DOCTORS' BLOG

Archive for the ‘Headache Drugs’ Category

Researchers have discovered the first common gene linked to migraine risk, according to their report in Nature Genetics. The researchers compared DNA samples from 2,731 migraine sufferers to 10,747 otherwise similar subjects, examining more than 400,000 DNA sequences per participant. A variation in only one sequence, on the long arm of chromosome 8, appeared to have any effect on the debilitating condition.
The researchers confirmed their initial findings by examining this sequence in another 3,202 people with migraine and 40,062 controls. Overall, 24.3% of migraine sufferers and 20.6% of on-sufferers carried the variant-an 18% higher rate for sufferers. The sequence’s location, between two genes that help regulate the neurotransmitter glutamate, provides fresh clues for understanding and treating migraine.

Cyclical Vomiting Syndrome (CVS) has long been regarded as a migraine equivalent disorder. It is manifested by attacks that carry the whole mark of migraine, except for the absence of headache. (Fleisher and Matar, 1993; Abu-Arafeh and Russell, 1995).
Children between the ages of 4 and 15 were studied in Scotland using well-defined clinical criteria for the diagnosis of both CVS and migraine. Although severity, frequency, and duration of CVS attacks may vary considerably, the symptoms are in a comparable pattern to childhood migraine. Emphasis has been placed on the similar clinical features including the complete resolution of symptoms between attacks and the almost identical provoking and relieving factors (Wyllie and Schlesinger, 1993; Cullen and MacDonald, 1963).
The common typical diagnostic features of CVS are manifested by recurrent, sudden, and self-limiting attacks during which the child looks ill and miserable, with complaints of nausea, vomiting, pallor, and lethargy. The duration of vomiting episodes is from hours to days, with the average length of episode being 24 hours. The intervals of normal health between episodes vary. In this study the mean age of onset of CVS was 5, with the majority of cases (72%) starting in early childhood. Each episode is similar within individuals as to time of onset, intensity, duration and frequency. Similar to migraine, attacks of CVS may be precipitated by travel, stress, excitement, tiredness, and lack of sleep, but this is only in the minority of children who can identify a trigger factor. The attacks may be preceded by non-specific changes in mood and behavior and sensory aura symptoms.
It is very important that the diagnosis of CVS should only be made on the exclusion of other, more serious disorders that require specific investigations and treatment. The goals of management of acute CVS are to prevent dehydration, replace fluid loss, relieve pain and provide general supportive measures. Most children can be safely treated at home. Additionally Pizotifen, used successfully in the treatment of migraine, has had some success in reducing the frequency and severity of CVS and abdominal migraine attacks.
In addition to treatment and the closely related clinical features, along with other similar characteristics, it is strongly suggested that the two disorders represent an extended disease spectrum.

A recent study conducted by Dr John-Anker Zwart, MD,PhD at the University of Oslo, found that teens who regularly have headaches may find that their problem is linked to overweight, smoking and/or lack of physical exercise.
The article, published in the medical journal, Neurology, found teens with all three factors were 3.4 times more likely to suffer from recurring headaches, compared to individuals of their age who did not smoke, were physically active and were not overweight.
This study revealed that of the teens with all three negative lifestyle factors, 55% had frequent headaches. Furthermore, teens with two negative factors were 1.8 times more likely to have recurring headaches.
Teenagers who had one negative lifestyle trait were affected as follows:
• Overweight teens were 40% more likely to have recurring headaches than their peers with no negative factors.
• Teen who smoke regularly were 50% more likely to have recurring headaches than their peers with no negative factors.
• Teens who exercised less than twice a week were 20% more likely to have recurring headaches than their peers with no negative factors.
This study involved almost 6,000 students, 13 to 18 years of age. The study author suggests that treatment and prevention of headaches in teenagers should perhaps include management of healthy lifestyle habits, such as regular physical activity, good diet, and cessation of smoking.

A recent study conducted by Dr John-Anker Zwart, MD,PhD at the University of Oslo, found that teens who regularly have headaches may find that their problem is linked to overweight, smoking and/or lack of physical exercise.
The article, published in the medical journal, Neurology, found teens with all three factors were 3.4 times more likely to suffer from recurring headaches, compared to individuals of their age who did not smoke, were physically active and were not overweight.
This study revealed that of the teens with all three negative lifestyle factors, 55% had frequent headaches. Furthermore, teens with two negative factors were 1.8 times more likely to have recurring headaches.
Teenagers who had one negative lifestyle trait were affected as follows:
• Overweight teens were 40% more likely to have recurring headaches than their peers with no negative factors.
• Teen who smoke regularly were 50% more likely to have recurring headaches than their peers with no negative factors.
• Teens who exercised less than twice a week were 20% more likely to have recurring headaches than their peers with no negative factors.
This study involved almost 6,000 students, 13 to 18 years of age. The study author suggests that treatment and prevention of headaches in teenagers should perhaps include management of healthy lifestyle habits, such as regular physical activity, good diet, and cessation of smoking.

