Alternative Therapies | Headache NewsBlog

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.

Magnesium reduces the size of hemorrhagic strokes

By: Dr. Mauskop

28-08-2017

Alternative Therapies, Brain disorders

Researchers at Northwestern University in Chicago examined possible correlation between magnesium level on admission to the hospital with the size of a stroke due to bleeding as well as functional outcomes. Their findings were published in Neurology.

290 patients presenting with a non-traumatic intracranial hemorrhage had their demographic, clinical, laboratory, radiographic, and outcome data analyzed and assessed for associations between serum magnesium levels and initial hematoma volume, final hematoma volume, in-hospital hematoma growth, and functional outcome at 3 months.

Lower admission magnesium levels were associated with larger initial bleeds and larger final hematoma volumes. Lower admission magnesium level was associated with worse functional outcomes at 3 months after adjustment for age, initial hematoma volume, hematoma growth, and other factors. The evidence indicates that the beneficial effect of magnesium is due to the reduction in hematoma growth.

The authors concluded that having higher magnesium level can reduce the size of a bleed in the brain.

Unfortunately, magnesium is not a part of the routine blood tests included in the so-called comprehensive metabolic panel. This panel does include potassium, sodium, calcium and other tests, but magnesium needs to be ordered by the doctor separately. Very few doctors do and this can be detrimental to your health. Not only strokes are bigger, but many other much more common health problem can stem from magnesium deficiency. Readers of this blog know well that magnesium deficiency is very common in migraine patients and that taking magnesium (or getting an intravenous infusion) can provide dramatic relief.

Magnesium also helps asthma, palpitations, muscle cramps, PMS, brain fog, and many other symptoms. The next time you have any kind of a blood test, ask your doctor to add a magnesium test, preferably “RBC magnesium”, which is more accurate than “serum magnesium”. If you have any of the above symptoms, you can just start taking 350-400 mg of magnesium glycinate, which is the daily recommended allowance for magnesium.

Another study shows benefits of fish oil

By: Dr. Mauskop

21-08-2017

Alternative Therapies, Trigeminal and other neuralgias

Omega-3 polyunsaturated fatty acids (PUFA) which are found in fish oil, have been studied in a wide variety of diseases, ranging from Alzheimer’s disease to Herpes Zoster (shingles). Omega-3 PUFA have proven anti-inflammatory and neuroprotective properties and have been used to treat rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis, as well as migraine headaches.

A new study just published in Neurology showed a strong beneficial effect of Omega-3 PUFA in the treatment of diabetic nerve damage, or diabetic sensorimotor polyneuropathy in patients with type 1 diabetes. After one year of taking 750 mg of EPA and 560 mg of DHA (two of the main omega-3 fatty acids) there was a significant improvement in the nerve function.

Omega-3 PUFA are proven to help patients with coronary artery disease, while in many other conditions, including migraines, the evidence is not as strong. However, considering that we have a very large amount of data showing a benefit in a wide variety of conditions and that Omega-3 PUFA are very safe and inexpensive, it is reasonable to try EPA with DHA for any auto-immune or inflammatory condition, as well as depression.

Eating fatty fish, such as salmon and sardines 2-3 times a week can be sufficient for general health, but those with coronary artery disease and other conditions could benefit from a daily supplement. Also, fish often contains mercury, which can cause neurological and other problems. Omax3 and prescription fish oil, Lovaza are my preferred products because they contain no mercury and are highly concentrated, requiring only 1 or 2 pills a day.

Anxiety contributes to disability in kids with headaches

By: Dr. Mauskop

07-08-2017

Alternative Therapies, Headaches in children, Psychology of headaches

Anxiety is at least twice as common in both children and adults with migraine headaches compared to people without migraines. A new study presented at the recent American Headache Society meeting examined the impact of anxiety on functioning in pediatric migraine population. The researchers analyzed records of 530 kids with migraine and 371 with tension-type headache seen in the pediatric neurology clinic of the Boston Children’s Hospital.

Dr. Lebel and her colleagues discovered that physiological anxiety was associated with more severe functional disability in kids with both migraines and tension-type headaches. Physiological anxiety often manifests itself by sleep difficulties, racing heart, shortness of breath, feeling shaky, fatigue, and other. The other two types of anxiety, worry and social anxiety did not seem to lead to more disability.

This study confirms the importance of cognitive and behavioral treatments, such as progressive relaxation, biofeedback, meditation, and cognitive therapy. Kids are very good at these techniques and they are particularly receptive to smartphone-based apps. For meditation, I recommend 10% Happier and Headspace. TaraBrach.com offers free podcasts for meditation and ThisWayUp.org.au provides very inexpensive and scientifically proven cognitive-behavioral therapy.

At the NY Headache Center we always try to avoid drugs, especially in children. In addition to cognitive and behavioral techniques, we address sleep, exercise, diet and supplements such as magnesium, CoQ10, and other. If medication is needed, this study suggests that a beta blocker, such as propranolol (Inderal) may be a good choice because in addition to preventing migraines, it reduces physiological symptoms of anxiety (it is also used for performance anxiety). Potential side effects of beta blockers are mostly due to its pressure lowering effect and include fatigue, dizziness, and lightheadedness.

