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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Migraines Peg Risk Of Facial Palsy Significantly

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Migraineurs at Double The Risk Of Developing Facial Paralysis (1)

As per a recent study conducted by a team of scientists working with Taipei Veterans General Hospital in Taiwan and National Yang-Ming University, migraineurs are at almost double the risk than non-migraineurs to develop facial paralysis also known as Bell’s Palsy.

The report of the study was published in the 13th January, 2015 issue of the medical journal Neurology of the American Association of Neurologists. Bell’s Palsy occurs due to the dysfunction of a specific cranial nerve that controls facial muscle movements. Some characteristics involve not being able to blink with the eye on the side the facial nerve is affected. Other signs include development of a facial droop on the affected side. Other things such as smiling, frowning, tear-formation, salivation, flaring nostrils and raising eyebrows may all be affected in Bell’s Palsy.

As per lead researcher and author of the study, Shuu-Jiun Wang, MD, “This is a very new association between migraine and Bell’s palsy. Our study also suggests that these two conditions may share a common underlying link.” (2)

It is assumed that anything between 11 to 40 people in every 100,000 people get Bell’s Palsy due to recurring migraines. In the study two groups of adult population were selected. The total persons under study were 136,704. One group had the migraineurs and the other had the non-migraineurs. The observations of the study continued for a period of 3 years. During that time, 671 people in the migraine group and 365 of the non-migraine group were newly diagnosed with Bell’s palsy. People with migraine were twice as likely to develop Bell’s palsy even after researchers accounted for other factors and medical conditions. (3)

According to Dr. Wang, “Infection, inflammation or heart and vascular problems could be shared causes for these diseases. If a common link is identified and confirmed, more research may lead to better treatments for both conditions.”

SOURCES

  1. Image Credit: Woman Face With Natural Look by Phasinphoto; freedigitalphotos.net; Web January 2015; http://www.freedigitalphotos.net/images/woman-face-with-natural-look-photo-p247674
  2. Migraine May Double Risk Of Facial Paralysis; ScienceDaily.com; Web December 2014; http://www.sciencedaily.com/releases/2014/12/141217171315.htm
  3. Does Migraine Produce Facial Palsy? Neurology; Web January 2015; http://www.neurology.org/content/84/2/108.short

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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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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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Finally A Stroke Guideline For Women!

Brain-Haemorrage

Hemorrhagic Stroke Risk In Women Addressed By AHA/ASA For The First Time (1)

Recent research has shown that migraineurs and especially those who experience aura are at an increased risk of a stroke (brain hemorrhage) or a heart attack during a migraine episode. My post of June 20th, 2013 speaks of this research (on high risk of stroke among the migraining population): http://bit.ly/1iON349

A stroke may be either ischemic or hemorrhagic in nature. A hemorrhagic stroke is the rupturing of an artery in the brain which results in bleeding in the tissues surrounding the rupture and killing the brain cells there which are devoid of blood, oxygen and nutrition. An ischemic stroke occurs when there is an obstruction like cholesterol or clot in the arteries in the brain. These account for almost 90% of all strokes and are less likely to result in fatality if given immediate attention. However, migraineurs are more susceptible to the deadlier hemorrhagic strokes. (2)

[Read WebMD research on how women with migraine with aura may be at increased risk for an additional type of stroke called hemorrhagic stroke here: http://bit.ly/1cmHW6Y ]

Given that women are more susceptible to migraines with aura, the higher risk of getting a stroke is inherent yet there have been no guidelines to date to address stroke issues in women. Finally a guideline has been issued by The American Heart Association/American Stroke Association for health professionals to prevent strokes in women. Here are a few of the important recommendation highlights you should know:

1. FOR MIGRAINEURS

“Women are four times more likely to have migraines than men, and they often coincide with hormone swings. Migraines alone don’t raise the risk of stroke, but ones with aura do. Using oral contraceptives and smoking raise this risk even more, so the guidelines urge stopping smoking.” (3)

2. FOR ELDERLY WOMEN

Women over 75 years of age should be screened for atrial fibrillation as it is an increased stroke risk factor.

