Brain disorders | Headache NewsBlog

The Right Tempo in Music May Help Reduce Pain

By: Dr. Mauskop

17-03-2025

Alternative Therapies, Brain disorders, Headaches, Migraine, New treatments, Pain, Pain Research, Psychology of headaches

New research from McGill University published in the journal Pain suggests that the tempo—or speed—of music plays a crucial role in how well it helps reduce pain.

In this study, researchers explored whether music that matches a person’s natural rhythm—called their spontaneous production rate (SPR)—could provide better pain relief. SPR is the pace at which people naturally hum or tap out a tune, almost like a personal internal metronome.

Sixty participants first had their SPR measured by tapping out “Twinkle Twinkle Little Star” at a comfortable pace. Later, they were exposed to mild heat pain while listening to music specially adjusted to three tempos: their exact SPR, 15% faster, or 15% slower. A silent condition was also tested.

The results? Music alone reduced pain compared to silence, confirming what many of us know instinctively—music helps us cope. But the biggest surprise was that music adjusted exactly to each person’s SPR provided the most pain relief. Faster or slower versions just weren’t as effective.

Why does this happen? We think it may be because music at our natural tempo syncs better with our body’s internal rhythms, helping us relax and shift focus away from pain.

What does this mean for you? The next time you’re using music to manage discomfort—whether it’s during a workout, a medical procedure, or just a headache—try finding songs that feel “just right” in speed. It might be your body’s way of telling you it’s syncing up for maximum relief.

This research paves the way for more personalized music therapy—helping us move from simply picking our favorite songs to using science-backed soundtracks tuned just for us.

Here is a part of the chapter on music from my book, The End of Migraines, 150 Ways to Stop Your Pain, providing additional scientific evidence that music can relieve pain.

‘Music relieves experimental pain in healthy volunteers who are paid to endure pain and music. In one study, 18 volunteers were subjected to pleasant music, unpleasant music, and a silent period. Heat-induced pain was reduced only by pleasant music.

Children with migraines exposed to music improved as much as those given butterbur extract. Both groups improved more than a control group.

Music relieved the pain of osteoarthritis in the elderly. Those who listened to music for 20 minutes a day felt better than those who sat quietly for 20 minutes.

A study of 20 volunteers showed that both happy and sad melodies reduced heat pain. Listening to a lecture did not.

Another group of researchers examined the potential pain-relieving properties of three aspects of music: arousal, valence, and depth. Arousing music is characterized as “intense, forceful, abrasive, or thrilling”. Valence refers to “fun, happy, lively, enthusiastic, and joyful”. Depth means “intelligent, sophisticated, inspiring, complex, poetic, deep, emotional, and thoughtful.” The degree of arousal and the depth of music had a greater effect on pain than valence. The authors concluded, “With the advent of online music streaming services, this research opens new possibilities for music-based pain interventions.”

The new study suggests that tempo is another factor to consider when choosing soothing music.

Vitamin B12: “Normal” blood Levels are often not normal

By: Dr. Mauskop

27-02-2025

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Migraine, post-traumatic headache, Science of Migraine

A new study published in the Annals of Neurology by researchers at UCSF challenges our current understanding of what constitutes “normal” vitamin B12 levels, particularly regarding brain health. The findings suggest that even B12 levels currently considered adequate may not be optimal for maintaining brain function, especially in older adults.

Key Findings

The study examined 231 healthy older adults with B12 levels that would typically be considered normal. Surprisingly, those with lower B12 levels – though still within the “normal” range – showed several concerning signs:

Slower nerve conduction in visual pathways

Reduced cognitive processing speed, particularly in older participants

More white matter damage visible on brain MRI scans1

Why This Matters

The current normal levels for vitamin B12 were determined decades ago, and it is not clear how reliable the research that led to these values was. Quest and Labcorp, two major chains of laboratories, define normal levels as 200 – 1,000 pg/ml and 232 -1,245 pg/ml, respectively. The WHO considers 480 pg/ml to be the bottom of the normal range, while it is 500 pg/ml in Japan. Some experts suggest these higher standards may contribute to lower rates of Alzheimer’s and dementia in Japan.

