Bridging the Gaping Divide With Pain Self-management Tools

Most migraineurs are aware that the medical fraternity has yet not arrived at the cause of migraines. We know of triggers and the way the pain unfolds or what happens inside of the brain hours before, during and after a migraine episode but are still clueless about what causes migraines and why or how the pain stops.

Though a good number of migraineurs do consult a ‘migraine specialist’ or a ‘headache specialist’ after enduring the onslaught of merciless pain years after they first experienced their episodes, they often take back selective important tips back from the doctor’s office. A relatively new program called painACTION.com developed by Inflexxion now offers many tools to the migraineur that can help them manage their symptoms better when they are out of the doctor’s office and back into their lives.

Better Pain Management With Online Self-help Application (1)

This free and non-promotional program is available online and is believed to be especially beneficial to those who are chronic migraineurs. The tool was studied by researchers at Inflexxion using 185 participants to test the clinical efficacy of this web-based program. The program uses various symptom-based management techniques and offers a wide range of tips on relaxation and on getting support groups, doing daily activities to do etc.

It was observed that those who used the program reported better stress and pain management skills, were more confident in their ability to handle an episode. The study as well as it’s findings were reported in the medical journal The Journal of Head and Face Pain, titled ‘A Randomized Trial of a Web-based Intervention to Improve Migraine Self-Management and Coping’. (2)

According to the lead author and researcher, Jonas Bromberg, PsyD, Director of Health Communications and Senior Research Scientist at Inflexxion, “Self-management training should help patients learn how to identify, avoid, and manage headache triggers, and learn to perform other essential prevention, management, and coping behaviors. The integration of behavioral support in the medical care of migraine is essential in helping people with migraine to manage their condition more effectively, safely manage their prescription pain medications, avoid disease progression, and reduce the high cost of migraine and migraine-related disability to individuals and society.” (3)

This free online program is particularly beneficial to those who live and work in areas which do not have easy or ready access to neurologists, mental health support services or behavioural experts.

SOURCES:

1. Image by Jeroen van Oostrom; Freedigitalphotos.net; February 2012;  
   http://www.freedigitalphotos.net/images/view_photog.php?photogid=413
   
2. Technical report of the study may be accessed at: A Randomized Trial of a Web-Based Intervention to Improve Migraine Self-Management and Coping; Wiley Online Library; February 2012;
   http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.02031.x/abstract
   
3. Migraine Self-Management Improved And Migraine-Related Psychological Distress Reduced By painACTION.com; Medi Lexicon News; February 2012;
   http://www.medilexicon.com/medicalnews.php?newsid=241832
   

The web-based program may be accessed through this link:
http://painaction.com/

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Why NICE (U.K) Will Not Recommend Botox As Migraine Preventative Any Time Soon

National Institute for Health and Clinical Excellence (NICE) in the U.K will not be endorsing the use of purified botulinum toxin A (Botox) as a preventative for migraineurs anytime yet. According to sources, there is not enough evidence that confirms the efficacy of Botox in pain management. This news comes as a bit of a surprise especially because back in the summer of 2010, Medicines and Healthcare Products Regulatory Agency (U.K) had approved the use of Botox in migraine management. Here is a news report that runs in News- Medical.Net written by Dr. Ananya Mandal MD (1):

Botox Being Injected Into a Migraineur (2)

“Botox – used as an anti-wrinkle agent – is unlikely to be recommended for the treatment of chronic migraines on the NHS in England and Wales. According to the National Institute for Health and Clinical Excellence (NICE) draft guidelines there is insufficient evidence that it works.

Migraines are severe headaches, which are often accompanied by nausea and vomiting and finding light or sound painful. Chronic migraines are defined as headaches at least 15 days a month, eight of which have to be migraines.

In July 2010, Botox was approved as a preventive treatment for chronic migraine in the UK by the Medicines and Healthcare Products Regulatory Agency. Botox is injected into at least 31 sites around the head and neck every 12 weeks. However, how the neurotoxin might prevent chronic migraines is unknown. The therapy uses a purified version of botulinum toxin A and it is thought to block overactive nerve impulses which trigger excessive muscle contractions.

