Cosmetic Eyelid Surgery Offers Significant Relief To Some Migraineurs: Study

Migraine Blog Eyelid

Eyelid Nerve Decompression Surgery Benefits Some Migraineurs (1)

What some migraineurs are willing to risk to shut off that pain. Turns out that getting under a knife that works on your eyelid is a risk well worth taking for them. This is not a procedure recommended for every migraineur. To be eligible for this eyelid cosmetic surgery, you need to meet certain criteria and thus screened to check if you should do this. The surgery essentially decompresses the nerves in the eyelid that trigger migraine episodes in many.

Dr. Oren Tessler, Assistant Professor of Clinical Surgery at LSU Health Sciences Center New Orleans School of Medicine, have seen that more than 90% of the patients who underwent this surgery experienced relief and also got a bonus cosmetic eyelid surgery. The study and it’s findings have been published in the medical journal Plastic and Reconstructive Surgery.

The study examined 35 patients all of whom suffered from chronic nerve decompression triggering migrainous episodes. All of them had used some sort of nerve blocking treatment earlier or Botox at some point of time trying to tackle the pain.

As per Dr. Oren, “Surgery is a valid treatment for migraines in certain patients. We believe that these patients should have ready access to migraine trigger site decompression surgery. Although larger studies are needed, we have shown that we can restore these patients to full and productive lives.” (2)

The eyelid nerve decompression surgery is an alternative to the much done endoscopic approach where sensors are passed under scalp skin. However, this latter method makes it unsuitable for many depending on their anatomy. Also endoscopes are not available with every team and neither is it safe to assume endoscopy expertise in ever surgeon. However, in the eyelid cosmetic surgery for the screened and selected patients simply involved making a minor slit in their upper eyelid resulting in release of the decompressed nerve and subsequent deactivation of the nerve involved in the migraine episodes. (3)

The team involved in the study also included surgeons from Massachusetts General Hospital and Harvard Medical School.

Some statistics on the surgery:

  • An overall positive response of 90.7%
  • Complete elimination of migraines in 51% of the patients.
  • 33% of the patients had between 50 and 80% of their symptoms resolved.

SOURCES

  1.  Caucasian Girl’s Blue Eye; Image Credit – Serge Bertasius Photography; Free Digital Photos; Web August 2014; http://www.freedigitalphotos.net/images/Younger_Women_g57-Caucasian_Girls_Blue_Eye_p154783.html
  2. Surgeons report significant migraine relief from cosmetic eyelid surgery technique; Eureka Alert; Web August 2014; http://www.eurekalert.org/pub_releases/2014-07/lsuh-srs073114.php
  3. Cosmetic eyelid surgery technique can help cure migraine: Study; Business Standard; Web August 2014; http://www.business-standard.com/article/news-ani/cosmetic-eyelid-surgery-technique-can-help-cure-migraine-study-114080101045_1.html

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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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Migraines Could Lead To White Matter Damage In Brain: New Study

Migraine photo

Abnormalities are common in the signal-sending white matter of migraineurs with aura (1)

A recent analysis of some 19 medical studies put together on migraineurs point that permanent changes likely occur in the brain of those who suffer from migraines and particularly those among them who experience aura – visual or otherwise, before the onset of an attack.

The analysis which was published online in the latest Journal of Neurology concluded that migraineurs with aura were almost two times as likely to have anamolies/abnormalities in the brain structure as those who do not suffer from migraines.

MRIs clearly show white-matter blips and other tissue changes in the migraineurs brain images but how exactly do these neurological variances translate to significant imagery correlate or give a prognosis of progressive deterioration is yet to be seen.

According to Dr. Richard B. Lipton, a neurologist who heads the Montefiore Headache Center in the Bronx, N.Y. “Part of the message I hope to communicate here is: If you have migraine with aura and you have white-matter lesions, they’re probably not a cause of concern.”  (2) However he noted that migraineurs with aura have twice the risk of getting a stroke than non-aura migraineurs

The 19 medical study analysis said the occurrence of tiny lesions that imitate scars left from strokes in aura migraineurs have left them inconclusive because there was no significant evidence of cognitive decline or other neurological symptoms from such lesions or other white-matter anomalies.