What This Means for You

Your B12 levels might be worth checking if you are experiencing neurological symptoms like:

Mental fogginess

Memory issues

Balance problems

Numbness or tingling

Migraine headaches, especially with visual auras

Dizziness

If you have this blood test done, don’t accept “it’s normal” from your doctor, but ask about your actual level.

Why are so many people deficient

Ironically, a healthy diet is low in vitamin B12. Vegetarians are at a greater risk of becoming deficient. Another common factor is antacid medications such as omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), and others. Genetic factors also play a role.

Special Considerations for Older Adults

The study found that older adults may be particularly vulnerable to the effects of lower B12 levels. This is especially important because:

B12 absorption tends to decrease with age

The impact of lower B12 on cognitive processing speed was more pronounced in older participants.

Suzetrigine: A Promising New Treatment for Pain

By: Dr. Mauskop

30-01-2025

Brain disorders, Chronic migraine, Cluster headaches, Headache medications, Headaches, Migraine, New treatments, Pain, Pain Research

FDA has approved suzetrigine (Journavx) for the treatment of moderate to severe acute pain. The drug was found to be as effective as Vicodin (hydrocodone with acetaminophen) after surgery to remove a bunion and after a “tummy tuck”.

Suzetrigine is a selective NaV1.8 inhibitor, targeting a key sodium channel involved in pain signaling. The NaV1.8 channel is crucial in transmitting nerve pain signals to the brain. However, the drug does not enter the brain and works only on the nerves outside the brain and in the body.

Unlike traditional pain medications such as opioids, suzetrigine provides effective pain relief without addiction risk or severe systemic side effects. Early clinical trials suggest it may be beneficial for conditions like neuropathic pain, post-surgical pain, and chronic pain syndromes. Hopefully, it will also prove effective in the treatment of migraines and other types of headaches.

In clinical trials, about 37% of patients experienced adverse events, though most were mild. These included itching, rash, constipation, and muscle spasms.

As a non-opioid option, suzetrigine provides clinicians with an additional tool for acute pain management. The medication is expected to become available in the second quarter of 2025. The expected cost is about $15 a pill.

Why I Take These Supplements – A Doctor’s Personal Perspective

By: Dr. Mauskop

16-12-2024

Alternative Therapies, Brain disorders, Migraine

As a 68-year-old physician, I’m often asked about my own supplement regimen. Here is my approach to supplementation.

The uncomfortable truth about our modern diet is that even those of us eating “healthy” may not be getting adequate nutrition. Our food supply, while abundant, often lacks the nutrient density of previous generations. Even fresh vegetables and fruits grown in depleted soils may not provide the nutrition we expect. Having practiced medicine for decades, I’ve observed this reality in countless blood tests and patient outcomes.

My own blood tests have revealed borderline-low levels of vitamins D, B12, and magnesium – technically “normal” but at the bottom of the range. Scientific studies have shown that laboratory “normal” ranges are often too wide. When you’re at the bottom of that range, you’re likely functioning sub-optimally.

With few exceptions, herbal supplements are rarely subjected to large, controlled clinical trials. A rigorous study of turmeric showed that it improves memory. Astragalus has been subjected to many small clinical and preclinical studies that point to many possible benefits. Other herbal supplements I take have various degrees of evidence for their efficacy and safety.

You can see all the supplements I take in the photo below. You can also see the brands of these products. To select the best brands, I usually consult Consumerlab.com. This independent testing organization is funded by membership fees and does not accept advertising or payments from manufacturers. They provide an extensive description of clinical trials and potential side effects and rank the brands according to their quality and cost.

Psyllium husk (Yerba Prima brand) is also part of my routine. Beyond maintaining regular bowel movements, it’s helped lower my cholesterol and apoB levels – crucial markers for cardiovascular health.

