Migraine Experts Remain Skeptical of Acupuncture

A report last year suggesting that the benefits from acupuncture “persist” long term has led to some interesting discussion among migraine experts. An interesting theme of their commentsthey might recommend acupuncture, but they’re still skeptical.

Acupuncture: Experts SkepticalMany migraine clinics and professionals seem reluctant to speak out against acupuncture. Part of the reason is that they see few or no side effects, which is a good start. But acupuncture is also very heavily promoted, and many patients swear by it and would not appreciate hearing anything against it.

The study released in October (The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain.) drew on earlier studies. However, as has been noted again and again, these studies are not as reliable as many of the medical trials we’re familiar with.

Dr. Richard Lipton pointed out once again that “blinding” is difficult – in other words, how do you make someone “think” they’re receiving acupuncture when they’re not (an important part of blind clinical trials). One of the most often cited trials showing benefit from acupuncture for migraine did use “fake” acupuncture, but concluded that Treatment outcomes for migraine do not differ between patients treated with sham acupuncture, verum acupuncture, or standard therapy. In other words, just stick the needles anywhere.

Long term studies of acupuncture for migraine remain nonexistent. Dr. Dawn C. Buse notes that some studies may simply reflect that patients who apparently benefit from acupuncture are actually more self sufficient and willing to try new treatments – in other words, it’s not the acupuncture, it’s the overall way of life.

But if some studies seem to show that acupuncture may compare to more traditional treatment, why doesn’t everyone use it?

Some of the reasons include:

  • Poor clinical trials (as mentioned above), or trials with mixed results, and therefore a lack of confidence in the results.
  • Emphasis on a combination of treatments. Most specialists are positive about complimentary treatments, but most of these treatments work best along with more traditional treatments. Acupuncture isn’t the cure.
  • Many other good options. Although acupuncture tends to get a lot of press, there are many, many non-traditional and complimentary treatments available. Many specialists simply put acupuncture further down the list, feeling that there are better options.
  • Expense and time commitment. Even Dr. Alexander Mauskop, who is a licensed acupuncturist, admits to treating very few patients with acupuncture. For one thing, acupuncture is not likely to be covered by insurance. And it takes time – one of the cited studies, for example, had patients in for acupuncture 5 times a week. If you need to go 5 times a week, to actually get a benefit, would you do it?

Between studies with mixed results, time and expense, and many other and often better options, many specialist would agree with Dr. Deborah I. Friedman: “In general, I don’t discourage it, but I rarely suggest it …”

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Concussion: What Kind of Rest is Needed?

A large study is questioning some of the common wisdom regarding treatment of concussion in children.

We’ve talked a lot in the past about concussion (which is a brain injury), especially related to sports injuries. Concussion needs to be taken seriously – it could result in ongoing symptoms. Recent recommendations include being very cautious of activities that could result in another concussion, and getting sufficient rest after the injury.

In particular, cognitive rest. That is, avoiding (for example) reading, homework, and video games. (For more, see the 2014 study Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms)

But while getting rest and avoiding activity with a risk of concussion seems to be the best, does that mean that the child or teen should lie in bed all day? Apparently not.

A study involving 3063 children and teens (up to the age of 18) compared patients who returned to physical activity (within 7 days) with those who were restricted to more “conservative” rest. The question – which group was experiencing more postconcussive symptoms at 28 days?

Postconcussive Symptoms in Children and YouthAs you can see from the chart, those who went back to physical activity within 7 days were significantly less likely to have the unwanted symptoms.

Depending on who you talk to, there seem to be two dangers. First, keeping your child away from any physical activity seems to be a danger. Activity is all the more critical to growing children and teens – it can play an important part in their recovery. But the other danger remains – not taking the concussion seriously, and putting the child right back into the sport that caused the injury in the first place.

A slow and cautious return to low-risk physical activity, with limited brain-work for a while, seems to be the best advice.

For more on the study, see the abstract: Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Also see Early return to physical activity after concussion may reduce post-concussive symptoms at the New York Headache Clinic.

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Migraine and Epilepsy: A Common Target?

Migraine and epilepsy have a lot in common. For example, there are genetic connections. Epilepsy drugs are often used to treat migraine. And patients with one disease are likely to have the other as well.

Migraine and Epilepsy: A Common TargetOne interesting connection between migraine and epilepsy is the “cortical spreading depression” (CSD). CSD is a kind of electrical storm that passes through the brain of a migraine patient. It’s also been observed after a traumatic brain injury, and in patients with malignant strokes.

As you may have guessed, CSD has also been observed in patients with seizures. So – could we just target the CSD, and get rid of both the seizures (in some patients) and migraine attacks (in others)?

One of the tricks is that the CSD is not nearly as predictable in patients with epilepsy as it is in patients with migraine (although we still have a lot to learn about its role in both diseases). Does the CSD occur before the seizure, during, or after? Well – yes, it could be any of those three. So – is it a cause, or is it actually a protective measure? Sometimes it does seem that the CSD can put up a wall to stop the seizure in the brain. Other times, it seems to prepare the brain for the next seizure.

