So how would you feel about taking an antibiotic for your headache? If you’d be uncomfortable with that, you’re not alone, and I’m proud of you. 
But that’s no reason to ignore the small study that was done by Dr. Todd D. Rozen of the Michigan Headache and Neurological Institute. In the study he used Doxycycline to treat new daily persistent headache. Before we get to the results, a quick overview of Doxycycline itself.
Doxycycline is the generic ingredient in a whole host of brand name antibiotics, such as Adoxa, Doryx, Monodox, Periostat, and Vibramycin. These types of antibiotics work by interrupting the life cycle of the bacteria. It’s used for a number of different bacterial infections.
New daily persistent headache (NDPH) is one of the most treatment-resistant types of headache. In fact, the patients in this trial had already tried (unsuccessfully) 5 different preventive treatments. Interestingly, many patients get NDPH after an infection. And one theory is that a certain type of inflammation is behind NDPH.
That inflammation chain-reaction can also be stopped by Doxycycline, making it a candidate for treatment.
Only 4 patients were in the trial, but 2 became 100% pain free, 1 had an 80% improvement in daily pain intensity, and the last person had a slight improvement in pain intensity and a more than 50% decrease in severe pain episodes. On average, patients improved after 3 months (2 daily dosages of Doxycycline, 100mg). There was only one notable side effect – one patient got a severe sunburn (you have to be careful about your time in the sun when you’re on Doxycycline). These are very good results for something so difficult to treat!
So the results are pretty positive, and it probably wasn’t because of the antibiotic properties of Doxycycline at all. If these findings are confirmed by larger studies, it may show that our understanding of NDPH is on target. And it may open the door to better treatments.
Doxycycline itself may or may not be a good treatment. Obviously, we need to be cautious about taking antibiotics. Also, many medications, supplements and foods can decrease its effectiveness, so it needs to be taken properly under the care of a doctor.
This study was brought to my attention by the Headache News Blog.
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{ 8 comments… read them below or add one }
Definitely more research needs to be done… the placebo effect can’t be discounted, and one of the obvious dangers of overuse of antibiotics is developments of “super bugs”.
Though, as a sister of NDPH (I have CDH) I can certainly understand how eager a daily pain sufferer is to be rid of the pain!
Be well,
MJ
Yes, you’re exactly right about the antibiotics. But it sounds like there are some real interesting reasons why this may have worked, which is why I spent the time I did talking about it.
I certainly hope there will be more help for your sister soon (you too!)!
“So how would you feel about taking an antibiotic for your headache?
If you’d be uncomfortable with that, you’re not alone, and I’m proud of you. ”
Why would you “be proud” of someone for being uncomfortable with taking a treatment that they don’t know anything about – if it hasn’t been properly explained to them yet?
This is why a doctor / patient relationship is so important when treating chronic headache; explaining the advantages and disadvantages of a new treatment is crucial in treating chronic pain.
I should also note that new daily persistent headache (NDPH) is very different from chronic migraine. NDPH almost NEVER responds to typical migraine medications, and maintaing a website that encourages people to “be uncomfortable” with treatments that may help their painful condition is not helping anyone.
You failed to mention that doxycycline is quite frequently taken for extended periods for acne rosacea, a less than life threatening condition.
What I mean to say, is that people should try to keep an open mind; that is something to take pride in.
Why would I be proud of someone for being uncomfortable taking a treatment they know nothing about? Isn’t it obvious?
That’s exactly my point. Too many people are taking things they know nothing about. Recently the report came out that a huge number of doctors are giving patients antibiotics as a placebo! I’m uncomfortable with that, yes.
Yes, people should keep an open mind – and people with NDPH mostly do, from what I see. But they should also not blindly take whatever is recommended – they should be cautious, and most people know that.
Taking an antibiotic requires extra caution. Nowhere in my post am I suggesting people completely avoid antibiotics. I’m pointing out 2 things:
1) This study is not just about an antibiotic. It may be a breakthrough in understanding how NDPH works, and a doorway to new and better medications.
2) If someone is going to take an antibiotic, for anything, they need to be cautious. Yes, if they’re taking it without knowing all the facts, they should indeed be uncomfortable, to say the least! (and please note I specifically pointed out that there needs to be a doctor/patient relationship)
If larger studies show this treatment to be safe, I will have no trouble recommending people talk to their doctor about it. You’re right, this is a very difficult condition to treat, and I’ll celebrate when we can help a larger number of patients!
But please, get the facts, talk to your doctor, and feel free to get second opinions. And I think we can still be cautiously optimistic about this study.
Can you fwd a pointer to the original article?
Or provide any additional info about what exactly you mean by the
“inflammation chain reaction” is that is being stopped?
My neurologist mentioned to me today that there is a growing number
of reports of success for this treatment. I would like to understand
more about the mechanism, and the hypothesized impact of the
antibiotics.
Long before I ever heard of this, I noticed a correlation that I felt much better, and had far fewer headaches, when on antibiotics for some
other condition (sinus infection, etc.).
Hi Lisa,
Sorry about the missing link.
I read about the study in the abstracts from the 50th Annual Scientific Meeting of the American Headache Society. You can access it (it’s a pdf file) here: Program Abstracts
There is a brief explanation there of how the doxycycline may work. It mentions CNS (central nervous system) inflammation, and how doxycycline may stop CNS inflammation from happening in the first place.
Again, this was a very small “open label” study, which means the patients were aware of the treatment (as opposed to a blind of double blind study).
For more on problems with antibiotics, here’s an article from the FDA in the USA on the reasons for antibiotic resistance in society. Basically, the problem is on a personal and a worldwide scale. Taking antibiotics only kills certain strains, and so can allow resistant strains to flourish. The result is that an individual may take longer to get better, or may need different kinds of antibiotics as time goes by. On a worldwide scale, the concern is that new strains (perhaps a “super-bug”) may emerge, and we won’t have the right kinds of antibiotics to fight it.
Thanks for your questions – hopefully that will start you on your research! This is really just an early phase of study, and we’ve a long way to go before we understand how it works, or even if it will work significantly for a good percentage of people.
I have monthly hormonal migrains (severe) and rosacea. For the rosacea I am on doxycycline (works pretty good!), but now really curious if it will help with the migraine as well, as both are, as I understand, related to inflammation of the vessels. Wouldn’t surprise me! But I’ll let you know if it works.
i am 53yr old female. i have suffered from migraines since i was
in my late twenties, i also suffer from severe depression. In the last 4-5 yrs, my migraines have skyrocketed. I have horrible pain everday, I live on Imitrex, I know that can’t be healthy. i also have severe neck pain which i did find out were two bulged discs. doctors assure me it is not severe enough to cause my headaches! I have even had cortizone injected into my neck to help the pain, it didn’t help much and of course it wears off fairly quickly. I am at my wits end. i don’t think i have left my house all summer. i walk outside and the heat hits me like an oven, the sun almost blinds me and i get sick very quickly. it starts with profuse sweating, my face turns red and feels like its on fire, then i get a horrible migraine. so i stay in my air conditioned house with shades drawn in the dark, but now i am still getting migraines everyday. i feel overwhelmed. my family doctor seems a litte disinterested in treating me.
so i ask:
what type of doctor should i see?
what should i take with me when i go?
i would also like to hear from anyone who has aquired a good treatment plan.
thank you SJW