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Alternative Therapies

Jan Mundo, who is a Somatic and Headache Coach, and Bodyworker just wrote a book, The Headache Healer’s Handbook, which was published by the New World Library. I’ve known Jan and her wonderful work with headache patients for many years and was happy to write a foreword to her very readable and useful book. Here is the foreword:

Headaches afflict close to half of the US population with 40 million suffering from migraines, which can be very disabling. Many books have been written for the general public, including two of my own, but Jan Mundo’s Headache Healer’s Handbook brings a unique perspective to this problem.
When I treat patients in the office, they are usually reassured by the fact that I am also a migraine sufferer and so it is with Jan’s book – she knows first-hand what it feels like to have a migraine. More importantly, she has discovered ways to relieve her own attacks and those of other countless migraineurs.
Like Jan, I am a big proponent of non-drug treatments and this is what she details in her book. I also like her hands-on approach, both literally and figuratively. Psychologists have proven that active treatments, where people are doing things to improve their condition, are much more effective than passive treatments, such as massage, chiropractic, and acupuncture, where things are done to them. This leads to the transfer of external locus of control to internal locus of control or in other words, a shift from a passive and helpless victim of external circumstances, to being an active participant in the events with a significant degree of control.
Jan begins with the basics – identifying your type of headache and finding possible triggers that make headaches worse. She does recommend at least one visit to the doctor to confirm the diagnosis. This is important not because a brain tumor or an aneurysm is likely to be found since those are very rare, but a routine blood test could detect magnesium or thyroid deficiency, anemia, or another medical problem that could be contributing to headaches.
Once your diagnosis is confirmed, with Jan’s help you can take an inventory of your diet, sleeping habits, your physical environment, and posture, and try to find triggers, which can be corrected. Then Jan recommends breathing exercises which to me had echoes of the Feldenkrais method – becoming aware of how you breathe and improve not only your breathing, but also the movements of your chest, spine, and the rest of your body.
In the chapter, Being still: Mindfulness and Headaches Jan describes another powerful tool in combating not only headaches, but many other physical and mental ailments. Yes, everyone is talking about the proven benefits of meditation, but it is surprising how few people actually practice it.
Posture, Ergonomics, and Sleep is followed by a chapter on physical exercise, which is proven to not only be good for you, but to specifically reduce the frequency and the severity of headaches.
A large portion of the book is devoted to the Mundo method, Jan’s unique hands-on therapy, which she has developed to treat her own headaches and which has helped many sufferers she has worked with. The healing power of touch is scientifically proven to dramatically improve outcomes in premature babies and without a doubt, can be also harnessed to relieve a variety of headache conditions. Just follow Jan’s advice and watch your headaches go away.

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Medical marijuana appears to be very effective for the treatment of pain, according to a new study just published in the European Journal of Internal Medicine.

The study was conducted by researchers at the Soroka University Medical Center, Ben-Gurion University of the Negev, in Be’er-Sheva, Israel. Israeli scientists have been at the forefront of the research of medical applications of cannabis, starting with the discovery of THC in 1964 by a Hebrew University professor Raphael Meshulam.

In the current study, the researchers evaluated 2736 patients above 65 years of age who received medical cannabis from January 2015 to October 2017 in a specialized medical cannabis clinic. The mean age was 74 years. The most common indications for cannabis treatment were pain (67%) and cancer (61%). After six months of treatment, 94% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. Most common adverse events were dizziness (9.7%) and dry mouth (7.1%). After six months, 18.1% stopped using opioid (narcotic) analgesics or reduced their dose.

The authors concluded that “the therapeutic use of cannabis is safe and efficacious in the elderly population. Cannabis use may decrease the use of other prescription medicines, including opioids.” Even though it was a very large study, it was an observational study with its obvious limitations. They also stressed the need for double-blind prospective trials to confirm the safety and efficacy of medical cannabis for the treatment of pain in the elderly.

