New Research From AAN: Your Pain Threshold Directly Links To Cortical Thickness

Brain Cortical Thickess

Brain Cortical Thickness Directly Implicated In Feeling Migraine Pain (1)

A new study presented by Mayo Clinic at the AAN’s (American Academy of Neurology) 67th Annual Meeting was highlighted by the Vice Chair of the Academy. The study clearly demonstrated that there was a direct and positive correlation between the cortical thickness in the brain and the thresholds of pain in migraineurs.

As per the Vice Chair of the AAN, Dr. Rost, who is also the director of acute stroke services at the Massachusetts General Hospital and an associate professor at the Harvard Medical School, “The object of study was to evaluate the cortical thickness in the areas that are potentially associated with pain processing.” (2)

Incidentally, other independent studies conducted previously have also indicated that migraineurs are hypersensitive to perceiving their pain partially because they are over-vigilant to certain painful stimuli and are usually not able to distract themselves from the pain or pain stimuli successfully.

The study examined a total of 63 subjects out of which 31 were migraineurs and the remaining were healthy individuals and formed the control group. Using the T1 sequencing technique in MRIs they studied the cortical thickness of each region of their brains and calculated the relation to the person’s pain threshold.

The values arrived at showed a negative correlation in cortical thickness and pain threshold among non-migraineurs. However, the control group had lower cortical thickness in the area of their interest. On the contrary, migraineurs not only had a positive correlation but had less tolerance to specific pain stimuli. The most significant difference in the cortical thickness between the migraineurs and the control group was found to be in the left superior temporal, anterior parietal regions of the brain. Thus this finding, along with some previous studies form a new approach where the doctors should not only use the old techniques to manage migraines but also apply new one where migraineurs are able to inhibit their pain to a significant extent by distracting themselves from it.

According to Dr. Rost, “This is in face the region of the brain that participates in attention to painful stimulus and orientation to that stimulus. It opens an interesting segue into the dynamic interaction of neurons during a migraine. There is a way to retrain the brain and that plasticity, biofeedback and other therapies, play a role in that.”

SOURCE

  1. Human Brain by Dream Designs via Stock Photo; Freedigitalphotos.net; Web May 2015; http://www.freedigitalphotos.net/images/human-brain-photo-p214120
  2. A New Way To Think About Migraines: Biosciencetechnlogy.com; Web May 2015; http://www.biosciencetechnology.com/articles/2015/05/new-way-think-about-migraines
  3. Correlations between Brain Cortical Thickness and Cutaneous Pain Thresholds Are Atypical in Adults with Migraine; PLOSOne.com; Web May 2015; http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0099791

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Middle Age Migraineurs At Risk Of Parkinson’s Later

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Studies Show Some Middle-Age Migraineurs Go On To Develop Parkinson’s At Old Age (1)

A recent study conducted at the Uniformed Services University in Bethesda, and published in the medical journal Neurology (of the American Academy of Neurology) , showed that there was a link between migraines and the development of Parkinson’s Disease.

Though severe migraine attacks are considered as disabling as serious illnesses such as dementia, active psychosis or even quadriplegia, it is still the most under-funded and less researched of all neurological diseases in the world.

As per lead author of the study, Ann I. Scher, M.D migraines are the most common brain disorder among both the sexes linked to both cerebrovascular and heart disease. However, the study exhibited that the link between middle-age migraining and Parkinson’s is stronger for women who suffer migraines with aura. She says, “This new possible association is one more reason research is needed to understand, prevent and treat the condition.” (2)

The research involved 5620 persons from Iceland for a period of 25 years. Their ages were between 33 and 65 years at the time when the study began. Of the 5620 persons studied, 1028 had headaches without migraine symptoms, 238 had migraines without aura and 430 experienced migraines with aura. Here are the result highlights:  (3)

  • Migraineurs with aura twice as likely to develop Parkinson’s later than Migraineurs without aura
  • 1% of the persons without headaches developed Parkinson’s later when compared to 2.4% who developed it and had migraines with aura.
  • People with migraine with aura were also around 3.6 times more likely to report at least four of the six symptoms of Parkinson’s, and people with migraine without aura were 2.3 times more likely.
  • Overall rates in absolute terms were as:
        • In people with migraine with aura: 19.7%
        • In people with migraine without aura: 12.6%
        • In people with no headaches at all: 7.5%.

