New Guidelines from American Academy of Neurology On Reduction of Migraine Frequency

New guidelines or strategy if you will, have been chalked out and released by scientists at the American Academy of Neurology in conjunction with the American Headache Society on the approach migraineurs should take to reduce the frequency of their attacks. These guidelines have been released just this week and basically are a little different from the previous guidelines in terms that they reduce the ranking of certain migraine drugs (such as Verapamil and Gabapentin) which were highly recommended in the last guidelines due to evidence gathered against them. In addition, the new guidelines are based on evidence-based research on a larger population than were done for the last set of guidelines covering various demographics – gender, races etc. (1)

Want Fewer Migraine Attacks? Follow a Preventative Regimen Everyday (2)

As per the neurologists, almost 38% of all migraineurs should follow a preventative strategy to reduce the number of their migraine episodes. But only a third of that percentage followed a daily preventative regimen with the rest of them only resorting to band aid approaches and tackling the pain once they are in the throes of a migraine attack or are expecting one within a few hours. The approaches they often took were such as were not proven effective in scientific testing before.

According to Mark Green, MD, director of the Headache Center at Mount Sinai School of Medicine, in New York, “What the guidelines do is pinpoint first-line treatments based on evidence and effectiveness.  If these guidelines are used widely, we will be able to up the odds of reducing headaches by 50 percent. Moreover, the stakes may be high if we undertreat migraines. Evidence is building to suggest that if we allow migraines to progress, the frequency of attacks may increase, and they may also become harder to treat” (3)

Here’s a quick look at what the evidence-based preventative guidelines suggests to migraineurs:

  1. First line prescription drugs must be taken on a daily basis to bring down the number and intensity of the attacks.
  2. Effective For Prevention: Anti-seizure medications Divalproex sodium, Sodium valproate, Topiramate, Metoprolol, Propranol, Tumolol.
  3. Effective Herbal Preparations: Butterbur / Petasites.
  4. Probably Effective: Nonsteroidal anti-inflammatory drugs or NSAIDS such as Fenoprofen, Ibuprofen, Ketoprofen, Naproxen, Naproxen Sodium, Subcutaneous histamine, Complementary treatments, Magnesium, Riboflavin, Feverfew.
  5. Found Not Effective: Anti-seizure drug lamotrigine was not effective in preventing migraine.

SOURCES:

  1. New Guidelines Assert That Daily Preventive Therapies Significantly Reduce Migraines; Newswise; April 2012; http://www.newswise.com/articles/view/588495/?sc=rsmn&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewswiseMednews+%28Newswise%3A+MedNews%29
  2. Image by Ambro; Freedigitalphotos.net; April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=1499
  3. New Guidelines: Treatments Can Help Prevent Migraine; American Academy of Neurology (AAN); April 2012; http://www.aan.com/press/index.cfm?fuseaction=release.view&release=1062

Video of the 2012 AAN Conference may be accessed at:

  1. 2012 AAN Press Conference: New Guidelines on Preventing Migraine Headache; YouTube.com; April 2012; http://www.youtube.com/watch?v=LoKPwq9JcKE&feature=g-upl&context=G2423319AUAAAAAAAAAA

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Brain Freeze and Migraines: A Shared Mechanism At Play

Spoon in a large dollop of ice cream after you enter the house on a warm summer day and you know you are in trouble. The brain freeze will make you repent the haste almost immediately. Same with guzzling down a chilled soda. The sensation on the upper palate almost stops you in your tracks in a very uncomfortable way. Turns out, the mechanism involved in brain freeze is also at play during any migraine episode. (1)

Change in Brain’s Blood Flow Similar in Brain Freeze and a Migraine (2)

It is believed a brain freeze is an experience brought on by other experiences that are interpreted by the brain as traumatic and are often suffered by soldiers who have been close to explosions or have had combat injuries. One link between the brain freeze and the events in the onslaught of a migraine is the way there occurs a change in the blood flow of the brain.

