Are You Taking These Common Medications (that could hurt your brain?)

A new study from Indiana University in the USA is raising more questions about the use of many common medications – including medications that many people are taking for migraine, or for a related condition. Could taking these medications actually hurt your brain?

The short answer is a resounding – maybe. But there does seem to be a clear link.

I really appreciated Kerrie Smyres’ article on this topic. I’ll summarize here, but I encourage you to read it here: Some Migraine Drugs Linked to Cognitive Impairment, Dementia in Older Adults

The drugs are known as anticholinergic medications, and some are more “anticholinergic” than others. These drugs, to varying degrees, block a chemical known as acetylcholine, a neurotransmitter in your body.

Some examples of these include:

  • amitriptyline (Elavil)
  • brompheniramine (Dimetapp)
  • dimenhydrinate (Dramamine, Gravol)
  • methocarbamol (Robax)
  • paroxetine (Paxil)

Are these common drugs damaging your brain?As you can see, many of these are very common medications.

Previous studies have linked the use of these drugs with dementia and other types of cognitive impairment. The new study (Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults) confirms that there is a link with cognitive impairment/decline.

Now, what does that mean, “linked”? It means that older patients who take these kinds of medications on a regular basis seem to be more likely to experience decline in their ability to think clearly. But why? Is it the medication? Or could it be related to some of the diseases that lead them to take the medication? Or could there be another factor these patients have in common?

These questions have not been answered, and it will be very difficult to answer them in the near future. At this point, there is an increased motivation to avoid prescribing too many of these medications to older patients.

For those of us who are younger, just what is the risk? We don’t know. There seems to be little doubt that the benefits outweigh the risks for certain patients who are greatly helped by these medications. Plus, a healthy lifestyle may slow or even reverse cognitive decline, including brain shrinkage. So if a carefully prescribed medication keeps you active and eating healthy, the dangers could even cancel each other out.

The fact of the matter is that there are many dangers in drugs – even over the counter drugs. We could go over many studies and many warnings that we’ve heard in the past about other types of drugs. But the advice seems to be the same. Don’t panic – instead, minimize the drugs you take when you can, and weigh the risks when you and your doctor feel a medication is necessary.

That being said, we’ll be watching for more studies on anticholinergic medications, because they could help us better understand where the risk is and how to avoid it.

For more information, including some more specific drugs in this category, read Kerrie Smyres’ article above. Also see IU scientists: Brain scans link physical changes to cognitive risks of widely used class of drugs

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Chronic Migraine: Losing the Ability to Control Pain

Dike (levee) system

Dike (levee) system – just how safe are we sheep? :)

Imagine that a system of levees or dikes had been built to control the flow of a certain river. Although no levee is perfect, it does provide a certain amount of safety from flooding. Flooding may still happen, but hopefully it will happen on a smaller scale.

But maybe these dikes were built long ago. Maybe they’re getting old, and they’re starting to let water through, not only when there’s a very unusual amount of water, but even when the water is just a little higher than normal.

Could that be a good analogy for chronic migraine?

A big area of study right now is the question of just how and why migraine disease goes from being episodic (an attack once in a while) to chronic (an attack every day or two). One of the studies published this month in The Journal of Headache Pain was focused on a certain aspect of chronic migraine.

Research focused on female migraine patients and their responses to pain when they were not in the middle of a migraine attack. This is very important, because migraine does involve changes in the body that are present whether someone is actually having a “migraine attack” or not.

In this case, sure enough, researchers found that there was a significant difference in “trigeminal pain processing” (how trigeminal (a certain type of nerve) pain was managed by the body) between patients with episodic migraine and patients with chronic migraine.

We know that migraine involves “hyperexcitability” – that is, the brain seems to over-react to stimuli. But this hyperexcitability seems to be different in different types of migraine, in this case chronic or episodic.

It could be that the brain’s natural mechanisms for controlling the flow of pain and other symptoms are actually impaired, or completely broken, in the case of chronic migraine. If so, is there a way to “repair the levees” and reduce the migraine attacks?

Many patients have successfully reduced their attacks. But the more we know about the actual function of chronic migraine and other chronic pain conditions, the more easily and quickly we’ll be able to fix the problem.

Study abstract: Differences in central facilitation between episodic and chronic migraineurs in nociceptive-specific trigeminal pathways.

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10 Highlights from the past 3 Months (April 2016 edition)

It’s time to take a look at the articles that have been the most popular with you, guests to Headache and Migraine News. As always I’ve put in bold the three articles that have the most “likes” on Facebook. In this case, it’s the top three posts in general.

I hope you’ve enjoyed the Migraine World Summit! I don’t know how many people attended, but I hope it will go a long way to helping migraine patients around the world. If you didn’t catch all the interviews (I didn’t!), you can still purchase the full library of interviews. It’s a lot to absorb, and I’m looking forward to learning more from the summit in the weeks ahead.

