5-HTP for Migraine and Tension-Type Headache

With all the new treatments becoming available for migraine, it’s easy to forget about some of the older treatments that have helped some people avoid attacks.

Back in the 1960s, researchers began to realize the important connection between migraine and a certain neurotransmitter – serotonin. As the decades went by, there was an increasing interest in the relationship between serotonin and migraine, and finding ways use this knowledge to treat attacks.

Today we know more about the complexity of migraine and migraine attacks. But serotonin remains an important, and at times controversial, component. Low levels of serotonin not only relate to migraine, but other comorbid diseases and disorders, including depression, sleep problems, and other types of chronic pain.
5-HTP
One complimentary treatment has been especially studied as a migraine preventative – 5-hydroxytryptophan, or 5-HTP.

The body uses 5-HTP naturally in the creation of serotonin. As a supplement, 5-HTP is made from the seeds of griffonia simplicifolia, a climbing shrub native to central and west Africa. 5-HTP supplements have been used to treat a variety of conditions, including depression, fibromyalgia, insomnia, obesity, and sleep disorders.

The use of 5-HTP for migraine and other types of headache remains controversial, because not all clinical trials showed a significant benefit. Also, it seems that very little serotonin increase can be seen in the brain itself.

However, several trials did show that 5-HTP benefited patients, with a lessened need for other medication, lower pain levels, shorter attacks, and fewer attacks. It may be that the increase in serotonin the the body as a whole does benefit patients with migraine in particular.

Taking 5-HTP for Migraine or Headache

Like many supplements, it is best to use 5-HTP as a complimentary preventative treatment. And as with any preventative, it is helpful to try it for at least three months, using a headache diary to measure its effectiveness.

Clinical trials have generally used 400-600mg of 5-HTP daily for adults (20mg per 10lbs/4.5kg of body weight for children).

You should take extra caution with 5-HTP if you have diabetes or high blood pressure. Do NOT take 5-HTP with antidepressants. If you are taking triptans, or other supplements, talk to your doctor.

5-HTP can be purchased at drugstore.com and amazon.com or amazon.co.uk, where you can find both 100mg and 200mg tablets or capsules.

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Are we ruling out hemicrania continua too soon?

You’ve had a headache for weeks – then months – it may get better or worse, but it rarely (if ever) goes away completely.

It’s a one-sided headache, and some strange symptoms go along with it. Flushing or sweating in the face, congestion, watery eyes, feeling restless. A sensitivity to light or noise.

Are we missing hemicrania continua?Part of the problem is that sometimes the symptoms play tricks on you. They may look a lot like migraine symptoms. Or they may not look like hemicrania continua (HC) symptoms – for example, a key diagnostic criteria, that HC is pain on one side of the head, seems to be almost always but not always the reality.

But there is another concern that neurologist Dr. Randolph W. Evans has. In his recent article Migraine Mimics, he suggests that some doctors may not be using the typical HC treatment properly.

HC is one headache condition that is diagnosed by treatment. It always responds to indomethacin. When the patient takes indomethacin, the headaches go away, and the diagnosis of hemicrania continua is confirmed.

But there is a catch. How much indomethacin should the patient take, and for how long? Could it be that some doctors are not raising the dosage high enough?

Dr. Evans mentions one case in which a woman had tried indomethacin for five months – surely a long enough trial. The problem was, the dosage was too low.

Missing a diagnosis by a few milligrams is pretty frustrating, especially considering that it’s not unusual for a patient to go through several doctors and wait 5-10 years for a proper diagnosis.

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID), and doctors are right to start on a low dose. Side effects can include abdominal pain, nausea, and diarrhea to name a few.

Dr. Evans suggests that doses as low as 25-50mg a day can be effective for some patients. Some patients may go up to a high dose, but be able to taper off down to about 60mg.

One specific suggestion is to try going from 75mg to 150mg to 225mg, trying each dosage for 5 days. Patients will often split the daily dose throughout the day.

Although the usual recommendation is to try up to 225mg (for example, 75mg 3x daily), there are some reports of patients responding to 300mg/day.

Because indomethacin can help us get a clear diagnosis, even if the patient can’t continue taking it, doctors should be cautioned not to stop raising the dose too soon. If the patient is able to get rid of the headache, but can’t tolerate the medication, there are other options to try.

Hemicrania continua is so often misdiagnosed, it may be more common than we think. This may be a simple way to catch cases and provide better treatment.

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Botox for Migraines: Will it work when other treatments don’t?

Are patients who take Botox for migraines actually improving in the real world? In other words, are their migraine attacks actually decreasing, and is their quality of life improving? And what about patients that don’t respond well to other treatments?

Dr. Modar Khalil at the Hull Royal Infirmary in the UK has been studying headache disorders for a number of years, and most recently the use of Botox (OnabotulinumtoxinA) for migraine. His latest Botox study followed 465 patients treated in England for migraine.

It’s important to note who these patients were. First, they had a median history of four years with chronic migraine. They averaged 15 migraine attack days per month and 27 headache days. And 97% had already tried three or more preventative treatments without success.

So these aren’t people who occasionally get a headache, these are patients whose lives are seriously and constantly affected by migraine.

The best outcome was for 21% of patients, who had at least a 50% reduction in headache days in the first month after treatment, at least a 50% reduction in migraine days, and double the “crystal clear” days with no headache or migraine symptoms.