Researchers at the Department of Veterans Affairs New Jersey Health Care System, the National University of Ireland Galway, Harvard Medical School and the the War Related Illness and Injury Study Center of the Veterans Affairs New Jersey Health Care System have observed in the experiments conducted in their study that sudden headache seems to be triggered by an abrupt increase in blood flow in the anterior cerebral artery and disappears when this artery constricts.

In the study the researchers observed 13 healthy adults whose cerebral blood flow was monitored using transcranial Doppler as they sipped ice water with a straw on their upper palate. This was done in order to have an onset of brain freeze. Next their cranial blood flow was noted using the same tool when they were made to sip water of room temperature in the same way. The volunteers were made to signal the onset and the dissipation of the brain freeze. The observations showed that one particular artery, called the anterior cerebral artery, dilated rapidly and flooded the brain with blood in conjunction to when the volunteers felt pain. Soon after this dilation occurred, the same vessel constricted as the volunteers’ pain receded.

As per the study lead Jorge Serrador of Harvard Medical School, “The brain is one of the relatively important organs in the body, and it needs to be working all the time. It’s fairly sensitive to temperature, so vasodilation might be moving warm blood inside tissue to make sure the brain stays warm. But the brain is a closed structure, so the sudden influx of blood could raise pressure and induce pain. The following vasoconstriction may be a way to bring pressure down in the brain before it reaches dangerous levels.” (3)

Serrador has pointed that similar changes in blood flow is noticeable in those who have migraines during a migraine attack or in those with post-traumatic headaches. This provides avenues for pharmaceutical companies to work on a drug that targets on areas based on the finding of this study, thus bringing about a change in the course of migraines and certain headache types.

SOURCES:

  1. Changes in Brain’s Blood Flow Could Cause ‘Brain Freeze’; Science Daily News; April 2012; http://www.sciencedaily.com/releases/2012/04/120422231742.htm
  2. Image by Victor Habbick; Freedigitalphotos.net; April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=4036
  3. Changes in Brain’s Blood Flow Could Cause ‘Brain Freeze’; American Physiological Society – Onsite Newsroom; April 2012; http://www.the-aps.org/mm/hp/Audiences/Public-Press/For-the-Press/releases/12/15.html

 

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Migraine Symptoms & Some Fixes

Besides the debilitating pain, migraineurs often experience some symptoms that precede and/or last during the time the migraine episode is on. Here’s a list of some of the symptoms a migraineur may experience before or during an attack:

  • Nausea
  • Dizziness
  • Sleep disturbances
  • Visual disturbances/aura
  • Hyper-sensitivity to sound
  • Hyper sensitivity to light
  • Increased sensitivity to odours
  • Frequent yawning
  • Frequent need to urinate
  • Constipation
  • Diarrhea
  • Non-visual aura
  • Confusion
  • Fatigue

Symptoms and Some Fixes (1)

The exact reason why a migraine attack begins is not yet clear to scientists. However, based on years of data gathered from cases that report for treatment assistance to clinics and hospitals, several migraine triggers have been identified.

Despite the extreme discomfort migraines give, it is possible to obtain symptomatic relief at least some extent. Here are a few tips at what can be done should you be in the grips of a migraine attack. However, it is important to keep in mind that the priority is get a medical help and consultation at the earliest. The tips below are to serve only till you are able to see a doctor. (2)

  • Excruciating pain

Pain may be tackled with NSAID (Non-Steroidal Anti Inflammatory Drugs) brufen, naproxen, diclofenac sodium etc. It may also be managed by analgesics such as paracetamols, spirins etc. However, it is recommended that you take any one of them as per the dosage and instructions on the label after a light meal of complex carbohydrates or some non-acidic foods. It is important that painkillers be taken at the first signs of migraine. Putting an ice pack on the painful area also helps. (3)

  • Nausea

Nausea may be tackled with taking of anti-emetic along with the analgesic in the prescribed dosage. It is also important to not stay on an empty stomach for long durations. A light snack taken frequently helps in stubbing the queasiness and helps by utilising the excessive bile migraineurs release during attack episodes.

