Chronic migraine is very disabling and poorly treated according to a study by Dr. Marcelo Bigal and his colleagues published in the current issue of journal Neurology. The study looked at 520 patients with chronic migraine (those who had more than 15 days with headaches a month) and 9,424 with episodic. More than half of the patients with chronic migraines missed at least five days of household work, compared 24% of patients with episodic migraine. The majority of chronic migraine sufferers (88%) had previously soguht care, but most of them did not receive specific acute or preventive medications. Only 33% of these patients were on preventive medications at the time of the study. Millions of Americans who suffer from migraines do not receive appropriate treatment, but those with chronic migraines are particularly under-treated and suffer needlessly.
Chronic migraine is a common conditions
Written by Dr. Mauskop | 26.08.2008 | No comments
Migralex is a new over-the-counter medication for the treatment of headaches, which will become available at the beginning of next year. Results of the first study of Migralex was presented at the recent annual scientific meeting of the American Headache Society in Boston. In an open-label study 50 patients with migraine headaches who were being treated at the NYHC compared Migralex with their usual medication. Half of the patients found Migralex better or much better than their usual treatment and 27 were willing to take it again. In 31 of 50 patients the usual medication was a triptan ( a prescription migraine medication) and in 19 it was a prescription or over-the-counter pain medication. Migralex was well tolerated, with only one patient reporting upset stomach.
Written by Dr. Mauskop | 15.07.2008 | 1 comment
Vitamin D deficiency has become a very popular topic in lay and professional literature, and deservedly so. Vitamin D is important not only for bone health, but for normal functioning of many organs. Its deficiency appears to be much more common than it was previously suspected. Dr. Steve Wheeler has found vitamin D deficiency in 42% of 55 patients with chronic migraine headaches. He presented these findings at the recent meeting of the American Headache Society. We do not have evidence that taking vitamin D will help relieve headaches, however if a deficiency is present correcting it can certainly improve overall health of the patient. One possible cause of what appears to be increasing incidence of vitamin D deficiency is widespread use of prescription and over-the-counter antacids. Reducing stomach acidity helps relieve heartburn and other symptoms of reflux, but it may also interfere with absorption of vitamins and minerals.
Written by Dr. Mauskop | 15.07.2008 | No comments
A study conducted by one of the leading headache researchers, Dr. Richard Lipton looked at possible factors that worsen migraine headaches. The study looked at people with frequent migraines (15 or more days with headache a month) and found that these patients were more likely to be female, overweight, depressed, have a lower education level and overused medications. The overused medications included narcotics, barbiturates (Fioricet, Fiorinal and Esgic) but also over-the-c0unter drugs such as Excedrin. The only exception was aspirin - it appeared to be protective, that is people taking aspirin were less likely to develop chronic headaches. Dietary caffeine and stresful life events were also more common prior to development of chronic migraines.
Written by Dr. Mauskop | 09.07.2008 | No comments
A person empathizing with someone in pain perceives his or her own pain as more severe and unpleasant. Researchers at McGill University published these findings in the current issue of journal Pain. This observation could explain, at least in part, high frequency of pain symptoms observed in spouses of chronic pain patients. Even laboratory mice have heightened pain behavior when exposed to cagemates, but not to strangers, in pain. Clearly, the thing to do is not to ignore your spouse’s or friend’s pain, but rather try to get the pain relieved. If that is not possible, hopefully, a cognitive-behavioral psychologist may be able to devise a way to be very supportive and helpful without constantly feeling badly for the person in pain.
Written by Dr. Mauskop | 07.06.2008 | No comments
Patients who faced delays in the treatment of their chronic pain were found to have worsening of their condition, according to a recent review published in the journal Pain. The review of 24 trials showed that patients had a significant deterioration of their health-related quality of life and psychological well being. This was true for patients who waited for six or more months to receive treatment. Studies looking at shorter wait times were less conclusive. The authors conclude that waiting for treatment of chronic pain for six months or longer is medically unacceptable. While our medical system is often to blame for such delays, many patients delay their treatment for a variety of other reasons as well. It is important for friends and relatives to urge someone who suffers from chronic pain (including headaches) to seek medical attention from a qualified specialist.
Written by Dr. Mauskop | 06.06.2008 | No comments
Facial expression of pain seems to make you feel worse, according to a study published in the May issue of The Journal of Pain. Healthy volunteers were asked to make a painful expression before the pain started and without anyone appearing to be watching (to avoid “social feedback”). The pain was perceived more unpleasant when the volunteers made a painful facial expression compared to when a neutral facial expression was made. Practical application of this study is in that people in pain should try to avoid grimacing from pain and keep their faces relaxed. The authors discuss recent brain imaging studies which seem to confirm an old observation that facial expression can cause one to experience emotion that is being expressed. In other words, forcing yourself to smile may improve your mood, while making an angry face can make you feel angry.
Written by Dr. Mauskop | 06.06.2008 | No comments
Treating migraines in adolescents presents some unique challenges. Besides difficulties, such as getting them to bed before midnight and getting them to improve their diets, we face the problem of not having any FDA-approved drugs to treat migraine attacks. And it is not for lack of trying on the part of makers of triptans, which are drugs that work miracles for many adult headache sufferers. The problem has been proving to the FDA that these drugs work in kids. Because children tend to have shorter attacks, by the time we try to assess the efficacy of a particular drug two and four hours after the pill is taken, the headache is gone even if the pill was a placebo. Many studies have shown that the triptans are safe and effective (as was observed in kids who have longer duration of attacks). Many, but far from all headache specialists use triptans, such as Imitrex and Maxalt in adolescents. A study just published in Headache proved that Axert, another drug in the triptan family and that was tested in 866 children, is effective in children 15 to 17 years of age. The bottom line is that triptans can be safely used in kids who suffer from severe migraine headaches. I am often asked by other physicians, what is the youngest age I would prescribe a triptan? Because of a shortage of pediatric neurologists I feel compelled to see children as young as 10 and this is the youngest age at which I will prescribe triptans.
Written by Dr. Mauskop | 21.05.2008 | No comments
For many years headaches were thought to be triggered by elevated blood pressure. Evidence had suggested that only very sudden increase in blood pressure triggered a headache in some patients, but the myth of high blood pressure headaches has persisted. Norwegian researchers published a very surprising finding in the April issue of journal Neurology. They looked at the data on 120,000 people and found that increasing systolic blood pressure was associated with a decrease in migraine and non-migraine headaches. Even more striking was the inverse correlation with the pulse pressure (difference between systolic and diastolic pressure, for example blood pressure of 110/80 means that the pulse pressure is 30). Patients with higher pulse pressure had fewer migraine and other headaches. It can be speculated that hardening of arteries that occurs with elevated blood pressure makes them less likely to constrict and dilate, which is part of a migraine process.
Written by Dr. Mauskop | 20.05.2008 | 2 comments
Menstrual migraines are at times very difficult to treat. Triptans, such as Maxalt, Imitrex and other are usually very effective, but in some patients do not provide sufficient relief. Corticosteroid drugs, such as prednisone and dexamethasone can help some patients. Marcelo Bigal and his colleagues compared treatment of menstrual migraines with Maxalt alone, dexamethasone alone, and combination of the two. Maxalt was much better than dexamethasone, providing sustained 24-hour relief in 63% of patients vs 33%, but the combination was better than Maxalt alone, giving relief to 82% of women. We would always try Maxalt or a similar drug alone, but if one drug is insufficient a combination with dexamethasone should be tried. Corticosteroids should not be used for more than a few days a month because frequent and prolonged use can lead to serious side effects.
Written by Dr. Mauskop | 14.05.2008 | No comments
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