I include creatine in my regimen, timing it within an hour of exercise. While many associate creatine with bodybuilding, research shows it also supports cognitive function – particularly valuable as we age.

While I’m sharing my personal protocol, remember that supplementation needs vary significantly between individuals. Factors like age, medications, health conditions, and even genetic variations can affect what supplements are appropriate. What works for me may not be right for you.

The need for supplementation in our modern world stems from multiple factors: aging-related absorption issues, medication effects, chronic stress, and changes in our food quality. When I compare the taste and quality of foods during my travels in France and Italy to what we typically find in American supermarkets, the difference is notable.

Remember, supplements are exactly that – supplemental to a healthy diet and lifestyle. They’re not magic pills but tools to optimize health in our modern environment. Always consult with your healthcare provider before starting any supplement regimen, especially if you’re taking medications or have underlying health conditions.

Can Magnetic Brain Stimulation (rTMS) Prevent Pain?

By: Dr. Mauskop

02-12-2024

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Headaches in children, Migraine, Migraine in pregnancy, neurostimulation, New treatments, Pain, Pain Research, Science of Migraine, TMJ

Modern technology may help manage or even prevent pain before it becomes chronic. A recent study exploring the effects of repetitive transcranial magnetic stimulation (rTMS) on pain sensitivity offers some intriguing insights.

What is rTMS?

rTMS is a non-invasive method of brain stimulation. It involves sending magnetic pulses to specific areas of the brain through a coil placed on the scalp. This technique has been used to treat conditions like depression and chronic pain, but researchers are now looking at its potential to prevent pain. We used rTMS at the New York Headache Center to treat chronic migraine, other pain and neurological conditions that do not respond to usual treatment.

In a controlled experiment, researchers led by Nahian Chowdhury examined the role of rTMS in reducing future pain in healthy volunteers. The results were published in the latest issue of Pain, a journal of the International Association for the Study of Pain.

The subjects were divided into two groups:

Active rTMS Group: Received high-frequency rTMS to the area of the brain responsible for hand movements.

Sham rTMS Group: Received a fake treatment for comparison.

Both groups were then given an injection of nerve growth factor (NGF) into their jaw muscles, which causes prolonged pain similar to temporomandibular disorders (TMD), a condition causing jaw pain and dysfunction.

Results:

Pain Reduction: Participants who received active rTMS reported significantly less pain when chewing or yawning than the sham group. This effect was more pronounced in the early stages after the injection but persisted for days and weeks.

Brain Activity: The study found an increase in what’s known as peak alpha frequency (PAF) after rTMS, which is linked to lower pain sensitivity.

What Does This Mean for Pain Management?

Preventive Potential: This research suggests that rTMS could be used prophylactically to reduce pain sensitivity when pain is expected, like before surgery.

Future Directions: While promising, this study opens the door to further research into how rTMS can be optimized for pain control, potentially exploring different frequencies, duration, and areas of stimulation.

Pre-Surgery: rTMS might be used to reduce postoperative pain, potentially preventing the transition to chronic pain.

Chronic Pain Management: For those already dealing with chronic pain, understanding how brain activity changes with rTMS could lead to more effective treatments.

Conclusion

While we are still in the early stages, this study of rTMS offers hope for pain sufferers. It suggests a future where we might not only treat pain more effectively but also prevent it from becoming a long-term problem. This could revolutionize our approach to pain management, making it less about reducing and enduring pain and more about preventing it from taking root in the first place.

A new textbook on headaches and facial pain.

By: Dr. Mauskop

21-11-2024

Alternative Therapies, Blocks, Botox, Brain disorders, Chronic migraine, Cluster headaches, Head trauma, Headache medications, Headaches, Headaches in children, injections, Migraine, Migraine in pregnancy, neurostimulation, New treatments, Trigeminal and other neuralgias

It’s an honor to have contributed, alongside Andrew Blumenfeld and Sait Ashina, a chapter on Botox injections to the upcoming textbook Headache and Facial Pain Medicine. Edited by Sait Ashina of Harvard Medical School and published by McGraw Hill, the book is set for release in 2025 but is already available on Amazon.

