A pharmacogenetic study by Italian researchers discovered that absence of a certain gene can predict therapeutic response in migraine patients who are treated with riboflavin (vitamin B2). Pharmacogenomics has been a very promising field of medical science that may enable doctors to select the most effective and safe medicine for each patient based on their genetic profile. This is a small but important step in utilizing this science to treat headache patients.
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Vertigo is a common symptom in patients with migraine headaches. It appears that obverse is also true – migraine is very common in patients with vertigo. A study just published in Cephalalgia looked at 208 patients with benign recurrent vertigo. It turned out that 87%, or 180 of these patients had migraine headaches. Of these 180 patients, 112 or 62% had migraine with aura and 38% had migraine without aura. Thirty percent, or 54 patients always had vertigo without any migraine symptoms, while in 70% vertigo occurred with a headache or other migraine symptoms, such as visual aura, sensitivity to light and noise. The duration of attacks of vertigo in most patients was between one hour and one day.
Read MoreMigraine headaches in patients with post-traumatic stress disorder tend to be more frequent and disabling, according to a study in soldiers led by Dr. Jay Erickson. Soldiers with PTSD had almost twice as many headaches as soldiers without PTSD and were more likely to have chronic migraines (headaches on more than 15 days a month). Treatment with preventive medications was slightly less effective in the PTSD group. Botox injections were not tried in these patients. It is a well established fact that patients with a history of abuse are more likely to have chronic pain, including headaches. This is an important part of history since inclusion of psychotherapy may improve treatment outcomes in these patients and, at least in theory, using antidepressants rather than other classes of preventive drugs may be more appropriate.
Read MoreBoth overweight and underweight people are more likely to have migraine headaches, according to a recent study published in journal Cephalalgia. Being overweight has been shown to increase the risk of chronic migraines in a previous large study, but the discovery of the link between being too thin and migraines is new. These findings do not mean that regaining normal weight will lead to improvement in headaches, but only that there is an association. This is not to say that we do not encourage our overweight patients to lose weight. The best way to achieve this is not only by dieting, but also by engaging in frequent aerobic exercise, which has been found to be associated with fewer migraine headaches.
Read MorePhysical inactivity was strongly associated with headache disorders, according to a large study by Swedish researchers published in Headache. They looked at 43,770 people with recurrent headaches and migraines and found that economic hardship and psychosocial factors (poor social support and experience of being belittled) seem to play a role in headache disorders. Of lifestyle factors, physical inactivity was strongly associated with headache disorders, while smoking to a lesser extent. Skipping breakfast, being overweight and underweight seemed to be connected to headaches.
Read MoreRed wine to relieve migraine? Red wine is a well-known trigger of migraine headaches (although French tend to disagree). A recent study published in journal Pain found that resveratrol, the active ingredient in red wine which is responsible for its health benefits, has pain relieving properties when given to rats. There have been no reports in the literature or from my own patients that resveratrol causes headaches and judging from this study, it may in fact help.
Read MoreTreatment of menstrual migraines often is more difficult than of non-menstrual attacks. A double-blind study by Marcelo Bigal and his collaborators just published in Headache shows that a combination of 10 mg of rizatriptan (Maxalt) and 4 mg of a steroid medication, dexamethasone (Decadron) is more effective than either drug alone. Both drugs are effective in treating many refractory migraine attacks (although I usually use 8 mg of dexamethasone), this is the first trial of two drugs together. While the results are not very surprising, the study may lead to wider acceptance of combination therapy and better relief for many women. While in the past the emphasis was placed on finding a single drug to treat a disease, in recent years combination therapy has become a standard approach in many conditions. Treximet, a combination of sumatriptan (Imitrex) and naproxen (Aleve) was also shown to be better than either of the two ingredients alone.
Read MoreMigraines may be helped by omega-3 fatty acids, a supplement that has gained well deserved popularity. Several recent studies suggesting benefits for the cardiovascular system prompted me to look at the headache literature. An article in Cephalalgia in 2001 by Pradalier and his colleagues concluded that this supplement is ineffective, at least when they looked at the number of headaches in the last 4 weeks of treatment. However, the active treatment with 6 grams of omega-3 fatty acids was significantly better than placebo when they looked at the total number of attacks during the entire 4 months of treatment. Taking into account this finding and considering that omega-3 fatty acids have other benefits while being very safe, it is worth trying to take daily 6 grams of omega-3 fatty acids if you suffer from migraine headaches.
Read MoreRefractory migraines may respond to occipital nerve stimulation, according to Dr. Joel Saper who led a multicenter trial of this treatment. An electrode was surgically implanted in the back of the head, where the occipital nerve is located, and a pacemaker-size device was implanted under the skin. The trial looked at 110 patients who had more than 15 days with migraines each month and who did not respond to a variety of medications. 66 patients completed the diary information for three months following the start of treatment. The results were encouraging – 39% of patients improved, compared with 6% in the control group. None of the patients had any adverse events.
Read MorePatients who suffer from migraine headaches are 30% less likely to develop breast cancer. It is well established that fluctuating estrogen levels throughout the menstrual cycle can trigger migraine attacks. These fluctuations are reduced during pregnancy and menopause, resulting in cessation of migraine attacks in two thirds of women. At this point it is not clear what common estrogen-based mechanisms are responsible for the reduction of breast cancer risk in migraine sufferers.
Read MoreIt is well known that if you take a snapshot of the population, about 18% of women and 6% of men suffer from migraine headaches. However, a report by Dr. Stewart and his colleagues in the latest issue of Cephalalgia indicates that cumulative lifetime migraine incidence is much higher – 43% of women and 18% of men have migraine headaches at some point in their lives. Migraine incidence peaked between the ages of 20 and 24 in women and 15 and 19 in men. In 75% of cases migraine started before the age of 35.
Read MoreMagnesium is effective in preventing migraine headaches according to a new study published in the last issue of journal Magnesium Research. The researchers found that patients treated with magnesium, compared to those treated with placebo, had fewer migraine attacks and the attacks were milder. In addition, magnesium treated patients had improved blood flow in their brains, while those on placebo did not. This is just another confirmation of previous findings of the efficacy of magnesium in the treatment of migraine headaches. Since magnesium is very inexpensive and extremely safe, every patient with migraine headache should be given a trial of magnesium supplementation.
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