Bob Martin
This is the second in a series of articles on the connection between Migraine headache and Ear Disease. Part 1 explained the theory of vestibular-related migraine. There will be one more post from our distinguished contributor, Dr. Bob Martin in a couple of weeks. We appreciate all of his insight and knowledge these past few years!
In conventional medicine, when we talk about ear, eye, or nose disease we tend to focus on one specific part of the body. Take the “sinuses” for example. It is almost impossible to talk about “sinus headaches” without thinking about the tissues in the sinuses. One would anticipate treatment to be directed to these tissues; a nose spray comes to mind.
But, as you will see in this series of articles, it may be a mistake to believe that a “sinus headache” is a problem that originates in the sinuses. A genetic defect that causes an inability to habituate an obnoxious response may be the actual cause.
This series of blog posts discusses genetic defects that affect the different areas in the head that are served by the trigeminal nerve. The new understanding suggests that “sinus headache,” for example, is the result of defective Trigeminal nerve function that is caused by a genetic defect that brings about destructive inflammation. If this theory is true, treatment of sinus headache will be directed toward calming down the Trigeminal nerve.
In a recent talk published in Audio-Digest, Otolarygology, Volume 46, Issue 06, March 21, 2013, Michael Teixido, MD, talked about research that he said “rocked the professional world.” He told about a study in which patients with sinus headache were sent to physicians with three different medical specialties: ear, nose and throat (ENT), allergy, and neurology. These patients had a history of both sinus headache and migraine headache. As you might anticipate, the physicians tended to treat these patients based on their own specialties’ point of view. Thus, ENT physicians tended to treat the sinus headache as a problem associated with the nose. The connection between the sinus headache and migraine headache was seldom recognized.
Dr. Teixido suggested a new approach, one that posits a genetic defect as the cause.
WHY DO AUDIOLOGISTS NEED TO KNOW THIS?
You may ask, “Why do I need to know this?” The answer is simple. Many of your patients and friends are impacted by this problem. The solution—a far more effective treatment—is now possible.
We are entering a new era of medicine. The field of genetics is quickly rewriting medical books and changing medical diagnostics. Diseases that were once thought to be conditions of the “ear” are now seen as diseases that result when genetic defects are expressed. The cause of some types of hearing loss, nose problems, and balance disorders may be genetic in nature.
Many people suffer from these disorders. No doubt you have patients and friends who get migraines. The disease may be affecting their “head” and/or their “ears.” You may need to help them understand and manage the problem from a “migraine” point of view, regardless of whether or not they are experiencing headaches. Treatment often involves dietary restrictions, behavioral changes (avoiding triggers), and medications. In a few cases, the elimination of coffee from the diet eliminated the patient’s symptoms.
It may sound strange to say you are going to manage an ear (vestibular or cochlear) problem by managing triggers (especially migraine triggers). But if this new theory on migraine holds, then many traditional diseases (BPPV, vertigo, Meniere…) may, in the future, be treated by working with food, stress, or motion triggers.
These patients must often work with a variety of medical specialties: their family doctor, an ENT, an oto-neurologist, a dietitian, a physical therapist, and an audiologist. We are part of this treatment team because many of these people have problems with hearing and balance, and we serve the role of counselor, advisor, and/or hearing aid specialist.
I will continue this discussion in my final post and cover some of the specifics on dealing with the patient.