The book includes chapters on Primary Headaches, Secondary Headaches, Facial Pain and Cranial Neuralgias, Special Treatments and Procedures, Special Populations, and Special Topics. It is an excellent textbook for health care providers.

Having migraines does not lead to brain damage with age

By: Dr. Mauskop

17-10-2024

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

If you’re one of the millions of people who suffer from migraines, you might be worried about the long-term effects on your brain. Recent studies have suggested that people with migraines might be at higher risk for structural brain changes, such as damage to small vessels in the brain and shrinkage of the brain or brain atrophy.

A recent study published in Cephalalgia by Dutch researchers examined the connection between migraines and brain health in over 4,900 middle-aged and elderly people. The researchers used magnetic resonance imaging (MRI) to study the brains of the participants and assess any structural changes.

The study found that people with migraines were not any more likely to have structural brain changes than those without migraines. There were no significant differences between the two groups in terms of:

Total brain volume
Grey matter volume
White matter volume
White matter hyperintensity volume (a marker for small vessel disease)
Presence of lacunes (tiny holes in the brain)
Presence of cerebral microbleeds (small bleeds in the brain)

This study suggests that having migraines may not increase your risk of developing structural brain changes as you age. This is reassuring news for people who suffer from migraines and are concerned about the long-term effects on their brain health.

Severe vitamin B12 deficiency can occur with normal blood levels of B12

By: Dr. Mauskop

15-10-2024

Alternative Therapies, Brain disorders, Migraine, Pain Research, Science of Migraine

Vitamin B12 deficiency is common in the elderly, vegetarians, people with diabetes, and other chronic conditions. This deficiency can cause neurological, psychiatric, hematological, and other symptoms. It can be a contributing factor to migraines, especially in people who experience visual auras.

If not treated, vitamin B12 deficiency can cause dementia, spinal cord damage, loss of vision, and permanent nerve damage. I check vitamin B12 levels in all of my patients. The blood test, however, is not always reliable. There are reports of severe deficiency with perfectly normal levels. This is why when a deficiency is suspected, additional tests are needed. These are homocysteine and methylmalonic acid levels. These tests can disclose the presence of a deficiency when vitamin B12 level is in the normal range.

To further complicate matters, a report by neurologists at UCSF described a patient with normal blood tests who nevertheless had a severe vitamin B12 deficiency in the brain. They discovered that this patient had antibodies to a receptor (CD320) that is necessary for the uptake of vitamin B12 from the blood into the brain across the blood-brain barrier. The spinal fluid of this patient completely lacked vitamin B12. Her presenting symptoms were difficulty speaking, unsteadiness, and tremor. She had no peripheral manifestations of vitamin B12 deficiency, only those related to the brain. She recovered with high doses of vitamin B12 supplementation and immunosuppressive therapy to reduce the amount of antibodies against the CD320 receptor.

The authors screened a few hundred patients with lupus, multiple sclerosis, and healthy controls. They found these antibodies in 6% of healthy controls, 6% of those with lupus without neurological symptoms, and 6% with multiple sclerosis. Antibodies were present in 21% of patients with lupus who had neurological symptoms.

This newly described condition is called autoimmune B12 central deficiency (ABCD). The role of these antibodies in healthy people is not clear. However, people with unexplained neurological symptoms should have a blood test for homocysteine, methylmalonic acid, and CD320 antibodies.

New Daily Persistent Headache may respond to TMS

By: Dr. Mauskop

06-10-2024

Alternative Therapies, Brain disorders, Chronic migraine, Headaches, Headaches in children, Migraine, Migraine in pregnancy, neurostimulation, New treatments, Pain

Researchers at a hospital in Northern India reported good results in treating New Daily Persistent Headache (NDPH) with repetitive transcranial magnetic stimulation (rTMS).

