What Should Work, What Might: Migraine Meds Reassessed

ID-100308698

New Studies Re-assesses Migraine Drug Efficacies (1)

Efficacy of migraine drugs was under another new review from researchers who have examined all of the scientific literature available on the treatment as well as followed up on migraine patients and the scientists have come up with what in their view prove effective in acute cases of migraine. Besides these 2 criteria the study was also based on the depth of the published research done on the medications as well as the quantum of studies on them.

The conclusions of the new study at a glance are:

DEEMED EFFECTIVE (LEVEL A) PROBABLY EFFECTIVE (LEVEL B)
TRIPTANS – Sumatriptan, Zolmitriptan, Rizatriptan, Frovatriptan, Almotriptan, Naratriptan, Eletriptan, Avitriptan OPIOID – Codeine+Acetaminophen, Tramadaol+Acetaminophen
Dihydroergotamins
NSAID – Aspirin, Ibuprofen, Naproxen
OPIOID – Butorphanol Nasal Spray
Caffeine with NSAIDS

Findings of the study were published in the January 2015 issue of the medical journal Headache. As per Dr. Stephen Silberstein , professor of neurology and director of the Jefferson Headache Center of Thomas Jefferson University in Philadelphia, “We hope that this assessment of the efficacy of currently available migraine therapies helps patients and their physicians utilize treatments that are the most appropriate for them.” (2)

Based on the study criteria, drugs were thus rated as deemed effective (Level A), probably effective (Level B), possibly effective (Level C). For such medications where the proof was found either inadequate or gave such results which refutes the use of that medicine, was classified as Level U. For a drug to be classified as deemed effective or a Level A drug, the studies done on the drug must be supported by at least well-designed, double-blind, randomized, placebo-controlled clinical trials.  (3)

The American Headache Society will soon be translating the research findings that will aid in providing evidence-based guidelines to clinical practice. In any case, doctors treating migraine patients must consider the individuals on a case to case basis keeping in view the drug side-effects, patient history, costs and drug efficacy.

SOURCES

  1. Image credit: Pills and Capsules – Stock Photo; freedigitalphotos.net; Web February 2015; http://www.freedigitalphotos.net/images/pills-and-capsules-photo-p308698
  2. Study Rates Migraine Medications; WebMD.com; Web February 2015; http://www.webmd.com/migraines-headaches/news/20150120/study-rates-migraine-medications
  3. American Headache Society Provides Updated Assessment of Medications to Treat Acute Migraine; Newswise.com; Web February 2015; http://www.newswise.com/articles/american-headache-society-provides-updated-assessment-of-medications-to-treat-acute-migraine

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Sex Migraine Is For Real: Loyola Neurologist

Migraine Sex

Migraines & Headaches After Sex (HAS) More Common Than Reported (1)

‘Not tonight honey, I have a headache’ may not be an excuse in avoidance after all,  because for some, especially men, migraines and headaches develop after sexual intercourse, making them avoid it. It is estimated that only as many as 1% of migraning adults actually report experiencing migraines or severe headaches after they have had sex. (2) The real percentage is considered much higher but generally goes under-reported since there is a feeling of discomfort talking about it on the part of the patients who suffer this type of a migraine and doctors who should be asking if the patients suffer this type of an ordeal.

According to Dr. Jose Biller who is the chair of Loyola’s Department of Neurology, and is certified in Headache Medicine by the United Council for Neurologic Subspecialties, “Many people who experience headaches during sexual activity are too embarrassed to tell their physicians, and doctors often don’t ask. Headaches associated with sexual activity can be extremely painful and scary. They also can be very frustrating, both to the individual suffering the headache and to the partner.” (3)

Though a fair percentage of headaches associated with sex (HAS) are considered benign and not life-threatening, others need running neurological diagnostics to look at and rule out dangerous causes such as brain aneurysm, stroke, cervical artery dissection or subdural hematoma etc. It is confirmed that HAS are 3-4 times more likely to occur in men than women.

Basically, the study has identified 3 types of HAS:

Type

Area Intensity Timing

1

Head and Neck Dull

Before Orgasm

2

Back of the head Intense Pain lasting hours

During Orgasm

3

Half Head, Any side Mild To Extreme Pain

After Sex

The cause for the third type of HAS has been identified as internal leaking of spinal fluid extending from lower portions of the skull to lower spine. The pain worsens when a person stands as the brain sags down. Relief is felt when the person lies down.

The different types of HAS require different types of treatment and management. However, the best bet still is on exercising regularly, keeping weight under control, not consuming too much alcohol and reducing exposure to known migraine triggers.

SOURCES

  1. Image Credit: Couple Lying In Bed Back-to-Back Stock Photo; Image by Ambro; Free Digital Photos; Web June 2014; http://www.freedigitalphotos.net/images/CouplesPartners_g216-Couple_Lying_In_Bed_BacktoBack_p76440.html
  2. Headaches during sex likely more common than reported; Science Daily News; Web June 2014; http://www.sciencedaily.com/releases/2014/06/140610100303.htm
  3. Sex headaches: More common than you’d think; Loyola Medicine Publication; Web June 2014; http://loyolamedicine.org/newswire/news/sex-headaches-more-common-youd-think

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Danger Of Ischemic Stroke In Older Migraineurs

stroke_isc_web Older Migraineurs Have Higher Chances Of Suffering Silent Brain Injuries – (1)

A new study published in the May 15th issue of American Heart and Stroke Association’s medical journal Stroke, suggests that older migraineurs have an double the risk of suffering from silent brain injuries and ischemic stroke than those who do not experience migraines.