NICE is deciding whether the injection should be offered across the NHS in England and Wales. NICE said the injections had been “shown to have some benefit” such as in a trial involving 1,384 patients, published in the journal Headache. However, it said the effect was small and may have been confused by the way the studies have been conducted. A review in the Drug and Therapeutics Bulletin in February 2011 said there is “limited evidence” for using Botox.

Prof Carole Longson, director of the health technology evaluation centre at NICE, said, “Our independent committee is asking Allergan to provide further information and analysis as part of this public consultation, so that it has sufficient evidence to develop sound advice for the NHS regarding the use of Botox for the prevention of headaches in adults with chronic migraine. Without this additional evidence, potentially we will be unable to advise the NHS that this drug is good value for money for these adults because there are currently too many uncertainties.” NICE estimated the cost to the NHS would be £349.40 for every 12-week cycle of treatment.

Allegan said it was “working constructively” and would provide new evidence to NICE which it said would demonstrate “that treatment with Botox is both a cost effective and clinically meaningful treatment option for patients suffering from this debilitating condition”.

The chief executive of The Migraine Trust, Wendy Thomas, told the BBC, “I’m a bit disappointed really. For these people with chronic migraine, they’ve already tried various preventative treatments which have failed. For these people their only hope is Botox. It doesn’t work for everybody – it can change people’s lives or not make very much difference.”

Joanna Hamilton-Colclough, director of Migraine Action, said using Botox for her headaches had “absolutely transformed my life”. She said, “I’ve been having chronic headaches for 40 years – I wake up every day with a headache. After my first Botox treatment I woke up the next day feeling ill. At lunchtime I realized that I felt different because I didn’t have a headache. I’ve been able to work without a headache and sleep properly for the first time.” She admitted it did not work for everyone but added that clinical trials also suggested a 50 per cent reduction in migraine days for some patients.

Mrs Hamilton-Colclough said, “We don’t think the treatment is expensive when you take into account the cost to the economy from people needing time off work for migraine and to the NHS from A&E treatment.”

Professor Anne MacGregor, a migraine expert at St Bartholomew’s Hospital, London, said she was concerned Botox might be used as a ‘quick fix’ for chronic headaches. She added, “It’s not a blanket treatment but it might be appropriate for a small number of patients.”

A decision from NICE is expected in June.”

SOURCE:
1. Botox efficacy uncertain in treating migraine says NICE; Medical News.Net; February 2012;
http://www.news-medical.net/news/20120218/Botox-efficacy-uncertain-in-treating-migraine-says-NICE.aspx

2. Image by Ambros; Free Digitial Photos; February 2012; 
http://www.freedigitalphotos.net/images/view_photog.php?photogid=1499

Acupuncture: A ‘Yes’ or A ‘No’ For Migraineurs?

This post has been drawn from Medicine News Today for the benefit of migraineurs:

In order to find out the effect of acupuncture compared with sham acupuncture in treating migraines, a team of investigators carried out a randomized controlled human trial. 480 individuals at 9 hospitals in China who experienced migraines for over one year, with two or three migraines in the 3 months prior to the investigation, were enrolled to participate in the study.

The researchers randomly assigned the volunteers to four groups. Those in one group received sham acupuncture, while participants in the other three groups received different types of acupuncture. Their ages ranged from 18 to 65 years.

In the United States and England, migraines affect approximately 16% to 18% of women and 6% to 8% of men. Evidence on how effective acupuncture is at treating migraines is mixed, as some studies suggest it is the placebo effect, instead of a therapeutic effect that relieves symptoms. Acupuncture distinguishes between real acupuncture points and non-acupuncture (sham) points.