3. FOR WOMEN WITH HYPERTENSION/ HIGH BLOOD PRESSURE

Low dose aspirin or calcium supplement therapy is recommended to cut of stroke risk

4. WOMEN WITH PRE-ECLAMPSIA

Preeclampsia is a condition where a pregnant woman experiences both high blood pressure and a significant increase in protein in her urine. Women with preeclampsia are twice as likely to get a stroke and four times as likely to suffer from high blood pressure later in life. In addition, they are to be treated for weight and cholesterol issues as well as smoking.

5. PREGNANT WOMEN:

Such women who are pregnant and suffer from high blood pressure (>=160/110 mmHg) should be given medication for high blood pressure. Those who are expectant are to be treated for readings in the range of 150-159 mmHg/100-109 mmHg. (4)

SOURCES

  1. Image Credit: Brain Hemorrhage; Sanitarian.net; Web February 2014; http://www.sanitarian.net/wp-content/uploads/2010/11/Brain-Haemorrage.jpg
  2. Study Shows Increased Risk of Heart Disease and Stroke for Migraines With Aura; WebMD.com; Web February 2014; http://www.webmd.com/stroke/news/20100824/migraines-with-aura-may-raise-stroke-risk
  3. Guidelines For Stroke Prevention In Women Issued; Forbes.com; Web February 2014; http://www.forbes.com/sites/robertglatter/2014/02/09/guidelines-for-stroke-prevention-in-women-issued/2/
  4. Stroke prevention in women: guidelines set for the first time; Medical News Today; Web February 2014; http://www.medicalnewstoday.com/articles/272351.php

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Drug Effectiveness & Power of Suggestion: Migraine Study

Role of Self Suggestions In Migraine

Doctor’s Words Affect Migraineurs’ Response To Drug (1)

A recent study conducted by researchers from Harvard Medical School and Beth Israel Deaconess Medical Center in Boston on migraineurs has shown that the type of labeling on the drug affects the body’s response to pain, nausea, photo-sensitivity, sound-sensitivity as well as vomiting (symptoms associated with a typical migraine attack).

According to Dr. Andrew Charles professor and director of the headache research and treatment program in the department of neurology at University of California School of Medicine, Los Angeles, who was not involved in the research, “When migraine patients were told by their doctor that a pill would help ease their headaches, this advice seemed to produce results whether or not the pill was a real migraine medication or a dummy placebo. Relief was still higher with the actual medicine, so drugs do work beyond the placebo effect, but the researchers say that the placebo effect may still account for half of the therapeutic value of a drug.” (2)

The research studied over 450 migraine attacks in total of 66 migraineurs over a period of their seven attacks.

  • The first attack was to go untreated but the migraineurs were expected to self-rate their pain and migraine-associated symptoms on a scale.
  • From the second attack up to the seventh attack the migraineurs were given medication (pills) in packets that were labelled.
  • The packets were labelled ‘Maxalt’ (Rizatriptan) – positive suggestion ( a drug that will help); ‘Placebo’ – a negative suggestion (drug with no effect on pain); ‘Maxalt or placebo’ – neutral suggestion (unknown if the drug will help or not).
  • But for two situations, one of the “Maxalt” envelopes actually held a placebo and one of the “placebo” envelopes contained Maxalt.
  • The migraineurs were to record the level of pain and discomfort 30 minutes from the onset of the migraine attack (for each of episode 2 through 7th episode)
  • Then they were to take the pills in the labelled packets.
  • Then they were to record their pain and discomfort two our thence ( A total of 2.5 hours after the commencement of a migraine attack)
  • In addition, they were also given a rescue medication in the event that the study medicines did not provide them with any relief. This rescue medication consisted of 1 Maxalt and 2 Naproxen tablets.
  • But for two situations, one of the “Maxalt” envelopes actually held a placebo and one of the “placebo” envelopes contained Maxalt.

