Alternative Therapies | Headache NewsBlog

Why sleep regularity is important

By: Dr. Mauskop

25-12-2023

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Science of Migraine

Lack of sleep is a common migraine trigger. A less common trigger is getting too much sleep. I always recommend that patients try to go to sleep at the same time and get up at the same time. Even on weekends. Instead of sleeping in on the weekend, take a 30-minute nap in the afternoon.

A new study by Australian researchers published in Neurology reports another important reason for sleep regularity. This was a large and rigorous study involving 88,094 UK subjects. All subjects wore an accelerometer that detected their sleep patterns. The researchers controlled for variables that are known to predispose to dementia – age, sex, ethnicity, material deprivation, retirement status, current shift work status, household income, highest level of education, smoking status, use of sedative, antidepressant, or antipsychotic medication, and genetics (APOE ?4 carrier status).

They “identified a nonlinear relationship between day-to-day sleep regularity and dementia risk such that dementia rates were highest in those with the most irregular sleep, dipped as sleep regularity approached the median, and then marginally increased at the highest estimates of sleep regularity.” In subjects who underwent brain MRI (n = 15,263), gray matter and hippocampal volume (area of the brain critical to memory) similarly tended to be lowest at the extremes of the sleep regularity index. This was surprising – subjects whose sleep patterns were extremely chaotic did slightly better than those with moderately irregular sleep.

Other sleep disorders that can contribute to migraines and increase the risk of dementia are restless leg syndrome, sleep apnea, and sleeping too much or not enough.

More on combination supplements

By: Dr. Mauskop

21-12-2023

Alternative Therapies, Chronic migraine, Headaches in children, Migraine

My recent blog post on supplement combinations mentioned one that contains magnesium, riboflavin, and feverfew. I did not mention its name to avoid the appearance of a conflict of interest. I am a paid consultant to the manufacturer. However, many readers of this blog want to know the name of this mystery product. It is called MigreLief.

Akeso, the manufacturer, also makes several related products. One is MigreLief NOW, which contains magnesium, feverfew, ginger, and boswellia. Both ginger and boswellia have proven anti-inflammatory properties.

Another product is a daily MigreLief supplement for children. It also contains magnesium, riboflavin and feverfew but at a lower dose and in smaller caplets.

Meditation can be harmful

By: Dr. Mauskop

26-11-2023

Alternative Therapies, Chronic migraine, Migraine, Psychology of headaches

I tell most of my patients that after physical exercise, meditation is the second-best preventive treatment for migraine headaches.

It turns out that meditation is not an unalloyed good. In a recent podcast, Tim Ferris interviews a psychologist, Dr. Willoughby Britton whose research is devoted to the negative effects of meditation. Tim Ferris describes his experience of going on a week-long silent meditation retreat, while also fasting and taking psychedelic mushrooms. It is not too surprising that Tim Ferris ended up needing professional help. However, even meditation alone, if taken to an extreme can cause psychological problems. In California, the joke is that meditation is a competitive sport.

Dr. Britton and her colleagues identified a staggering 59 different symptoms that can be triggered by meditation. Cheetah House, an organization led by Dr. Britton, is dedicated to assisting individuals who have experienced negative effects from meditation. According to one study, the most common adverse effects are anxiety, traumatic re-experiencing, and heightened emotional sensitivity. Those with a history of adverse childhood experiences are at a higher risk. But surprisingly, even individuals with adverse effects reported being glad they had meditated.

Dr. Britton suggests that meditating for less than 30 minutes is not likely to result in negative effects.

I have been meditating for years, and it was only when I extended my meditation time to 45 minutes about a year ago that my migraines completely stopped. Fortunately, I have not encountered any side effects.

Combining supplements

By: Dr. Mauskop

20-11-2023

Alternative Therapies, Chronic migraine, Headaches, Migraine

Every patient visiting our clinic undergoes a routine blood test, which includes an assessment for magnesium and vitamin deficiencies. We know that close to 50% of patients with migraines are deficient in magnesium and many are deficient in riboflavin and other nutrients.

