A Migraine Treatment for Pregnant Women, Children, and maybe You (video)

Although there are many good migraine treatments available for children and pregnant women, the number of well tested treatments is small compared to what is available for the rest of us. This is especially true if the migraine symptoms are severe, and the patient has already tried many of the standard treatments.

One treatment that may help these patients is a sphenopalatine ganglion (SPG) block. This simple, out-patient procedure has actually been practised for decades, but it’s benefiting from new technology.

The “new” method is to use a specially designed device, inserted into the nose, to deliver a local aesthetic to the SPG, a nerve bundle.

You may ask – what good is a temporary local aesthetic in fighting migraine? First, the procedure seems to interrupt the “migraine circuit”, bringing almost instant relief in many cases (though not necessarily total relief). But that’s not all – some patients find that it relieves their attacks for months afterwards.

Back in 2015, a study was done in Phoenix (USA) to see how children and teens responded to this treatment. There were 133 procedures performed on 85 patients, using lidocaine as the anesthetic. Scoring migraine pain from 1 to 10, the patients’ pain on average decreased from 5.55 to 3.28, almost immediately. (Study abstract: Safety and efficacy of sphenopalatine ganglion blockade in children – initial experience)

At first this may not seem like a huge improvement. But remember, these are patients who probably have suffered from severe headaches and who have already tried many other treatments. Also remember that improvement will vary – some won’t experience significant relief, while others will improve much more than the average.

But there’s one more thing to keep in mind. This treatment has the potential to fight symptoms for several months afterwards. Although this wasn’t a part of the study, the potential of better health for several months and fewer other medications makes this treatment one to seriously consider.

There is also much less worry about side effects, other than possible irritation to the nasal passage (although your doctor should be fairly careful to minimize the chance of this).

The sphenopalatine ganglion block is a treatment that should be seriously considered in pregnancy and for children and teens. But it’s not limited to those groups. Anyone with severe migraine that is not responding to the front line treatments may benefit.

One of the devices that is used for the SPG block (and the one used in the study above) is the SphenoCath. The brief promotional video below shows how the SphenoCath works and what the benefits are. Keep reading below the video if you’re interested in seeing the actual procedure being performed.

If you’re interesting in seeing the actual procedure, anesthesiologist Dr. Ezra B. Riber from the USA has a video demonstrating the block with a woman with migraine. See SphenoCath® Headache Treatment. If the procedure seems a little involved, that’s because Dr. Riber is taking steps to make the experience as comfortable as possible, with little to no irritation to the patient.

See also Innovative treatment offers relief to children with frequent migraine headaches

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A “Smart” Non-Drug Arm Patch to Fight Migraine

A new form of migraine treatment is in the testing phase – a new kind of migraine fighting patch. Of course, putting a patch on your body for medical reasons, even to fight migraine, isn’t anything new. Of course, we’ve had mixed success in the past – take the famous example of Zecuity, which shows no signs of returning to the market soon.

But these are mostly drug options. How about a non-invasive, non-drug patch? One that you can actually control from your smart phone? How would that work?

The company is Theranica, and the Nerivio Migra patch is the product currently being tested.

Nerivio MigraRecently I updated you on the Cefaly device, which is billed as a external trigeminal nerve stimulator (e-TNS). Various similar devices are available or are being tested for migraine.

Although we don’t completely understand how these devices fight pain, one theory is the “pain inhibits pain” theory. The idea is that pain in one part of the body may actually inhibit pain in another part.

But who wants to hammer their finger, to stop a migraine attack? No thanks. So – what if we could trick the body into thinking that there was pain, even though we couldn’t feel it?

Now things get really complicated, but that is one way of looking at nerve stimulation.

However you look at it, there is evidence that such devices can lower your migraine pain (without causing more pain!).

Now unlike Cefaly, this new patch is not a preventative, but an abortive. It’s intended to stop individual attacks. But what else sets it apart?

Well, Theranica asked some questions – how can we make a device that’s more discreet – less bulky – so that it could easily be hidden and used anywhere? How can we make sure there is no pain, or muscle “twitching” when the device is used? And how can we avoid parts of the body that are often the most sensitive during a migraine attack (head and neck)? And most importantly, how can we create a device that will provide long term relief?

