New York Headache Center

A new treatment for migraines is very effective and well tolerated, according to a paper published in Neurology.  Two years ago I mentioned on this blog that this new migraine drug did well in Phase II trial and now the results of Phase III also appear to be very positive.   The study was double-blind and placebo-controlled and involved more than 1,200 patients.  The drug’s chemical name is telcagepant and it belongs to a new family of migraine drugs, CGRP antagonists.   They work on a different receptor than the triptans (sumatriptan or Imitrex and similar drugs) and appear to be as effective.  Possible advantages of this drug are that it may work when triptans are ineffective and it does not appear to constrict coronary blood vessels, which can happen, albeit rarely, with triptans.

Two large trials of Botox provide unequivocal proof of its efficacy in the treatment of chronic migraine headaches.  The results of these two double-blind, placebo-controlled studies (I participated in one of the two trials) of onabotulinumtoxinA (Botox) in chronic migraines were presented at the International Headache Congress in Philadelphia last week.  Botox was proven to reduce the number of days with headaches, improve multiple headache symptoms, and improve the quality of life.  The treatment was extremely well tolerated with very few side effects overall and no serious side effects.   Having used Botox for the treatment of various headache types for over 15 years in several thousand patients it is very gratifying to finally have well-designed trials which confirm my and my colleagues’ experience.   The manufacturer is submitting the results of these trials to the FDA and we expect to have approval of Botox for the treatment of chronic migraines by the end of 2010.  FDA approval will force insurance companies to pay for this highly effective treatment and will make it affordable for people who desperately need it.

Migraine headaches are more frequent in people who suffer from allergic rhinitis and who have more than 10 positive skin allergy tests.  This finding by Dr. Martin and his colleagues presented at the International Headache Congress last week is not surprising since many of my patients report that their migraines worsen during periods when their allergies flare up.  It is also not surprising because almost any medical condition affecting the head, whether it is an ear infection, a dental problem, or conjunctivitis, can trigger a migraine attack.

Vitamin B12 (cyanocobalamine) deficiency is known to cause a wide variety of neurological symptoms.   It also seems to produce facial neuralgia, according to a report presented at the International Headache Congress in Philadelphia a week ago.  Two physicians from Milwaukee described 17 patients who had facial pain that was not typical of trigeminal neuralgia because they had no trigger area and had numbness on the affected side.  They all had vitamin B12 deficiency and they pain improved with injections of vitamin B12.  In a previous post I mentioned another study that found an association between migraine headaches and high homocysteine levels, which can also be caused by vitamin B12 deficiency.  Oral absorption of vitamin B12 supplements is often inadequate and a nasal spray (which is expensive) or an injection are the best ways to correct this deficiency.

Migraine headaches are three times more common in patients with multiple sclerosis than in people of similar age and gender without MS.  Ilya Kister and his colleagues at NYU who established this fact make a very important point – multiple sclerosis symptoms often overshadow the symptoms of migraine and this can result in migraine not being treated properly leading to additional avoidable disability.