January | 2018 | Headache NewsBlog

Feverfew for migraines

By: Dr. Mauskop

28-01-2018

Feverfew (tanacetum parthenium) is one of the oldest herbal remedies for the treatment of migraine headaches. It was first mentioned as a treatment for inflammation 2,000 years ago. Feverfew is a member of the daisy family and all above-ground parts of the plants are safe to ingest and it is usually consumed as dried leaves or tea made of dried flowers. Besides migraine, it has been used for the treatment of fevers, rheumatoid arthritis, stomach aches, toothaches, insect bites, psoriasis, allergies, asthma, tinnitus, dizziness, nausea, and vomiting, infertility, problems with menstruation and labor during childbirth.

We do have some scientific evidence for the effectiveness of feverfew in the prevention of migraine headaches. Here is a brief description of two of the five published trials of feverfew.

A study, Randomized double-blind placebo-controlled trial of feverfew in migraine prevention was published in the Lancet by British researchers led by JJ Murphy. 60 patients completed this study, in which half of the migraine patients received feverfew and the other half, placebo. After four months the treatment was switched (so called crossover study). Patients in the feverfew group had 4.7 fewer attacks, while placebo resulted in 3.6 fewer attacks. Global assessment of improvement was 74 vs 60. Feverfew also reduced the severity of nausea and vomiting.

Another, more rigorous study by German researchers led by HC Diener was published in Cephalalgia. It was entitled, Efficacy and safety of 6.25 mg t.i.d. feverfew CO2–extract (MIG-99) in migraine prevention – a randomized, double-blind, multicenter, placebo-controlled study.
This study enrolled 170 migraine sufferers with 89 receiving a special extract of feverfew and 81, placebo. The number of migraine attacks dropped by 1.9 in the feverfew group and by 1.3 attacks in the placebo group. The difference in the global assessment of efficacy was also statistically significant.

As far as side effects, mouth sores have been reported and, like with any herbal product, feverfew can cause upset stomach or an allergic reaction.

An issue with feverfew that applies to all herbal products is that every manufacturer processes the plant differently. In some cases, the product contains very little of active ingredients, such as parthenolides. The British researchers in the study cited above grew their own feverfew in the back yard of the hospital. An easier solution is to buy products of companies with good reputation, such as Nature’s Way, Source Naturals, and Oregon’s Wild Harvest.

Terrorism and headaches

By: Dr. Mauskop

22-01-2018

Chronic migraine, Headaches, Headaches in children, Psychology of headaches

Survivors of terrorist attacks are four times more likely to suffer from migraines and three times more likely to suffer from tension-type headaches, according to a study just published in Neurology. The researchers evaluated 213 of 358 adolescent survivors of the 2011 massacre at a summer camp in Norway that resulted in deaths of 69 people. These survivors were compared to over 1,700 adolescents of the same sex and age who were not exposed to terrorism. The survivors were not only much more likely to suffer from migraines and tension-type headaches, but were also much more likely to have daily or weekly attacks.

Many previous studies have shown that physical, sexual, and emotional abuse in childhood and posttraumatic stress disorder (PTSD) are strong risk factors for the development of migraines and chronic pain in many previous studies. Having a family history of migraines further increases this risk, as does head trauma, and having other painful or psychological disorders. Headache is also one of the first symptoms reported by adolescent girls and women who were raped.

The authors of the current report cite evidence that “Childhood maltreatment during periods of high developmental plasticity seems to trigger modifications in genetic expression, neural circuits, immunologic functioning, and related physiologic stress responses. It is plausible that exposure to interpersonal violence could induce functional, neuroendoimmunologic alterations, affecting central sensitization and pain modulation and perception. Central sensitization, expressed as hypersensitivity to visual, auditory, olfactory, and somatosensory stimuli, has long been thought to play a key role in the pathogenesis and chronification of migraine.”

It is likely that early intervention after a traumatic event will result not only in better psychological outcomes, but also in fewer and milder headaches. One such intervention is cognitive-behavioral therapy. However, there are several different types of such therapy and a study just published in JAMA Psychiatry compared 12 sessions of cognitive processing therapy (CPT) with 5 sessions of written exposure therapy (WET) for the treatment of posttraumatic stress disorder. WET was shown to be at least as good as CPT with fewer treatment sessions required. This makes WET more efficient and affordable and patients are more likely to complete it.

