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#PARENTS: If kids wet the bed over age 5, they might be at higher risk for the onset of #migraine. If they're over 5, peeing while sleeping AND have #migraine or #headache, the bedwetting is likely neurological, not behavioral. /thread ncbi.nlm.nih.gov/pmc/articles/P…
The relationship bwn #migraine & #sleep disorders is well known: sleepwalking, sleep terrors, insomnia, and, in kids, betwetting over age 5.

The same abnormalities in brain structure & function that make migraine also make sleep disorders.
Migraine & sleep disorders share "common pathophysiological substrates. In particular, the increased prevalence of #migraine in patients with #sleep disorders is associated with the hypothalamus regulation of circadian rhythm" (Ferrara 2016).
Ready? Studies have observed "sympathetic & parasympathetic nervous system hyperactivity" in kids w/ #migraine & bedwetting. Anatomically, many of the same brain structures thought to be involved in the "pathogenesis" of migraine are also involved in bedwetting (Ferrara 2016).
It gets better: "periaqueductal grey matter, the dorsal raphe nuclei & the locus coeruleus represent the 'migraine generator'; furthermore, the locus coeruleus plays an important role in the activation of arousal circuits & it is also related to [bedwetting] pathophysiology."
#Migraine is common in kids. 5-10% of kids age 3+ have the disease; that's 5-10 times the number of kids with #epilepsy. Up to 28% of teens. Each attack makes the brain increasingly susceptible to future attacks. Like adults, kids can develop chronic, continual migraine.
Delayed diagnosis & ineffective treatment of episodic #migraine are leading risks for continual migraine. Kids & adults w/ 4+ migraine or headache days monthly are at high risk of continual migraine & should talk to an MD about preventive meds.
In kids, recurrent headache &/or stomachache are the most common #migraine symptoms & typically involve sensory sensitivity (light, sound, smell, motion, touch). Think Princess & the Pea. Think "Can you cut this tag off my shirt?" Think "My hair hurts."
🟡 If you have hypersensitive skin (to touch, to heat or cold, and/or to wind or hair brushing you) AND recurrent head or stomach pain, you're at higher risk of continual #migraine. That's allodynia, & it's a sign of disease progression in the brain.
🟡 Head pain is only 1 of many full-body, full-brain #migraine symptoms, but 1 Q diagnoses most migraine: Do you have recurrent head pain accompanied by sensitivity to light or sound AND/OR nausea or vomiting?

Multiple days monthly puts you at high risk for CONTINUOUS migraine.
Resources: Fb has a large group for parents whose kids have pediatric or adolescent #migraine.
migraineresearchfoundation.org/about-migraine…

Also>americanmigrainefoundation.org/resource-libra…
2019 practice guideline update for preventive treatment for #migraine in kids:
…adachejournal.onlinelibrary.wiley.com/doi/pdf/10.111…
2020 review: Acute meds for #migraine in kids: Most effective to get pain-free results: sumatriptan with naproxen sodium. Most effective to get pain-relief (lower standard): ibuprofen & ibuprofen suspension. sciencedirect.com/science/articl…
.@headsUPmigraine's fb group is open to anyone: we don't even demand you have #migraine to join the fun! No FB cops! No nosy administrators. No rules. No "Before we let you in, we have a few intrusive Qs." If it weren't on Facebook & we didn't have #migraine, it'd be PERFECT!
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@NitaGhei I didn't know the locus coeruleus plays an important role in the activation of arousal circuits & is related to both #migraine & post-age-5 bedwetting pathophysiology, did you?
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Jill Piggott
@JillPiggott
Study found that head pain (#migraine & #headache) has the "strongest association with suicidality" of all types of #pain. The risk is independent of depression & likely linked to altered functioning of serotonergic systems, not poor coping (Ilgen et al). ncbi.nlm.nih.gov/pmc/articles/P…
"People with chronic #headache or #migraine were 4.3 times more likely to think about suicide, 4.6 times more likely to plan suicide, & 6.5 times more likely to have attempted suicide in the past 12-months than those without chronic headaches" (Ilgen).
Multiple studies report a particularly strong relationship between #migraine & #suicide. But "even after controlling for depression, anxiety disorders, & substance use disorders," most types of severe &/or #ChronicPain are "associated with suicidal thoughts and attempts" (Ilgen).
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Jill Piggott
@JillPiggott
82 people volunteered to taper rx #opioids. In or by the 4th month, 38% dropped out. They were excluded from results. The finding that "Neither pain intensity nor pain interference increased with opioid reduction" is based ONLY on the 62% who stayed in, not all 82. (1/5)
The outpatient study was 4 months long. Oliva (BMJ 2020) found post-discontinuation deaths (OD/suicide) are highest in the 1st 3 months. I assume researchers checked to see whether anyone died, but it's not mentioned in the paper. (2/5)
Here's what the study actually found: For the 62% who successfully tapered, neither pain intensity nor interference increased w/ rx #opioid reduction. No information is available about why 38% of participants did not successfully taper or dropped out. (3/5)
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Jill Piggott
@JillPiggott
Risk of OD in medical use of #opioids is highest in doses ≥100 MME but still less than one quarter of 1% (0.23%).

Canadian Guideline for Opioid Therapy (2017)

thread: 3 studies on #suicide, OD, & rx opioids
ncbi.nlm.nih.gov/pmc/articles/P…
2009 study: moderate to severe #pain triples the risk of #suicide even in otherwise healthy people "independent of poor functional capacity or chronic medical illness.”

Untreated pain can lead to death by suicide "unnecessarily and prematurely.” jpsmjournal.com/article/S0885-…
2016 VA study didn't find evidence to support the claim that increases in med'l #opioid use lead to increases in intentional OD.
ncbi.nlm.nih.gov/pmc/articles/P…
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