Predicting: Will This Medication Work?

Which would you prefer?

  1. You walk into the doctor’s office, and the doctor offers you a medication that happens to interest them at the time.
  2. You walk into the doctor’s office, and the doctor offers you the medication that works with the highest percentage of patients with your condition.
  3. You walk into the doctor’s office, and the doctor checks your statistics and offers you the medication that is most likely to work for you.

I don’t know about you, but I would sure prefer #3. I would take a well-educated #2 if I couldn’t get #3. (And frankly, there are worse things than #1.)

Migraine Medication PredictionsAt this stage in migraine research, with a good specialist you’ll hopefully get a combination of #2 and #3 (and likely a pinch of #1). But researchers are trying to gather the information we need to offer more customized treatments.

As we gain the ability to gather more information about ourselves (e.g. FitBit and Migraine), the possibility of fitting the treatment more exactly to the patient is becoming a reality.

Perhaps a more immediate benefit is avoiding treatments that aren’t likely to work. Today, there are so many migraine treatments that a patient could spend a lifetime trying them – why start with treatments that probably won’t work because you’re a) a women or b) diabetic or c) suffering from a certain symptom?

A recent study in the USA studied responses from 8233 patients with episodic migraine to see which variables could predict whether or not an abortive treatment would work. Typical go-to medications for migraine are the various types of triptans.

So here’s the question – what types of things should a doctor know, that may predict whether or not a typical abortive treatment will work?

First, symptoms.

  • How intense is the headache?
  • How frequent are the attacks?
  • Does the patient suffer from cutaneous allodynia?
  • How intense are the symptoms overall?

Second, medical profile.

  • What comorbid conditions does the patient suffer from? Do they suffer from depression, for example?
  • Are they taking preventative medications (for migraine)?
  • Are they overusing any medications?

Finally, certain basic factors come into play, such as

  • Gender
  • Body mass index

These and other factors may help us better customize your treatment in the future.

In the mean time, the more information you can keep track of (don’t let it take over your life) the better. Keep in mind your medical history (and family medical history) as well, which can help your doctor a great deal.

To read the abstract of this study, go to Predicting Inadequate Response to Acute Migraine Medication: Results From the American Migraine Prevalence and Prevention (AMPP) Study from the October 2016 edition of Headache.


Flavonoids – Could they fight fatigue and headache?

Flavonoids have a bad name in the world of migraine and headache because of concerns that certain flavonoids found in tannins (found in wine, for example) may actually trigger migraine attacks.

Concord grapes - packed with flavonoidsBut flavonoids are actually very important to health, and they may actually help to fight fatigue, cancer, and neuropathic pain.

Right now, research is being focused on using flavonoids as a treatment for Gulf War Illness (also known as Gulf War Syndrome, and Gulf War Veterans’ Medically Unexplained Illnesses). Gulf War Illness (GWI) may not even be one disease – very little is known about what it is. However, fatigue, headaches, cognitive dysfunction, and pain are all typical symptoms.

A new study wants to focus in on cognitive problems (such as memory and attention), as well as fatigue. Certain foods are especially high in flavonoids – chocolate and grapes, for example. Chocolate does seem to help with fatigue, and Concord purple grape juice may fight fatigue and cognitive problems.

So, the grape juice study is now recruiting volunteers with GWI (for more information see Development of a Polyphenol-rich Dietary Preparation for Treating Veterans With Gulf War Illness).

Although both chocolate and grape juice have been traditionally thought of as migraine triggers, there has been a lot of questions recently about just how much evidence there is behind this for the general population of migraine patients (see Can Eating Chocolate Cause Headaches?). It may actually be that regular intake (regular – not 6 cups of grape juice tonight!) may actually fight migraine symptoms.

It will be interesting to see how this and other studies turn out. Meanwhile, let’s hope that this approach can at least provide some relief to those with GWI.

More information: Development of dietary polyphenol preparations for treating Veterans with Gulf War Illness (pdf)


Anti-inflammatory Juice

Recently in the free ezine HeadWay, we’ve been talking a lot about diet. In particular, sources of vitamin D, juices and smoothies, and anti-inflammatory foods.

Anti-inflammatory juiceVery often a key component of headache-fighting diets is simply more fruits and vegetables – especially more green veggies.

