Stanford headache specialist demystifies migraine auras

Photo by r. nial bradshaw

I have close friends who get debilitating migraines so I knew a bit about auras, which are sensory disturbances that often precede migraine headaches. But experiencing one myself was still quite frightening.

It snuck up on me: I was happily reading a novel in bed when a spot on the page became blurry, even when I closed one eye. It quickly expanded in size, turning into a flickering, zig-zag pattern. After checking online and guessing that I probably had a migraine aura, I tried to go to sleep — and that’s when it really got weird. Suddenly I saw the geometric pattern in color moving across my field of vision, even when I had my eyes closed.

Luckily, my aura lasted less than 30 minutes, so I was eventually able to go to sleep. I was also very happy to avoid the unbearable headache pain common in migraines. But my experience inspired me to learn more about auras.

According to Stanford neurologist Nada Hindiyeh, MD, about 30 percent of people that suffer from migraines get an aura before their headache pain. However, migraine auras can also occur without a headache. This used to be called an ocular migraine, but it is now classified by the International Headache Society as a “typical aura without headache,” she said.

“Aura is a term used to describe focal neurological disturbances that precede a migraine headache and typically develop over a 5 to 60 minute period and last less than an hour. The most common neurological symptoms include visual changes,” said Hindiyeh, who works at the Stanford Headache Clinic. “During a visual aura, people may describe a blind spot in part of their field of vision, sparkles or stars, colored spots, zig-zag lines, flashes of light or tunnel vision.”

A migraine aura is thought to be initiated by a phenomena in the brain known as cortical spreading depression — a self-propagating wave of electrical silence in which cortical neurons stop firing and go quiet. This starts a chain of reactions in the brain that causes the various symptoms of a migraine attack, Hindiyeh explained.

A long list of factors can trigger migraines, she said, including stress, changes in sleep patterns, hormonal changes in women, skipping meals, and eating certain foods and beverages such as high processed foods and excessive caffeine.

“Migraine symptoms can change throughout a person’s lifetime. Attacks of migraine aura without a headache are more common as migraine sufferers get older,” Hindiyeh said. “However, if you are older than the age of 40 and develop a migraine with aura for the first time, you should be evaluated by a neurologist. If needed, you may then be referred to a headache specialist.”

And it turns out I’m not the only one who finds auras frightening. “Having an aura can be quite a scary experience,” Hindiyeh said. “Talk to your doctor about what steps to take when you do have one, such as pulling over if you’re driving, taking deep breathes, lying in a dark room or taking specific medication. That way you have an action plan in place and are prepared when an aura comes on.”

Hindiyeh said she has focused her research and practice on migraines because she believes it to be an underdiagnosed and undertreated disease. “Migraine affects 36 million people nationwide and is the seventh leading cause of disability worldwide. These statistics are staggering. I felt that this was a field in neurology where I could hopefully provide care for many patients, and raise awareness about this disabling disease.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Stanford medical student juggles his studies, graphic art and numerous extracurriculars

Collage by Ryan Brewster

I’m a freelance science writer adept at multi-tasking. But I feel like I’ve been sitting on both hands when I read the jam-packed resume of Stanford medical student Ryan Brewster.

For nearly two decades Brewster competed as a nationally ranked mogul skier, but knee Injuries led to his retirement in 2011 and a new career in medicine. While studying molecular biology and biochemistry at Middlebury College, he kept himself busy as an EMT, an advocate of sustainable agriculture in Rwanda, a Spanish-English medical interpreter at a community health center, a senior admissions fellow and the co-founder and graphic designer of Ron’s Closet Apparel Company — and that’s just a few highlights. After working as a research assistant at Harvard Medical School, he headed to Stanford for medical school last fall.

Intrigued, I spoke with Brewster about what he’s doing now. I admit that I was hoping to learn his multitasking secrets, but I was also really interested in his graphic art.”

How did you get started as a graphic artist?