In addition to vitamins and magnesium, we often recommend herbal supplements. One of the herbal remedies that has been used for centuries, is feverfew. It is helpful not only for migraines but also for fever, arthritis, and other conditions. Often referred to as “medieval aspirin”. Most importantly, it has proven to be safe, that is if it is manufactured by a reputable company or you grow your own.

Many patients find it daunting to have to take multiple tablets every day. There are several products on the market that combine various supplements in one tablet. One such supplement that has been on the market the longest, includes magnesium, riboflavin (vitamin B2), and feverfew. I’ve helped develop and promote this combination, so I may be biased. However, it has high-quality ingredients and the same experienced and knowledgeable team that developed it still stands behind it.

Some products also include CoQ10. One-third of migraine sufferers are deficient in this supplement. Because CoQ10 is relatively expensive, many combination products contain insufficient amounts of it. I usually check CoQ10 levels in the blood and if a patient is deficient, I recommend that she takes it separately, 200-300 mg a day.

An important consideration is that you may have a vitamin or RBC magnesium level within the normal range, but if your level is at the bottom of this range, you are likely to be deficient. RBC magnesium level should be above 5, CoQ10 level, above 0.7, vitamin D level, above 45, and vitamin B12 level, above 500.

Shingles vaccine for the prevention of cluster headaches

By: Dr. Mauskop

12-11-2023

Alternative Therapies, Cluster headaches, Headache medications, Headaches, New treatments

Cluster headaches arguably cause the worst imaginable pain, hence the moniker, suicide headaches. Fortunately, there are many treatments for this condition, including two FDA-approved drugs. One is sumatriptan injections taken as needed to stop an attack. The other is a preventive monthly injection of galcanezumab (Emgality). We also use Botox injections, oxygen and a variety of medications. Nevertheless, some people do not respond to these treatments.

A report by Japanese neurologists from Tokyo suggests a new treatment. One theory of the origin of cluster headaches is the reactivation of the varicella-zoster virus that causes chickenpox and shingles.

The study included over 160 patients with episodic cluster headaches who received a shingles vaccine. The response to the vaccine was measured by the amount of antibodies in the blood. Those patients who had more antibodies had a longer delay to the next cluster episode than those with low antibody counts. They also found that those who had a COVID infection and received multiple COVID vaccines, tended to do worse.

It is premature to recommend shingles vaccine to patients with cluster headaches unless they are over 50, the age when everyone is advised to get it.

More research on vitamin D and migraine

By: Dr. Mauskop

06-11-2023

Alternative Therapies, Brain disorders, Headaches, Migraine, New treatments

There is growing evidence that vitamin D is important in the development and treatment of migraines. In the past 15 years, I have written a dozen posts on the role of vitamin D in migraines.

At the last meeting of the International Headache Society, Maria Papasavva and her Greek colleagues presented a study entitled, Genetic variability in vitamin D receptor and migraine susceptibility: a case-control study.

Their study aimed to investigate an association of three genetic variants of vitamin D receptor with the susceptibility to develop migraine. DNA sample was collected and extracted from 191 patients diagnosed with migraine and 265 headache-free subjects. According to their statistical analysis, a significant association between migraine susceptibility and abnormal variants of vitamin D receptors was found. They also showed a significant association of two variants with migraine without aura. Their conclusion was that there is a clear association between migraine susceptibility and two vitamin D receptor variants. This further supports the role of vitamin D and its receptor in migraine.

Vitamin D is important not only for migraines but also for your immune system. Vitamin D deficiency increases the risk of COVID and other viral infections. Lower levels of vitamin D are associated with a higher risk of attacks of multiple sclerosis even if the level is still within normal range. There are many other reasons to maintain your blood vitamin D level at least in the middle of the normal range. The normal range is 30 to 100, so keep it well above 40. If your doctor tells you that your level is normal, ask for the actual number.

A double-blind study of cannabis for the acute treatment of migraine

By: Dr. Mauskop

30-10-2023

Alternative Therapies, Chronic migraine, Headache medications, Headaches, Migraine, Migraine in pregnancy, New treatments

Since the legalization of medical marijuana in New York in 2014, I have prescribed it to several hundred patients. My experience suggests that approximately one-third of my patients benefit from its use and continue to rely on it for their medical needs. Some have reported relief from symptoms such as nausea and anxiety, often associated with migraines, while others find it highly effective in aiding sleep. Additionally, there are patients who have reported significant pain relief.

