Neural mechanism for hypothalamic-mediated autonomic responses to light during migraine.

Migraineurs avoid light because it intensifies their headache. However, this is not the only reason for their aversion to light. Studying migraineurs and control subjects, we found that lights triggered more changes in autonomic functions and negative emotions during, rather than in the absence of, migraine or in control subjects, and that the association between light and positive emotions was stronger in control subjects than migraineurs. Seeking to define a neuroanatomical substrate for these findings, we showed that, in rats, axons of retinal ganglion cells converge on hypothalamic neurons that project directly to nuclei in the brainstem and spinal cord that regulate parasympathetic and sympathetic functions and contain dopamine, histamine, orexin, melanin-concentrating hormone, oxytocin, and vasopressin. Although the rat studies define frameworks for conceptualizing how light triggers the symptoms described by patients, the human studies suggest that the aversive nature of light is more complex than its association with headache intensification.

Migraine photophobia originating in cone-driven retinal pathways.

Migraine headache is uniquely exacerbated by light. Using psychophysical assessments in patients with normal eyesight we found that green light exacerbates migraine headache significantly less than white, blue, amber or red lights. To delineate mechanisms, we used electroretinography and visual evoked potential recording in patients, and multi-unit recording of dura- and light-sensitive thalamic neurons in rats to show that green activates cone-driven retinal pathways to a lesser extent than white, blue and red; that thalamic neurons are most responsive to blue and least responsive to green; and that cortical responses to green are significantly smaller than those generated by blue, amber and red lights. These findings suggest that patients' experience with colour and migraine photophobia could originate in cone-driven retinal pathways, fine-tuned in relay thalamic neurons outside the main visual pathway, and preserved by the cortex. Additionally, the findings provide substrate for the soothing effects of green light.

Complementary and alternative medicine use among adults with migraines/severe headaches.

OBJECTIVE: Our objective was to determine patterns, reasons for, and correlates of complementary and alternative medicine (CAM) use by US adults with migraines/severe headaches. BACKGROUND: While many patients with chronic conditions use CAM, little is known about CAM use by adults with migraines/severe headaches. METHODS: We compared CAM use between adults with and without self-reported migraines/severe headaches using the 2007 National Health Interview Survey (n=23,393), a national cross-sectional survey. RESULTS: Adults with migraines/severe headaches used CAM more frequently than those without (49.5% vs 33.9%, P< .0001); differences persisted after adjustment (adjusted odds ratio=1.29, 95% confidence interval [1.15, 1.45]). Mind-body therapies (eg, deep breathing exercises, meditation, yoga) were used most commonly. More than 50% of adults with migraines/severe headaches reporting CAM use had not discussed it with their health care provider. Nonetheless, those with migraines/severe headaches used CAM more often than those without because of provider recommendation and because conventional treatments were perceived as ineffective or too costly. Correlates of CAM use among adults with migraines/severe headaches included anxiety, joint or low back pain, alcohol use, higher education, and living in the western USA. Only 4.5% of adults with migraines/severe headaches reported using CAM to specifically treat their migraines/severe headaches. CONCLUSIONS: CAM is used more often among adults with migraines/severe headaches than those without. However, few report using CAM to specifically treat migraines/severe headaches. Mind-body therapies are used most frequently. Further research is needed to understand the effectiveness and mechanisms of CAM treatments in adults with migraines/severe headaches.

n-3 fatty acids and periodontitis in US adults.

BACKGROUND: Periodontitis is a common, chronic inflammatory disease. Although n-3 fatty acids have anti-inflammatory properties, it is unclear whether n-3 fatty acids can treat or prevent periodontitis. METHOD: We studied 9,182 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey between 1999 and 2004. Periodontitis was assessed by dental exam and was defined as >4 mm pocket depth and >3 mm attachment loss in any one tooth. Intake of n-3 fatty acids was assessed by 24-hour dietary recall. We used multivariable logistic regression to estimate the associations between periodontitis and intakes of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and linolenic acid (LNA). RESULTS: The weighted prevalence and 95% confidence interval (CI) of periodontitis was 8.2% (95% CI 7.0 to 9.4). Compared with the lowest tertiles, the adjusted odds ratios for periodontitis associated with the highest tertiles of dietary n-3 intake were 0.78 (95% CI 0.61 to 1.00; P=0.009) for DHA, 0.85 (95% CI 0.67 to 1.08; P=0.10) for EPA, and 0.86 (95% CI 0.60 to 1.23; P=0.28) for LNA. The associations were little changed by multivariable adjustment or exclusion of individuals reporting use of dietary supplements containing DHA, EPA, or LNA. CONCLUSIONS: In this nationally representative sample, higher dietary intakes of DHA and, to a lesser degree, EPA, were associated with lower prevalence of periodontitis. Interventional studies are needed to confirm the potential protective effects of n-3 fatty acids on periodontitis.

Herbal supplement use and blood lead levels of United States adults.