“For as long as I can remember, visual art has been an important tool for self-expression. An engineer, architect and carpenter, my father encouraged me from a young age to communicate ideas in creative ways. I spent most of my childhood drawing before teaching myself computer software, such as Photoshop, in high school. It soon became clear that this interest could be applied to all my activities — from biomedical research to community service.

My skills in graphic design and illustration have been honed experientially rather than through any formal training. Starting a clothing brand, creating visual aids for community health workers in Rwanda and maintaining a healthy habit of doodling, among so many other opportunities, has allowed me to develop technically and stylistically. My style has largely been informed by Owen Davies, Chip Kidd, Jorgen Grotdal, Frank Netter and Mary Kate McDevitt. Furthermore, I have benefitted tremendously at Stanford from the support of Samuel Rodriguez, MD; Audrey Shafer, MD; Jacqueline Genovese; and artist Lauren Toomer, who have provided many opportunities to further my training in the arts.”

What have you been working on recently?

“I was the student coordinator for this year’s Medicine and the Muse symposium. I designed the marketing and branding materials, and exhibited a collection of anatomy-inspired illustrations (shown above).

Another first year MD candidate, Jacob Blythe, and I were fortunate to be selected as recipients of the Stanford MashUp Grant. It awarded us $600 to produce an art installment. We created a 3-D collage of the humerus and associated vasculature encased in glass. The piece is based on the novel Blood of the Lamb, which concerns a young girl who passes away from leukemia. Jacob and I wanted to capture this narrative of illness using related ‘artifacts,’ including blood smears, medical charts and actual pages from the book.

Also, earlier this year, James Lock, MD, approached me on behalf of a Stanford Medicine-wide diversity committee. They wanted to make a pin to be worn by physicians as a mark of LGBTQ alliance. The design features a DNA molecule with the traditional pride colors. This was a particularly rewarding project and we hope to have the pins fabricated and distributed by the end of the summer.”

And you sing, too?

“Another important artistic passion has been acoustic guitar and songwriting. The same imperatives that motivate me as a graphic designer similarly motivate me as a musician. Composing and performing a song challenges you to not only bear your emotions and feelings, but also to communicate them in a way that is relatable to your audience. Knowing that so many students held identities beyond that of future physician, Stanford medical students Shay Aluko, Andrea Garofalo and I founded the Stanford Medicine Open Mic to create a space for musicians, dancers, poets and other artists to showcase their talents.”

Are there other interests you’d like to mention?

“In the fall quarter, I completed the course Biodesign for Mobile Health, which exposes students to the emerging field of mobile technology. My project team — comprising two medical students, an undergraduate product designer and a bioengineering PhD student — developed a platform targeting users of the Supplemental Nutrition Assistance Program. Specifically, our NuLeaf team aims to provide individualized nutritional recommendations based on one’s health condition, budget, location and cultural preference. As Biodesign NEXT fellows, we have developed a functional prototype and have established strong partnerships with the Second Harvest Food Bank, physicians and other stakeholders. We hope to pilot the product with a local user population by the end of the summer.

Athletics also remain central to my wellness and extracurricular activities. Since retiring as a skier and college baseball player, I took up distance running and have struggled through several half- and full-length marathons. I am also an avid backpacker and camper. In fact, a major reason for choosing Stanford was the allure of the many outdoor playgrounds found in the state.”

How do you balance your different interests?

“Each of my activities serves as a reprieve from the other. Art balanced by science. The outdoors and fitness balanced by studying (unfortunately the latter wins out more often than not). Self-care balanced by community. That said, the past months have been a tremendous exercise in time management. ‘Triaging’ my commitments has not been easy, but it has allowed me to continue the things I value most.”

What are your career plans as an artist and physician?

