An email I just received, which is attached at the end of this post, prompted me to write again about magnesium. In my opinion, every migraine sufferer should try taking magnesium. It’s been 20 years since we published our first study of magnesium, in which we showed that during an attack, half of migraine sufferers have a magnesium deficiency. In that study, patients who were deficient had a dramatic relief of their acute migraine with an intravenous infusion of magnesium. Subsequent studies by other researchers have shown that oral magnesium supplementation can also help. The results of those studies were not as dramatic because many people do not absorb magnesium taken by mouth and in one large study the type of magnesium that was used caused diarrhea in almost half of the patients. The magnesium salts that are better absorbed include magnesium glycinate, gluconate, aspartate (these are so called chelated forms), but some people do well with magnesium oxide, citrate, or chloride. The recommended daily dose of magnesium for a healthy adult is 400 mg a day, but some people need a higher dose. However, higher doses can cause diarrhea, while in others, even a high dose does not get absorbed. In these cases, monthly intravenous injections can be very effective. To establish who is deficient, a special blood test can help. The regular blood test is called serum magnesium level, but it is highly unreliable. A better test is RBC magnesium, but even with this test, if the value is normal, but is at the bottom of normal range, a deficiency is likely to be present. In many people there is no need for a test because they have multiple symptoms of magnesium deficiency. These symptoms include coldness of extremities, leg or foot cramps, PMS in women, “brain fog”, difficulty breathing, insomnia, and palpitations.

Here is the email I just received:

Dr. Mauskop,

I am a 76 year old male; serious headaches began at 8 years of age.
Full migraines started at 18 years of age, with aura, intense pain on one side, violent vomiting.
Sought treatment at UCLA, Thomas Jefferson University, London, Singapore. Had brain scans, biofeedback, full allergy testing, beta blockers. Started on Imigran/Imitrex in 1993 in Singapore, worked well, but did not stop pain completely. Still took a day to recover.
Nothing stopped the 2 to 4 episodes per week.
Two months ago, I read about magnesium deficiency. (Not recommended by any doctor before.)
Took 600 mg capsule per day for three days. No migraine.
Had a bit of diarrhea – checked on internet, saw it was the dose of magnesium.
Dropped intake to 340 mg per day.
Miracle: No migraine in two months.
Thank you for your research and service.
I had an annual physical in December, and mentioned to my doctor – an internist – what I had recently read about magnesium. He had not heard about it; checked on the internet while I was there; and said “interesting”. So, the word is certainly not out.

BH

Read More

Many medical and pain conditions, including migraines, are more likely to occur in people who were abused in childhood. A new study by Richard Lipton and his colleagues compared the risk of developing migraines with the risk of developing episodic tension-type headache in people who experienced emotional abuse, emotional neglect, or sexual abuse. Episodic tension-type headaches are relatively mild and are experienced by most people from a variety of triggers, such as stress, sleep deprivation, hunger, and acute medical illness. Migraines, on the other hand, are much more severe and often cause inability to function and interfere with the quality of life.

Incidence of history of abuse was compared in 8,305 migraine sufferers and 1,429 people who had tension-type headaches. Emotional neglect and sexual abuse was more common in those with migraines but with these two types of abuse the development of migraine was linked to the development of anxiety and depression. Only those with emotional abuse had an increased risk of having migraines even without having anxiety and depression. All three forms of maltreatment were also associated with an increase in migraine headache frequency, but only when anxiety and depression was also present. This study also showed that having two or three forms of abuse was more likely to cause migraines than if only one type of abuse was reported.

Previous studies have also shown a correlation between the number of maltreatment types and pain conditions. These pain conditions include fibromyalgia, irritable bowel syndrome, interstitial cystitis, and temporo-mandibular joint disorder. Exposure to abuse or a traumatic event is thought to lead to a persistent increased excitability of the nervous system, which in turn makes one more predisposed to various pain conditions.

The importance of Lipton’s study is in reminding doctors who treat pain conditions to ask about maltreatment in childhood and about other traumatic events. Post-traumatic stress disorder is common in abuse victims and it needs to be recognized and addressed when treating migraines and pain. Psychological approaches, such as biofeedback and cognitive-behavioral therapy should always be included in the treatment of chronic pain and headaches, but it is particularly necessary in people with a history of abuse or emotional trauma.

 

Read More

A study by Australian doctors led by Dr. Lyn Griffiths confirmed a previous observation that higher dietary intake of
folic acid leads to lower frequency of migraine headaches. A 2009 study by Spanish doctors showed that patients with migraine with aura are more likely to have high homocysteine levels in their blood, a condition that can be corrected by taking folic acid and other B vitamins.

The authors of this new study have shown before that folic acid, vitamin B6, and B12 supplementation reduces migraine symptoms in patients with a certain genetic mutation (MTHFR gene), which leads to high homocysteine levels. However, the influence of dietary folate intake on migraine has been unclear. The aim of their current study was to analyze the association of dietary folate intake with migraine frequency, severity, and disability.

They studied 141 adult caucasian women with migraine with aura who had the MTHFR gene C677T variant. Dietary folate information was collected from all participants. Folate consumption was compared with migraine frequency, severity, and disability.

