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Tag "stroke"

A recent study by Dr. Bigal and his colleagues just published in Neurology compared more than 6,000 migraine sufferers with over 5,000 matched control subjects without migraines.   They discovered that people with migraine with aura and to a lesser extent those with migraine without aura are significantly more likely to have strokes, heart attacks, hypertension, poor circulation, diabetes, and high cholesterol.  This clearly does not mean that migraine causes all these diseases, but only that if you have one you are more likely to have the other.  It is important to recognize this association in migraine sufferers in order to regularly screen them for these conditions.  We know that controlling diabetes, high blood pressure, and high cholesterol can prevent strokes, heart attacks and poor circulation in extremities.  We also recommend that women who have migraine with aura should not take estrogen-based oral contraceptives or hormone replacement therapy since estrogen in these women also increases the risk of strokes.  All migraine suffererss (and everyone else) should not smoke and exercise regularly, which also reduces the risk of the conditions mentioned above.

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High homocysteine levels increase the risk of cardiovascular disease (strokes and heart attacks) and can be reduced by folic acid and vitamin B12 (cyanocobalamine).   A study by Spanish doctors published in Headache found elevated homocysteine levels in patients who have migraines with aura.  Patients who have migraine with aura are known to have increased risk of cardiovascular disease and it is possible that elevated homocysteine levels are at least in part responsible for this risk.  I routinely check homocysteine, vitamin B12 and folic acid levels in all of my patients.  One caveat is that vitamin B12 levels are not very reliable – you may have a normal level, but still be deficient.  While laboratories consider a level of over 200 to be normal, clinical deficiency is often present at levels below 400.  A single case report has been published of a severe deficiency with neurological symptoms and a vitamin B12 level of over 700.  This patient lacked the ability to transport vitamin B12 from his blood into the cells.  Injections of high doses of vitamin B12 corrected the problem.  Oral magnesium supplementation is not as effective as injections because vitamin B12 is poorly absorbed in the stomach.   Other ways to get vitamin B12 is by taking it sublingually (under your tongue) or by a nasal spray (it requires a prescription and is fairly expensive).  Many of my patients a willing to self-inject vitamin B12, which they do anywhere fro once a week to once a month.   Vegetarians are more likely to be deficient since meat (and liver) are the main sources of vitamin B12.  Smokers are also at a high risk because cyanide in smoke binds to vitamin B12.

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Medications used for the preventive treatment of migraine headaches can cause weight loss, but more often cause weight gain.  An interesting study by Dr. Bigal and his colleagues, just published in Cephalalgia looked at this effect of drugs in 331 patients.  They found that 16% of them gained weight (5% or more of their baseline weight) and 17% lost weight.  The various treatments given to these patients were equally effective in both groups.  However, not surprisingly, those who gained weight had elevation of their cholesterol, blood glucose, blood pressure and pulse.  Patients who have migraine headaches with aura (about 15-20% of migraine sufferers) already have an increased risk of strokes, so adding additional risk factors for both strokes and heart attacks should be especially avoided in this group.  The only preventive migraine drug which consistently lowers weight in many patients is topiramate (Topamax).  This drug is now available in a generic form, making it much less expensive.  While topiramate does lower weight and helps prevent migraine headaches only half of the patients stay on it.  For the other half it causes unpleasant side effects (memory impairment and other) or it does not work.

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Clopidogrel, 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. 

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