Our report on stem cells for migraines is published

By: Dr. Mauskop

28-06-2017

Alternative Therapies, Chronic migraine, Migraine

Stem cells hold great promise in the treatment of many conditions, possibly including migraines. In a post from 3 years ago I’ve written about a report from Australia that described 4 patients with refractory chronic headaches who had a very good response from stem cells. They were given stem cells for other conditions and coincidentally their migraines improved.

Since many patients come to our practice after seeing several other neurologists and headache specialists, we often have to resort to new, non-traditional, and unproven treatments. This is how I started using Botox 25 years ago (the FDA approved it for migraines only 6 years ago).

After reading the Australian report I decided to try stem cell treatment in some of my most refractory patients. Only patients who failed to respond to Botox and at least 3 preventive drugs were offered to participate in this pilot study. The only type of stem cells that the FDA allows to be injected are cells taken from patient’s own body without altering them. The richest source of stem cells in our bodies is fat. My colleague, Dr. Kenneth Rothaus who is a plastic surgeon, performed a liposuction to obtained fat tissue, from which we separated active cells.

We enrolled 9 patients and 3 did have significant temporary improvement. The results are obviously not dramatic, but it is possible that in less severely affected patients this treatment could work better. More importantly, using stem cells from an umbilical cord or placenta is more likely to be effective as these are younger and more active stem cells. There are many companies researching these cells for various indications, but not yet migraines. The reason why stem cells should help at least some migraine sufferers is the fact that they have strong anti-inflammatory properties while migraine involves neurogenic inflammation.

The results of our pilot study were just published in Case Reports in Neurology.

Living at high altitudes leads to more migraines

By: Dr. Mauskop

21-06-2017

Alternative Therapies, Migraine

Many migraine sufferers complain about worsening of their migraines when they travel to high altitudes. But do people who permanently live at high altitudes are more likely to have migraines? A report published in the European Journal of Neurology describes a population-based study done in Nepal in which researchers compared the incidence of migraines in Nepalese living at low and high altitudes. A previous study done in Peru suggested such an association between migraine and living at a high altitude.

2,100 Nepali-speaking adults were recruited into this study. More than half, or 1,100 (52.4%) lived above 1000 meters (3,280 feet) and almost one quarter or 470 (22.4%) lived at 2,000 meters (6,560 feet). The researchers took into account the age and the gender of participants. Migraine prevalence increased from 28% to 46% with altitude between 0 and 2,499 meters and thereafter decreased to 38% at 2,500 meters. The likelihood of having migraines was almost two times greater at all higher altitudes compared with those living below the altitude of 500 meters. In addition, frequency and duration of migraine attacks doubled and pain intensity increased by 50% at higher altitudes.

The authors concluded that “dwelling at high altitudes increases not only migraine prevalence but also the severity of its symptoms”.

Acetazolamide (Diamox) can be an effective drug for the prevention of headaches at high altitudes and with barometric pressure drops. Unfortunately, we do not know if taking this medicine long-term is also effective for the prevention of headaches in people living at high altitudes.

New research on cannabis for migraines

By: Dr. Mauskop

19-06-2017

Alternative Therapies, New treatments, Science of Migraine

Medical marijuana has been legalized in NY and more than 20 other states. It is approved in NY for several medical conditions, including pain and some of my patients with headaches (about one out of 3), arthritis, and other pains have found it to be very helpful. Some patients use it acutely (as a vaporizer or tincture) and report relief of pain, and/or nausea and for some it allows them to go to sleep and sleep off their migraines. Tablets of medical marijuana can prevent migraines if taken once or twice a day. Most people need products with a low THC/CBD ratio which does not cause euphoria or other cognitive effect.

Despite the requirement by states to have verified amounts of active ingredients, THC and CBD in the medical marijuana products, the efficacy and the side effects vary from manufacturer to manufacturer. This could be in part due to ingredients other than THC and CBD. Fortunately, many researchers are looking into the effect of pure ingredients and their mechanism of action.

Such a study was presented at the recent meeting of the American Headache Society by scientists from the Missouri State University led by Paul Durham. They developed a new animal model of migraine in rats and triggered a process in the rats’ brains that is similar to a migraine in humans. Administering cannabidiol (CBD) suppressed increased sensitivity in the trigeminal nerve and produced other positive effects, suggesting a possible mechanism by which CBD may relieve migraine and other facial pains. The next logical step would be to add small amounts of THC to see if it enhances the effect of CBD (so called entourage effect).

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

Magnesium reduces the size of hemorrhagic strokes

Another study shows benefits of fish oil

Anxiety contributes to disability in kids with headaches

Our report on stem cells for migraines is published

Living at high altitudes leads to more migraines

New research on cannabis for migraines

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