Alternative Therapies | 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.

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.

Vomiting from too much pot is similar to cyclic vomiting syndrome

By: Dr. Mauskop

02-12-2017

Alternative Therapies, Migraine

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.

Psychological factors in chronic migraine

By: Dr. Mauskop

24-11-2017

Alternative Therapies, Chronic migraine, Pain, Pain Research, Psychology of headaches

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.

Curcumin helps improve memory, possibly migraines.

By: Dr. Mauskop

13-11-2017

Alternative Therapies, Brain disorders, Chronic migraine, Migraine

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.

More on intravenous ketamine for migraines

By: Dr. Mauskop

05-11-2017

Alternative Therapies, Headache medications, Migraine, New treatments

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.

Stem cells help stroke victims, will revolutionize medicine

By: Dr. Mauskop

30-10-2017

Alternative Therapies, Brain disorders, Chronic migraine, Head trauma

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.

The effect of post-traumatic headaches on the brain

By: Dr. Mauskop

21-10-2017

Alternative Therapies, Botox, Chronic migraine, Head trauma, post-traumatic headache

Chronic pain is known to alter the structure of the brain. Mayo Clinic researchers used MRI scans to examine brains of 29 patients with post-traumatic headaches and compared their scans to those of 31 age-matched healthy volunteers. The average frequency of headaches was 22 days a month. Patients with post-traumatic headaches were found to have thinning of several areas of their cerebral cortex which are responsible for pain processing in the frontal lobes. Cortex covers the surface of the brain and contains bodies of brain neurons. Drs. Chiang, Schwedt, and Chong, who presented their findings at the annual meeting of the International Headache Society held last month in Vancouver, also discovered that the thinning was correlated with the frequency of headaches.

This study did not address possible treatments, but it would make sense that with better control of headaches, this brain atrophy might be reversible. To treat post-traumatic headaches we often use Botox injections, which have been shown to help posttraumatic headaches. Even though Botox is approved only for chronic migraines, many patients with post-traumatic headaches do have symptoms of migraines and can be diagnosed as having post-traumatic chronic migraines (without such a designation insurance companies may not pay for Botox). We also check RBC magnesium, CoQ10 and other vitamin levels, which are often low in chronic headache sufferers and if corrected, can lead to a significant improvement. Epilepsy drugs and anti-depressants can also help.

While the above mentioned treatments can help headaches and potentially could reverse brain atrophy, there is only one intervention that has been shown to increase the thickness of the brain cortex on the MRI scan. This intervention is meditation. And this effect was demonstrated in several studies. An 8-week course of mindfulness-based stress reduction led to a measurable increase in the gray matter concentration of certain parts of the brain cortex. A pilot study of migraine sufferers showed that meditation has a potential not only to restore thickness of the brain, but also to relieve migraines.

In one of my previous blog posts that described a sceintific study of meditation, I mentioned several ways to learn meditation: Free podcasts by a psychologist Tara Brach an excellent book, Mindfulness in Plain English by B. Gunaratana, and several apps – Headspace, 10% Happier, and Calm. You can also take an individual or a group class, which are widely available.

Gut bacteria can cause big holes in the brain

By: Dr. Mauskop

16-10-2017

Alternative Therapies, Chronic migraine, Headaches, Migraine

Biome, or the collection of bacteria living in our bodies has been receiving belated and well deserved attention. The discovery that bacteria living in our intestines can cause cerebral cavernous malformations or CCM (see photo) is quite dramatic. But there is no need to panic since this is a rare condition. However, it does indicate that gut bacteria can have a major impact on our brains.

It was a serendipitous discovery by Dr. Mark Kahn, professor of medicine at U. Penn, who studied mice with CCM. He noticed that mutant mice prone to CCM stopped developing holes in their brains after being moved to a new building. The exception was mice who developed an abscess after having their intestines accidentally stuck with a needle during a routine injection. Dr. Kahn and his colleagues identified a specific bacterium, Bacteroides fragilis, which was responsible for the development of brain caverns.

This finding may explain why there is such a wide variety of presentations in people who have the familial form of CCM. Some have no lesions even when they are 70, while others have hundreds of them at age 10. Just like mutant mice, humans seem to need an additional trigger to start developing CCMs. This finding provides a clear path to developing an effective treatment and perhaps, just a simple probiotic could keep such patients healthy.