A significant correlation was observed between dietary folate consumption and migraine frequency. The conclusion of this study was that folate intake may influence migraine frequency in female sufferers with migraine with aura.

Good dietary sources of folic acid include spinach, lettuce, avocado, and other vegetables. If you suffer from migraine with aura you may want to ask your doctor to check your homocysteine level, as well as levels of folic acid and vitamin B12. Vitamin B12 level is not a reliable test because it can be normal even when a person is deficient and that is why it is important to check homocysteine level as well.

Read More

Vitamin D deficiency has received wide attention and many doctors now check for this deficiency during routine check-ups. I’ve posted about the importance of vitamin D in migraine headaches and for general health. Vitamin D deficiency seems to increase the risk of cancer, other serious diseases and death.

However, just like with vitamin B12 and magnesium, the regular blood test for vitamin D can be misleading. It appears that while blacks have lower levels of vitamin D than whites, they have healthier bones. A study by R. Thadhani of Massachusetts General Hospital explained this paradox. It appears that some of vitamin D circulates in the blood in a free form, while the rest is bound to protein. Only the free form is active, but the blood test measures only the total amount of vitamin D. Blacks appear to have much less of the protein-bound vitamin D, so the amount of the active form can be higher in blacks even if the overall amount of vitamin D is lower. These researchers are developing a more sensitive test for vitamin D levels.

To be on the safe side, most people should aim to have their vitamin D level at least in the middle of normal range. The normal range is 30 to 100 and some studies (for example, in multiple sclerosis) suggest that the higher the level (within the normal range), the better. So, I would recommend getting your level up into the 40s and 50s. Many multivitamins, calcium with vitamin D products, and plain vitamin D supplements have only 200 or 400 units of vitamin D (it is usually listed as vitamin D3). I have seen many patients who need to take 2,000 or even 5,000 units daily to have a good level in the blood. In severe deficiency that does not respond to even these amounts, I prescribe 50,000 units of vitamin D weekly, which is available only by prescription. Unfortunately, unlike with magnesium or vitamin B12, vitamin D is not available in an injection.

The bottom line is that if you are taking a supplement, it does not necessarily mean you have enough of vitamin D in your blood and you should have the test repeated.

Read More

While being overweight doese not cause migraines, in those who do suffer with migraines there is an inverse relationship between person’s weight and the frequency and severity of migraine headaches. Weight loss, including that due to weight loss (bariatric) surgery, has been reported to reduce the frequency of migraine headaches and migraine-related disability. Obesity is also associated with headaches due to increased intracranial pressure (also called pseudotumor cerebri) and losing weight improves such headaches as well.

However, while bariatric surgery may improve migraines, in a small number of people it can cause a different type of headaches. This rare type of headache is caused by a spontaneous leak of cerebro-spinal fluid (CSF), the fluid which surrounds the brain and the spinal cord. Such leaks are common after a spinal tap or can be a complication of epidural anesthesia. Loss of CSF can cause severe headaches, which are strictly positional. They are severe in the upright position, sitting or standing, but quickly improve upon lying down.

A study of 338 patients who underwent bariatric surgery at the Cedars-Sinai Medical Center in Los Angeles detected 11 patients who developed a spontaneous CSF leak with severe headaches. Headaches started anywhere within three months and 20 years after surgery. Clearly, headaches starting 20 years later are not likely to be related to surgery, which suggests that this link between bariatric surgery and headaches is far from proven. Of these 11 patients, 9 improved with treatment. The typical treatment for a CSF leak is a “blood patch” procedure, which involves taking blood from the patient’s vein and injecting it into the area of the leak. When blood clots, it usually seals the leak and the headache improves within hours.

Read More

Vertigo and dizziness are more common in migraine sufferers than in people without migraines. A patient I am treating for migraines emailed me a few days ago complaining of vertigo. Dizziness is a term which can mean unsteadiness, lightheadedness, or vertigo. Vertigo is a sensation of spinning, which is most often caused by a disturbance of the inner ear. One type of vertigo is called benign positional vertigo (BPV). BPV usually causes very severe vertigo. One patients told me that while lying on the floor he felt as if he was falling off the floor. BPV is caused by a loose crystal in the inner ear. As the name implies, this type of vertigo occurs only when turning to one side, but not the other. If turning in bed to the right causes vertigo, then the problem is in the right inner ear. A simple (Epley) maneuver can quickly cure this problem by stopping this loose crystal from rolling around and causing havoc. I emailed my patient a link to a YouTube video showing how to do the Epley maneuver and half an hour later she emailed back saying that the vertigo was gone. Sometimes this maneuver needs to be repeated a few times before vertigo completely disappears. Here is the link to the Epley maneuver https://www.youtube.com/watch?v=llvUbxEoadQ&authuser=0

Read More

A report by Taiwanese doctors just published in the journal Neurology suggests that having migraine headaches may double the risk of Bell’s palsy.

Several medical conditions, such as asthma, anxiety, depression, irritable bowel syndrome, epilepsy, and other occur with higher frequency in migraineurs, but until now, no one suspected an association between migraines and Bell’s palsy.