The brain seems to use the CSD in some interesting ways that we’re just beginning to understand. But some researchers of both migraine and epilepsy are hopeful that we may be able to use our growing knowledge of this “brain storm” to help the brain heal and avoid future attacks, whether they be migraine attacks or seizures. One treatment that is being studied and used today is vagus nerve stimulation, which may actually inhibit the CSD. It’s hopeful that more treatments will be developed for both diseases, and maybe the cortical spreading depression will be the common target.

For a more in-depth discussion, see Interplay between Cortical Spreading Depolarization and Seizures

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Women, Migraine, and Stroke

The link between migraine and stroke is nothing new, but recent research is making it a hot topic once again. In particular, there are increased concerns about the risk of stroke in women with migraine.

RISKFor example, a study published last month in the American Journal of Medicine researched data on women who were evaluated for ischemic heart disease (“hardening of the arteries”). Of those women, anyone who had reported a history of migraine was at a higher risk of a “cardiovascular event” such as stroke or heart failure. (Study abstract: Migraine Headache and Long Term Cardiovascular Outcomes: An extended follow-up of the Women’s Ischemia Syndrome Evaluation.)

A study in Turkey (Istanbul University) focused on patients with their first stroke, between the ages of 15 and 50, compared to gender and age matched healthy patients. Frequency of migraine was almost double in the stroke patients. But when different types of migraine were compared, the results were much more specific. The only ones with an increased risk were women with migraine with aura. Another study in the American Journal of Obstetrics and Gynecology suggested that women with migraine with aura who also used hormonal contraceptives were at a significantly higher risk.

(See Migraine as a risk factor for young patients with ischemic stroke: a case-control study. and Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke.)

Another study out of Harvard University and Massachusetts General Hospital in Boston focused on those who experienced stroke after surgery – again, patients with migraine – especially migraine with aura – were at an increased risk in the first 30 days after surgery. (Migraines tied to increased stroke risk after surgery)

Each of these studies has its strengths and weaknesses, but the research continues to suggest that people with migraine, especially women with migraine with aura, have an increased risk of stroke.

It’s important to remember that this is not a high risk, in the sense that you’re just guaranteed to have a stroke. If you have migraine, chances are you won’t have a stroke any time soon. But, like smoking or a poor diet, migraine does increase your risk. It increases your chances.

So its all the more important to treat your migraine, and minimize other risk factors that you can control.

Finding good treatment for migraine may do more than just alleviate pain – it may decrease your risk of stroke. And some migraine-fighters, such as magnesium, may also fight stroke.

For more on migraine and heart disease, see Migraine and Heart Disease: 7 Critical Things to Know Now

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The Early Stages of a new Hemiplegic Migraine Treatment

Recent genetic research has identified some possible new treatments for hemiplegic migraine – treatments which may also work for other types of migraine in the future.

It may be much more exciting when a new treatment is just about to hit the market, but it’s worth noting the steps that many of these treatments have had to go through in order to get to your medicine cabinet. So this is one of those treatments that is still in the very early stages.

This study, based in Spain, received a research grant from the Migraine Research Foundation. The study was based around certain genetic mutations, in this case in the P/Q-type calcium channel (CaV2.1). These types of mutations have been linked to a number of disorders, including hemiplegic migraine. It is believed that the functional changes caused by these mutations may lead to the cortical spreading depression – a kind of brain storm that occurs in other types of migraine as well (a storm of activity that sometimes leads to the visual auras many migraine patients have experienced).

So if there is a dysfunction in this calcium channel, the question is – could we find a medication that could fix it? And, importantly, a targeted tool – a medication that won’t cause a bunch of other problems and make other unwanted changes at the same time.

In other words, we want laser surgery, not a dynamite blast.

Computer researchThe researchers started with a database of millions of compounds that interact with this calcium channel. Then they started narrowing things down. Would this compound do what we want? Would it likely cause major side effects? Is it even available? If available, is it too expensive to manufacture? And so on, and so on.

After this extensive research, the millions were narrowed down to 6 – yes, just six – six possible compounds that have a good chance to be treatments.

At this point, animal studies often follow to test general safety before a possible drug for humans is developed.

This is an amazing process that would not be available without our knowledge of genetics, international cooperation, and modern computers. And one more thing – funding. Thanks to those of you who have given to the Migraine Research Foundation, research like this is possible.

If a medication could be developed to stop the hyper-sensitivity of migraine, stopping the cortical spreading depression, it could drastically improve the lives of millions.

To read more about this research, check out Identification of novel, selective voltage-gated CaV2.1 calcium channel inhibitors which reverse the gain of channel function produced by Hemiplegic Migraine CACNA1A mutations.

To donate to the Migraine Research Foundation, just visit this page.

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