BACKGROUND: Some herbal supplements may contain lead. OBJECTIVE: To examine whether use of specific herbal dietary supplements during the last 30 days is associated with blood lead levels in US men and women. DESIGN: Cross-sectional analysis. STUDY POPULATION: NHANES participants from 1999-2004, a representative sample of the civilian non-institutionalized US population. MEASUREMENTS: Lead was measured in blood. Associations between lead and self-reported supplement use were estimated using multivariable regression weighted to account for NHANES sampling. Herbal supplements investigated were those previously reported to contain high heavy metal content: Ayurvedic or traditional Chinese medicine herbs, echinacea, ginkgo, ginseng, St. John's wort, and "other" herbs (specifically, kava, valerian, black cohosh, bee pollen, and nettle). MAIN RESULTS: Among 6,712 women > or =20 years, those using herbal supplements had lead levels that were 10% higher than non-users (95% CI 3%-17%, p = 0.005). Women using Ayurvedic or traditional Chinese medicine herbs, St. John's wort, and "other" herbs had lead levels 24% (95% CI 5%-45%, p = 0.01), 23% (95% CI 4%-46%), p = 0.02), and 21% (95% CI 2%-44%, p = 0.03) higher, respectively, than non-users. No significant associations were observed between herb use and lead levels among men (n = 6,095). Among reproductive-aged women (16-45 years), herbal supplement users had lead levels 20% higher than non-users (95% CI 5%-34%, p = 0.008). In contrast, garlic and other dietary supplements were not associated with higher lead levels. CONCLUSION: Use of specific herbal supplements is associated with higher blood lead levels among women. Our data suggest testing guidelines for herbal supplements and regulations limiting lead in supplements are needed.

Factors and common conditions associated with adolescent dietary supplement use: an analysis of the National Health and Nutrition Examination Survey (NHANES).

BACKGROUND: Little is known about the prevalence of dietary supplement (DS) use in American adolescents. We conducted this study to analyze the prevalence of DS use and factors associated with this use in a national population-based sample. METHODS: We used data from the 1999 - 2002 National Health and Nutrition Examination Surveys (NHANES) for adolescents age 11 to 19. Using weighted logistic regression, we identified demographic and clinical factors associated with the use of any DS, vitamins or minerals, herbs and other DS. RESULTS: Among the 5,306 responses representing approximately 36 million Americans 11-19 years old, 27% reported use of one or more DS in the prior month. The most commonly used DS were: multivitamins (16%) and vitamin C (6%). In the multivariable analysis, African American [adjusted odds ratio 0.40 (0.31-0.50) 95% CI] and Mexican American [0.55 (0.44-0.69)] adolescents were less likely to use DS compared with non-Hispanic whites. DS use was more common in those who used prescription medications [1.37 (1.10-1.72)] and among those who had a diagnosis of chronic headaches [1.25 (1.04-1.50)]. DS use was less common among those reporting fair or poor health status [0.59 (0.40-0.88)]. CONCLUSION: Twenty seven percent of American adolescents use DS. DS use is higher among teens that use prescription medications; physicians and pharmacists should be aware of this, ask patients, and check for potential interactions.

Use of dietary supplements among United States adults with coronary artery disease and atherosclerotic risks.

The study seeks to describe the use of dietary supplements promoted for cardiovascular health and the relation between supplement use and coronary artery disease (CAD) and the presence of major CAD risk factors. The aim is also to explore whether use of medications for the treatment of cardiovascular disease or diabetes mellitus (DM) is associated with supplement use. We performed a cross-sectional analysis of the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) of 6,671 adults (representing 119.3 million US adults) aged > or =40 years. We categorized adults into 4 nonoverlapping groups as (1) having reported CAD or stroke (CAD/stroke), (2) DM without CAD/stroke, (3) hypertension (HTN) or hypercholesterolemia (HC) without CAD/stroke or DM (HTN/HC), or (4) none of these conditions (no reported CAD/CAD risk) and performed weighted (NHANES) multiple logistic regression to determine the odds of using supplements (reference group, no reported CAD/CAD risk). After controlling for sociodemographics, health, and lifestyle factors, we found that persons with CAD/Stroke used more supplements (any), vitamin E, folic acid, and niacin, and less fish oil. Those with DM used less coenzyme Q10, and adults with HTN/HC used more supplements (any), herbs (any), and ginseng. Adults with CAD/stroke who used medications for the treatment of cardiovascular disease or DM were more likely to use folic acid compared with those who did not use medications for these conditions. In adults with CAD/stroke, DM, or HTN/HC, those who did not use medications for these conditions were more likely to use herbs and other select supplements. In conclusion, use of dietary supplements is common in those with CAD or CAD risks.

Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses' health study.

PURPOSE: Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM). PATIENTS AND METHODS: We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers. RESULTS: Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery. CONCLUSIONS: Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

Systematic review of the effects of ginseng on cardiovascular risk factors.

OBJECTIVE: To examine the evidence for the efficacy of ginseng (Panax spp.) on cardiovascular risk factors, including blood pressure, lipid profiles, and blood glucose, and to summarize reported cardiovascular adverse events. DATA SOURCES: We searched MEDLINE, AMED, BIOSIS, CAB, EMBASE, and the Cochrane Controlled Trials databases through July 2005 and performed hand searches of bibliographies. STUDY SELECTION AND DATA EXTRACTION: Short- or long-term, randomized, controlled trials and nonrandomized studies published in English were included. Data were extracted in a standardized manner, and 2 independent investigators assessed methodologic quality of the studies. Thirty-four studies were identified with results for blood pressure, lipids, and/or blood glucose. Due to heterogeneity of the studies, we were unable to perform a meta-analysis. Data on cardiovascular adverse events were extracted from events reported in identified studies and from case reports. DATA SYNTHESIS: The majority of studies were short term. Ginseng may slightly decrease blood pressure compared with placebo (range 0-4%). We found mixed results for an effect on lipids, with 5 of 9 studies showing improvement in one or more lipid parameters compared with baseline (range 7-44%). We identified several studies showing that ginseng lowers blood glucose, but overall studies were inconsistent. CONCLUSIONS: Current evidence does not support the use of ginseng to treat cardiovascular risk factors. Some studies suggest a small reduction in blood pressure. Despite some evidence showing that ginseng lowers blood glucose and improves lipid profiles, well-designed, randomized, controlled trials evaluating its effects are lacking.