Medication overuse headache (MOH) does not respond to steroids according to a new study published in the July 3 issue of journal Neurology. Patients who take Fioricet, Fiorinal, Esgic, Excedrin and other, mostly caffeine-containing drugs often have a headache that is perpetuated by the constant intake of these drugs. This is less likely to happen from triptans, such as Imitrex, Maxalt and Relpax or ibuprofen and acetaminophen. When we try to stop these medications headache usually worsens for several days or weeks before it gets better. We do use corticosteroids (prednisone, dexamethasone, methylprednisolone) to treat not only headaches that result from medication withdrawal but also severe migraines that do not respond to the usual migraine drugs. Corticosteroids are safe when taken occasionally, but can cause many different and often dangerous side effects if taken for long periods of time (weeks and months). We limit the use of corticosteroids to a few days a month.
The editorial which accompanies this report comments on the fact that a previous, larger but less rigorous study found that steroids are beneficial for MOH. The possible reasons for this discrepancy are: 1. the dose of prednsione used in the study was not high enough; 2. corticosteroids are only effective for MOH in patients who suffer from migraines and not tension-type headaches (both were included in this study); and 3. the older and larger study was not blinded and placebo might have played a bigger role.
The bottom line is that because of our positive experience and in the absence of a definitive negative study, we at the NYHC will continue using corticosteroids both for MOH and for other refractory migraine attacks when other treatments (triptans, intravenous magnesium, Botox, etc) fail.

Chronic migraine headaches can be helped by topiramate (Topamax) even in those patients who are having rebound headaches from daily intake of pain or migraine medications, according to a report in the latest issue of Cephalalgia. Chronic migraine headaches can be helped by topiramate (Topamax) even in those patients who are having rebound headaches from daily intake of pain or migraine medications, according to a report in the latest issue of Cephalalgia. Common thinking is that in order for a preventive drug, like topiramate to work the patient first has to stop drugs that cause rebound headaches. This study suggests that patients can obtain relief even without stopping the drug that causes rebound. We find that the same is true for Botox – it can also help relieve chronic migraines without the patient having to first get off drugs such as Fioricet and Excedrin.

Women with migraine have a higher frequency of excessive and/or prolonged menstrual bleeding and endometriosis, according to a study published recently in Headache, the journal of the American Headache Society. While as many as 60% of women experience migraine in conjunction with their menstrual periods, there is little information regarding the relationship between migraine and menstrual disorders.(1,2). A study published in 2004 found an increased prevalence of migraine in women with endometriosis (a condition in which the endometrial tissue is outside of the uterus) (3), but the reason for this association is unknown. Menstrual problems are common, and unusually heavy bleeding over several cycles in a row occurs in about 30% of women.4 Endometriosis affects 0.5% to 5% of fertile women and 25% to 40% of infertile women.(5-7)

To understand more about the association between menstrual disorders and migraine, Dr. Gretchen Tietjen of the Medical College of Ohio in Toledo, and colleagues, enrolled 50 female migraineurs (diagnosed according to the International Headache Society criteria) of childbearing age and 52 age-matched women. They were asked to complete a questionnaire regarding migraine and migraine-related disability, menstrual history, other bleeding history, vascular event history, and vascular risk factors.

The frequency of smoking, oral contraceptive use, and hormone replacement therapy was similar between the two groups of women. Twenty-three of the 50 migraineurs reported that migraine was associated with their menstrual period, and 36% suffered from chronic headache (15 or more days/month).

More migraineurs reported unusually heavy periods (63% vs. 37%), and endometriosis was more commonly diagnosed in migraineurs (30% vs. 4%). More migraineurs (24% vs. 14%) had undergone a hysterectomy, and endometriosis was identified as the reason in over half of the cases. Interference in life activities and mood from menstrual periods was three times more likely to be reported in migraineurs compared to controls.

A greater prevalence of hypertension (25% vs. 10%) and Raynaud’s disease (10% vs. 2%) and the trend to report transient ischemic attacks/stroke (10% vs. 2%) in the migraine group suggest an altered vascular response,8 but the researchers say the study is too small to make any definitive conclusions.

They say the findings support further research to study the factors influencing endometriosis and menstrual blood flow, such as hormonal influences and blood clotting disorders.

References

1. Kelman L. Women’s issues of migraine in tertiary care. Headache 2004;44:2-7.
2. Epstein MT, et al. Migraine and reproductive hormones throughout the menstrual cycle. Lancet 1975;1:543-548.
3. Ferrero S, et al. Increased frequency of migraine among women with endometriosis. Hum Reprod 2004;19:2927-2932.
4. Oehler MK, Rees MC. Menorrhagia: an update. Acta Obstet Gynecol Scand 2003;82:405-422.
5. Houston DE, et al. Incidence of pelvic endometriosis in Rochester, Minnesota, 1970-79. Am J Epidemiol 1987;125:959-969.
6. Strathy JH, et al. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril 1982;38:667-672.
7. Haupt BJ. Utilization of short-stay hospitals: annual summary for the United States, 1980. Vital Health Stat 1982;13:1-60.
8. Planchon B, et al. A quantitative test for measuring reactivity to cold by the digital plethysmograph technique: application to 66 control subjects and 65 patients with Raynaud’s phenomenon. Angiology 1986;37:433-439.

Source:

Tietjen GE, et al. Migraine is associated with menorrhagia and endometriosis. Headache 2006; doi:10.1111/j.1526-4610.2006.00290.x

Curtis Schreiber and Roger Cady reported their study at the recent annual meeting of the American Academy of Neurology. This was a randomized, double-blind, placebo controlled study Another study of Botox for migraines. Curtis Schreiber and Roger Cady reported their study at the recent annual meeting of the American Academy of Neurology. This was a randomized, double-blind, placebo controlled study (that is the most reliable kind of a study) of patients who had disabling headaches and had difficulty complying with their previous prophylactic treatment. 60 received Botox and 21 received placebo injections. There was a significant improvement in headache frequency, headache impact (so called HIT-6 measure) and treatment satisfaction in patients who received Botox compared to those who received placebo. There are about 100 published reports on the use of Botox for migraine headaches and the experience of most headache experts in the US is very positive. However, many insurance companies will not cover Botox because the FDA has not yet approved it for migraines. Allergan, the company that manufactures Botox is conducting the FDA-required trials (we at NYHC are participating in one of the two trials), but the earliest possible time for approval is 2009.

Patients who suffer from chronic migraines say they would do anything to rid themselves of the
pain-but heart surgery?

Click here to download the full article ( .pdf )

Medtronic Begins Study of Occipital Nerve Stimulation for Chronic, Refractory Migraine Headaches; Implanted Device Delivers Electrical Impulses to Occipital Nerves. Medtronic Begins Study of Occipital Nerve Stimulation for Chronic, Refractory Migraine Headaches; Implanted Device Delivers Electrical Impulses to Occipital Nerves

Medtronic, Inc. today announced the first patient implant in a preliminary study to evaluate if an implanted device might help some of the thousands of Americans who suffer the agony of chronic migraine headaches that have not responded to other treatments.

More on occipital nerve block: The current issue of journal Headache presents a report of two patients whose prolonged hemiplegic migraine aura resolved with greater occipital nerve block. It is hard to explain how blocking a nerve would stop this brain dysfunction, but Botox which we routinely use to treat migraines, also seems to affect brain processes through peripheral nerves. I might try occipital nerve block for my next patient with a prolonged aura, but only if an intravenous infusion of one gram of magnesium sulfate fails.