And so, Nerivio Migra was born. Designed as a wireless patch, placed high on the arm, it tries to balance being portable, easy to use, and effective.

A preliminary study has already been completed, showing promise. Compared to sham treatment, patients were far more likely to report a reduction in pain – in many cases, a complete elimination of pain. The results were easily comparable to taking sumatriptan, a common migraine-targeting medication.

The study was small, and there were some problems with it, so it’s time for a (hopefully) more robust study. The study is not yet recruiting participants, but will be soon. If you live in the United States or Israel, and suffer from episodic migraine, you may be eligible. For more details and contact information, just go here.

Whether or not Nerivio Migra is ultimately successful, it represents more thoughtful progress and research into non-drug, non-invasive treatments for migraine. Stay tuned.

For a detailed discussion of the medical theories behind Nerivio Migra, see Acute Migraine Pain Relief via Remote Electrical Nerve Stimulation – a systematic analysis

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A Quick Update on Cefaly for Migraine

The Cefaly device is a non-invasive, migraine-fighting external trigeminal nerve stimulator (e-TNS) device used daily to prevent migraine attacks. It’s been a while since we’ve talked about Cefaly, so here’s what’s new.

First, yes, migraine patients do continue to find relief using Cefaly. As with any treatment, that doesn’t mean everybody, but it is still a recommended treatment.

New design

Cefaly 2

Ignore those old pictures floating around the internet – this is what Cefaly looks like now.

Cefaly has been refined – and is now sold as Cefaly 2 or Cefaly II (ok, they just call it Cefaly, because the old version is no longer being made). So what’s the difference?

Cefaly 2 is more compact and portable. It’s powered by a rechargeable battery (instead of using AAAs like the old version). Also, it’s simply more functional – patients have a lot more control over pausing sessions and changing intensity so that they can customize treatment.

Availability

Also, Cefaly is more available than ever. If you’re interested, click through to your country below:

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Transient Global Amnesia: Risk of Related Problems?

It’s been a while since we talked about transient global amnesia (TGA). TGA is an illness that has been linked to migraine. Patients who have TGA have trouble remembering recent events, and have trouble retaining new information. However, this usually only lasts for a few hours.amnesia

Very little is known about TGA, which may lead to concerns about the lasting impact it may have on the brain. Patients who have a TGA episode may be more likely to have a history of migraine. But what about the future? Is there an increased risk of seizures, further cognitive problems, or serious brain/vascular events?

Good news – according to a recent study from the Mayo Clinic in the USA, the answer is no.

The study followed 221 patients for about 12 years. Of those, about 5 or 6% had another episode of TGA, which also is a very low percentage.

This should be good news for many people and their families who have been affected by this strange illness.

To see the study abstract, go to Long-Term Outcome in Patients With Transient Global Amnesia

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Candesartan for Migraine

Recently a HeadWay subscriber mentioned a treatment that has been working well for her, and I realized that I haven’t mentioned it before. So here is a brief description of candesartan and its use in migraine treatment.

Candesartan is sold under the brand names Atacand, Amias, Blopress, and Ratacand, although it’s also available as a generic drug. It’s classified as an angiotensin II receptor blocker (ARB). ARBs are often used to treat hypertension, and candesartan is no exception. But antihypertensive drugs are also used as migraine preventatives.

In 2013, a study compared candesartan with a more common migraine preventative, propranolol. The study concluded that 16mg daily of candesartan was comparable to 160mg of propranolol – both led to fewer days with migraine symptoms. (see A comparative study of candesartan versus propranolol for migraine prophylaxis)

Sometimes we make the mistake of thinking that just because we’ve tried a certain kind of drug, we shouldn’t bother trying similar drugs. But the truth is that every drug – even sometimes different versions of the same drug, can have a different effect on an individual. That’s why candesartan can help a patient when propranolol might not, or vice versa.

As always, talk to your doctor before trying any medication. You may not need 16mg – a lower dose may be helpful. Candesartan is NOT for use by anyone who may be pregnant.

Another bit of good news is that candesartan may be a better option for patients concerned about weight gain.

If you’re interested in trying a new preventative medication, talk to your doctor about candesartan. It’s now an often recommended option.

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