New York Headache Center

Two recent studies suggest that music can relieve migraine headache in children and relieve experimentally-induced pain.  In a study of 58 children with migraine headaches published in the European Journal of Pain music therapy was compared to a placebo pill and an herbal supplement, butterbur.  Both music therapy and butterbur provided significantly better relief than placebo.  In the second study published in journal Pain, healthy volunteers were subjected to pain by heating up a spot on their forearms.  The volunteers were divided into three groups: a silent control group, a group listening to pleasant music and another group listening to unpleasant music.   Those who listened to pleasant music felt less pain than the other two groups.  These two studes provide scientific support to the use of music therapy for painful conditions, including migraine headaches. 

A new drug may be better for the prevention of migraines than the old ones in the same category.  A study just published in Headache suggests that nebivolol, a beta-blocker just approved in the US for the treatment of high blood pressure may be as effective as old beta-blockers, but with significantly fewer side effects.  Beta-blockers, such as propranolol (Inderal), timolol (Blocadren) metoprolol (Toprol), atenolol (Tenormin) and nadolol (Corgard) have been used for the prevention of migraines for many years.  However, many patients could not tolerate them because of side effects, mostly fatigue, slow heart beat and low blood pressure.  Nebivolol appears to cause these side effects 50% less often, while preventing migraine attacks with equal efficacy. 

Anti-epilepsy drugs such as Neurontin (gabapentin), Topamax (topiramate) and Depakote (divalproex) have been proven to prevent migraine headaches.  Each drug works for about half of the patients who try it.  The other half either does not get any benefits or develops side effects.  This does not seem to be that effective, but these drugs do beat placebo in blinded trials.  We also know that not all anti-epilepsy drugs work for headaches.  Tegretol (carbamazepine) was never shown to help and a study just published in Neurology confirms our impression that its cousin, Trileptal (oxcarbazepine) does not work either.  We do occasionally see good results with two other epilepsy drugs, Keppra (levetiracetam) or Lamictal (lamotrigine), but large  clinical trials proving their efficacy are lacking.

Memantine is an old medication which has been available in Europe for over 30 years, but was only recently introduced in this country for the treatment of Alzheimer’s disease.  Memantine blocks a specific receptor in the brain cells.  Activation of this so called NMDA receptor is responsible for many negative effects, including pain and nerve cell damage.  As soon as the drug was introduced in the US pain and headache specialists tried using it for pain, but probably because it is a weak blocker of the NMDA receptor our experience with this drug has not been very impressive.  However, in the recent issue of journal Headache Greek doctors report that one patient with chronic migraines obtained complete relief due to memantine.  One case report clearly does not prove that memantine is going to work for any significant percentage of patients.  However, this drug has relatively few side effects and if the usual treatments fail it may be worth trying.