  • Visual Aura

The best way to manage a visual aura is to stop or put down what you are doing and stand until you can get to a place where you can sit or lay down. It is dangerous to operate any machinery or drive at such times. Breathing in deeply and fully and massaging of temples with a balm may aid temporarily.

  • Light and sound sensitivity

Going to a dark room or one with curtains drawn and lights turned off helps. Wearing dark glasses helps when outdoors. Noise disturbances may be managed with an earplug or by putting cotton wool in the ears to keep out or dull the surrounding noises.

  • Constipation

Constipation may be helped by taking tepid fluids such as warm milk or ginger tea or warm water etc. It is also advisable to have allergy-free natural laxatives like flaxseeds and high fiber diet including wholegrain cereals if you are gluten tolerant.

  • Diarhhea

Yet another accompanying nuisance with migraines, diarrhoea may be managed by taking stomach-binding foods and avoiding those with high fibre content.

DIET INCLUSIONS:

Holistic Health Therapist recommended the inclusion of herbs such as feverfew, St. John’s Wort and butterbur in one’s diet. Conventional physicians are of the opinion that calcium and magnesium supplements help take the edge off migraines. Tryptophan and omega 3 rich foods and B vitamins are also advised by doctors.

Complementary Alternative Medicines offer support therapy that aid in the management of migraines. Help comes from the sciences of yoga, aromatherapy, massage, reflexology, shiastu, acupuncture, sujok, biofeedback, chiropractic, cranial osteopathy, homeopathy, ayurveda, reiki, Alexander technique, autogenic training etc

MAINSTREAM MIGRAINE MEDICATION

  • Excedrin Migraine

Excedrin is a leading non-prescription drug from Novartis from the acetaminophen or paracetamol family that uses a combination of paracetamol with caffeine and aspirin designed especially to tackle migraine pain. Excedrin is available in geltab, tablet and caplet forms. Dosage and frequency of drug intake should be as per label instructions or doctor’s advice. It is important to understand and comply by the contraindications and warnings mentioned on the label of Excedrin Migraine and all other drugs.

Other ABORTIVE MEDICATIONS sometimes used by doctors are:

  • Analgesics: Aspirin, Paracetamol/Acetaminophen
  • NSAIDs: Ibuprofen, Diclofenac sodium, Fenoprofen, Ketorolac, Indomethacin, Tolmetin, Celecoxib
  • Ergotamines: Dihydroergotamine mesylate, Ergotamine tartrate
  • Corticosteroids: Methylprednisolone, decsamethasone
  • Opiods: Morphine, Codeine, Oxycodone
  • Combination: Analgesics containing barbiturates, analgesics containing opiods/narcotics
  • Triptans: sumatriptan succinate, Elitriptan hydrobromide, Almotriptan malate, Frovatriptan, Naratriptan

SECONDARY PROPHYLACTIC DRUGS (those that would keep the symptoms from getting worse) could also be recommended by the doctor to manage migraines. Examples are:

  • Anti-depresants: Phenelzine, Nortriptyline, Amitriptyline
  • Beta Blockers: Propanolol, Atenolol, Verapamil
  • Anti convulsants: Topiramate, Divalproex sodium
  • MAO inhibiters: Phenezine sulfate
  • Calcium channel blockers: Flunarazine (4)

SOURCES:

  1. Image by Michal Marcol; Freedigitalphotos.net. April 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=371
  2. How Can We Manage The Common Symptoms At Home; Migraines For The Informed Woman (Book); April 2012; http://www.amazon.com/Migraines-Informed-Woman-Tips-Sufferer/dp/8129115174
  3. Migraine Awareness Group: A National Understanding For Migraineurs (M.A.G.N.U.M); Treatment and Management- Current Treatment Methods – General Pain Management; http://www.migraines.org/treatment/treatctm.htm; 2006
  4. MedicineNet.com; Migraine Headache; Dennis Lee, MD, Harley I. Kornblum, MD, PhD; http://www.medicinenet.com/migraine_headache/page6.htm; 2010

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