Dr. Fan-rong Liang, Chengdu University of Traditional Chinese Medicine, Chengdu, China, explains: ”We found that the outcomes following acupuncture were significantly better than with sham acupuncture during weeks 13-16, but the effect was clinically minor.”
After 16 weeks, approximately half to three-quarters of participants were better after sham acupuncture and proper acupuncture. The researchers said: ”Acupuncture has a large effect on treating migraines, but the specific therapeutic effect may be minor.”
In an associated commentary, Dr. Albrecht Molsberger, Ruhr University, Bochum, Germany and the University of North Carolina, explains that according to previous evidence, acupuncture helps treat severe migraine attacks.

Molsberger explains: ”On the basis of the existing evidence, acupuncture should be an option for the first-line treatment of migraine to supplement other non-pharmacologic treatment options.”
In a second randomized controlled trial, investigators in the Netherlands enrolled 490 patients from 64 general practices, 233 of them attended consultations to assess treatment of their migraines, as well as 257 in the control group. The researchers set out to examine whether a proactive approach by primary care physicians to patients with suboptimal migraine treatment would result in improvements.

In the Netherlands, only 8% to 12% of all patients with migraines used prophylaxis, while a considerable amount of individuals used too much medication for migraine attacks.

Even though more individuals took prescription medication to prevent migraines as a result of the approach, the researchers observed no clinically relevant effect after six months.

Dr. Antonia Smelt, Leiden University Medical Center, Leiden, the Netherlands, with co-authors, explained: ”We found no clinically relevant effect of a proactive approach to migraine in primary care for patients who were using two or more doses of triptan per month.”

The researchers conclude:
“It is possible that the intervention resulted in better treatment for patients not using prophylactic medication at baseline who had two or more attacks of migraine per month. Future interventions in primary care should target these patients.”

 

SOURCE:

Migraine – The Enigma Of Trial Results; Grace Rattue; Medical News Today; January 2012;
http://www.medicalnewstoday.com/articles/240139.php

Sharing Your Invaluable Experience

Hi everyone,

I have noticed considerable traffic on this blog which encourages me to write new posts every other day. However, I am surprised at migraineurs not leaving their views on the subject. 

It would be very considerate (and tis a Season of Giving) if more migraineurs share their experiences of medications, therapies, practices and other relevant data on managing pain effectively. Any help to a fellow-migraineur will be very very appreciated and very very welcome!

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Allergy to your own hormones!

Do you think it is possible to develop an allergy – to your own hormones? No? Well, think again. For many migraineurs this is precisely what happens. The spiked bodily reaction to changed hormone levels in the times just before periods, such as bloating of the abdomen, acne, breast tenderness etc, indicates allergy to hormones. In fact, it has been confirmed through various studies that migraineurs actually develop antibodies (!) to their hormones. These antibodies are called IgE and are released when hormone levels become high in the body. Migraine just before monthly menstruation, is considered in many a medical quarters, as an allergic reaction to the body’s changed levels of hormones.

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Best Regards

Trying Magnesium

About 2 years back, I stumbled upon magnesium’s big role in regulating calcium ion inflow to neuron cells, channelopathy in migraineurs and of course its spiral effect on the all important serotonin and eventually prostaglandin and a whole gamut of things that go on for a migraineur. By the way, migraineurs are generally defecient in magnesium. Run a blood test and find out if you are in this bracket.

In desperation, I calculated the approximate amount of magnesium I was getting from my diet and it was apallingly low! (Incidentally, magnesium absorption is also inhibited by the caffeine and alcohol intake). I started out on magnesium-calcium supplements for a month that gave me RDA values on both (esp magnesium at 400 mg a day). OK, now get this. I had an episode of migraine the following month but it was so much milder than usual. It arrived one day before I was to head out to London. My work didnt have to stop on the day I was travelling out to London. This was a big deal for me, as will be, I am sure, for many, many migraineurs. I would not have been able to do this without the supplements. Ever since, I have made magnesium a part of diet. I do go off it now and then by choice but I usually do take them and benefit from it immensely.

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Best Regards