Shingles And Stroke

Shingles And Stroke

Shingles (dermatomal zoster) is caused by reactivation of latent herpes zoster virus, the agent that causes chicken pox. Risk of shingles increases steadily with age. The most feared complication is postherpetic neuralgia, which can be very severe and intractable.

For years, it has been recognized that activation of the zoster virus affects nerve roots and areas of the spinal cord to cause shingles but, simultaneously, the virus can affect arteries, causing inflammation within the arteries, and this leads to stroke.

A study published in Mayo Clinic Proceedings, December 9, 2015, concluded that people with shingles had increased risk of stroke in the next 3 months but not beyond that.

A new and fascinating finding, not covered in that article, is the fact that the condition termed giant cell arteritis / temporal arteritis, which can cause blindness, may be caused by reactivation of the virus. Patients with this disorder may need steroids for years with attendant adverse effects. It is now recommended that when this disorder is diagnosed patients be put on an antiviral agent such as acyclovir, valacyclovir, or famciclovir concurrently with steroids with the hope that the combined therapy will reduce duration of need for steroids.

Headache Gets No Respect

Headache Gets No Respect.

Up to three-quarters of all adults have a headache at least once a year, and daily or near daily headaches affect 2-4% of the world’s population. Women in their 50s have a significantly higher prevalence, especially of medication-overuse (rebound) headaches. The World Health Organization rates a day of severe migraine as disabling as Alzheimer’s or in fact quadriplegia. Whether or not one agrees with that assessment, migraine accounts for 1.3% of all years of life lost to disability worldwide, according to the WHO.

Given the great burden of migraine, it is lamentable that the National Institutes of Health has awarded headache research grants of only 24 million in 2014. Asthma research received 10 times that amount. Research into diabetes received 1 billion and into behavioral and social sciences 3.7 billion.

At least 1% of all people in the United States, thus totalling 3.5 million, are being treated for epilepsy. The societal cost of headaches is 3 times that of epilepsy.

Public awareness campaigns, such as those by the International Headache Society, the American Migraine Foundation, and the WHO’s The Global Burden of Headache, are beginning to improve the funding situation.

See The Lancet Neurology, March 2016, page 242.