One of the most difficult challenges for someone in the middle of a migraine attack is surviving the emergency room/department.  By this time, your symptoms are so severe you can hardly think straight, and you went to the ER/ED and – you get a million questions, bright lights, strange smells, and treatments that don’t work.

*sigh*

So we want to do all we can to make the visit to the hospital easier for you.

To do list

Recently, Dr. Alexander Mauskop of the New York Headache Clinic suggested a sequence of treatments – a sequence that you can recommend to the doctor.

His advice especially has to do with someone who has been throwing up, and needs hydration.

Here’s a brief summary of the sequence he recommends, with some comments of my own.  You can read his whole article at:  What to ask for if your migraine lands you in the emergency room.

  1. Intravenous hydration with at least 1 gram of magnesium added to the intravenous fluids:  This really gives an excuse to get the magnesium.  Magnesium is a common and helpful migraine treatment in emergency, and can relieve a number of migraine symptoms on its own (see this study).  This approach has recently been questioned, and may work better in some cases than others.
  2. Sumatriptan (Imitrex) injection:  Best case scenario – you’ve already taken a sumatriptan injection before coming to the hospital.  If you haven’t, ask for it.  But of course be sure the doctor knows what you’ve already taken.
  3. Ketorolac (Toradol):  This is one of the recommended treatments in the new guide from the Agency for Healthcare Research and Quality in the USA and the University of Alberta Evidence-based Practice Center in Canada.  Access their recommendations here.
  4. Metoclopramide (Reglan):  Only if you’re nauseus.
  5. If the above treatments don’t help after a reasonable length of time, the doctor may try dexamethasone (Decadron) and DHE-45 (dihydroergotamine).

Dr. Mauskop emphasizes that you should not be starting your treatment with divalproex sodium (Depakene) or an opioid (such as Demerol).

Certainly these guidelines aren’t the magic bullet for everyone, but it’s good to have a place to start, and this sequence is based on some of the latest research.

Of course, you’re not going to want to go through a big explanation with clinic trials at your fingertips when you’re in emergency.  Why not make up a card which you can bring in, explaining the medications you currently take, and the recommended sequence, with links to information like the Effective Health Care Program Guide?  It might help you get better treatment faster, and you’ll only have to answer dozens of questions instead of millions.

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For our Facebook Fans

by James on 15 April 2014

Pssssst… guess what ….

Did you know that over 22 THOUSAND people have “liked” the Headache and Migraine News page on Facebook?  Did you know that there are always great conversations going on over there, about things you see on the blog, and even things you don’t see here?

I really think it’s time to say “thanks” to our Facebook users.

So sometime during the next three weeks there is going to be a prize given out on Facebook.  All you’ll have to do is be someone who likes the page, and you’ll need to follow some simple instructions.

Actually – hey – let’s make it four prizes.

Just stay tuned on our Facebook page for more instructions.  Oh, I’ll also give a little more information here on the blog about what the prizes actually are.

Why wait for Christmas?  Let’s wrap some presents…

Facebook Giveaway ... coming soon!

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Baking Soda for Headaches?

by James on 14 April 2014

Some people do report that baking soda alleviates their headache or migraine symptoms.  Why might that be?

Baking soda, also known as sodium bicarbonate, is commonly used in food.  It’s also used in medicine, most notably as an antacid.

Baking soda - for headaches?
Photo courtesy of HomeSpot HQ

Baking soda tends to lower acidity, hence the term “antacid”.  Could it be that lowering acidity in the stomach could actually help with headaches?

Although this is by no means a cure, and won’t help everyone, the idea is not far-fetched.  The link between migraine in particular and the health of the gut is well known.

You’ve probably heard terms such as heartburn, acid reflux, acid indigestion, and gastroesophageal reflux disease (GERD).  Many people with headaches and/or migraine also have gastrointestinal problems.

