A person empathizing with someone in pain perceives his or her own pain as more severe and unpleasant. Researchers at McGill University published these findings in the current issue of journal Pain. This observation could explain, at least in part, high frequency of pain symptoms observed in spouses of chronic pain patients. Even laboratory mice have heightened pain behavior when exposed to cagemates, but not to strangers, in pain. Clearly, the thing to do is not to ignore your spouse’s or friend’s pain, but rather try to get the pain relieved. If that is not possible, hopefully, a cognitive-behavioral psychologist may be able to devise a way to be very supportive and helpful without constantly feeling badly for the person in pain.
Written by Dr. Mauskop | 07.06.2008 | No comments
Patients who faced delays in the treatment of their chronic pain were found to have worsening of their condition, according to a recent review published in the journal Pain. The review of 24 trials showed that patients had a significant deterioration of their health-related quality of life and psychological well being. This was true for patients who waited for six or more months to receive treatment. Studies looking at shorter wait times were less conclusive. The authors conclude that waiting for treatment of chronic pain for six months or longer is medically unacceptable. While our medical system is often to blame for such delays, many patients delay their treatment for a variety of other reasons as well. It is important for friends and relatives to urge someone who suffers from chronic pain (including headaches) to seek medical attention from a qualified specialist.
Written by Dr. Mauskop | 06.06.2008 | No comments
Facial expression of pain seems to make you feel worse, according to a study published in the May issue of The Journal of Pain. Healthy volunteers were asked to make a painful expression before the pain started and without anyone appearing to be watching (to avoid “social feedback”). The pain was perceived more unpleasant when the volunteers made a painful facial expression compared to when a neutral facial expression was made. Practical application of this study is in that people in pain should try to avoid grimacing from pain and keep their faces relaxed. The authors discuss recent brain imaging studies which seem to confirm an old observation that facial expression can cause one to experience emotion that is being expressed. In other words, forcing yourself to smile may improve your mood, while making an angry face can make you feel angry.
Written by Dr. Mauskop | 06.06.2008 | No comments
Treating migraines in adolescents presents some unique challenges. Besides difficulties, such as getting them to bed before midnight and getting them to improve their diets, we face the problem of not having any FDA-approved drugs to treat migraine attacks. And it is not for lack of trying on the part of makers of triptans, which are drugs that work miracles for many adult headache sufferers. The problem has been proving to the FDA that these drugs work in kids. Because children tend to have shorter attacks, by the time we try to assess the efficacy of a particular drug two and four hours after the pill is taken, the headache is gone even if the pill was a placebo. Many studies have shown that the triptans are safe and effective (as was observed in kids who have longer duration of attacks). Many, but far from all headache specialists use triptans, such as Imitrex and Maxalt in adolescents. A study just published in Headache proved that Axert, another drug in the triptan family and that was tested in 866 children, is effective in children 15 to 17 years of age. The bottom line is that triptans can be safely used in kids who suffer from severe migraine headaches. I am often asked by other physicians, what is the youngest age I would prescribe a triptan? Because of a shortage of pediatric neurologists I feel compelled to see children as young as 10 and this is the youngest age at which I will prescribe triptans.
Written by Dr. Mauskop | 21.05.2008 | No comments
For many years headaches were thought to be triggered by elevated blood pressure. Evidence had suggested that only very sudden increase in blood pressure triggered a headache in some patients, but the myth of high blood pressure headaches has persisted. Norwegian researchers published a very surprising finding in the April issue of journal Neurology. They looked at the data on 120,000 people and found that increasing systolic blood pressure was associated with a decrease in migraine and non-migraine headaches. Even more striking was the inverse correlation with the pulse pressure (difference between systolic and diastolic pressure, for example blood pressure of 110/80 means that the pulse pressure is 30). Patients with higher pulse pressure had fewer migraine and other headaches. It can be speculated that hardening of arteries that occurs with elevated blood pressure makes them less likely to constrict and dilate, which is part of a migraine process.