It is possible that the relatively low response rate I see in my patients is due to the fact that I reserve medical marijuana for those patients who do not respond to multiple drugs.

At the recent meeting of the International Headache Society, Dr. Nathaniel Schuster and his colleagues presented a study titled “Vaporized cannabis versus placebo for the acute treatment of migraine: a randomized, double-blind, placebo-controlled, crossover trial.” This study aimed to investigate the potential of medical marijuana in alleviating pain and associated migraine symptoms.

In this study, participants were instructed to treat moderate-to-severe migraine attacks within four hours of onset using vaporized cannabis flower. They were asked to treat up to four separate migraine attacks, using vaporized cannabis with different compositions: 1) THC-dominant (6% THC), 2) CBD-dominant (11% CBD), 3) THC/CBD mix (6% THC/11% CBD), and 4) placebo cannabis, with the order randomized and double-blinded.

Out of the 92 participants enrolled, 71 treated at least one migraine attack. Two hours after vaporization, the THC/CBD mix outperformed the placebo in achieving pain relief (69% vs. 48%), pain freedom (36% vs. 16%), and freedom from the most bothersome symptoms, such as nausea, photophobia, or phonophobia (62% vs. 36%). The THC-dominant option was superior to the placebo for pain relief at 2 hours (71% vs. 48%) but was not significantly different from the placebo regarding pain freedom or freedom from the most bothersome symptoms. The CBD-dominant option did not significantly differ from the placebo in terms of pain relief, pain freedom, or freedom from the most bothersome symptoms. The most common side effects reported were sleepiness, followed by euphoria, with no serious adverse events observed.

In conclusion, the authors of the study found that the acute treatment of migraine with a vaporized THC/CBD mix (6% THC/11% CBD) was superior to the placebo in terms of pain relief, pain freedom, and freedom from the most bothersome symptoms at the 2-hour mark.

This study has significant practical implications. In the past, I would leave the choice of products to the licensed pharmacist at the dispensary, while advising patients that finding the right combination is often a trial-and-error process. However, now, I will be better equipped to advise my patients on the most suitable type of medical marijuana for their specific needs based on the findings of this study.

Magnificent Magnesium and Movement Disorders

By: Dr. Mauskop

15-10-2023

Alternative Therapies, Chronic migraine, Headache medications, Headaches, Migraine

Magnificent Magnesium is the title of a book my colleague and friend, cardiologist Dr. Dennis Goodman wrote about this underappreciated mineral. Magnesium produces magical results, albeit only in those who are deficient. And millions of Americans are deficient. Our research has shown that close to half of migraine sufferers are. Magnesium saves lives in cardiac care units by reducing the risk of arrhythmias. It is given intravenously for acute asthma attacks and treats eclampsia and pre-eclampsia in pregnancy. The list goes on.

A report by Canadian neurologists just published in a leading neurology journal, Neurology, describes magnesium’s role in the treatment of movement disorders. Sixty patients with low magnesium levels who had a movement disorder were identified in medical journals. Movement disorders observed were postural tremor (14 patients), resting tremor (5), intention tremor (6), ataxia involving the trunk (29) or limbs (15) and dysarthria (13), athetosis (5), myoclonus (4), and chorea (1). Some patients also had downbeat nystagmus, tetany (muscle cramping), drowsiness, vertigo, and proximal muscle weakness.

The most common culprit in these patients was a class of drugs called proton pump inhibitors (PPIs). These are drugs like omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), and dexlansoprazole (Dexilant). They are known to interfere with the absorption of not only magnesium but also other vitamins. Long-term users of these drugs are at a higher risk of dementia, most likely because they prevent absorption of vitamin B12. I try to get all of my patients off PPIs. This is not easy because stopping the drug causes a rebound in acid production. Some people have worse heartburn than when they started the PPI. One strategy is to replace these drugs with famotidine (Pepcid) and Rolaids (better than Tums since Rolaids have calcium and magnesium while Tums have only calcium). After a period of time, patients are able to stop famotidine and take only Rolaids and then, stop Rolaids as well. A healthy low-acid diet, stress management, weight loss, and sleeping on the left side can also help.

