New York Headache Center

“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.”

Postpartum 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 mangesium 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 aggresively (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.

Migraine is known to subside in most people, often when they reach their 40s or 50s.   A recent report from Sweden suggests that even patients with more severe migraines who end up going to a headache clinic have favorable long-term prognosis.  One third of both men and women reported complete cessation of their migraines.  Of the other two thirds the majority reported reduction in frequency and duration of attacks 12 years after their initial visit to the headache clinic.  The bad news is that many of the patients who continued to have headaches still had some impairment of quality of life.

Results of a phase II study of a new headache medicine was published in journal Neurology.  Merck and Co. is starting phase III trials of this drug, which works by blocking the release of a neurotransmitter CGRP.  Previous migraine medicines, such as sumatriptan (Imitrex), rizatriptan (Maxalt), eletriptan (Relpax) and other in “triptan” family worked on serotonin receptors.  While the triptans are very safe they very rarely can constrict blood vessels in the heart and cause a heart attack.  The new medicine, which is known as MK-0974 does not constrict blood vessels.  In the published trial it was at least as effective as Merck’s older drug, Maxalt.  If phase III studies go well we could see this medicine on the market in a couple of years.