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An electric stimulation device, gammaCore has received clearance from the U.S. Food and Drug Administration (FDA) as an acute treatment of pain associated with migraine in adult patients. gammaCore is a hand-held device that stimulates the vagus nerve in the neck through the skin and was developed following and based on my 2005 publication describing the use of implantable vagus nerve stimulator for refractory chronic cluster and migraine headaches. This adds to the approval gammaCore received for the acute treatment of pain associated with episodic cluster headache in adult patients in April 2017. The clearance is limited to pain of migraine, rather than migraine attacks, meaning that the device relieves pain and may not relieve other migraine symptoms, such as nausea and sensitivity to light and noise.

The FDA clearance of gammaCore for the acute treatment of pain associated with migraine was supported by the results of the multicenter, randomized, double-blind, sham-controlled trial that demonstrated that “treatment with gammaCore for the acute treatment of pain associated with migraine was superior to sham, and also enabled patients to reach pain freedom more frequently by 30, 60, and 120 minutes compared with sham treatment”. Just like with all other studies with gammaCore, the therapy was found to be well tolerated by patients.

gammaCore is also available outside of the U.S., including in Canada and the European Economic Area. The manufacturer offers a free trial of the device, which cannot be purchased, but only rented. Some insurance plans may pay for the rental.

Here are a few disclaimers and warnings from the manufacturer:

The safety and effectiveness of gammaCore (non-invasive vagus nerve stimulator) has not been established in the acute treatment of chronic Cluster Headache.
This device has not been shown to be effective for the prophylactic treatment of chronic or episodic cluster headache.
The long-term effects of the chronic use of the device have not been evaluated.
Safety and efficacy of gammaCore has not been evaluated in the following patients, and therefore is NOT indicated for:
Patients with an active implantable medical device, such as a pacemaker, hearing aid implant, or any implanted electronic device
Patients diagnosed with narrowing of the arteries (carotid atherosclerosis)
Patients who have had surgery to cut the vagus nerve in the neck (cervical vagotomy)
Pediatric patients
Pregnant women
Patients with clinically significant hypertension, hypotension, bradycardia, or tachycardia

Patients should not use gammaCore if they:
Have a metallic device such as a stent, bone plate, or bone screw implanted at or near their neck
Are using another device at the same time (eg, TENS Unit, muscle stimulator) or any portable electronic device (eg, mobile phone)

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A recent article in the New York Times by the health columnist, Jane Brody, Trying the Feldenkrais Method for Chronic Pain, described her very positive experience with the Feldenkrais method. Then, at about the same time a patient told me that Feldenkrais lessons made a big difference in her neck and back pain. I started to read about Feldenkrais (download an article from the Smithsonian Magazine), took a lesson with my patient’s teacher, and then invited this teacher to work in our office.

This method was developed by a Russian-born Israeli engineer Dr. Moshe Feldenkrais (1904-1984). He was a physicist who was educated at Sorbonne and worked with Frédéric Joliot-Curie, then worked in the British survey office and during the war, as a science officer in the Admiralty. In 1936, while in France, he became one of the first Europeans to earn a black belt in judo.

A knee injury led Feldenkrais to develop a movement method named after him. He did not call it therapy and always insisted that he did not treat patients, but rather taught lessons on how to move naturally. At the same time, his lessons often led to a dramatic relief of pain, improved movement and functioning in individuals who suffered from cerebral palsy, strokes, multiple sclerosis, back, and neck pains. He felt that the key to healing was to become aware of what one is doing. Dancers, artists, and athletes have been using Feldenkrais lessons to improve their performance and to heal and avoid injuries. In the early 1950s Feldenkrais worked with the first Prime Minister of Israel, David Ben-Gurion, whose decades-long chronic back pain dramatically improved. Feldenkrais quit his position as the first director of the electronics department of the Israeli Defense Force and decided to devote all of his time to teaching his movement method. He had trained hundreds of practitioners all around the world and they in turn trained the next generation of teachers.