Here is a chart depiction of the study methodology: (3)

Migraine Placebo Effect

As per Dr. Ted Kaptchuk, a senior author of the study, director of the Program in Placebo Studies, Beth Israel Deaconess Medical Center, and a professor of medicine at the Harvard Medical School, “We found that under each of the three messages, the placebo effect accounted for at least 50 percent of the subjects’ overall pain relief. When Maxalt was labelled “Maxalt,” the patients’ reports of pain relief more than doubled compared to when Maxalt was labeled “placebo.This tells us that the effectiveness of a good pharmaceutical may be doubled by enhancing the placebo effect.”

The authors were surprised to find that even when patients were given a placebo labeled as “placebo,” they reported pain relief, compared with no treatment. They had no idea why this occurred.

However, the findings of the study are best used for indicative purposes only and more research will be needed to be done to find out these results could be applied to clinical care and how placebos might help boost drug treatment care. As per Kaptchuk it is possible that simply hearing the words of medicine can have a healing effect, he noted.

SOURCES:

  1. Image Credit: Help Yourself Key Shows Self Improvement Online; Image by Stuart Miles; Freedigitalphotos.net; Web January 2014; http://www.freedigitalphotos.net/images/help-yourself-key-shows-self-improvement-online-photo-p211446
  2. Power of Suggestion Shown in Study of Migraine Drug; WebMD.com; January 2014; http://www.webmd.com/migraines-headaches/news/20140108/power-of-suggestion-revealed-in-study-of-migraine-drug
  3. Table Credit: Placebo effects are not the “power of positive thinking”; Science-Based Medicine; Web January 2014; http://www.sciencebasedmedicine.org/ted-kaptchuk-versus-placebo-effects-again/

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What Your Skin Temperature Could Tell About Your Migraine

 

Voila

Lower Temperatures At Body Extremities Could Indicate Migraine In Women (1)

A small scale study observing a women-only population of 41 Finnish women stated that skin temperatures in migraining women can be used as a bio-marker of vascular health since migraineurs are more at risk of developing cardiovascular diseases than healthy populations.

The study’s report published in Autonomic Neuroscience also observed that those with migraines usually have colder nose as well as hand and feet and that it could be attributed to abnormalities in the underlying blood vessels.

Here’s a quick look at the study statistics: (2)

  • Total women studied: 41
  • Those with migraines: 12; 10 with family history of migraines
  • Those without migraines: 29; 9 with family history of migraines

Out of the 12 migraining women 7 were found to experience right-sides migraines and 5 suffered the brunt of left-sided pains. The migraining population experienced visual aura. The study used digital infrared camera to measure skin temperatures in both migraining and control group. Temperatures of the cheeks, nose, forehead, fingertips and toes were taken for comparisons during headache-free periods.

The following results were obtained:

  • Women with right-sided migraines had higher blood pressure.
  • Women with right-sided migraines had lower hand and finger temperatures.
  • Compared to controls (healthy population) there was a 12 deg C (9 deg F) difference in temperatures at the fingertips and nose (extremities)

This could be explained by the fact that migraineurs often have constricted peripheral arteries or impaired functioning of the autonomic nervous system which in turn also makes them more susceptible to cardiovascular diseases.

The average temperature of the nose and hands was about 16 deg C (approx 3.6 degrees F) lower in migraine subjects than controls. Of the migraine patients, 58% had skin temperatures below 30 deg C (or 86 deg F), which is considered a normal skin temperature, in both the nose and fingers.

However, it must be noted that this study was not only small sized but also did not include men. Larger population studies including men and other ethnic groups should be conducted to come to a definitive conclusion. It however, does provide some indication to the direction in which medication development can be done. Biofeedback as an alternative medical therapy makes use of this skin temperature differential in migraineurs to manage pain episodes.

 SOURCES

  1. Image Credit: Business Woman Worried Stock Photo; freedigitalphotos.net; Web January 2014; http://www.freedigitalphotos.net/images/Business_People_g201-Business_Woman_Worried_p76375.html
  2. The Connection Between Migraines and Skin Temperature; The Wall Street Journal; Web January 2013; http://online.wsj.com/news/articles/SB10001424052702303497804579242423379994080

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