According to Scher, “A dysfunction in the brain messenger dopamine is common to both Parkinson’s and Restless Leg Syndrome (RLS), and has been hypothesized as a possible cause of migraine for many years. Symptoms of migraine such as excessive yawning, nausea and vomiting are thought to be related to dopamine receptor stimulation.  More research should focus on exploring this possible link through genetic studies”

SOURCES

  1. Image Credit: Frustrated Caucasian Woman by Stock Images; Freedigitalphotos.net; Web October 2014; http://www.freedigitalphotos.net/images/Emotions_g96-Frustrated_Caucasian_Woman_p81435.html
  2. Link Found Between Migraine And Parkinson’s; Medical News Today; Web October 2014; http://www.medicalnewstoday.com/articles/282678.php
  3. Migraines In Middle Age, Parkinson’s Risk Later? WebMD.com; Web October 2014; http://www.webmd.com/migraines-headaches/news/20140917/are-migraines-in-middle-age-tied-to-raised-parkinsons-risk-later

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New Drugs Targeting CGRP Offer Hope: American Academy of Neurology

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Role Of CGRP and Antagonists In Migraine Attack (1)

CGRP is critically implicated in the occurrence and unfolding or progress of a migraine attack. CGRP or Calcitonin gene-related peptide is a powerful protein/peptide containing a short chain of amino acid monomers. It plays a critical role in transmitting pain signals through the body in events such as migraines. It is also involved in the vasodilation, inflammation, immune-modulatory responses among others during migraine attack apart from increasing heart beat and altering sensory transmission.

CGRP is produced by the peripheral and central neurons of our central nervous system specifically around the spinal cord and the trigeminal ganglion. Prior to and during migraine episodes, the central and peripheral neurons release more CGRP. This is then mediated through CGRP receptors (CALCRL and RAMP1) found throughout the body. One way to prevent pain from occurring is to block the receptors that receive the CGRP protein using a chemical/drug. Such drugs are called CGRP antagonists or CGRP blockers.

In a post of March 28th, 2012 I had written (‘CGRP Blockers & SRAs – The New Faces In Research For Migraine Management’) on work being done on drugs that targeted CGRP receptors but were abandoned after Phase III trials due to adverse reaction found in some of the trial population. (2).

Currently, two studies showing work with calcitonin receptor blockers have moved into Phase II trials. This means that though positive outcomes have been had from these researches involving smaller populations, larger studies are required to clear the drug for sale or prescription.

Research 1:

This involves a prospective drug that aims to prevent migraine from starting rather than trying to stop attack from progressing once it has begun. The drug involves monoclonal antibodies or antibodies that are identical immune cells – clones of their unique parent cell. Such monoclonal antibodies are being directed at the CGRP to target the protein.

This research examined 163 migraineurs for a period of six months, who had migraine attacks ranging anything from 5 -14 days every month. In this time, they gave the population either a placebo or the drug under study called ALD403 without the migraineurs knowing what they were taking. Those who took the drug reported a 66% reduction in number of migraine days and in 12 weeks time reported to be migraine-free.

As per lead author Peter Goadsby, MD, PhD, of the UC San Francisco and a member of the American Academy of Neurology, “These results may potentially represent a new era in preventive therapy for migraine. Migraine remains poorly treated, and there are few effective and well tolerated treatments approved that prevent attacks from occurring.” (3)

Research 2:

This potential drug in injectable form too is a preventative rather than a mitigator of migraine condition and is based on monoclonal antibodies targeting CGRPs. In Phase II trials as well, the research studied 217 migraineurs who experienced anything from 4-17 days of migraine days every month.

The population being observed was also administered either a placebo or the drug under study called LY2951742 via the subcutaneous injection route, without being told which was which for a period of three months. Those who were receiving the real drug reported more than 4 days less of migraine days in a month. However, they also experienced more side-effects such as abdominal pain and upper respiratory tract infections.