Feldenkrais emphasizes gentle and often small movements that re-educate and re-establish the connection between the body and the brain. It also makes you do movements that do not come naturally and that we never do, such as turning your head to one side and moving your eyes in the opposite direction. It is difficult to describe this method in words, but even a single lesson can show its dramatic potential. Try this simple exercise. Check the range of movements in your neck – how far can you turn your head to one side, then the other without straining. Then, put palms of your hands on your cheeks and attach your arms to the body. Now, turn your body at the waist from the midline to the left and back to the midline, again only as far as you can comfortably do it. Repeat this 10 times and then 10 times from the midline to the right. Now, put down your arms and test your range of movements again. Most people, including those who have very tight neck muscles, will noticed a significant and a very surprising improvement. Surprising, because it happened without moving your neck. You can watch me doing this exercise on youtube; I also show another exercise that improves the lateral flexion of your neck.

A possible explanation is that our brains get visual cues indicating that our head moved far to one side, but the brain cannot tell if the movement came from turning the torso or the neck. Repeating the move 5-10 times trains our brain to allow such movement even when we only move the neck. This explanation has some scientific support. When vision and proprioception were incongruent, participants were less accurate and initially relied on vision and then proprioception over time.

This explanation has some scientific support. The authors of an article in the Experimental Brain Research, Untangling visual and proprioceptive contributions to hand localisation over time, conclude that “When vision and proprioception were incongruent, participants were less accurate and initially relied on vision and then proprioception over time” (proprioception is our sense of the relative position of our body parts).

Another fascinating phenomenon that provides Feldenkrais method additional scientific support is the observation that when we cross our hands, we feel less pain in the hand. The Journal of Pain published an article “Seeing One’s Own Painful Hand Positioned in the Contralateral Space Reduces Subjective Reports of Pain…” Scientific research using functional MRI images of the brain led to the publication of another article in the same journal: Crossing the line of pain: FMRI correlates of crossed-hands analgesia.

It appears that our visual cues are very important to our ability to move and feel pain and this may be one of the ways the Feldenkrais method improves movement and relieves pain.

Individual lessons can be expensive ($100-$200 an hour), but Feldenkrais is often taught in groups, which makes it more affordable. You can also learn it by reading books, such as Awareness Heals: The Feldenkrais Method For Dynamic Health , audio recordings – The Feldenkrais Lessons: Awareness Through Movement by Bruce Holmes , and youtube videos

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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.

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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.

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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.

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Excessive consumption of marijuana can lead to bouts of severe nausea and vomiting, which in medicalese is called cannabinoid hyperemesis syndrome (CHS). With many states legalizing medical and recreational marijuana, there has been an increase in ER visits and admissions to the hospital for severe vomiting. This is often misdiagnosed as cyclic vomiting syndrome (CVS), a condition which is more common in children than adults and is related to migraines. CVS, which is mentioned in a previous post, is often relieved by sumatriptan (Imitrex).

Unfortunately, people who overindulge in pot, do not realize that it is responsible for their symptoms and end up undergoing endoscopies, MRI scans and other procedures. Taking a hot shower is known to relieve pot-related vomiting, but hot shower also works for some patients with CVS, so this does not help in differentiating the two conditions. German researchers tried to find a reliable way to differentiate CHS and CVS and concluded that the only way to tell these apart is to completely stop marijuana. They do note that CHS can develop after years of using marijuana and that after marijuana use is stopped, it may take several days and up to a couple of months for symptoms to subside.

So far, we’ve prescribed medical marijuana to a couple of hundred patients with headaches, migraines, and nerve pain and have not seen such a problem. It is possible that the amount used for medicinal purposes is too small to cause CHS. The cost of medical marijuana is relatively high and could be preventing its overuse.

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Psychological factors play a major role in migraines. This is not to say that migraine is a psychological disorder – we have good genetic and brain imaging studies confirming its strong biological underpinnings. The divide between biological and psychological is very artificial since we know that physical illness leads to psychological problems and the other way around. Stress is obviously one of the major triggers of migraines and we know that people with migraines are at least twice as likely to develop anxiety, depression, and other mental disorders. These are not cause-and-effect relationships because anxiety and depression can precede the onset of migraines. The connection is probably due to shared underlying problems with serotonin, dopamine, and other neurotransmitters.

