Alexander Mauskop

7 March 2024

More on [Avoiding] Heartburn Medications

It’s been several years since we talked about headache and heartburn medications, but it’s such a big issue that we should probably revisit the question more often.

Woman with heartburn, headache, and gut problems.

As you probably don’t recall, we were talking about “Why Headache Patients Are Running from Esomeprazole (Nexium) and other “Heartburn” Drugs”. The main concern are proton-pump inhibitors (PPIs), and concerns seem to be rising rather than subsiding.

Back then we were talking about the link to headache, which may be especially linked to certain deficiencies that use and long-term use of medications such as Nexium, Prilosec, Dexilant, and others may cause.

Prompted by 2023 study, which once again linked PPIs with dementia risk, Dr. Alexander Mauskop at the New York Headache Center updates us with a few more years of experience on the topic.

First, he points out the specific link to migraine – “…one study found that past and current use of PPI increased the odds of migraine by 2.56-fold and 4.66-fold, respectively”. In other words, current use significantly increases risk, but even past use may increase migraine risk.

But most helpful were his tips on quitting PPIs:

Stopping a PPI can cause severe rebound acidity. This is why people get stuck taking them for years. The way to try is by replacing the PPI with an H2 blocker such as famotidine (Pepcid, Zantac 360) along with an antacid such as Rolaids (it’s better than Tums because it contains not only calcium but also magnesium) or Gaviscon. After a few weeks, people can often stop famotidine and after another few weeks, stop the antacid. Famotidine does not cause problems associated with PPIs.
Dr. Alexander Mauskop

There is also some advice for those who need to be on PPIs for certain conditions. You can read the whole post here: More on the dangers of PPIs such as Prilosec, Nexium, Dexilant, et al.

One thing to consider is whether or not you may have a vitamin deficiency or ongoing problems with your gut flora. It might not hurt to check your B vitamin levels, and magnesium levels. Also, remember to keep your gut healthy. You may want to try a probiotic such as Primal Defense Ultra. (I’m very picky about probiotics, because so many are not as advertised, and others don’t have the types of probiotics you need most.)

29 June 2021

“The End of Migraines” – Is the New eBook Worth a Read?

James Resources 0

Published earlier this year, The End of Migraines is the latest work from neurologist and migraine specialist Dr. Alexander Mauskop. There are a lot of books on migraine out there, and of course a lot of information online. So is this particular book worth your time?

The End of Migraines: 150 Ways to Stop Your Pain

Dr. Mauskop admittedly comes to the topic from a unique perspective. Not only has he suffered from migraine himself, he has also treated migraine patients personally for decades. He founded and directs a migraine clinic (the New York Headache Center), and has also been involved for many years in migraine research. There are few professionals in the world that could boast the same credentials.

He has also written before, both books for migraine patients and for professionals, and has published in many scientific journals.

So in his new book, Dr. Mauskop has combined that experience with a recognition of the quickly changing and advancing world of migraine medicine. He decided to publish in eBook format, not only to make it affordable, but also “to be able to update this book regularly, as new scientific data emerges”.

Along with important background and basic information on migraine (as well as quite a few other headache conditions), the book is basically an index of current migraine treatments – hence the full title, The End of Migraines: 150 Ways to Stop Your Pain. Combining his extensive personal experience with the scientific literature, he discusses each treatment and actually gives it a rating from 1-10 (although he doesn’t include any 1s, and doesn’t give anything a 10). The eBook format allows him to link directly to articles, studies, papers, and other resources for those who want to investigate further.

One of my favourite quotes from the book: “When a link to a scientific study is provided, you need not assume that the study proves something.” We would all do well to take that advice. It’s not skeptical in a negative sense – it’s realistic. For years, doctors and researchers have been expressing their concerns about the way in which studies are used. Dr. Mauskop’s recognition of the the value and limitations of these studies, including the reality that every person is complex and different, is a breath of fresh air.

No one, including myself, will agree with all of Dr. Mauskop’s choices of treatments. (There are some interesting treatments on the list, such as the unusual combined discussion of prayer and cursing (not blessing and cursing – more like certain forms of prayer, and swearing!)) But I appreciate the approach of admitting that there is always some subjectivity involved, while also pointing to the research of others.

Many of you will also appreciate the fact that this is not a listing of drugs. Yes, there is extensive discussion of various medications. However, Dr. Mauskop doesn’t begin with medications or push them as the only or even preferred solution. Migraine-fighting devices, lifestyle choices, triggers, supplements, and many other treatments and related conditions are investigated.

