Archives for February 2013

A few weeks ago, on an otherwise uneventful Sunday afternoon, I got an urgent call on my cell phone from my daughter-in-law, Robin, a vigorous 42-year-old. She was calling from her health club, barely “10 minutes into a decent run” on the treadmill

Suddenly, she told me, she had gotten a “hole” in her vision in her right eye, and zig-zaggy lines like lightening when she closed her eye, a predictable sign, she knew from past experience, that a migraine headache was about to start.

An exercise-induced migraine was not a total surprise for Robin, who has had about a dozen such episodes over the years. “It does make me scared to exercise for a few days,” she told me later. “But then I just get on with my life. I only get four or five migraines a year, so it’s not as scary for me as for some people.”

For years, exercise has been believed to be a significant “trigger” for migraines, along with other triggers, or premonitory symptoms, such as food cravings, being very tired, mood changes, increased urges to urinate, muscle aches, stuffy noses – all part of what Dr. Carolyn Bernstein, a neurologist and migraine specialist at Beth Israel Deaconess Medical Center calls the “build up of what’s changing in the brain before migraine pain gets going.”

But in a recent study in the journal Neurology, researchers explored the exercise-migraine link in a novel way.

They gathered 27 people, good sports and brave souls all, who reported getting migraines with aura that were triggered by bright or flickering light or strenuous exercise. (Migraine auras are typically visual symptoms like Robin had, but can also be other sensory problems or even difficulty speaking.)

The researchers, from the University of Copenhagen, then deliberately exposed the 27 volunteers in the lab to light stimulation, strenuous exercise or both. For the exercise stimulus, patients either went for an intense run or used an exercise bike for an hour, reaching 80 percent of their maximum heart rate. They were also exposed to bright light for 30 to 40 minutes, then were monitored for three hours afterwards and told to report any symptoms of migraine or migraine with aura.

Surprisingly, hardly anyone did. Only three patients reported an attack of migraine with aura after being exposed to light or exercise; three others reported a migraine without aura. Nobody got a migraine with exposure solely to light.

The fact that these triggers for migraine were not as powerful as long believed has left researchers scratching their heads.

Perhaps, suggested two headache specialists in an editorial accompanying the research, the triggers that people believe are harbingers of migraines are not so much triggers that lead to migraines as symptoms of a migraine already in progress.

“Are patients driven to exercise as a premonitory symptom and could their migraines be the cause, not the consequence?” they wondered. “Is the association with light simply reporting photophobia during the premonitory phase?”

Good questions, of course. But here’s an even more important one: What is a migraine patient – most of whom are young women like Robin – to do? Exercise? Not exercise? Avoid other supposed triggers as well?

“It’s a delicate balancing act,” the study’s lead author, Jes Olesen, said in an email. “People with migraines are often told to avoid triggers, including exercise, but exercise is a valuable health activity, and it doesn’t make sense to tell people with migraines to avoid all exercise.”

The solution, in other words, becomes a juggling act. If pounding up and down while running on the pavement or a treadmill brings on migraines, said Bernstein, perhaps exercising on a stationary bike or elliptical machine might help, though Robin has gotten migraines on elliptical machines, too.

If ramping up your heart rate triggers migraines, “you might walk for a while but not increase your cardiac rate.” If getting hot and sweaty brings on an attack, staying cool by swimming might be the solution.

Be vigilant, Bernstein said, and keep a diary of when migraines occur, noting exactly what was going on prior to the attack, including stress level, sleep loss, mood changes, exercise patterns and so on.

But don’t let migraines become an excuse not to exercise. “The idea is to understand how exercise affects your migraines, but don’t think it’s a license to say, ‘Okay, I won’t exercise.’ ”

Robin agrees: “If I think I’m close to getting a migraine,” she said, “I won’t exercise. But otherwise, I do.”

(This post was originally published in WBUR’s CommonHealth blog, 2/19/13)

Nearly two years ago, a giant earthquake off the coast of Japan sent a 13-meter high tsunami crashing into the Fukushima Daiichi nuclear power plant, causing meltdowns in three of the six reactors and ultimately, triggering an explosion. Thousands were killed by the tsunami and earthquake.

No one has died from radiation and in fact no radiation health effects have yet been observed among the public or workers, according to a December, 2012 statement from a United Nations expert committee.

But even as the actual health effects from radiation — at least so far — are turning out to be much less dramatic than many people feared, a host of other, less-feared but very real, outcomes are causing lasting trouble. These include mental health problems such as alcoholism, depression, anxiety and, in the case of children whose parents and teachers are too afraid to let them play outdoors, a rise in obesity.

It is a striking illustration of what often happens in public health. What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks. We fully believe, for instance, that we are being killed by toxic stuff in our air, water and food and ignore the huge health risks from sedentary lifestyles.

What we think we should be most afraid of is often, in reality, less dangerous than we think, while other things that we are blasé about, carry higher risks.

A fascinating article in last month in the journal Nature illustrates the point beautifully.

The Fukushima Health Management Survey, described in detail in the Nature article, found that the doses of radiation experienced by people evacuated from the nuclear zone were surprisingly low. For nearly all the evacuees, the exposure level was only about 25 millisieverts (mSv). That is considerably less than the 100-mSv level, at which risks from radiation, including cancer, are believed to increase. (A Sievert is a unit of ionizing radiation.)

And this is not the only research team to have found lower levels of radioactive pollution than feared. A World Health Organization project studied exposure to radiation in the six months after Fukushima.

The report concluded that “the estimated effective doses outside Japan from the Fukushima Daiichi NPP accident are below (and often far below) dose levels regarded as being very small by the international radiological protection community. Low effective doses are also estimated in much of Japan.”

Even right around Fukushima the report said, “the effective doses are estimated to be below 10 mSv, which can be considered within the order of magnitude of the natural radiation background, except in two locations.”

Indeed, that 10 mSv level is not dramatically more than the 6.5 mSv the average American gets every year from natural background radiation and medical procedures, according to another assessment of Fukushima after effects in the March, 7, 2012 Scientific American. That article, too, notes that heart disease and depression are likely to claim more lives post-Fukushima than radiation.

Indeed, the emotional fallout from Fukushima is serious. The big Japanese survey asked the more than 200,000 evacuees about their stress and anxiety and found that they showed about five times the normal rates of extreme stress, with children showing about double the normal levels.

Ronald Kessler, a professor of Health Care Policy at Harvard Medical School, said in an email that he was not surprised by this. “The possibility of radiation exposure creates long-term uncertainty that can complicate emotional recovery…the anxiety associated with this uncertainty, if not managed, could itself create long-term health problems even in the absence of subsequent physical health problems caused by radiation exposure.”

Obesity, too, is another serious consequence of radiophobia, or radiation fears, as the British newspaper, The Guardian, recently reported. Children in the Fukushima area are now the most obese in Japan, according to an education ministry report, because post-Fukushima radiation fears have meant restrictions on outdoor exercise.

All very sobering. Obviously, no one would advocate skimping on safety procedures around nuclear plants. In fact, the rapid evacuation of people out of the immediate Fukushima power plant area probably contributed substantially to the low radiation levels among the general public.

But if Fukushima is teaching us that our fears of radiation may be exaggerated, it also provides another lesson: That we should take seriously the more mundane, but potentially more lethal, aftereffects of disasters such as anxiety, depression, alcoholism and physical inactivity.