Depression (and anxiety) is 2-3 times more common in those suffering from migraines than in people without migraines. Depression is not caused by migraines because patients who develop depression first are 2-3 times more likely to develop migraines than people without depression. It is likely that abnormalities in the function of certain brain chemicals (serotonin, norepinephrine and other) that cause one condition predispose people to develop the other one as well. Certain types of antidepressants prevent migraine headaches even in patients who have none of the signs of depression. It appears that treatments that work for depression can help with migraines as well. At the NYHC we showed this to be true for an experimental treatment using vagus nerve stimulation. We have always advised our patients that one of the best preventive treatments for migraines is to engage in aerobic exercise for 20-30 minutes five days a week. Possible reasons why this treatment works include relief of stress, improved blood circulation in the brain and the release of endorphins – natural painkilling substances. We did not have scientific studies to prove that we were right, but the majority of patients who followed this advice improved. Now we have a scientific study that indirectly supports this treatment. The study by James Blumenthal and his colleagues, published in the journal Psychosomatic Medicine, included 202 men and women who were diagnosed with major depression. They were randomly assigned to one of four groups: one that worked out in a supervised, group setting three times per week; one that exercised at home; one that took the antidepressant sertraline (Zoloft); and one that took placebo pills. After 16 weeks 47 percent of patients on the antidepressant recovered from depression. The same was true of 45 percent of those in the supervised exercise group and 40% in the home-based exercise group. In the placebo group 31 percent of patients improved.

The bottom line – exercise can help your depression and your migraine headaches.

It is no big news that acupuncture helps migraine patients. Nevertheless, it is good to see yet another study confirming this. Maybe, once the health care mess is straightened out and common sense prevails, the insurance companies will notice all these studies and start paying for acupuncture. The latest study published in the September issue of journal Headache was controlled and randomized, that is it was scientifically sound. The Italian researchers led by Dr. Facco compared true acupuncture with sham acupuncture and no preventive treatment. They found that three and six months after the start of treatment patients in the true acupuncture group did significantly better.

A study just published in the British medical journal Lancet reports on the effect of food colorings in children. This study found that food colorings cause symptoms of attention deficit disorder in young children. Many of my patients report that food colorings, and more often food preservatives, trigger their migraines. The role of colorings, preservatives and sugar substitutes in causing migraine headaches has not been evaluated as rigorously as it was done in this Lancet study of children and remains controversial. However, this study clearly indicates that food colorings can have a negative effect on the brain, which makes it very likely that some migraine sufferers may benefit from eliminating colorings (and preservatives and sugar substitutes) from their diets.

Noise is a well-known trigger of migraines. Recent findings by WHO researchers indicate that excessive exposure to noise causes other health hazards as well. Noise from daytime traffic can result in chronic stress with an increase in the risk of heart attacks and strokes. Installing noise-insulating windows and using noise-cancelling ear phones can be helpful, albeit expensive. Listening to music to drown out the noise is another option, but can be hazardous when walking in the streets of a big city. Mayor Bloomberg’s recent focus on reducing noise pollution in New York City is a step in the right direction.

A recent survey by Beatrice Golomb and her colleagues which was reported by Reuters Health discovered that when patients reported adverse reactions to drugs their doctors routinely denied that the drug was responsible for these side effects. To a great extent this is due to doctors’ lack of knowledge about potential side effects, but I suspect it is also because doctors have an unreasonable degree of reliance and faith in drugs. Pharmaceutical companies are doing a great job selling benefits of drugs to doctors, but the education about potential side effects is clearly lacking. Medical school training also makes doctors biased toward drugs and against alternative therapies. In treating migraine patients I often see people who were prescribed by their doctor 2-3 daily medications and who were never offered any alternatives. The efficacy of many of the supplements (magnesium, CoQ10, alpha-lipoic acid and others) is as good as that of many drugs doctors use for headaches. Eliminating caffeine, regular exercise, dietary changes, biofeedback and even Botox injections are some of the other excellent approaches that should be tried before drugs.

According to a recent study by Magis and colleagues (Headache 2007;47:52-57) daily dose of 600 mg of alpha lipoic acid (also known as thioctic acid) was significantly better than placebo in reducing the frequency of migraine attacks, headache days and pain severity. This natural supplement is being investigated as a treatment for multiple sclerosis and HIV disease and it may be helpful for patients with Alzheimer’s and Parkinson’s as well as diabetes, strokes and heart attacks. Since the publication of this study we have been recommending alpha lipoic acid to many of our migraine patients.

A study just published in the journal Pain looked at the effect of patient expectations on outcome of acupuncture treatment. Four large studies were analyzed and one of the four A study just published in the journal Pain looked at the effect of patient expectations on outcome of acupuncture treatment. Four large studies were analyzed and one of the four involved treatment of migraines and one of tension-type headaches. Patients who prior to the start of treatment thought that acupuncture was effective or highly effective did much better than those who were skeptical about it’s efficacy. The difference persisted 6 months following the treatment. These finding are not very surprising, but they do have an important practical application. If you do not believe acupuncture will work you are better off trying another treatment.

(Linde K, Witt, C, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 128 (2007) 264-271)

Intranasal use of capsaicin (on the side of the headache) has been reported to relieve cluster headaches. Capsaicin is an extract of hot peppers and can cause burning pain and irritation of the nasal mucosa. It must be used twice a day for several days before improvement is noticed. Intranasal use of capsaicin (on the side of the headache) has been reported to relieve cluster headaches. Capsaicin is an extract of hot peppers and can cause burning pain and irritation of the nasal mucosa. It must be used twice a day for several days before improvement is noticed.

A study published in Neurology, the journal of the American Academy of Neurology, indicates that oral zolmitriptan (Zomig) is effective in the treatment of cluster headaches. The study used a 10 mg dose, which exceeds the FDA-approved maximum dose of 5 mg for migraines. However, oxygen inhalation and injectable sumatriptan (Imitrex), when effective, usually provide faster relief.

Prophylactic treatment

Several reports suggest that in addition to such standard therapies as Depakote, verapamil, and lithium a nightly 10 mg dose of over-the-counter melatonin can prevent cluster headaches in some patients. Since a short course of melatonin is very safe, it is worth a try after consultation with your physician.