NDPH is a type of headache that begins suddenly and persists daily without specific features, distinct MRI presentation, or blood test abnormalities. It can present similarly to chronic migraines or chronic tension-type headaches. While published reports suggest NDPH is difficult to treat, this is often not the case. However, patients who do not respond to initial standard treatments may become discouraged.

The Indian researchers conducted a pilot study with 50 NDPH patients who received 10 Hz rTMS sessions on the left prefrontal cortex of the brain for three consecutive days. They found that after 4 weeks:

70% of patients had at least a 50% reduction in headache severity
Patients gained an average of 11 headache-free days per month
76% had significant improvements in headache-related disability
Depression and anxiety scores also improved significantly

The treatment was well-tolerated, with only minor side effects in a few patients. The benefits seemed especially pronounced in patients who had NDPH that resembled chronic migraine.

I never give the diagnosis of NDPH, but diagnose it as a condition it most resembles and treat the person with a wide variety of available options. Many respond. For those who do not, we offer rTMS, a procedure that uses magnetic fields to stimulate nerve cells in the brain. An electromagnetic coil device is placed against the scalp near the forehead. The coil painlessly delivers a magnetic pulse that stimulates the brain with the goal of reducing headache symptoms. The FDA has approved it for the treatment of depression, anxiety, and OCD. We use it for various neurological conditions, including headaches that do not respond to standard therapies. To treat migraines and other types of pain, we usually stimulate not only the left prefrontal cortex, as was done in this study, but also two additional sites that have been reported to help with pain and migraines. These additional sites are either the motor cortex or the occipital cortex, on both sides.

Sometimes, we obtain a functional magnetic resonance imaging (fMRI) scan to better target rTMS. fMRI is a research procedure that is not available commercially (and is not covered by insurance).

What can you do about long COVID

By: Dr. Mauskop

26-08-2024

Alternative Therapies, Brain disorders, Chronic migraine, neurostimulation, New treatments

Long COVID, also known as post-COVID conditions, can present with a wide range of symptoms that persist for weeks or months after the initial COVID-19 infection. The most common symptoms of long COVID include:

Neurological Symptoms

Headaches
Difficulty thinking or concentrating, often referred to as “brain fog”
Memory problems
Changes in smell or taste

Psychological Symptoms

Depression or anxiety
Mood changes

Other Symptoms

Fatigue or tiredness that interferes with daily life
Shortness of breath or difficulty breathing
Cough
Chest pain or heart palpitations
Sleep problems
Dizziness when standing up (orthostatic hypotension)
Joint or muscle pain
Fever
Stomach pain or other gastrointestinal issues
Changes in menstrual cycles

There is evidence of persistent inflammation in people with long COVID. This inflammation of blood vessels, brain tissues, and other organs is likely the cause of all of the above symptoms.

Receiving a COVID vaccination may prolong the symptoms of long-term COVID-19 in people who have already contracted COVID and now suffer from long COVID. However, vaccines seem to reduce the risk of severe COVID and long COVID.

Unfortunately, we do not have any proven therapies for long COVID. However, it is very important to make sure that nutritional deficiencies do not contribute to long COVID symptoms. I often find a deficiency of vitamin B12 and other B vitamins, vitamin D, magnesium, CoQ10, omega-3 fatty acids, zinc, and others. I recommend looking at your test results yourself since doctors may glance at the report and tell you everything is fine if nothing is flagged. The normal ranges for vitamins are too wide, and if you are at the bottom of the normal range, you are probably deficient. For example, vitamin B12 levels are considered normal between 200 and 1,200. Most neurologists will tell you that your level should be above 500. The same applies to RBC magnesium level – normal is 4.0 to 6.4, but you need to be above 5. Vitamin D should be well above 40, while 30 is still considered normal.

Another supplement I often recommend is NAC. A small study by Yale neurologists showed that 600 mg of NAC improved working memory, concentration, and executive functions. NAC helps the body produce glutathione, an important antioxidant. We sometimes give glutathione infusions along with other vitamins.

Supplements that reduce inflammation include ginger and turmeric extracts.