We have strong evidence that addressing psychological factors involved in migraines through biofeedback, meditation, and cognitive therapy can lead to the reduction of migraine frequency, severity, and disability. Studies in chronic pain patients have shown that people with external locus of control (thinking that uncontrollable outside chance events are major contributors to pain) have more disability than people with internal locus of control (those who feel that their actions are contributing to pain and that active involvement in treatment can relieve pain).

Chronic migraine sufferers (defined as those with 15 or more headache days each month) are known to have greater disability than those with episodic migraines. In a recent study by researchers at the Yeshiva University and Albert Einstein College of Medicine, 90 chronic migraine patients were evaluated for psychological symptoms. Of these 90 patients, 85% were women, their mean age was 45, and half reported severe migraine-related disability. They were twice as likely to be depressed and to have external locus of control. The half with severe migraine-related disability were 3.5 times more likely to have anxiety and depression and were twice as likely to have a symptom described as catastrophizing. Catastrophizing is defined as having irrational thoughts about pain being uncontrollable, leading to disability, loss of a job, partner, ruined life, etc.

The good news is that many studies show that with cognitive therapy locus of control can be shifted from external to internal, catastrophizing can be reduced or eliminated, and disability diminished. This may not eliminate migraines or chronic pain, but can make you less anxious and depressed, and much more functional. Cost and access to therapy can be a problem, but studies suggest that even online therapy can be very effective.

Besides psychological approaches, regular aerobic exercise (stationary bike is easiest for migraine sufferers), certain supplements and prescription drugs can also help. Supplements that can relieve anxiety and depression include SAMe, omega-3 fatty acids (fish oil), methylfolate, and other. Some antidepressant medications relieve not only anxiety and depression, but also provide relief of migraines even when psychological factors are absent. These include so called SNRIs (duloxetine or Cymbalta, venlafaxin, or Effexor, and other) and tricyclics (amitriptyline, or Elavil, protriptyline, or Vivactil, and other). The most popular group of antidepressants, the SSRIs (fluoxetine, or Prozac, escitalopram, or Lexapro, and other) do help anxiety and depression, but have no pain or headache-relieving properties. Obviously, all drugs have potential side effects and for most patients it makes sense to try non-drug treatments first.

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Curcumin, which is one of the ingredients in turmeric, has long been touted for many of its anti-inflammatory and anti-cancer properties. A study presented at the 2017 Alzheimer’s Association International Conference showed that curcumin improves memory in healthy adults without Alzheimer’s disease.

This double-blind study was performerd by Dr. Gary Small and his colleagues at UCLA and it involved 40 men and women with a mean age of 63. Half of these subjects received 90 mg of Theracurmin brand of cucurmin twice a day, while the other half was given placebo for a period of 18 months. Researchers administered both verbal and visual memory tests and also measured brain deposits of amyloid plaques and tau tangles using special imaging methods (PET scans). These deposits are found in the brains of patients with Alzheimer’s.

The scores for both types of memory improved in the curcumin group, but not in the placebo group. Curcumin also prevented buildup of amyloid plaques and tau tangles in the brains. Daily curcumin also improved attention and mood.

Four patients in the curcumin group and two in the placebo group had stomach pains and nausea. These were the only side effects.

The authors concluded that “This relatively inexpensive and nontoxic treatment may have a potential for not only improving age-related memory decline, but also as a prevention therapy, possibly staving off progression, and eventually future symptoms of Alzheimer’s disease.”

There is less clinical evidence for the use of curcumin for the prevention of migraines. A recent study, published in the journal Immunogenetics, Iranian researchers reported that a combination of omega-3 fatty acids and curcumin reduced the production of TNF. TNF is a protein that is involved in sending messages between cells, which leads to increased excitability of neurons, neuroinflammation, and pain. The study involved 74 patients with migraines, who were divided into 4 groups – placebo, curcuming, omega-3, and combination of omega-3 and curcumin. The combination produced not only a reduction in TNF levels, but also fewer migraine attacks than seen in the other 3 groups.