A recent study conducted by Dr John-Anker Zwart, MD,PhD at the University of Oslo, found that teens who regularly have headaches may find that their problem is linked to overweight, smoking and/or lack of physical exercise.
The article, published in the medical journal, Neurology, found teens with all three factors were 3.4 times more likely to suffer from recurring headaches, compared to individuals of their age who did not smoke, were physically active and were not overweight.
This study revealed that of the teens with all three negative lifestyle factors, 55% had frequent headaches. Furthermore, teens with two negative factors were 1.8 times more likely to have recurring headaches.
Teenagers who had one negative lifestyle trait were affected as follows:
• Overweight teens were 40% more likely to have recurring headaches than their peers with no negative factors.
• Teen who smoke regularly were 50% more likely to have recurring headaches than their peers with no negative factors.
• Teens who exercised less than twice a week were 20% more likely to have recurring headaches than their peers with no negative factors.
This study involved almost 6,000 students, 13 to 18 years of age. The study author suggests that treatment and prevention of headaches in teenagers should perhaps include management of healthy lifestyle habits, such as regular physical activity, good diet, and cessation of smoking.

A recent study conducted by Dr John-Anker Zwart, MD,PhD at the University of Oslo, found that teens who regularly have headaches may find that their problem is linked to overweight, smoking and/or lack of physical exercise.
The article, published in the medical journal, Neurology, found teens with all three factors were 3.4 times more likely to suffer from recurring headaches, compared to individuals of their age who did not smoke, were physically active and were not overweight.
This study revealed that of the teens with all three negative lifestyle factors, 55% had frequent headaches. Furthermore, teens with two negative factors were 1.8 times more likely to have recurring headaches.
Teenagers who had one negative lifestyle trait were affected as follows:
• Overweight teens were 40% more likely to have recurring headaches than their peers with no negative factors.
• Teen who smoke regularly were 50% more likely to have recurring headaches than their peers with no negative factors.
• Teens who exercised less than twice a week were 20% more likely to have recurring headaches than their peers with no negative factors.
This study involved almost 6,000 students, 13 to 18 years of age. The study author suggests that treatment and prevention of headaches in teenagers should perhaps include management of healthy lifestyle habits, such as regular physical activity, good diet, and cessation of smoking.

The efficacy of cannabis to relieve cluster headache is still uncertain, according to a study discussed in the August 2010 issue of Neurology Reviews. Elizabeth Leroux, MD of the Emergency Headache Center in Paris studied 139 patients who presented with cluster headache, to determine the frequency of cannabis use as well as its effect on headache attacks. 27 of these patients had specifically tried cannabis in an attempt to treat their cluster headaches, while fewer than 30% of those studied avoided marijuana use during a headache attack.
The investigators stated that “substance use should be addressed when caring for cluster headache patients to prevent complications from use and potential interactions with prescription drugs. The therapeutic potential of cannabis for cluster headaches is to be considered on a scientific basis, but mixed results observed by patients suggest that structured trials with synthetic, selective cannabinoids should be the way to investigate this topic further.”

A recent article in The New York Times debunks the theory that all children are intrinsically good until influenced otherwise. The notion that they are mere products of their environment, and if there is chronic bad behavior, there must be a parent behind it is being challenged. Dr. Richard A Friedman, a professor of Psychiatry at Weill Cornell Medical College in Manhattan, states, “for better or worse, parents have limited power to influence their children. They should not be so fast to take all the blame-or credit-for everything that their children become. The fact remains that perfectly decent parents can produce toxic children”.

Interestingly, little has been written about the paradox of good parents with toxic children. Dr. Friedman continues that we “marvel at the resilient child who survives the most toxic parents and home environment and goes on to a life of success. Yet the converse–the notion that some children might be the bad seeds of more or less decent parents–is hard to take”. The reality is that character traits, like all human behavior, have hard-wired and genetic components that cannot be molded entirely by the best environment, let alone the best psychotherapists. Dr. Theodore Shapiro, a child psychiatrist at Weil concurs; “The era of ‘there are no bad children, only bad parents’ is gone.”

Cervicogenic headache is technically a headache by definition yet its origin is in the neck Frequently, it is combined with neck pain to a varying degree and occasionally, even arm pain of a non-radicular type.

An article in Headache Quarterly by Doctor Otto Sjaastad, Professor Emeritus of Neurology, Trondheim, Norway, discusses terminology of cervicogenic headaches and the misunderstandings with the definition of the term. A headache indicates an ache in the head, and not an ache in the neck-a nuchalgia. An ache felt in the head, but originating in the neck is cervicogenic. Cervicogenic headache is a concept with a solid content, and the term is intimately linked to its contents.

A revised edition of the definition is being prepared. In its most typical recognizable form, it is unilateral in the sense that there is no real side shift. The one side is always involved, either completely alone or with varying of contralateral involvement, but never with only a contralateral pain or predominance of such.