#magnesium #migraine #ataxia #dysarthria #tremor #PPIs

New Daily Persistent Headache is very treatable

By: Dr. Mauskop

09-10-2023

Alternative Therapies, Botox, Brain disorders, Chronic migraine, Headache medications, Headaches, injections, Migraine, New treatments, Psychology of headaches, Science of Migraine

New daily persistent headache (NDPH) is condition that is defined solely by the fact that the headache begins suddenly one day and does not go away. There are no scientific studies to suggest possible underlying mechanisms or treatments. Some patients develop it after a viral infection while others, after a period of stress and many with no apparent trigger.

In my latest book, I mentioned how a seemingly benign idea of classifying medical conditions can cause harm. In case of NDPH, many anecdotal reports in medical journals indicate that this condition is not responsive to treatment. However, there are no controlled double-blind studies, only anecdotal reports. Many patients with this condition will look up this literature and conclude that there is no hope of getting better. I have seen many such devastated people. But this bleak picture is clearly wrong.

I have seen many patients with NDPH who responded to various treatments. In my 30 years of using Botox, I have found it to be one of the safest and most effective treatments for NDPH as well as migraine and other types of headaches.

At the recent meeting of the International Headache Society held in Seoul, two presentations described good responses of NDPH to Botox injections.

The first report was by S. Cheema and colleagues of Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK. They compared patients with NDPH (58) and those with chronic migraine (CM) with daily attacks (153) and chronic migraines without daily attacks (85). There was a 30% reduction in mean moderate and severe headache days in 33% of patients with NDPH, 43% with daily CM and 55% with non-daily CM.

The second report was by Shuu-Jiun Wang and colleagues of the Neurological Institute, Taipei Veterans General Hospital. They looked at the response of patients with NDPH who had predominately migraine features and those who had predominantly features of tension-type headaches. Of 228 patients diagnosed with NDPH, 199 patients (87%) had migrainous features and 29 patients (13%) had tension-type features. Their conclusion: “Through a mean follow-up duration of 2.5 years, around 40% patients with NDPH showed a favorable outcome at our headache center. Our results suggest NDPH might not be as grave as previously reported.”

Yes, these were also anecdotal reports rather than controlled trials, but they clearly show what I have also observed in my practice – NDPH is a very treatable condition. Hopefully, the next, fourth edition of the International Classification of Headache Disorders will no longer list NDPH as a diagnosis since it has no scientific basis.

Gut bacteria and migraine

By: Dr. Mauskop

18-09-2023

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Migraine, New treatments, Science of Migraine

Most people have heard about the gut-brain connection. Research published in The Journal of Headache and Pain examined this connection in relation to migraine headaches. The researchers looked at whether the collection of microorganisms living in our guts (called the gut microbiome) could be linked to the development of migraine headaches and its different types – migraine with and without aura.

To do this, the scientists used information from a big genetic study that looked at the genes related to the gut microbiome. They also used data from studies that explored the genetics of migraine headaches. They employed sophisticated methods to analyze this data, and they also checked for other factors that could affect the results.

In the analysis, they found that certain types of bacteria in the gut were connected to migraine headaches, including ones with and without aura. They also found that some specific types of bacteria were more likely to be associated with certain types of migraines. Even after doing some statistical adjustments, these connections still held up.

So, this study suggests that the mix of bacteria in our guts might actually influence whether we get migraines and what kind they are. It shows that there might be a link between our gut and our brain when it comes to migraines.

They found that while some bacteria seemed to contribute to migraines, one type appeared to be protective. This protective effect was linked to the Bifidobacterium family. You can find Bifidobacterium in many probiotics, including a well-known brand called Align. Additionally, various fermented foods like milk kefir, sourdough bread, sauerkraut, kimchi, and other fermented vegetables contain Bifidobacterium.