My previous blog posts mention online self-administered courses of cognitive-behavioral therapy for PTSD, anxiety, depression, OCD, insomnia, chronic pain, and other conditions. The site is ThisWayUp.org.au and the researchers behind it have published scientific data indicating that their approach is very effective. It is also very inexpensive – some courses are free and some cost about $50.

Migraines can be prevented with CoQ10 supplementation

By: Dr. Mauskop

08-01-2018

Alternative Therapies, Headaches in children, Migraine

Deficiency of coenzyme Q10 (CoQ10) is the second most common deficiency in migraine sufferers after magnesium. Fully one third of migraine sufferers are deficient in CoQ10, according to a study by Dr. Andrew Hershey and his colleagues published in the journal Headache. They tested 1,550 children and adolescents and a study in such a large population tends to be very reliable. Supplementing these children with 1 to 3 mg/kg of CoQ10 produced significant improvement not only in CoQ10 levels but also in the frequency of attacks (from 19 a month to 12) and the disability (the disability score dropped from 47 to 23).

This deficiency is present in adults as well, as was shown in another study by a Swiss neurologist, Dr. Peter Sandor and his colleagues. They gave 100 mg of CoQ10 three times a day or placebo to 42 adult migraine sufferers and discovered that a 50% drop in migraine attack frequency occurred in 48% of patients on CoQ10 and only 14% of patients on placebo.

The Hershey study was done in a more logical way – determine who is deficient and give them CoQ10. If you give CoQ10 to those who need it and those who don’t, the results of the study and in practice will not be as impressive. Although CoQ10 is not expensive ($7 a month for 200 mg a day) and is very safe, why supplement to someone who does not need it? Although the blood test for CoQ10 is fairly expensive ($158 at Labcorp), it is usually covered by most insurance plans. It is important to ask your doctor what the actual blood level was because the laboratories will report as normal values between 0.37 and 2.2 (Labcorp) or 0.44 and 1.64 (Quest Diagnostics), studies have shown that the level should be at least 0.7.

As far as side effects, a few of my patients developed insomnia, possibly because CoQ10 is involved in energy generation, so I always advise taking it in the morning. While Sandor gave his patients 100 mg three times a day, in Hershey’s study the benefit appeared at lower doses. I usually recommend 100 to 200 mg (depending on body weight and how low the level is), to be taken once, in the morning.

Dementia and magnesium levels

By: Dr. Mauskop

03-01-2018

Alternative Therapies

Magnesium deficiency is found in up to 50% of migraine sufferers, 40% of those with cluster headaches, 45% of the elderly diabetics, and in a high percentages of people with other chronic diseases. Magnesium has been shown to relieve migraine and cluster headaches, post-concussion syndrome, lower blood pressure, prevent irregular heart beats, and improve breathing in asthmatics.

A new study by Dutch researchers published in the leading neurology journal, Neurology reports on an association between magnesium and dementia (Alzheimer’s and other types). Brenda Kieboom and her colleagues measured magnesium levels in almost 10,000 people without any evidence of dementia and followed them for an average of 8 years. The average age at the start of the study was 65. Only 2 subjects had magnesium level above normal and 108 below normal.

The surprising discovery, which was suggested by previous contradictory studies, is that people with both low normal and high normal levels (lowest and highest quintile of the normal range) were at an increased risk of developing dementia.

There are two hypotheses as to why low magnesium levels could predispose to dementia. One is that magnesium blocks NMDA receptor, which is involved in the development of dementia, traumatic brain injury, pain, migraines, and other conditions. The second theory is that magnesium deficiency promotes inflammation, which is found in brains of patients with dementia (and migraines). The authors did not offer any theories as to why high normal magnesium levels were also associated with the development of dementia.

The researchers admit several weaknesses of their study, including poor correlation between serum magnesium levels and the total magnesium in the body and the reliance on a single measurement of magnesium level. The study does have many strengths, including large number of subjects, correction for a variety of confounding factors (education, weight, smoking, alcohol, cholesterol, kidney function, stroke, and other). The fact that this correlation was found as early as 4 years after the initial assessment also suggests a real correlation.

Although, correlation does not mean causation, it is prudent to keep your magnesium level in the middle of normal range. We rarely see high or high normal magnesium levels in our migraine patients and in this study only 2 out of almost 10,000 people had higher than normal levels and 108 had lower than normal levels. Ideally, everyone who suffers from any medical condition or has a family history of dementia, should have their magnesium level checked. The more accurate test is not the serum level, but the RBC magnesium level.

Feverfew for migraines

Terrorism and headaches

Migraines can be prevented with CoQ10 supplementation

Dementia and magnesium levels

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