As per Dr. David Dodick, MD, of Mayo Clinic Arizona in Phoenix and a member of the American Academy of Neurology, “We’re cautiously optimistic that a new era of mechanism-based migraine prevention is beginning. There is a huge treatment need for migraine — the third most common and seventh most disabling medical disorder in the world” (4)

SOURCES:

  1.  Image Credit: The Role of CGRP and its Antagonists in Migraine- Peripheral Actions of CGRP: Neurogenic Inflammation;  Flipper.diff.org; Web April 2014; http://bit.ly/PsCR7O
  2. CGRP Blockers & SRAs – The New Faces In Research For Migraine Management; Web April 2014; https://migrainingjenny.wordpress.com/2012/03/28/cgrp-blockers-sras-the-new-faces-in-research-for-migraine-management/
  3. New drugs offer hope for migraine prevention; ScienceDaily News; Web April 2014; http://www.sciencedaily.com/releases/2014/04/140422162048.htm
  4. Stopping Migraines Before They Start; DailyRx.com; Web April 2014; http://www.dailyrx.com/migraine-patients-had-fewer-attacks-monoclonal-antibody-treatment

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Butterbur Found Effective In Treating Migraines: Studies

butterbur

The Daisy-family Petasites Prove Themselves Effective In Migraine Treatment (1)

Butterbur, Petasites or Sweet Coltsfoot are residents of moist regions like marshes, ditches  and riverbeds and do well in temperate regions in the northern hemisphere. Studies have shown that certain species contain chemicals petasin and isopetasin which occur in high concentrations in the plant’s root and are very effective in treating migraines. 

In my post of April 26th, 2012, titled ‘New Guidelines from American Academy of Neurology On Reduction of Migraine Frequency’ I had outlined how the AAN listed out Butterbur as one of the herbal formulae that they found effective in the management of migraines. (2) 

The organic compound petasin found in butterbur is a combination of the ester of petasol and angelic acid known to stub inflammatory response in the body. It is also a proven muscle relaxant. Moreover, irritable blood vessels that are known to add to the woes of a migraineur are also soothed by petasin and isopetasin by control of blood pressure and spasmodic capillary action. Several German researches have found that incidences of migraines could be reduced by as much as 50% even in long-term patients. (3) 

Here are a list of studies that have expanded on the find: 

  • Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society; AHRQ (US Dept Of Health & Human Services); http://www.guideline.gov/content.aspx?f=rss&id=36897
  •  The First Placebo-Controlled Trial of a Special Butterbur Root Extract for the Prevention of Migraine: Reanalysis of Efficacy Criteria; European Neurology; Diener HC, Rahlfs VW, Danesch U. Eur Neurol. 2004;51(2):89-97. http://www.petasites.eu/PDF/Eur_Neurol.pdf
  •  An extract of Petasites hybridus is effective in the prophylaxis of migraine. NCBI Resources – PubMed; Grossmann M, Schmidramsl H. Int J Clin Pharmacol Ther. 2000 Sep;38(9):430-5. http://www.ncbi.nlm.nih.gov/pubmed/11020030
  •  Petasites hybridus root (butterbur) is an effective preventive treatment for migraine.NCBI Resources – PubMed; Lipton RB, Gobel H, Einhaupl KM, Wilks K, Mauskop A. Neurology. 2004 Dec 28;63(12):2240-4. http://www.ncbi.nlm.nih.gov/pubmed/15623680

Butterbur is available as a herbal tea though it is hard to palate because of it’s bitter taste. However, capsules of butterbur may be a better option. Doctors usually recommend 50-75 mg twice daily as effective prophylactic dosage.

It is imperative that you consult a doctor before taking any butterbur preparation. 

Once advised, choose a brand that says ‘PA-Free’ indicative of the removal of toxic chemical pyrolizidine alkaloid which is toxic to the liver. (4)  

SOURCES: 

  1. Image Credit: Butterbur 628x 323; Spring Allergy Relief; Prevention.com; Web February 2014; http://bit.ly/1nMkgOH
  2. New Guidelines from American Academy of Neurology On Reduction of Migraine Frequency; Migrainingjenny.wordpress.com; Web February 2014; https://migrainingjenny.wordpress.com/2012/04/26/new-guidelines-from-american-academy-of-neurology-on-reduction-of-migraine-frequency/
  3. Butterbur: For Migraines, Allergies, And More; Chiroeco.com; Web February 2014; http://www.chiroeco.com/chiropractic/news/14902/856/butterbur-%20for%20migraines-%20allergies-%20and%20more/
  4. Butterbur In The Treatment Of Migraines; WholesomeOne.com; Web February 2014; http://www.wholesomeone.com/article/butterbur-treatment-migraines

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