Co-morbidity of Migraine and Depression In Women

Most of us are aware that migraineurs have some comorbid conditions like generalised anxiety disorder, cardiovascular conditions and gastrointestinal disturbances. Research now has it that migraineurs especially women who have either experienced repeated episodes of migraines in the past or continue to have migraines are more likely to experience depression.

Women Migraineurs Very Likely To Develop Depression (1)

In fact another report goes on to suggest that the most ‘important’ comorbidity of migraines is depression with as many as 40% of all migraineurs also suffer from forms of depression. (2)

New research released on 23rd of February which was presented at the American Academy of Neurology’s 64th Annual Meeting showed that migraining women specifically had a higher risk of almost double for developing depression than those women who did not experience migraines.

This study had examined the medical history of 36,154 women participants. The whole population studied were classified into 4 groups:

  • Women with migraines and experiencing aura
  • Women with migraines who do not experience aura
  • Women who had suffered migraines in the past but have not in the last one year
  • Women who never had migraines

It was observed after collection and analysis of data that as many as 18% of the studied population had either current or past history of migraines and that of this group of 6, 456 women almost half of them developed depression 14 years on.

Another observation of note was that the results in terms of the probability of developing depression for women migraineurs remains almost same regardless of the type of migraines they experience (i.e. with or without visual aura)

The results did not vary substantially, regardless of the type of migraine. Those with aura, which is described as visual disturbances that appear as flashing lights, zigzag lines or a temporary loss of vision, had the same risks as other types of migraine.

According to Tobias Kurth, MD, ScD, with Brigham and Women’s Hospital in Boston and Inserm in France and a Fellow of the American Academy of Neurology, “This is one of the first large studies to examine the association between migraine and the development of depression over time. We hope our findings will encourage doctors to speak to their migraine patients about the risk of depression and potential ways to prevent depression.” (3)

This is a cue to doctors and headache specialists who treat migraineurs for assessing the patient for possible symptoms of depression and chalking out an appropriate management program for them.

SOURCES:

  1. Image by David Castillo Dominici; Freedigitalphotos.net; February 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=3062
  2. Comorbidities of Migraine – Page 4; Lisa K Mannix, MD; February 2012; http://www.headaches.org/pdf/CME_Mono02.pdf
  3. Migraine Increases Risk Of Depression In Women; Medical News Today; February 2012; http://www.medicalnewstoday.com/articles/242091.php

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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/

Copyrights apply on this blog. Please refer copyright permissions.

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