New York Headache Center

Needle-free injection of sumatriptan (Imitrex) was tested for its ease of use and for its bioequivalence in a study led by Dr. Jan Brandes.  The new device that provides needle-free subcutaneous injections was easy to use and if injected into the thigh or abdomen (but not the upper arm) delivered the same amount of medicine as an injection with a needle.  Unfortunately, needle-free does not mean pain-free, so the injection still hurts.  This device, when it is approved by the FDA, may be useful for those patients who are afraid of needles.  Many migraine sufferers still do not know that injections of sumatriptan can be easily self-administered using a pen-like device that does contain a needle.  Many doctors do not offer this option because they do not think that patients will readily accept an injection or because they don’t realize how severe the migraines are.  I see many migraine sufferers who gladly take an injection over the tablet.  It is particularly effective for people who have severe nausea and vomiting with their migraine.  The speed of relief is another reason to take an injection - some patients wake up with a migraine and have to go to work or take care of their children and cannot wait for 1-2 hours before the tablet provides relief.  I have taken sumatriptan injection many times myself.  Usually the tablet works for me, but if before going to bed I have a headache from the wine I had with dinner, I will often opt for a shot.  The shot works within 10-15 minutes and allows me to fall asleep right after that, while a tablet may take an hour or longer.

Dr. Oz : “Like Alexander Mauskop, I believe that magnesium can help—it relaxes arteries and muscles in the body, both of which can help with headaches”.   This statement in the latest issue of O, The Oprah Magazine is not very surprising coming from a cardiac surgeon - magnesium is routinely used after open heart surgery.  Unfortunately, many neurologist and other physicians treating headaches still do not recommend magnesium for their headache patients.  And this is despite all the scientific evidence and despite the recommendation of the American Academy of Neurology.  I think this is in part due to their training that emphasizes the use of drugs rather than natural approaches.  This bias is reinforced by the strong influence of the pharmaceutical industry.

Botox can relieve pain of occipital neuralgia, according to a pilot study by neurologists in Ohio, published in Headache.  Occipital neuralgia is a painful condition that manifests itself by pain in the back of the head, usually on one side.  Pain can be burning, but also sharp,or throbbing in character.  It is often the result of a spasm of occipital and suboccipital muscles, so it is not surprising that Botox would relieve this pain by relaxing these muscles.  In addition to relaxing muscles Botox also reduces activation of the sensory nerve that send pain messages to the brain.  Other treatments for occipital neuralgia include isometric neck exercise, acupuncture, medications, and occipital nerve block with corticosteroids and lidocaine.

Some migraine patients are more disturbed and disabled by migraine aura symptoms than by the headache itself.  Some people do not even have pain but only auras.  In the majority the aura is visual and consists of squiggly lines, flashing lights, distorted vision, or partial loss of vision on one side of each eye.  Less often people experience numbness of one side of the body, dizziness, or vertigo.  These symptoms are sometimes more difficult to treat than the pain.  Anecdotal reports suggest that a blood pressure drug belonging to the family of calcium channel blockers can help.  Another medication that has been reported to be effective (also only in case series and not double-blind trials) is an epilepsy drug, lamotrigine (Lamictal).  The effective dose of lamotrigine varies from 100 to 500 mg day, while verapamil is usually effective at 12-240 mg, although in some patients only much higher doses are effective.