In fact, a probiotic containing 14 different strains of bacteria (Bio-Kult, made in UK) is effective in preventing migraine headaches, according to a study presented by Iranian doctors at the recent International Headache Congress in Vancouver. Fifty patients were recruited into this study with half taking the probiotic and the other half, placebo. After 8 weeks, patients on the probiotic had fewer days with migraine and the pain was milder when compared to those taking placebo.

The big question is, what other brain disorders are triggered or worsened by our gut bacteria. We have more bacterial cells living in our bodies (about 39 trillion) than we have of our own cells (about 30 trillion) and scientists are finally beginning to study them. I Contain Multitudes: The Microbes Within Us and a Grander View of Life, is a fascinating and well-written book by Ed Yong on this subject.

Two different types of exercise prevent migraines

By: Dr. Mauskop

11-10-2017

Alternative Therapies, Headaches

A new study by Swiss researchers compared the effect of high intensity interval training (HIT) with moderate intensity continuous training (MCT) and with no exercise at all on the number of migraine headache days.

The results were presented at the International Headache Congress held in Vancouver last month. Not surprisingly, both types of exercise reduced the number of migraine headache days, but HIT was more effective. In the study, patients in HIT group did 4 periods of intensive exercise (90% of maximum intensity) each lasting 4 minutes, separated by periods of 3 minutes at 70% of maximum. The moderate intensity exercise was done at 70% for 45 minutes. Both groups performed these exercise twice a week.

A previous study has established that exercising for 40 minutes 3 times a week is as effective as relaxation training or taking a preventive migraine drug topiramate. Topiramate however has many potential side effects, including some serious ones. A Swedish study of 46,648 people established a strong inverse correlation between physical activity and the frequency of headaches.

HIT has been gaining in popularity since the 1980’s because it provides all of the benefits of exercise in a shorter period of time.

Color of the ambient light can help or worsen migraines

By: Dr. Mauskop

21-09-2017

Alternative Therapies

Bright light bothers many migraine sufferers and in some, a flash of bright light, such as sun reflecting off a window glass or water can instantly trigger a severe migraine. Sensitivity to light may be color dependent, according to a presentation by Japanese researchers at the International Headache Congress held in Vancouver earlier this month.

Dr. K. Niwa and his colleagues in Tokyo studied 936 patients with chronic headaches aged between 12 and 77. They compared 546 patients with episodic and chronic migraines with 392 patients with episodic and chronic tension-type, cluster, new daily persistent and other types of headaches. They exposed these patients to yellow, white, gray, blue green, and red ambient light. They measured the degree of discomfort on a 6-point scale, ranging from none to unbearable.

White, blue, and red lights aggravated discomfort both during a migraine attack and between attacks. Green light reduced discomfort between attacks of migraine and reduced pain intensity during a migraine, regardless of the presence or absence of light sensitivity. This was true for patients with both episodic and chronic migraine headaches. Those with chronic tension-type headaches had only mild discomfort from white light, while patients with all other types of headaches had no positive or negative reaction to various colors of ambient light.

This study confirmed previous reports (and our patients’ experience) that blue and white light worsens migraine pain. The more important finding is that green light seems to be very beneficial. Considering the low cost of this treatment, migraine sufferers, especially those with light sensitivity, may want to buy a green light bulb or sunglasses with green lenses. Some of our patients have a preference for different colors, including bright orange, which eliminates blue light. One of my previous blog posts mentioned research looking at individualizing color selection of eyeglass lenses. This customized service is not yet available and is likely to be expensive. However, several companies sell glasses with FL-41 tint that is specifically designed for migraine patients. Theraspecs is one and Axonoptics is another. The Fl-41 tint can also be applied to any lens.

Previous Next

Feverfew for migraines

Migraines can be prevented with CoQ10 supplementation

Dementia and magnesium levels

Vomiting from too much pot is similar to cyclic vomiting syndrome

Psychological factors in chronic migraine

Curcumin helps improve memory, possibly migraines.

More on intravenous ketamine for migraines

Stem cells help stroke victims, will revolutionize medicine

The effect of post-traumatic headaches on the brain

Gut bacteria can cause big holes in the brain

Two different types of exercise prevent migraines

Color of the ambient light can help or worsen migraines

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