13107 121st Way NE Seattle, WA 98034 SUGGESTED READINGS Thain M, Hickman M. Biology. London: Penguin; 1996. Quammen D. The Song of the Dodo. New York, NY: Touchstone Books; 1997. Silberstein SD. Wolff’s Headache. New York, NY: Ox- ford University Press; 2001. Olesen J. Genetics of Headache Disorders. Baltimore, Md: Lippincott Williams & Wilkins; 2000. Cenicola T. Do races differ? Not really, genes show. The New York Times. August 22, 2000. Caffeine Withdrawal: A Model for Migraine? Caffeine withdrawal syndrome, readily induced and similar in many respects to migraine, might make an excellent experimental model for studying pri- mary headache. Caffeine withdrawal and primary headache are remarkably alike. Caffeine withdrawal, like migraine, has been demonstrated to cause severe headache, hemicrania, nausea/vomiting, and dysphoria. Both caffeine withdrawal and migraine are accompanied by vasodilation in the head and neck. Both caffeine withdrawal and migraine are commonplace and irreg- ularly episodic. Both are, in many cases, relieved by administration of caffeine. Because the mechanism by which caffeine works is known, the mechanism of caffeine addiction and withdrawal may offer insight into the mechanisms of primary headache. The nature of caffeine withdrawal, however, needs to be better understood before it can be used as a model for primary headache. For one thing, caffeine withdrawal so closely resembles pri-
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Transcript of Caffeine Withdrawal: A Model for Migraine?
Headache
561
reflected in your external appearance, the basis bywhich we talk about race, the answer seems to be inthe range of .01%.”
In spite of tired racist comments to the contrary,there are far more differences between migraineursand nonmigraineurs than there are between peopleof different races. The differences between races,aside from melanin in the skin, would appear to in-volve minor orthopedic and muscular features. Ac-cording to the majority of writers and researchers,there are no significant differences in intelligence, or-gan systems, or cerebral neurons. Blacks are notmore hypersensitive to visual stimuli, nor do they suf-fer more or less migraine. (Asians may or may notsuffer more migraine, an issue which is yet to be set-tled.) The calcium channels of American minoritiesappear to be similar, as far as we know.
It’s ironic, then, that the physical characteristicsof being, say, white versus Asian, which are superfi-cial and immediately apparent have been given somuch importance. In fact, if one insists on being abigot, he or she should attack migraineurs for all ofour numerous and sundry differences from the norm.We’re an insidious presence in their midst, prone tomutually inconvenient attacks of disabling headache,unable to sit in the backseats of their cars, and likelyto tell them to quit smoking. We offend them becausewe don’t wish to try their homemade wine, and wedon’t care for their perfume or aftershave lotion. Inshort, it can be a nuisance to have us around, damnfluorescent light-hating
Homo sapiens
migrainosums.Granted, it’s probably not an issue of paramount
importance whether or not migraineurs receive desig-nation as a subspecies, but at least the argument in fa-vor might enable the citizen migraineurs to regard hisor her malady more realistically. Migraine is an inher-ent part of us who are afflicted—not an acquired per-sonality defect. Whether to deny its existence save forthe acute eruptions, to quail before it as a foreign in-truder, or to wear its presence as a badge of shame, allinvolve a misperception of self that can result in a lifeof needlessly reduced quality. It explains why justabout everything in life can be affected by the disease.
In closing, perhaps it would probably be better forall if the migrainous subspecies amidst us mated onlywith other members of the subspecies. Certainly, there
would be more empathy for the condition within thehome. Unfortunately, this would require polygamy, orelsewise two thirds of migrainous women would re-main single, searching in vain for another unattachedmale with recognized migraine.
Robert Singer, MDNorthwest Headache Clinic
13107 121st Way NESeattle, WA 98034
SUGGESTED READINGS
Thain M, Hickman M. Biology. London: Penguin; 1996.Quammen D. The Song of the Dodo. New York, NY:
Touchstone Books; 1997.Silberstein SD. Wolff’s Headache. New York, NY: Ox-
ford University Press; 2001.Olesen J. Genetics of Headache Disorders. Baltimore,
Md: Lippincott Williams & Wilkins; 2000.Cenicola T. Do races differ? Not really, genes show. The
New York Times. August 22, 2000.
Caffeine Withdrawal: A Model for Migraine?
Caffeine withdrawal syndrome, readily inducedand similar in many respects to migraine, might makean excellent experimental model for studying pri-mary headache.
Caffeine withdrawal and primary headache areremarkably alike. Caffeine withdrawal, like migraine,has been demonstrated to cause severe headache,hemicrania, nausea/vomiting, and dysphoria. Bothcaffeine withdrawal and migraine are accompaniedby vasodilation in the head and neck. Both caffeinewithdrawal and migraine are commonplace and irreg-ularly episodic. Both are, in many cases, relieved byadministration of caffeine.
Because the mechanism by which caffeine worksis known, the mechanism of caffeine addiction andwithdrawal may offer insight into the mechanisms ofprimary headache. The nature of caffeine withdrawal,however, needs to be better understood before it canbe used as a model for primary headache. For onething, caffeine withdrawal so closely resembles pri-
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mary headache that a way to distinguish between thetwo is needed. Currently, the only known way to dis-tinguish between them is to exclude the possibility ofcaffeine withdrawal, an exclusion not possible in out-patients.
And, the relationship between caffeine withdrawaland primary headache needs clarification. Does caf-feine withdrawal cause, influence, or merely resemblemigraine? Currently, it is not clear whether caffeinewithdrawal is distinct and separate from primary head-
ache or not. Nor is it known how often, if ever, caffeinewithdrawal is mistaken for primary headache, or viceversa.
To find the answers, studies of primary headacheand headache treatments should control for caffeinewithdrawal, a demonstrated cause of headache.
Barry [email protected]