The researchers compared two groups of 136,704 people aged 18 years and older – one group with migraine and the other without. They followed these two groups for an average of 3 years.

During that time, 671 people in the migraine group and 365 of the non-migraine group developed Bell’s palsy.

This association persisted even after other factors such as sex, high blood pressure, and diabetes were taken into account.

The authors speculated that the inflammation and the blood vessel problems seen in both conditions may explain this association.

This study appears to be of purely academic interest since we do not know how to prevent Bell’s palsy. However, I decided to write about it because a couple of my colleagues (one in our office and at least one other on a doctors’ discussion board) reported seeing Bell’s palsy soon after administering Botox injections for chronic migraines. This report by Taiwanese doctors suggests that Bell’s palsy might have been not due to Botox, but rather a coincidence since Bell’s palsy is more common in migraine sufferers.

Read More

Trigeminal neuralgia is a very painful and debilitating condition (Here is a review article I wrote for physicians). Fortunately, it is relatively infrequent – affecting 0.3% of the population, compared to 12% afflicted by migraines. This explains relative paucity of studies of this condition. A group of neurologists at the Danish Headache Center studied 158 consecutive patients with trigeminal neuralgia (TN) seen at their center over a period of one year. They published their findings in the journal Headache.

Average age of onset of pain was 53 years. TN was more common in women than men (60% vs 40%) and more common on the right side (56%). When only one of the three branches of the trigeminal nerve were affected, the first and the second were involved in 69% of cases and the third branch (lower third of the face) alone was involved in only 7% of sufferers.

The pain of trigeminal neuralgia is described the same way by almost all sufferers – it feels like a strong electric shock. It can be triggered by chewing, brushing teeth, speaking, air movement from wind or air conditioner, and at times it occurs without any provoking factor. In this study, half of the patients reported having a more persistent but milder pain in addition to the typical stabbing, electric-like pain. One fifth of patients reported to have some tearing on the side of pain and in 17% there was some loss of sensation over the area of pain.

Treatment of TN usually begins with epilepsy drugs,such as carbamazepine (Tegretol) or oxcarbazepine (Trileptal). Although 89% of patient in this study reported some improvement, only 56% of them were taking these medications because in others they caused unacceptable side effects. Other drugs that can be helpful for TN include baclofen (a muscle relaxant) and Botox injections. I’ve treated a handful of patients with TN with Botox
and about half of them responded. Botox is injected into the area of pain, which tends to be small and only a very small amount of Botox needs to be injected. Injections of Botox are safer than any oral medication, but depending on the area injected, they can cause cosmetic side effects – asymmetric appearance of the face. Botox is approved by the FDA for chronic migraines but not TN, which means that insurance companies are not likely to pay for it. However, only about one tenth of the amount of Botox used for migraine is needed to treat TN, the cost is much lower.

The authors plan to provide additional information about this group of patients in future publications.

Read More

Cost is the only major issue with Botox injections, which is the only FDA-approved treatment for chronic migraines and which is now covered by almost all insurance companies. It is very safe and highly effective, relieving headaches in 70% of migraine sufferers. A study just published in the journal Headache suggests that Botox may be not only clinically effective, but also cost-effective.

Researchers from the Renown Neurosciences Institute in Reno, Nevada analyzed data from 230 chronic migraine sufferers who did not respond to two or more prophylactic drugs and were given Botox injections. Botox was given twice, three months apart. Compared with the 6 months before Botox, there were 55% fewer emergency room visits, 59% fewer urgent care visits, and 57% fewer admissions to the hospital. In those 6 months the savings amounted to half of the cost of Botox treatments. Considering that improvement tends to get more pronounced with each subsequent Botox treatment, it is very likely that the costs savings would grow with additional treatments.

Obviously, besides saving money, Botox provides a significant improvement in the quality of people’s lives, which is much harder to measure. At our Center we give Botox to more than a quarter of our patients and see a dramatic improvement in the majority. Botox is not only much more effective for chronic migraines, but it is also much safer than any oral medication.

Read More

Cyclic vomiting syndrome (CVS) is usually seen in children. The attacks of vomiting often stop as the child gets older, but then they usually go on to develop migraine headaches. A recent report in Headache describes three adults with CVS. The article also mentions a previous report which described another 17 adults with this syndrome.

CVS typically consists of recurrent stereotypical attacks of incapacitating nausea and vomiting, separated by symptom-free periods. Supporting evidence that helps diagnose this condition include personal or family history of migraine and other symptoms, such as headaches, motion sickness, and sensitivity to light.

Just like in children, CVS in adults is a diagnosis of exclusion, meaning that other causes of vomiting must be considered and ruled out. I mentioned in a previous post that one out of three children with CVS turned out to have another medical problem rather than migraine.

CVS in adults seems to respond well to an injection of sumatriptan (Imitrex). This allows for a quick relief of symptoms and makes this debilitating condition very manageable. Besides Imitrex injections, Zomig (zolmitriptan) nasal spray can sometimes be effective as well.

Read More