In addition, Dr Lipton said that it was good to follow the ‘you never know’ strategy,  further saying, “If you have migraine with aura, certainly you shouldn’t smoke,. Certainly, if you are going to use oral contraceptives, you should use the lowest possible hormonal dose. If you have other stroke risk factors such as hypertension or diabetes or high cholesterol, it becomes particularly important to manage those risk factors.” (2)

What was found to be more disturbing was the uncertainty that surrounds the direction of the correlations. This especially so because it puts forth the reverse question on the table : Is it that the peculiar white-matter phenomena of aura migraineurs on MRI images is what makes for a migraine-prone brain? That is, are the brains of migraine patients different to begin with?

SOURCE:

  1. Image Credits: Sad Middle Aged Woman Suffering From Headache; StockImages; FreeDigitialPhotos.net; Web August 2103; http://www.freedigitalphotos.net/images/Emotions_g96-Sad_Middle_Aged_Woman_Suffering_From_Headache_p150766.html
  2. Migraine could be associated with brain damage, study warns; Los Angeles Times; Web August 2013; http://www.latimes.com/science/sciencenow/la-sci-sn-migraine-brain-damage-20130828,0,7497521.story

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Current Through Electrodes To Reverse An Unfolding Migraine: Research

A pain so incapacitating that a possible cure has to match the dramatics to be effective! A team of researchers from CCNY’s Grove School of Engineering have now devised a procedure by which electric current is passed through your brain to undo a migraine attack at it’s prodrome phase.

Sending Electric Currents To The Brain’s Pain Network (1)

The team of biochemical engineers led by associate professor, Dr. Marom Bikson, associate professor of biomedical engineering have clearly demonstrated that brain stimulation technology works. So what is done in this shocking procedure? The technique involves passing low voltage electric current to the brain from electrodes attached to a person’s scalp. The researchers focused on that part of the brain which has a network of interconnected brain regions involved in processing pain signals, called the pain network. To their surprise they found the technique could reverse ingrained changes in the brain caused by chronic migraine.

This procedure applies the principal of transcranial direct current stimulation (tDCS). As per Bikson, “We developed this technology and methodology in order to get the currents deep into the brain. The fact that people still suffer from migraines means that the existing treatments using electrical technology or chemistry are not working.” (2)

The study found that repeated sessions reduced both the duration and the intensity of pain in close to 40% of the migraineurs. The technique is recommended by Dr. Bikson to be used every day to ward off attacks, or periodically, like a booster. So far, the only side-effect recorded has been mild-tingling sensation in the person during the time s/he receives the procedure.

The researchers are looking forward to widen and scale up there clinical trials to come up with more findings across demographics so that once through te treatment can be made available at hospitals world over.

This new transcranial direct current stimulation (tCDS) has the following advantages over the other cranial nerve stimulation techniques available to medicine:

  • No need for unwieldy equipment
  • No potentially dangerous side-effects such as seizures
  • Stimulation of the deep brain instead of just the upper layer of the brain
  • No need for surgery to reach deep brain region to plant electrodes
  • Portable system and can develop the unit as small as an iPod working on a 9 volt battery.

SOURCES:

  1. Image by Victor Habbick; FreeDigitalPhotos.net; May 2012; http://www.freedigitalphotos.net/images/view_photog.php?photogid=4036
  2. Technology Eases Migraine Pain in the Deep Brain; Science Daily News; May 2012; http://www.sciencedaily.com/releases/2012/04/120430192625.htm

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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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The Haven of Homeopathy for Migraineurs

Despite its critics, homeopathy offers some of the most potent drugs to tackle migraines. The reason I recommend homeopathic treatments for migraines more than I do allopathic ones is because of the lack of side effects. Moreover, when you are talking of migraines, you are dealing with mid to long-term usage of any drug. If you are like me, you could be looking at 10 years of monthly migraines! In such a scenario, popping pills may not be a great idea. Yes, if it is an infectious or a life-threatening ailment, you will have to resort to mainstream allopathic medication, however.

HOWEVER, CONSULT A HOMEOPATHIC DOCTOR BEFORE YOU EMBARK ON A PROGRAM. Remember, practitioners select treatments according to a patient consultation that explores the physical and psychological state of the patient, both of which are considered important to selecting the remedy. Therefore, what worked for me, may not work for you and vice versa.

Natrum mur, Silicea (also called Silica), Sepia, Belladonna, Bryonia, Cimicifuga, Cyclamen, Gelsemium, Ignatia, Iris versicolor, Kali bichromicum, Lachesis, Natrum muriaticum, Sanguinaria and Spigelia are examples of some homeopathic medicines that effectively counter migraines. 

I will be discussing other effective migraine therapy options in my next post…Until then, take care

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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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