  1. What Does Tinnitus Sound Like?
  2. Why Headache Patients Are Running from Esomeprazole (Nexium) and other “Heartburn” Drugs
  3. The Secret of Wireless Migraine Relief
  4. Nose Powder for Migraine? Why Would I Want That?
  5. Headache After Eating? Common Causes and Fixes
  6. They Hated Swallowing Pills, Until . . .
  7. MS and Migraines: New Research
  8. RhinoChill Cools the Brain and Body – Could it Stop Migraine Symptoms?
  9. Is Your “Targeted” Migraine Painkiller Worth the $$$?
  10. Are You Experiencing Airplane Headache?
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Silent Migraine Symptoms – Should I Be Worried?

The onset of silent migraine symptoms can cause a lot of worry, even if the symptoms themselves aren’t too debilitating – which they can be. But are these symptoms something to worry about, or can they be safely ignored?

Silent Migraine Symptoms: Visual Aura

Migraine aura illustrated by Kathryn Greenhill

Migraine aura is not just one thing. Many people are familiar with visual auras, which may include seeing flashing lights, zig zags or patterns. Visual auras can even include a partial loss of vision – either an area of reduced vision or even temporary blindness.

But silent migraine symptoms are not limited to visual auras. An increased sense of smell, trouble speaking or finding the right word, even hearing things – there are a variety of possible symptoms.

The important thing to remember is that these symptoms are temporary, increasing for a few minutes and then typically lasting an hour or less.

Once commonly known as silent migraine symptoms, the condition is now considered a type of migraine called typical aura without headache. It is possible in this type of attack to have more than one symptom, but there is no muscle weakness, fainting or dizziness (if there is, it may still be migraine, but it’s a different type of migraine. For example migraine with brainstem aura).

The symptoms may be an inconvenience, or they can be extremely disabling. Either way, they can be scary because they can look a lot like stroke and other diseases.

If your symptoms are new, or there is a change in symptoms, it is critical to see your doctor right away. When the aura is very short, or very long, or includes blindness over half of your field of vision, your doctor will be particularly concerned and will need to rule out other causes.

Getting Rid of Silent Migraine Symptoms

As strange as the condition may seem, it is not uncommon. And it is a type of migraine. Depending on how disabling the symptoms are, your doctor will discuss with you the risks and benefits of treatments.

As a type of migraine, typical aura without headache is generally treated the way other types of migraine disease are treated. There are many drug and non-drug treatments available – for an introduction, see How to treat a migraine.

Should you be worried? If these symptoms are new or have changed, yes, you should be concerned. If ongoing, your doctor can help you manage them or even eliminate them with proper migraine treatment.

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Antibodies for Migraine: Finding a Target

A huge emerging area of medical treatment is in the study and use of antibodies. Imagine if you were a sharpshooter, with a special gun that could attack certain cells or substances in the body. There would be little or no collateral damage – the bullets would only hit what you wanted to hit.

Now imagine that you could use that gun (an antibody medication) to shoot the messengers that were carrying around pain signals in your body – and in this way you could stop a headache in its tracks.

Antibodies for MigraineSounds great, doesn’t it? That’s what many many researchers around the world are thinking too. Though a relatively new field, it’s growing quickly, especially in conditions such as cancer and immune related diseases (such as Crohn’s disease and multiple sclerosis).

And, of course, this type of treatment has caught the imagination of migraine specialists. But the question becomes – what should the antibody gun shoot at?

The use of monoclonal antibodies directed against CGRP (calcitonin gene-related peptide neurotransmitter) is probably the hottest area of research in the area of antibodies for migraine. CGRP is the target, and this type of medication is showing a lot of promise as multiple companies race to get it the market. (Read more: The “Revolution” in Migraine Treatment (Dr. Peter Goadsby))

But there are other targets that are being researched. For example, Dr. Yu-Qing Cao of the Washington University Pain Center has carried out research (funded by the Migraine Research Foundation) on cytokines and chemokines as new targets for the antibody sharpshooters.

Cytokines and chemokines? What are they? Well, they’re types of protein in the body that coordinate immune responses. They’re handy to have around, but when they get out of control they can cause inflammation and degeneration on a neurological scale.

There are certain proteins that may rise in headache patients – could we shoot them down and stop the headache?

In a trial with mice (you have to start somewhere), the results of the proper antibodies were promising.

Drugs are already in the pipeline that could hit some of these migraine-specific targets, such as clazakizumab which is being developed for arthritis pain.

So this is what many researchers are doing – finding possible targets, looking for links with headache and migraine, and finding ways to shoot them down to keep them from causing problems, such as PAIN.

Check out the links below if you want to learn more. But if you want to help further migraine research, visit the Migraine Research Foundation and donate today (if you don’t need a tax receipt, or you’re outside of the USA, encourage our community by donating through this link. Either way the funds go directly to the MRF.)

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