Anti-epilepsy drugs such as Neurontin (gabapentin), Topamax (topiramate) and Depakote (divalproex) have been proven to prevent migraine headaches. Each drug works for about half of the patients who try it. The other half either does not get any benefits or develops side effects. This does not seem to be that effective, but these drugs do beat placebo in blinded trials. We also know that not all anti-epilepsy drugs work for headaches. Tegretol (carbamazepine) was never shown to help and a study just published in Neurology confirms our impression that its cousin, Trileptal (oxcarbazepine) does not work either. We do occasionally see good results with two other epilepsy drugs, Keppra (levetiracetam) or Lamictal (lamotrigine), but large clinical trials proving their efficacy are lacking.
Read MoreMemantine is an old medication which has been available in Europe for over 30 years, but was only recently introduced in this country for the treatment of Alzheimer’s disease. Memantine blocks a specific receptor in the brain cells. Activation of this so called NMDA receptor is responsible for many negative effects, including pain and nerve cell damage. As soon as the drug was introduced in the US pain and headache specialists tried using it for pain, but probably because it is a weak blocker of the NMDA receptor our experience with this drug has not been very impressive. However, in the recent issue of journal Headache Greek doctors report that one patient with chronic migraines obtained complete relief due to memantine. One case report clearly does not prove that memantine is going to work for any significant percentage of patients. However, this drug has relatively few side effects and if the usual treatments fail it may be worth trying.
Read MoreTopamax is a popular drug for the prevention of migraine headaches. IT works for about half of the patients who try it. The main problem that makes people stop taking the drug is cognitive side effects. Patients tell us that they feel “stupid” on this drug. An article just published in the European Journal of Neurology pinpoints the main cognitive problem, which turns out to be word fluency. This means having trouble coming up with the right word.
Read MoreBright light can trigger migraine headaches and many migraine sufferers have increased sensitivity to light during an attack. A recent report has suggested that wearing amber colored lenses (Nike Maxsight) can relieve the light sensitivity. For some of our patients wearing these lenses has allowed them to go outdoors on a sunny day without getting a migraine. A new report in the journal Drug Development Research proposed a theory that each patient might best benefit from an individually selected tint (PSF, or precision spectral filters). The article, Prevention of visual stress and migraine with precision spectral filters presents a convincing argument which should be relatively easy to test. PSF appears to be more easily available in the UK where most of the research has been conducted.
Read MoreClopidogrel, which is also known as Plavix, is a drug used to prevent strokes and heart attacks. It works by preventing platelets from sticking together and causing a blood clot which can block a vessel in the heart or brain. Platelets also tend to become sticky in patients during a migraine attack, which is how this drug might help migraine sufferers. A British physician reported that a small number of patients given this drug stopped having migraine headaches after many years of unsuccessful treatments. A large study is currently under way to prove that this drug in fact works better than a placebo.Â
Read MoreBotox has been shown to relieve migraine headaches in another two studies published in Headache. One study compared the efficacy of Botox and an epilepsy drug, Depakote and found them to be equally effective. However, Depakote caused more side effects, which resulted in more patients taking Depakote dropping out of the study. The second study was done in patients who had difficulty complying with daily preventive medications. Half of them were injected with Botox and the other half with saline water. Neither the doctor nor the patient knew who received which treatment (double-blind study). The impact of migraines on patients’ lives was significantly improved by Botox. These two studies by leading headache specialists provides additional proof that Botox is effective for the relief of migraine headaches.
Read MoreMigraine does not cause cognitive impairment, according to a new Danish twin study. This important finding reassures millions of migraine sufferers and confirms our clinical observation.  Another recent study in mice suggested that inducing brain changes similar to what occurs during a migraine attack in humans can cause brain damage. This report was widely circulated in the media and has caused unnecessary anxiety in many migraine sufferers.  Clearly, whatever those mice experienced was not a migraine attack and, more importantly, brains of mice are very different from human brains.Â
The Danish study looked at 139 pairs of twins where one of the twins had migraines and the other one did not. Comparing their cognitive abilities revealed no difference for those who had migraine with or without aura, even after taking into account age, age of onset, duration of migraine history and number of attacks. Presence of aura is thought to indicate a more serious condition with a slight increase in the risk of stroke. However, on one cognitive test, men with migraine with aura did better than their twin without migraines.