For brain fog and other neurological symptoms, we have had some success with transcranial magnetic stimulation (TMS). Other neurostimulation methods, such as tDCS, are also worth trying.

Some patients benefit from intravenous infusion of immune globulin, which is approved for some types of neuropathies.

Low-dose naltrexone (LDN) may also help, but no studies prove this.

Probiotics can help people with gastrointestinal symptoms.

Stimulants can be tried to treat fatigue and brain fog. They can also help with depression.

For headaches, we often give Botox injections.

Depression can be treated with antidepressants or TMS.

Some people respond well to physical therapy, acupuncture, herbs, meditation, cognitive-behavioral therapy, and other mind-body techniques.

Disruption of brain networks by chronic pain can be prevented.

By: Dr. Mauskop

18-08-2024

Alternative Therapies, Brain disorders, Pain, Pain Research, Psychology of headaches

Chronic pain is known to alter the brain’s default mode network (DMN). The DMN is a group of interconnected brain regions activated when a person is not focused on the external world. Key DMN functions include mind wandering (daydreaming, thinking about the past or future, imagining scenarios), self-reflection (considering thoughts, feelings, and experiences), theory of mind (understanding others’ thoughts and intentions), and memory (retrieval and processing).

A recent study published in the journal Pain by German researchers investigated the relationship between chronic back pain and DMN alterations. The study, titled “Beyond the chronic pain stage: default mode network perturbation depends on years lived with back pain,” examined patients with chronic back pain (CBP), subacute back pain (SBP), and healthy controls using fMRI.

Results showed that the DMN is significantly altered in CBP patients compared to healthy individuals. Importantly, the degree of DMN disruption increased with the duration of pain, suggesting that the brain adapts to persistent pain over time. This adaptation is influenced by cognitive coping strategies or how individuals mentally manage their pain.

The study found that coping attitudes mediate the link between DMN changes and pain duration. This implies that how people think about and handle pain impacts their brain’s adaptation to it. Effective pain coping strategies could potentially lessen the negative effects of chronic pain on the brain, emphasizing the importance of psychological interventions like meditation, cognitive behavioral therapy (CBT), and acceptance-commitment therapy (ACT).

These findings also provide a scientific basis for treatments like transcranial magnetic stimulation (TMS) and other brain stimulation methods, which aim to restore normal brain connectivity, including DMN function.

If two antidepressants fail, TMS may offer relief.

By: Dr. Mauskop

11-08-2024

Alternative Therapies, Brain disorders, Chronic migraine, Headache medications, neurostimulation, Psychology of headaches

The FDA approved transcranial magnetic stimulation (TMS) to treat anxiety, depression, and OCD about 15 years ago. Most insurers cover this treatment. However, it remains highly underutilized.

A study just published by Dutch researchers in Psychiatry Online compared TMS with a third antidepressant in people who did not respond well to two different antidepressants.

Both treatments were combined with psychotherapy.

89 people with depression who hadn’t improved with at least two previous treatments took part.
They were randomly assigned to either TMS or a new antidepressant.
The treatment lasted eight weeks.
TMS involved 25 sessions of magnetic stimulation.
The medication group switched to a new antidepressant following standard guidelines.

The primary outcome measure was the degree of improvement in depression symptoms.

TMS was more effective than switching medications. More people responded well to MS (38% vs 15%) and more people’s depression went into remission with TMS (27% vs 5%).

TMS was better at improving symptoms of anxiety and lack of enjoyment (anhedonia)

Both treatments were equally effective for improving sleep, overthinking, and negative thought patterns. People’s expectations about their treatment were linked to how much their depression improved.

In conclusion, for people with depression that hasn’t responded well to a couple of medication attempts, TMS might be a more effective option than trying another antidepressant. The study also suggests that the choice between TMS and medication might depend on which specific symptoms a person struggles with most.

We started using TMS for people with migraine headaches if they do not respond to multiple standard therapies. About half of these patients respond well. However, we do not have large controlled trials to confirm that TMS effectively treats migraines.