Silent strokes can be asymptomatic i.e they do not show symptoms but increase the risk of future strokes. Silent stroke or a silent brain infarction is caused by a blood clot getting into the brain artery and thus interrupting the supply of blood, oxygen and nutrients to brain tissue surrounding the clot thus killing it.

As per Teshamae Monteith, M.D., lead author of the study, “I do not believe migraine sufferers should worry, as the risk of ischemic stroke in people with migraine is considered small. However, those with migraine and vascular risk factors may want to pay even greater attention to lifestyle changes that can reduce stroke risk, such as exercising and eating a low-fat diet with plenty of fruits and vegetables.” (2)

He raised caution that if an older migraineurs had other coexisting conditions like a high blood pressure (hypertension) or a sedentary lifestyle, it would add to the risk factor for suffering silent strokes and brain damage. He thus advised them to take medication to address hypertension and to bring it under control.

The study was a research on diverse ethnic groups including people of Hispanic and African origin. It was a collaborative investigation conducted by University of Miami and Columbia University.

Some of the highlights of the study were as follows: (3)

  • Approximate 40% of the population studied comprised of men.
  • The average age of the population was around 71 years old.
  • 65% of the population under study was of Hispanic origin.
  • Of the 546 studied, 104 had a history of migraines.

Some conclusions arrived at were as:

  • Risk of silent brain infarctions in those with migraine double even after adjusting other stroke risk factors.
  • Migraines with aura were not a deciding factor in measuring risk of silent strokes.
  • No real increase in the volume of white matter/ Small blood vessel anamolies was associated with migraines.
  • Some lesions came across in radiographic images as having ischemic origins but more research was required to confirm this.

According to Monteith, “We still don’t know if treatment for migraines will have an impact on stroke risk reduction, but it may be a good idea to seek treatment from a migraine specialist if your headaches are out of control. (4)

Previous studies indicated migraine could be an important stroke risk factor for younger people.

SOURCES:

  1. Image Credit: Ischemic stroke; Heart & Stroke Foundation – Canada; Web May 2014; http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3484151/k.7916/Stroke__Ischemic_stroke.htm
  2. Older migraine sufferers may have more silent brain injury; Science Daily News; Web May 2014; http://www.sciencedaily.com/releases/2014/05/140515163826.htm
  3. Abstract of the study can be accessed at: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.abstract
  4. Older people with migraines ‘more likely to have silent brain injury’; Medical News Today; Web May 2014; http://www.medicalnewstoday.com/articles/276842.php

Details of the study published in AHA journal, Stroke: http://stroke.ahajournals.org/content/early/2014/05/15/STROKEAHA.114.005447.full.pdf+html

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Sleep Quality Influences Migraine Frequency And Disability

Sleeping Woman - Migraine Blog

 

Sleep Quality Directly Effects How Often You Get Migraines (1)

Tests conducted by researchers at the University of Mississippi, U.S.A have shown a strong correlation between poor quality of sleep and the frequency of migraine episodes as well as the disabilities that go with the condition.

The Pittsburgh Sleep Quality Index (PSQI) was employed in the study which tested 78 migraineurs and 208 non-migraineurs who formed the control group.

The PSQI is a tool in the form of a scoring but subjective questionnaire developed by the Sleep Medicine Institute of the University of Pittsburgh. It has questions within it’s 7 broad components on which a patient is scored, viz;

  • Subjective Sleep Quality,
  • Sleep Latency,
  • Sleep Duration,
  • Habitual Sleep Efficiency,
  • Sleep Disturbance,
  • Use of Sleep Medicines,
  • Daytime Dysfunction.

Todd Smitherman and his team found that sleep quality was significantly worse for those experiencing episodic migraines than for those in the control group. The migraining group scored an average PSQI of 8.90 as compared to 6.63 in the control group. A PSQI score more than 5 is considered significantly bad.

Factors such as depression, anxiety were adjusted for the regression analysis calculations but still it accounted for 5.3% and 5.8% of unique variance in headache frequency and disability, respectively, which the researchers say is a modest but non-trivial amount. Even when depression and anxiety factors after poor sleep quality were included in the calculations the affective symptoms did not significantly improve these analysis models beyond that of sleep quality alone which made sleep quality almost an independent and very relevant factor in assessing headache frequencies and related disabilities.

As per Smitherman, “As such, sleep quality should be assessed preferentially to other sleep disturbance variables when subjective self-report measures of insomnia are used. In light of the present findings, conclusions from systematic reviews, and practice guidelines, the most potent means of improving sleep quality and insomnia among migraineurs is likely a treatment package that incorporates stimulus control and/or sleep restriction in addition to basic sleep hygiene education and management of comorbid psychiatric symptoms.” (2)

SOURCES:

  1. Image Credits: Freedigitalphotos.net; Tired Woman by Graur Codrin; Web August 2013; http://www.freedigitalphotos.net/images/agree-terms.php?id=10021635
  2. Sleep Quality A Key Contributor To Migraine Severity; MedWireNews.com (Springer Healthcare Limited); Web August 2013; http://www.medwirenews.com/44/104664/General_neurology/Sleep_quality_a_key_contributor_to_migraine_severity_.html
  •  Abstract of the research may be had at:

Sleep Disturbance and Affective Comorbidity Among Episodic Migraineurs; Wiley Online Library; Web August 2013; http://onlinelibrary.wiley.com/doi/10.1111/head.12168/abstract

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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/

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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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