Here’s a video to show you a quick and easy recipe for anti-inflammatory juice. Yes, there is good science behind this. However, a caution. I would drink this with a meal, or else turn it into a smoothie, thus hanging on to the fiber. Slowly using smoothies to add nutrients to your diet is a great migraine and headache fighter. Quickly adding a lot of juice, and so a lot of sugar, can do the reverse.

With that being said, this recipe is packed with great headache-fighters, and is a fun place to start.

Do you have a great anti-inflammatory recipe? Share it here!


Nerve Pain in Head: A Different Kind of Headache

Sometimes it’s difficult to recognize exactly what is causing a headache. It would be nice to go to the doctor’s office and simply check off nerve pain in head on a list, and have the doctor fix the nerve. But it’s not so simple.

Nerve pain in the head is a well recognized issue. In fact, there are several types of headaches that are specifically related to nerve pain.

Nerve pain in the headThey key word is “neuralgia”. And don’t get that confused with “neurotic” – it’s actually quite the opposite. Neuralgia refers to nerve pain, caused by damage or irritation to the nerve itself.

Neuralgia can occur wherever there are nerves. Typical symptoms may include sensitivity to any pressure (for example, “sensitive skin”), pain with movement, sharp stabbing pain, or pain that follows the path of the nerve. Neuralgia may even affect the muscles, causing weakness or even paralysis.

One thing to be aware of it that many patients have both neuralgia type head pain and another headache disorder. It’s important that both are recognized and treated.

Without going through all the possible diagnoses, here are some ways to recognize if you might have neuralgia head pain:

  • Pain is stabbing or shooting, or like an electric shock
  • Pain follows a certain path, and is almost always in the same place
  • Pain is made worse with touching or moving
  • Pain began at a certain time (may or may not be clearly related to a sickness or trauma/injury)

There are many possible causes in the category of nerve pain in head. It will help your doctor if you keep track of certain things. For example, do you know when the pain started? Where does it hurt (for example, back of the tongue, back of the head, jaw, etc)? What makes it worse/better? Are there other symptoms, such as eye redness, muscle weakness or contraction, sore throat, etc.?

If it seems possible that nerve damage may be involved, your doctor may call for imaging, such as an MRI, to take a closer look.

Treatment can vary drastically depending on the diagnosis (which can include Tolosa-Hunt syndrome, trigeminal neuralgia, occipital neuralgia, and many more – read about some examples of nerve pain in head). But getting the correct diagnosis early on can help you find helpful treatment as soon as possible.


Helicobacter Pylori and Migraine

Helicobacter pylori, or h. pylori, is the sneaky bacteria known for causing ulcers. Usually, ulcers are caused either by this bacteria, or long term use of NSAIDs, such as ibuprofen.

Helicobacter Pylori and MigraineFor many years researchers have been asking the question – does an h. pylori infection lead to more migraine attacks? And if so, could treatment lead to a better quality of life for migraine patients?

The research has been somewhat conflicting. But overall, it does seem more likely that migraine patients will have an h. pylori infection.

There are two sets of patients that may be tested – first, those who actually have ulcers. They are the ones who can benefit most from testing and treatment.

Second, those who are at high risk or who have had gastric cancer.

Now for the majority of the rest of us, testing and treatment has never been recommended. The fact is that many, many people seem to have the h. pylori bacteria, but most do not have any symptoms.

On top of that, the conflicting results of studies have not yet shown us exactly who may benefit, among migraine patients. It could be, for example, that h. pylori is more of a problem in patients who otherwise are at low risk of migraine (for example, they have no relatives with migraine – but h. pylori may be connected with the triggering of migraine symptoms).

A recent Mexican study into the gastrointestinal disorders related to migraine suggested that, in spite of the somewhat confusing past studies, there was at least enough evidence to support further research, and even testing of migraine patients (see Gastrointestinal disorders associated with migraine: A comprehensive review).

At the very least, if you’re a migraine patient at high risk for gastric cancer, or with ulcers, or you seem to be otherwise at low risk for migraine, you may want to ask your doctor about testing and treatment of h. pylori. Otherwise, it may not be a major factor for you, and you’re probably better to focus on other possibilities for the time being.

If you have been treated for h. pylori, have you seen any improvement in your migraine symptoms?

For more on treatment, see Helicobacter Pylori Infection Treatment & Management

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