Written by Dr. Mauskop | 20.05.2008 | 2 comments
Menstrual migraines are at times very difficult to treat. Triptans, such as Maxalt, Imitrex and other are usually very effective, but in some patients do not provide sufficient relief. Corticosteroid drugs, such as prednisone and dexamethasone can help some patients. Marcelo Bigal and his colleagues compared treatment of menstrual migraines with Maxalt alone, dexamethasone alone, and combination of the two. Maxalt was much better than dexamethasone, providing sustained 24-hour relief in 63% of patients vs 33%, but the combination was better than Maxalt alone, giving relief to 82% of women. We would always try Maxalt or a similar drug alone, but if one drug is insufficient a combination with dexamethasone should be tried. Corticosteroids should not be used for more than a few days a month because frequent and prolonged use can lead to serious side effects.
Written by Dr. Mauskop | 14.05.2008 | No comments
Scientists in Trieste, Italy suggested a new approach to the treatment of migraine headaches. They hypothesized that combining two different approaches would yield better outcomes than either one alone. A neurotransmitter CGRP antagonists appear to be effective in the treatment of an acute migraine. Merck has a product in late stages of development that works through this mechanism and hopefully will be the first of a new class of migraine drugs. Based on laboratory research the Italian group suggests that combining a CGRP antagonist with a blocker of nerve growth factor may result in a more effective treatment. This fits with a new trend in treatment of many conditions - combining drugs that work in different ways, rather than trying to always use a single medication.
Written by Dr. Mauskop | 10.05.2008 | No comments
Treatment of migraines leaves a lot to be desired and in part not because we do not have effective treatment, but because of a communication barrier. Doctors appear not to want to hear what migraine patients have to say about their headaches, according to a remarkable study by a top headache researcher Richard Lipton and his colleagues. Patients and doctors agreed to be videotaped during a visit and 60 such interactions were analyzed. The analysis showed that doctors did not ask about the disability of headaches and tended to ask closed-end short questions. Very often the information they did obtain was incorrect. 55% of doctor-patient pairs were misaligned regarding frequency of attacks; 51% on the degree of impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention. The authors recommended that doctors assess impairment using open-ended questions in combination with what is called the ask-tell-ask technique.
Written by Dr. Mauskop | 10.05.2008 | 2 comments
How long will I suffer from migraines? Will it ever go away? These are very common questions patients ask their doctors. Drs. Bigal and Lipton reviewed a recent large study that looked at what happens to migraine patients within one year of observation. The study found that migraine completely went away in 10%, improved in 3% and worsened and became chronic (occurring on more than 15 days each month) in 3%. This confirms what we’ve know all along – migraine headaches tend to go away with age. In women this often happens after menopause and in men at around similar age; however this study and our experience indicates that for many people migraines may go away earlier, at any point in their lives. The problem is that we can never predict when this will happen and in a small percentage of patients (about 3%) migraines never go away.
Written by Dr. Mauskop | 05.05.2008 | 3 comments
Treximet, a new migraine treatment was approved today by the FDA. Treximet is a combination of two old drugs - sumatriptan (Imitrex), 85 mg and naproxen (Aleve), 500 mg. The combination is more effective than Imitrex alone because naproxen provides additional relief through its anti-inflammatory and pain relieving effects. Imitrex is losing its patent protection and is going to be available as a generic drug in 2009. The maker of Treximet, GlaxoSmithKline is hoping to switch most of the patients currently taking Imitrex to Treximet before patent expiration, in order to reduce its losses to generic competition. However, it is likely that insurance companies will force physicians to prescribe generic Imitrex and generic naproxen rather than pay for Treximet. GSK argues that the combination drug, just like Imitrex are fast-dissolving and therefore faster acting drugs than the generic naproxen is and the generic Imitrex is going to be.
Written by Dr. Mauskop | 15.04.2008 | 4 comments
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