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.
Written by Dr. Mauskop | 23.02.2010 | No comments
Some headaches, usually migraines, do not respond to the usual over-the-counter and even prescription headache medications. Once it is clear that there is no serious underlying cause, such as an aneurysm, several injectable medications can be given in an emergency room (during office hours at the New York Headache Center we also give injections in the office). These medicines may include intravenous injections of: magnesium sulfate (which is not a medication, but a mineral), sumatriptan (Imitrex, which can be self-injected by patients at home), ketorolac (or it is also called Toradol, which is a drug in the aspirin family), dexamethasone (Decadron, a steroid drug, which can help pain of almost any type, but cannot be given for long periods of time), prochlorperazine (or Compazine, which is a nausea medication but can help pain as well), valproate sodium (Depacon), and several other drugs.
Written by Dr. Mauskop | 12.02.2010 | No comments
During pregnancy, two thirds of women stop having migraine headaches. However, one third continues to have them, and sometimes even worsen during pregnancy. As a general rule, only acetaminophen (Tylenol) is considered safe, but for most migraine sufferers it is completely ineffective. Codeine is also benign, but it also either does not work or causes side effects, such as nausea and sedation. Triptans, such as sumatriptan (Imitrex), rizatriptan (Maxalt), and other are very effective for migraines, but are not proven to be as safe. Pregnancy registries in the US have information on over 1,500 women who took a triptan during pregnancy and so far the drugs look safe for the baby. A new study from Norway in the February issue of Headache reports on another 1,535 women who took triptans during pregnancy and compared them to 68,000 women who did not. This study also found no increased risk of congenital malformation, even if triptans were taken in the first trimester. Women who took triptans in the second and third trimester also had healthy babies, but they had a slightly increased risk of atonic uterus and bleeding during labor.
Written by Dr. Mauskop | 07.02.2010 | No comments
There are several effective preventive medications for migraine headaches, however they are prescribed to only a small number of people who could benefit from them. A study by Dr. Richard Lipton in the journal Cephalagia and his colleagues discovered that only 13% of migraine sufferers are taking preventive medications, but those who do have significantly less disability than those who don’t. Among possible reasons, doctors who don’t realize how disabling migraines are, patients how think that medications are dangerous or will cause side effects. Cost does not seem to be a factor because all patients in this study had insurance and most of these medications are inexpensive. Patients are often reluctant to take medications, but would rather find and remove the cause. Unfortunately, in most cases migraine is a genetic disorder and true cure is not possible. However, for most migraine sufferers it is possible to find and remove triggers which make headaches worse. If this is not sufficient, magnesium, CoQ10, other supplements, biofeedback, Botox injections, and regular exercise can provide relief without drugs. If all this still does not provide relief, medications, such as anti-depressants, epilepsy drugs, and high blood pressure drugs can be very effective and improve the quality of life.
Written by Dr. Mauskop | 05.02.2010 | 4 comments
Large clinical trials are required to prove that a new drug or treatment is effective. Without such proof doctors will not (and should not) believe that any particular medicine or device is effective. The FDA also approves drugs by evaluating results of large trials, usually involving hundreds if not thousands of participants. If you want to help these new treatments to become available you should consider participating in such study. In addition to feeling good about helping science and possibly your descendants, you may also benefit from a free evaluation and treatment. Of course, there are risks associated with new treatments and the researchers are required to explain them to you in great detail.
One of the reasons for this post is to let you know about a new website which makes finding a clinical trial very easy. You can search these trials by disease, location, and other criteria. The site is http://www.medpedia.com/clinical-trials. Check it out.
Written by Dr. Mauskop | 03.02.2010 | No comments
Migraine and migraine medications do not appear to cause cognitive decline, according to a Dutch study just published in Headache. After 6 years of follow-up there was no difference between those who suffered from migraines and healthy controls. Taking migraine medications also did not have an effect on cognitive function. This is very reassuring, especially because a recent study in rats suggested brain damage from what the researchers felt was a process similar to migraine.
Written by Dr. Mauskop | 27.01.2010 | No comments
One of the oldest preventive headache medications for migraines is propranolol (Inderal), which belongs to the family of blood pressure medications called beta-blockers. There are newer and better beta-blockers, such as nebivolol (Bystolic), which have fewer side effects than propranolol. We also use other types of blood pressure medications, such as calcium channel blockers (verapamil or Calan, and other) and ACE inhibitors (lisinopril, or Zestril/Prinivil is one example). The newest category of blood pressure medications is ACE receptor blockers (ARBs) which are at least as effective and have fewer side effects than ACE inhibitors. The best scientific evidence (from a single double-blind study) for the efficacy of ARBs in migraines is for candesartan (Atacand).
Written by Dr. Mauskop | 27.01.2010 | No comments
74% of girls and 52% of boys have headaches at age 17, according to a Finnish study of 6,262 twins. At age 11, 60% of girls and 59% of boys had headaches at least once a month. The prevalence of weekly headaches increase d in girls from 16% to 25% between ages 11 and 14. Headaches in kids is a major problem, but unfortunately it does not receive proper attention. Sometimes parents do not believe that their child has a headache or if they do, they are reluctant to take the child to a doctor because they don’t want to resort to prescription medications. Fortunately, many non-drug approaches are very effective in kids. Regular sleep schedule (very hard to enforce in teenagers), regular meals, frequent aerobic exercise, biofeedback or meditation, and supplements can be very effective. Several studies have shown that kids with headaches are often deficient in magnesium, riboflavin (vitamin B2), and Co-enzyme Q10 (CoQ10). If a child still has headaches, a medications may also be appropriate.
Written by Dr. Mauskop | 13.01.2010 | No comments
Vitamin D deficiency is often found in patients with headaches and neuralgia, which I’ve already mentioned in previous posts. Chronic pain patients with low vitamin D levels were also found to have poor exercise tolerance, making their rehabilitation more difficult. Now, there is strong evidence from two independent studies, which involved over one thousand people, that those with low vitamin D levels were twice as likely to develop Alzheimer’s disease, other types of dementia, and strokes. The researchers and those commenting on this research called for more studies before any recommendations can be made. This response of the medical establishment is typical in its lack of common sense. Yes, there are dangers in taking too much vitamin D, but shouldn’t they call for doctors to test for this deficiency and correct it when it is present? Even if we don’t know exactly if this supplementation will prevent strokes, Alzheimer’s or headaches, it makes sense to keep everyone’s level in the middle of the normal range.
Written by Dr. Mauskop | 12.01.2010 | No comments
Migraines in blind people are made worse by light, according to Dr. Burstein and his associates at Harvard. Rami Burstein is one of the leading headache researchers who often asks questions no one else thought to ask. More importantly, he often finds the answers. When he mentioned to me that he wants to find out why bright light makes headaches worse (so called photophobia), I immediately thought of a blind patient I was treating. She was very interested in helping Rami discover the answer and helped him recruit many other blind migraine sufferers. After several years of work, his finding were published today in Nature Neuroscience. A recent discovery showed that in addition to rods and cones in the retina (cells that allow us to see), there are cells which react to light, but their input goes to non-visual parts of the brain. These cells regulate sleep-wake cycle and, according to Rami Burstein’s research, also magnify pain perception in headache patients.
Written by Dr. Mauskop | 11.01.2010 | No comments
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