However, it’s important to note that this research doesn’t mean other types of bacteria aren’t helpful too. A healthy human gut microbiome consists of many different types of bacteria. When there is an imbalance of these healthy bacteria, it can lead to various health problems, not just migraines. This imbalance can come in many different forms and may require different probiotics to correct it. That is why I recommend that patients try different types of probiotics for a few months at a time. Besides Bifidobacteria, some patients respond well to Saccharomyces, Lactobacillus, or other types, or even a combination of several.

Anxiety may facilitate transformation of pain from acute to chronic

By: Dr. Mauskop

07-09-2023

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Migraine, Pain, Pain Research, Psychology of headaches, Science of Migraine

Our thoughts and emotions can impact the development of chronic pain. However, there haven’t been many studies exploring what causes pain to transition from being short-term (acute) to long-lasting (chronic).

Australian researchers conducted a study to investigate how our thought patterns, anxiety related to pain, and the tendency to avoid pain affect both acute and chronic pain. They conducted two studies for this purpose. In the first study, they interviewed 85 individuals experiencing long-term pain to understand their thoughts and emotions. In the second study, they observed 254 individuals who had recently started experiencing acute pain and followed up with them three months later.

In both studies, they examined interpretation bias using a word association task and assessed pain-related anxiety, pain avoidance, pain intensity, and how pain interfered with daily life. In both cases, they discovered that the way people think about pain was linked to how much it disrupted their daily lives. In the second study, they also found that people’s thought patterns about pain were connected to increased anxiety about pain. This heightened anxiety, in turn, made the pain more severe and disruptive after three months. While anxiety about pain also led people to try to avoid it, this avoidance behavior didn’t seem to affect the level of pain they experienced later on.

This research provides valuable insights into how pain can transition from acute to chronic. It suggests that our initial thoughts about pain might trigger anxiety related to pain, which can contribute to the pain persisting and becoming more troublesome over time. This finding could be crucial in developing strategies to prevent chronification of pain by addressing how people perceive and manage their anxiety about pain during its early stages. Cognitive-behavioral therapy, meditation, and other mind-body techniques could be some of such strategies.

The role of a physical therapist in treating migraines

By: Dr. Mauskop

14-08-2023

Alternative Therapies, Chronic migraine, Headaches, Migraine, Migraine in pregnancy

Because migraine is fundamentally a brain disorder, the involvement of physical therapists in its treatment might seem unnecessary. However, their contribution can be profoundly impactful, provided they have a keen interest in the nuances of migraine care.

One such physical therapist to whom I refer patients, Pete Schultz, just co-wrote an article, A Multimodal Conservative Approach to Treating Migraine: A Physical Therapist’s Perspective.

This article shows how experienced physical therapists approach migraine patients. They usually perform a very thorough examination and they can sometimes detect a serious problem that was missed by a physician.

The physical therapist often discovers general weakness, muscle tension, poor posture, diminished endurance, neck pain, teeth clenching, visual symptoms, dizziness, poor balance and coordination and high stress levels.

The interventions may include exercise directed at strengthening neck and upper back muscles, manual therapy, general conditioning exercise, biofeedback and mindfulness techniques, and vestibular therapy.

There is a wealth of data on the therapeutic effect of exercise in migraine patients. Interestingly, weight training seems to be more effective in the prevention of migraines than aerobic exercise.

Vestibular symptoms, such as dizziness and unsteadiness, are very common and are highly responsive to vestibular therapy.

Biofeedback is typically done by mental health professionals, but also by physical therapists. Over 100 clinical trials have been performed utilizing biofeedback in the treatment of headaches. The consensus is that this is a very effective technique.

An additional benefit that physical therapists can provide is what psychologist call a shift in locus of control, from internal to external. This means that instead of feeling like a victim of external uncontrollable circumstances, people acquire agency and cam actively do things to help themselves. This shift has been consistently shown to increase the efficacy of headache and pain treatment.

Why sleep regularity is important

More on combination supplements

Meditation can be harmful

Combining supplements

Shingles vaccine for the prevention of cluster headaches

More research on vitamin D and migraine

A double-blind study of cannabis for the acute treatment of migraine

Magnificent Magnesium and Movement Disorders

New Daily Persistent Headache is very treatable

Gut bacteria and migraine

Anxiety may facilitate transformation of pain from acute to chronic

The role of a physical therapist in treating migraines

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