Cervicogenic headache is not defined as a vertebral disorder. It is a common misunderstanding that cervicogenic headache is only caused by disorders at the C2/C3 levels. Disorders at all cervical levels may cause cervicogenic headache. It is not an entity or a disease; it is a syndrome with a number of subgroups .

Headache is a common disease, with 21% of men and 36% of women reported as sufferers in Germany. While in most cases it is sufficient to treat headaches, a significant minority of patients with migraine need interval treatment as attacks occur too often or are insufficiently controlled.

A study in Germany was conducted to assess cost-effectiveness of acupuncture in addition to routine care for headache sufferers. This study was conducted at the Institute for Social Medicine, University Medical Centre in Berlin, Germany.

In this randomized, controlled trial, 3200 patients diagnosed with primary headache were studied during a 3 month period. In these 3 months, costs considered included direct health care costs of acupuncture, physician visits and hospital stays, and any drugs prescribed. Indirect costs caused by lost workdays were also taken into account.

Based on the findings of the study, the specialists determined that acupuncture is a cost-effective treatment for headaches. A quality of life assessment given at baseline and at 3 months further supported positive feedback from acupuncture with highly significant differences in favor of acupuncture-treated patients.

According to a 2009 study, individuals who experience chronic migraine (CM) often have significantly lower levels of household income and are twice as likely to suffer from conditions including depression, anxiety and chronic pain.
It has long been established that CM can be an especially disabling and burdensome condition. Both clinical and population based studies have demonstrated that CM, in comparison with EM (episodic migraine), results in greater migraine-related disability, and impairment in headache related quality of life.
This study, conducted by Dr. Dawn C. Buse and associates at the Montefiore Headache Center in New York, included 24,000 headache sufferers, comparing CM (15 or more headache days per month) and EM (14 or fewer headache days per month) sufferers. Dr. Buse’s findings showed multiple conditions were more common in the CM population including psychiatric (depression, anxiety, bipolar disease), respiratory (allergies/hay fever, asthma, COPD, sinusitis), cardiovascular and related risk factors: (angina, high cholesterol, obesity) and chronic pain. In fact, depression, chronic bronchitis, and ulcers were approximately twice as likely and chronic pain was 2.29 more likely in CM patients compared to EM sufferers.
The differences in the profiles between the two groups imply that CM and EM deviate not just in the degree of headache frequency but in these other important areas. These differences might provide important clues to further explore the differences between CM and EM. It is important for clinicians to maintain diagnostic vigilance and provide appropriate treatment or referrals when necessary.

This study of Repeater Phenomenon in Migraineurs included 465 migraine patients and was conducted by Veronica Villani, MD and colleagues at the “Enzo Borzomsti” Pain Center in Rome, Italy.
Headache is one of the most common symptoms in an emergency department (ED), while migraine is the most frequently observed headache in this setting.
All patients in this study underwent the Migraine Disability Assessment Scale for evaluation of migraine disability, in addition to the Beck Depression Inventory and other assessments for evaluation of depressive, anxiety and alexithymic symptoms (inability to identify and express emotion). According to Norman S. Lumley, MA (Psychosom Med) subjects with alexithymia may be more likely to seek the help of a physician for the treatment of physical signs and symptoms, which may largely explain the repeater phenomenon in our migraine patients.
The data from the study reveals that the personality of repeater migraine patients is characterized by HA behavior, a personality profile that indicates cautious, tense, apprehensive, fearful, and inhibited behavior, as supported by CR Cloninger, detailing a systematic method for clinical description and classification of personality variants (Arch Gen Psychiatry).
The repeater migraine is a complex phenomenon both from a clinical and personality point of view. The repeater migraine patient is characterized by alexithymic and harm avoidance behavior associated with a depressed and anxious state. Clinical aspects, and, or the psychological pattern, may predispose migraine subjects to multiple ED admissions and may, at the same time, be one of the main causes of undiagnosed migraine.
It is important for the HC and the ED to work in close collaboration to provide a correct diagnosis and specific therapy for this unique group of migraine patients. This network may also insure a proper follow-up, with the final outcome being a decrease in migraine disability and health care resource use and expenditure.

A recent study published in Neurology Update suggests transcranial magnetic stimulation (TMS) to be a viable therapy for acute migraine. This study, funded by Neuralieve, Inc., included 201 migraine sufferers. Half of the participants were given the portable TMS device, with the other half receiving an identical sham-stimulation device. All were instructed to use the device to treat as many as three episodes of migraine with aura during a three month period, and to initiate treatment as soon as possible and one hour after aura onset.
The primary outcome of the study was the proportion of patients with a pain-free response during the first migraine episode. 39% of the TMS group was pain free at 2 hours, compared to 22% of sham group. Analysis of secondary efficacy endpoints indicated TMS had significantly higher rates of sustained pain-free response at 24 hours (29% vs 16%) and 48 hours (27% vs 13%) post treatment Additionally, TMS users recorded lower rates of photophobia, phonophobia, and nausea than the sham group.