Read MoreA recent study published in Neurology showed that migraine sufferers have thicker gray matter in the part of the brain that perceives pain. Thickening of the gray matter indicates larger number of brain cells in that area, which is not necessarily a bad thing. However, all of the commentary in the media suggests that this is another indication of brain damage in migraine patients. This study is not a cause for alarm and all of the previous research also indicates that the vast majority of migraine sufferers are not at risk of brain damage.
Read MoreThis is a common question people ask when we suggest that they start taking a daily preventive medication. A groundbreaking study just published by Hans-Christoph Diener and his colleagues answers this question. Over 800 patients were placed on topiramate (Topamax), a popular epilepsy drug used to treat headaches. After 26 weeks half of the patients were switched to placebo and the other half contined on Topamax for another 26 weeks without doctors or patients knowing who was taking what.  It turns out that stopping Topamax did worsen headaches, but not that much – in a 28-day period those on Topamax had one fewer day with migraine than those on placebo. This suggests that what most headache specialists have suspected from their experience all along is correct. That is many patients can stop taking their daily medication after about six months without significant worsening. However, there are some patients who may need to stay on a medication for longerer periods of time.
Read More“Anne Frank’s headache” is the title of an article just published by RF de Almeida and PA Kowacs in the journal Cephalalgia. This is an abstract of the article: “There are a significant number of famous people who suffered from frequent headaches during their lifetime while also exerting an influence of some kind on politics or the course of history. One such person was Anneliese Marie Frank, the German-born Jewish teenager better known as Anne Frank, who was forced into hiding during World War II. When she turned 13, she received a diary as a present, named it ‘Kitty’ and started to record her experiences and feelings. She kept the diary during her period in hiding, describing her daily life, including the feeling of isolation, her fear of being discovered, her admiration for her father and her opinion about women’s role in society, as well as the discovery of her own sexuality. She sometimes reported a headache that disturbed her tremendously. The ‘bad’ to ‘terrifying’ and ‘pounding’ headache attacks, which were accompanied by vomiting and during which she felt like screaming to be left alone, matched the International Headache Society criteria for probable migraine, whereas the ‘more frequent headaches’ described by Anne’s father are more likely to have been tension-type headaches than headaches secondary to ocular or other disorders.”
Read MorePostpartum headaches are very common and are usually benign. A study presented at the meeting of the Society for Maternal-Fetal Medicine by Dr. Caroline Stella and her colleagues looked at 95 women with severe headaches that started 25 hours to 32 days after delivery and were not responsive to usual doses of pain medicines. Half of these women eventually were diagnosed to have migraine or tension-type headaches and they all responded to higher doses of pain drugs. In one quarter of patients headaches were due to preeclampsia or eclampsia and were relieved by intravenous magnesium or magnesium and high blood pressure medications. Fifteen women had spinal headaches due to complication of epidural analgesia and they responded to a “blood patch” procedure. Only one woman had a brain hemorrhage and one had thrombosis (occlusion) of a vein in the brain. The authors suggested that all these conditions should be considered when evaluating women with postpartum headaches and appropriate testing needs to be performed.
In another study presented at this meeting Dutch researchers found that women who suffered from an episode of eclampsia had persistent cognitive dysfunction 6-8 years later. This contradicts the widely held belief that women with eclampsia can expect full recovery. This study suggests that eclampsia needs to be treated early and aggressively (magnesium infusion is one of the main treatments) to prevent permanent brain injury. It is also important to understand that persistent cognitive dysfunction is not psychological in nature and that it should be treated with cognitive rehabilitation.
Read More
Recent Comments