59% of patients at least hit one of these targets.botox-for-migraines-khalil

The best results came for those with 21-25 headache days per month – 74% reached at least one goal. Those with more headache days seemed harder to treat (although there was still significant improvement), and those with fewer headache days had less drastic results.

A third of the patients had a 75% reduction in either headache or migraine attack days, and at least three times the “crystal-clear” days.

The medication was tolerated well – the most common problems were a stiff neck (16%) and pain at the injection site (15%) lasting more than 24 hours.

Here are some important things you may want to note about this study. First, these results are very good considering that these are hard-core patients who have had trouble finding treatments that help. At the same time, this was a study of patients in the “real world” – helpful because it shows that Botox actually helps real patients in a normal situation. However, without controls, and without a longer period of time, it is difficult to compare statistically between patients who took Botox and those who tried another treatment, or nothing, or a sham treatment. The numbers would probably be less impressive in a controlled study.

Still, taken along with what we hear in the “real world” about the benefits of Botox (I just received another email from a patient who has been helped significantly by Botox treatment), it should encourage the community to keep pursuing and improving Botox for migraines treatment, and consider its benefits for other chronic headache disorders.

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Is Your Medication Being Absorbed? Gastroparesis and Headaches

It’s unpopular, but it’s true. Many migraine and headache patients may need to stop taking pills and go to an injection or skin patch or other type of delivery that bypasses the stomach.

We’re frequently told that these other delivery methods, such as injection or IV, get the medication to us “faster”, and that, especially in migraine, faster is better.

The human digestive systemAnd that may be true. But for some people, the pills they take may be sitting in the stomach for hours, while their migraine pain continues.

This is a condition called gastric stasis (delayed gastric emptying), or, in severe cases, gastroparesis.

Gastroparesis and headaches can go together for a number of reasons, not just because your body doesn’t receive the medication you’re trying to give it. When food isn’t properly absorbed, patients can experience bloating, malnutrition, nausea, and problems with blood sugar levels.

In other words, gastric stasis and gastroparesis can cause problems with the body that can trigger headaches – and then the medication you take doesn’t help at all.

That’s why migraine patients can take the exact same medication, the exact same dosage, but if it goes through the stomach it doesn’t help, and if it bypasses the stomach it does.

So what can be done to solve the problem? Your doctor will help diagnose the problem and recommend treatments, such as:

  • Treating an underlying condition (for example, gastroparesis can be linked to diabetes)
  • Changes in diet – eating smaller amounts more frequently, cooking and chewing foods well, and drinking plenty of water with meals
  • Other lifestyle changes, such as gentle exercise after eating and avoiding carbonated beverages and alcohol
  • Certain medications such as metoclopramide (Reglan), domperidone (Motilium) and onabotulinumtoxinA (Botox).
  • Changing the delivery method of your medications

In very severe cases, surgery may be required to make sure you’re getting nourishment. (More on treating gastroparesis)

Gastric stasis can be a problem for migraine patients even when they’re not having a migraine attack, which can cause problems with regular nutrition and preventative medications. If you’ve found that migraine medication isn’t doing much, this may explain it. Gastroparesis and headaches can both be treated, but they can certainly complicate each other if they are not properly diagnosed.

Gastric stasis can be diagnosed using a gastric emptying study. If you suspect this may be a problem for you, this is something you can discuss with your doctor.

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The Migraine Brain: Very “Connected”

A fascinating study was released this past spring in the journal Neurology which gives us new insight into the way the “migraine brain” works.

Migraine - a connected brainAlthough migraine has been around for millennia, it’s only recently that we’ve started to uncover the progress of migraine attacks through the brain, and understand some of the mysteries of the way the body transmits messages of pain.

This study used imaging technology to look into the cerebral cortex and to measure “connections” within the brain. Comparisons were made between migraine patients and control subjects.

Functional magnetic resonance imaging (fMRI) is a neuroimaging technique that is commonly used to measure brain activity. The researchers were looking at a specific part of the cerebral cortex known as the anterior insula (AI). The AI is a part of the brain that measures and responds to stimulus that we take in via our senses.

Surprisingly, researchers found that there were unusual connections in the brain of the migraine patients. Their brains had more connections to the input of stimuli with auditory and visual centres, as well as pain centres. Essentially, there seems to be a way to “see” the extra sensitivity that many migraine patients have to light and sound.

Even more fascinating, these connections were detected when the patients were not having a migraine attack (examinations were done more than three days after and more than three days before an attack).

These images could explain why migraine patients are bothered by noises and light – even in between attacks. Would there be even stronger connections during an attack? This study, of course, doesn’t tell us.

Study author Dr. Amy R. Tso explains some of the benefits of the study, and some next steps:

Clinically, in general with migraine therapies, we only have medications that target the whole disorder … If you identify an imaging marker, then you could use the presence or absence of that to track whether patients are responding to therapeutics. …

An obvious next step is to find out if this is a marker for migraine particularly or if this is just a marker of this sensitivity, and whether it exists across all headaches that share the sensitivity.

It would be fascinating to be able to target certain aspects of migraine in the brain itself. It would also be helpful to be able to “measure” the effectiveness of treatment, even before the next migraine attack.

Dr. Tso was also interested in the connection between migraine and anxiety disorders. Many people (not all) with migraine also have an anxiety disorders – disorders with seem to have similar “connections” in the brain. This study may help us understand the connection between migraine disease and anxiety disorder, and lead to treatments that could fight both.

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