Migraine | Headache NewsBlog

Migraine and thyroid disease

By: Dr. Mauskop

11-12-2023

Chronic migraine, Headache medications, Headaches, Migraine, Migraine in pregnancy, Science of Migraine

The thyroid function test is in the initial battery of blood tests we order on all our headache patients (along with RBC magnesium, vitamins D, B12, folate, and others). Having either an overactive or underactive thyroid is known to worsen migraine headaches.

A new study published by Indian researchers confirmed that treating an underactive thyroid improves headaches. The researchers studied 87 headache patients with a mild decrease in thyroid function. Half of them were prescribed thyroid medicine and the other half received a placebo. Correcting thyroid deficiency improved headache frequency, severity, and disability (MIDAS score) at three months of follow-up in the treatment group compared to the placebo group.

The conclusion was that it is logical to check thyroid function status in patients presenting with migraine headaches.

Thyroid function can sometimes decline precipitously and cause worsening of headaches without any other symptoms. This can happen after delivering a baby and the cause is often misinterpreted. Lack of sleep, stress, hormonal changes (female hormones, not thyroid hormone), occlusion of veins inside the head, and even stroke are suspected. All those conditions can cause headaches after the delivery. But we should not forget to check the thyroid.

fMRI scan can establish the diagnosis of migraine

By: Dr. Mauskop

02-12-2023

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

Neurologists diagnose migraine by the description of symptoms provided by the patient. We have not had an objective test to confirm that a person suffers from migraines.

A group of researchers led by Dr. Yiheng Tu in the department of psychiatry at Harvard Medical School developed an AI program that can diagnose migraine using fMRI (functional MRI) scanning. The AI program was first fed information on fMRIs of 116 individuals with migraines and then had this data compared to healthy controls.

The AI program had 93% sensitivity and 89% specificity. This means that it missed the diagnosis of migraine in only 7 out of 1oo patients and diagnosed migraine in 11% of patients who did not have it. These are very good numbers, but clearly, the method is not error-proof.

When they compared people with migraines to those with other types of pain, the sensitivity dropped to 78% and specificity, to 76%. This can be explained by the fact that similar functional changes in the brain probably occur with any type of pain.

A major obstacle to the wide use of fMRI scans is the cost. They are more expensive to perform than a regular MRI. Insurance companies are not likely to cover it since this is an experimental procedure. Another potential difficulty is that fMRI takes much longer to do than a regular MRI – an hour vs 20 minutes. During this time you have to lie inside a tube while trying not to move and hearing loud banging noises.

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.

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.

Another report on triptan safety

By: Dr. Mauskop

22-10-2023

Chronic migraine, Headache medications, Headaches, Migraine

A presentation by Jing Jie Yu, Joshua E. Levine, and others from U. of Florida at the last meeting of the International Headache Society described their analysis of the potential risks of triptans.

Triptans are drugs that were first approved in 1992 and include sumatriptan (Imitrex, Imigran), naratriptan (Amerge, Naramig), rizatriptan (Maxalt), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert), and frovatriptan (Frova). Because triptans have the potential to constrict blood vessels they are contraindicated in patients who have coronary artery disease (CAD) or cerebrovascular disease (CVD).

The study was entitled, Association between Triptan Use and Cardiovascular Disease and All-Cause Mortality among Patients with Migraine: A Systematic Review and Meta-analysis

This meta-analysis of several studies showed that triptan use was not associated with increased risk of stroke, TIA, or all-cause death risk but with a decreased CAD risk in migraine patients.

A report presented in 2022 showed not only that triptans are safe in people without CVD, but are relatively safe even in those who have CVD. The risk of major adverse cardiovascular events with triptans was 1% while with NSAIDs, such as ibuprofen and naproxen, it was 3.8%.

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.

A better fix for Benign Paroxysmal Positional Vertigo

By: Dr. Mauskop

21-08-2023

Brain disorders, Chronic migraine, Migraine, New treatments, Science of Migraine

People who suffer from migraines are twice as likely to develop benign paroxysmal positional vertigo (BPPV) than individuals without a history of migraines. BPPV, though benign, can be a terrifying experience, especially for those experiencing it for the first time. It has a sudden onset and is often accompanied by nausea and vomiting. The first thought that enters people’s mind is a stroke or a brain tumor.

The cause of BPPV is a loose crystal in one of the semicircular canals of the inner ear. Epley maneuver usually succeeds in trapping and immobilizing this crystal. I’ve had a patient who emailed me with a typical description of BPPV. I emailed her this link to a YouTube video with the instructions on how to perform the Epley maneuver. She emailed back 30 minutes later reporting that her vertigo stopped.

A new study by Dr. Michael Strup, a neurologist at the Hospital of the Ludwig-Maximilians University in Munich and his European colleagues compared two different maneuvers to relieve BPPV. They showed that Semont-Plus maneuver is more effective than the Epley maneuver.

Of the 195 participants 64% were women and the mean age was 63. Initially, the procedure was administered by a physician. Subsequently, patients were instructed to perform the maneuver independently—three times each in the morning, noon, and evening. The Epley group stopped having vertigo after an average of 3.3 days, while the Semont-Plus group, after an average of 2 days.