There may be a biological link that brings these things together.  There are also medications, commonly taken for headache, which may make these things worse.  These include aspirin, ibuprofen, and even calcium-channel blockers.

But even if acid reflux and migraine go together, this doesn’t prove that baking soda will help.

Baking soda isn’t a cure for conditions such as heartburn or GERD.  However, if stomach acidity is causing you problems, baking soda may be a mild treatment worth trying.  And for some people, it does seem to lessen headache pain.

In fact, we’ve talked before about using Alka-Seltzer Gold as a treatment – and one of the ingredients of Alka-Seltzer is specially treated sodium bicarbonate.

Using Baking Soda as a Treatment

Sodium bicarbonate comes in many forms, and can be purchased as a tablet, powder, capsule, and in other forms.  As with any treatment, it’s wise to talk to your doctor.  Do even more investigation if you’re pregnant or breastfeeding, have a chronic illness, or are taking other medications.

For healthy adults, a half-teaspoon of baking soda (powder) in a glass of water an hour or two after your meal will help with stomach acid.  You can repeat this dosage after a couple of hours if the problem remains.

Another option is to take baking soda each day – again, this may be a half a teaspoon in a glass or water.  If you’re going to take baking soda for more than a couple of weeks, be sure to see your doctor again and discuss your progress.

Have you ever used baking soda to treat headache or migraine?

For more on baking soda for headaches and more, see:

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Under-30 with Migraine – Special Risk?

by James on 10 April 2014

A study among Canadian migraine patients says that the under-30 crowd may be at special risk.  You might be surprised to know why.

It’s not news that depression and migraine often go together.  The reasons are not so simple.  Many migraineurs are not depressed, and many with depression don’t have migraine.  But there does seem to be a link, possibly related to the body’s neurological system and genetics.

But a study that came out of Canada late last year sounded the alert for a specific group of people.  These people are young, unmarried, and had migraine.  And that migraine was significantly limiting their activities.

This group was more likely to be depressed, and more likely to have thoughts of suicide.

Although the reasons were not clear from the study, some reasons may be obvious.  Many of these people have been recently diagnosed.  When the world was supposed to be opening up to them, careers starting, and opportunities for new relationships appearing – they suddenly encountered a major roadblock.  Migraine.

Being unmarried, some of these may also have less support when they need it.

Depression and suicide are all-too common.  The answer is not “get a grip”.  When related to migraine, there are often physical problems that need to be – and can be – treated.

If you’re under 30 with migraine, there are excellent treatments available.  But you need to know that finding those treatments may take time.

If you had migraine when you were under 30 and you’re now older, what helped you?  If you’re under 30 now, and have migraine, what can we do to help?

For more, you can find the study here:  Migraine and Despair: Factors Associated with Depression and Suicidal Ideation among Canadian Migraineurs in a Population-Based Study

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An recently updated survey of triptan for cluster studies came up with a winner:  subcutaneous sumatriptan.

Of course, there weren’t a lot of competitors.  Cluster headache is rare and therefore the studies are few.

Other contestants included the placebo (the clear loser), oral zolmitriptan and intranasal zolmitriptan.

Because cluster symptoms are so fast and furious, oral medications generall do poorly.  That leaves us with the intranasal zolmitriptan and subcutaneous sumatriptan.

Intranasal medications are taken, as you may guess, through the nose.  It’s a fast way to get medications into the body without the needle factor.

Only about 28% of patients were left with no pain or mild pain after taking the intranasal zolmitriptan.

Sumavel DosePro

Finally, subcutaneous sumatriptan.  Subcutaneous is a fancy word that usually refers to an injection.  However, medications such as Sumavel DosePro are needle-free.

Patients who took the subcutaneous sumatriptan did the best.  Three quarters had little or no pain within 15 minutes.

Learn more about subcutaneous sumatriptan here.  This article is more focused on migraine, and does warn about using sumatriptan before talking to your doctor, which is always important.

Study abstract:  Triptans for acute cluster headache.

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