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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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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Serotonin and Neurological Afflictions

Hi,

Last week we saw how eating a tryptophan-rich diet didn’ t necessarily translate into increased serotonin levels in the brain unless backed by adequate Vitamin B3, B6 and complex carbohydrates. It however, did place one a better chance at getting a serotonin boost.

Studies have established some links to a defecient state of brain serotonin with other neurological afflictions besides migraines, such as alcoholism, depression, suicidal tendencies, PTSD, obsessive compulsive disorders, generalised anxiety disorders and social phobia to name a few.

We may experience low brain serotonin levels due to a variety of reasons:

1. Low levels of production of brain serotonin.

2. Less number of serotonin receptors in our brain region

3. High reuptake rate of serotonin back from the synapse into the presynaptic neurons, and

4. Defeciency in tryptophan levels in our body.

There is a new and fifth interesting dimension that has cropped up – that of the serotonin transporter gene (SERT). To relay a message, a neuron releases serotonin into the synapse or the gap between two neurons from where their dendrites begin. Once the message is relayed to the next neuron, the released serotonin in the synapse is collected and transported back to the pre-synaptic neuron by the SERT. SERTS are monoamine proteins. It has been found that when there are changes in the SERT metabolism, neurological afflictions begin.

It is also now being thought that the gene (called SLC6A4 – Solute Carrier family 6, member 4) that encodes the SERT can be mutated and result in changing the functions of SERT.

The area (aka promotor) in the gene SLC6A4 which synthesises RNA under the instrucions from DNA, contains polymorphism – some long repeats (16 repeats of a sequence) and some short repeats (14 repeats of a sequence). Shorter repeats obviously enable lesser coding in them and thus when we have a pair of short repeats we get an increase in the risks of developing disorder states.

So though SSRIs and beta blockers may help migraineurs as well as those suffering from insomnia, depression, PTSD and other anxiety disorders, their efficacy will not be the same between 2 persons with the same condition. Those predisposed to neurological and psychological conditions due to the presence of 2 short versions of the gene will be less benefitted than those with other variations (2 long or 1 long and 1 short).

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