Curcumin is not very well absorbed and several companies have tried to improve its absorption using various methods. The UCLA study utilized Theracurmin, which is an ingredient in several brands of curcumin. Another type, Longvida also seems to be better absorbed and is also used by several manufacturers.

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Ketamine is a medicine that is sometimes given intravenously for anesthesia. It is a controlled drug because it can induce euphoria and is potentially addictive. In a previous post I mentioned several anecdotal reports about the beneifical effect of ketamine for a prolonged migraine aura, hemiplegic migraine and other types of headaches.

A presentation at the recent annual meeting of the American Society of Anesthesiologists described the results of ketamine infusion on severe migraines in patients admitted to the Thomas Jefferson University Hospital in Philadelphia from 2014 to 2016. 48 of the 61 patients (77%) responded to this treatment, meaning that their pain levels improved by at least 2 points on a 1 to 10 scale. On average, the infusion had to be given for 5 days. Side effects included sedation (51%), blurry vision (38%), nausea or vomiting (38%), hallucinations (28%), vivid dreams (13%), and low blood pressure (5%). The authors described the adverse effects as mild in nature and only 1 patient discontinued treatment. However, having hallucinations, drop in blood pressure or vomiting does no sound like mild side effects to me. On the other hand, these were patients whose migraine did not respond to other treatments and they needed to be hospitalized, so these side effects could in fact be acceptable if the treatment ultimately provides relief.

Review of patient records admitted to the same hospital between 2006 and 2014 showed the mean headache pain rating using a 0-10 pain scale dropped from 7 on admission to 4 on discharge. The majority (55 out of 77, or 71%) of patients responded by the same definition of an at least 2-point improvement in headache pain at discharge. Only a quarter of responders maintained this benefit at their follow-up office visit. The mean length of infusion was also 5 days. And again, most patients tolerated ketamine well with “very few serious side effects”.

Anecdotal evidence also exists for the use of ketamine infusions to treat depression. There are some outpatient clinics that offer ketamine infusions for chronic pain and depression and a few of my patients have gone there, but unfortunately with little success.

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There is little doubt that stem cells, along with genetics and computer science will revolutionize medicine. There are more than a dozen journals devoted to stem cell research and many general and speciality medical journals also publish research on stem cells, which means that a couple of hundred articles are published every month. At first, the research was stymied by the controversy about the fetal sources of stem cells. For the most part this problem has been circumvented by the discovery of other sources, such as umbilical cord, placenta, fat tissue, and other.

In neurology, multiple sclerosis, spinal cord injuries, and strokes have been the main targets of stem cell research. The latest study of stem cells for stroke victims conducted at Stanford by Gary Steinberg and his colleagues produced very encouraging results. This trial included only 18 patients, but they all had their stroke anywhere between 6 months and 3 years before the study – past the usual time where further recovery is expected. Improvement occurred in the majority of patients and the improvement was not affected by the age of the patient or the severity of the stroke. Although stem cells were injected directly into the brain through a small hole that was drilled in the skull, there were no serious complications or side effects. The researchers also noted that stem cells did not replace damaged cells but rather stimulated patients’ own repair mechanisms. This is at odds with the original idea that stem cells by their nature could turn into nerve cells or any other cells in the body to replaced damaged cells.

This stimulating (and anti-inflammatory) effect of stem cells was our reason for conducting a small pilot study of stem cells in patients with refractory chronic migraines, which was described in a previous post. We did not inject cells into the brain, but into the muscles around the head and neck. Three out of 9 patients showed some improvement. We used patients’ own cells extracted from their fat tissue, while the stroke study used cells derived from the bone marrow of a donor. The future of stem cell research clearly lies in the use of such off-the-shelf cells, which have been shown to be safe and are probably more effective than fat-derived cells.

Stem cell lines are being developed to treat different medical conditions – Asterias for spinal cord injury, Pluristem for radiation damage, and many other.

The same team of researchers and SanBio, Inc. the Japanese company that developed these stem cells are conducting another larger controlled trial. You can email stemcellstudy@stanford.edu for information about participating in this trial.

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