“On one hand, I hope my career will marry the arts and medicine in direct ways, through medical illustration and data visualization. Perhaps of greater importance is the ethic of the artist carried by the physician. Doctors must be storytellers. They must be able to enter the patient’s world, listening, absorbing and acting on his/her narrative to inform treatment. The humanistic orientation in medicine requires the strengths of an artist — the observational skills to examine details beyond how they superficially appear, the perspective to understand information in isolation and in its broader context, and the empathy to acknowledge the human life that stands before them. It is in this framework where I see the noblest goals in medicine.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Taking steps to learn more about obesity with smartphones

Photo by Petr Kratochvil

Many of my friends use smartphones to track their steps as they walk about town to grocery shop, grab lunch or just take a break from the computer. Their daily goal is typically 10,000 steps. Now researchers are using this type of data to study public health.

Stanford researchers used step data captured by smart phones to analyze the activity levels of over 700,000 men and women from 111 countries during a 3-month period. Although the data was anonymized, it included key health demographics such as age, gender, height and weight so the research team could calculate each person’s body mass index.

The investigator’s goal was to figure out why obesity is a bigger health problem in some countries than others. As outlined in a paper in Nature, they found that people walked a similar amount each day in countries with little obesity, whereas there was a big activity gap in countries with high levels of obesity — and they dubbed this phenomenon the “activity inequality.”

“If you think about some people in a country as ‘activity rich’ and others as ‘activity poor,’ the size of the gap between them is a strong indicator of obesity levels in that society,” said Scott Delp, PhD, a Stanford professor of bioengineering and of mechanical engineering, in a Stanford news release.

Delp and his colleagues also found a gap in activity levels between genders — men walked more than women — that varied from country to country. Overall, their research identified strong correlations between activity inequality, the gender-activity gap and obesity levels.

How did the United States rank? It was ranked near the bottom for activity inequality due to a large gap between the activity rich and activity poor. It also has a large gender-activity gap and high levels of obesity.

The researchers hope their results will inspire designers to make cities more walkable and pedestrian-friendly. “In cities that are more walkable everyone tends to take more daily steps, whether male or female, young or old, healthy weight or obese,” explained Jennifer Hicks, director of data science for Stanford’s Mobilize Center.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Stanford experts discuss the future of bioengineering

Bioengineering — described by Stanford professor and radio host Russ Altman, MD, PhD, as the manipulation of biological systems to solve problems in medicine, the environment and energy — was the focus of a recent episode of the Sirius radio show The Future of Everything. On hand was Stanford’s Drew Endy, PhD, an associate professor of bioengineering, who spoke with Altman about how to unlock bioengineering’s full potential.

Endy told Altman that bioengineering is already incredibly important to the economy, but challenges to further growth still remain. “Regardless of what type of engineer you are and what kinds of problems you’re trying to find solutions to, you have to navigate what I call the core design-build-test engineering cycle,” said Endy. “So how do we get better at navigating this cycle for living systems?”

He suggested that one answer is synthetic biology. “It became apparent that the core of the engineering cycle for living matter could be massively and systematically upgraded. We could separate design from construction by getting better at printing DNA from scratch, called DNA synthesis,” he told Altman. By making the process more efficient, he said, scientists should be able to more quickly and cheaply create new genes or even organisms with specialized functions.

Endy went on to explain how DNA synthesis works: “This is a technology that lets you go from information to physical DNA made from scratch. So you can think of it like a keyboard with just 4 keys: ATCG. You play the keys as you wish, and the machine makes from raw ingredients the DNA depending on how you press the keys.”

DNA synthesis is a critical tool for many applications, such as vaccine development, gene therapy and molecular engineering. Although it has existed for years, it is now more affordable. “In 2003, it cost me four dollars a letter to press each key. This year, it’s about four cents,” he said. This dramatic reduction in cost makes new research more accessible and scientists are getting systematically better at engineering biology, he told Altman.

Endy envisions a future where we’ve made the living world fully engineerable. However, he said this raises many questions on safety, biosecurity and ethics that we need to address.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.