And they are all discussed succinctly – that is, a lot of information is quite often packed into a couple of paragraphs or a couple of pages. This is a book that is easy to scan, and an invaluable resource when you want to get the quick facts on some new treatment you’re considering. You could just flip through and do further investigation of any treatment that was rated higher than “6”. Or look up that treatment that Auntie Lisa mentioned. Or simply flip over to Dr. Mauskop’s top 10.

So yes, I highly recommend The End of Migraines. The combination of up-to-date information, prioritizing of what seems to work best, and experience with real people, make this a book that every migraine patient should have on their virtual shelf. (I should note that yes, you can purchase a printed copy if you prefer, but I would recommend the digital copy if possible – the many links are invaluable.)

One more quote that may help you understand this book, before we go. Many of us are rightly skeptical when we hear anyone who is trying to offer us hope. Like many of you, I have heard the line from a doctor “We’ve tried everything”. While recognizing that there are difficult cases out there, the truth is that – no, you most certainly have not tried everything.

Writing about refractory or resistant migraine, the author lists 16 treatments that some suggest you should try before being diagnosed. Then he writes:

If a doctor labels you as having refractory migraines, do not despair – these are only 16 out of over 150 methods you can try.
Dr. Alexander Mauskop – The End of Migraines

Exactly. It’s time to fight back.

10 March 2021

Amnesia Risk and Migraine

James Discoveries & Stats, News 0

Today we’re talking specifically about a condition known as transient global amnesia (TGA). TGA is diagnosed when someone suddenly becomes disoriented – they don’t know where they are or what they were doing. You may tell them something repeatedly, but they keep forgetting.

It’s a frightening condition, but it only lasts a few hours. However, your doctor will need to rule out possibly related factors, such as stroke or seizures.

We have long known that there is a relationship between transient global amnesia and migraine, along with other types of memory loss.

The Journal of Neurology published a meta-analysis of recent studies this year on TGA and migraine. Although the biological connection between the two is not known, it appears that migraine patients are almost 2.5x more likely to suffer from TGA than the general population.

Writing about the recent study, Dr. Alexander Mauskop mentions another study from last year that suggests that migraine patients are also more likely to suffer from more than one episode of TGA, which is certainly concerning because most often people only experience it once. Family history of migraine also increased the odds of repeated TGA.

Transient global amnesia is still largely a mystery. Although it doesn’t usually seem to cause future problems (except possibly an increased risk of dementia in older patients with diabetes – see Dr. Mauskop’s article above), it’s disturbing to say the least and can have major life consequences. Migraine is, in fact, one of the only known risk factors, along with age (it’s most common between the ages of 50 and 70).

The Mayo Clinic has done work with TGA, so if you’re interested check out their fact sheet here: Transient global amnesia

9 January 2021

Is New Daily Persistent Headache an “unhelpful myth”?

James Discoveries & Stats 1

New Daily Persistent Headache (NDPH) is a headache diagnosis in the International Classification of Headache Disorders (I believe it was added in the second edition). But a new study is raising questions about the value of this diagnosis.

The key feature of NDPH is that the patient can remember when it actually started, and yet we’re basically not sure why it started. Obviously headache from head trauma would not be NDPH. However, there do seem to be some “triggers”, such as a recent infection.

You may remember some of the people who have told their story of living with NDPH (read more here). So the question is not “Is this real?” – yes, it is.

Let’s look at the study first. The study was published in the journal Cephalalgia, and focused especially on children and adolescents with NDPH. The conclusion of the study was that the vast majority of patients had migraine symptoms – in other words, we can call it whatever we like, but it looks like migraine. The authors of the study write:

Overall, youth with continuous chronic migraine and new daily persistent headache did not have clinically meaningful differences in headache features and associated disability. Findings suggest that chronic migraine and new daily persistent headache may be variants of the same underlying disease.
Clinic-based characterization of continuous headache in children and adolescents: Comparing youth with chronic migraine to those with new daily persistent headache

This is interesting because there are a lot of headaches that “may be variants of the same underlying disease”. For example, now that we know that tension-type headache is a lot closer to migraine and normally not actually caused by muscle tension (hence the updated name).

So why have this diagnosis in the first place? After all, we usually don’t use a separate diagnosis of any other disease just because we “clearly remember” when it started!

There’s a simple explanation. Researchers believed that there might be good reason why this headache is different. Might there be a different set of symptoms (this study suggests that the answer may be “no”)? Might there be a different kind of treatment that works? Might there be a biological difference that we don’t yet understand?

The authors of the International Classification of Headache Disorders 2 explained it this way:

The subcommittee aims to stimulate further clinical characterisation and pathophysiological research of this entity, especially studies comparing 4.8 New daily-persistent headache with 2.3 Chronic tension-type headache.
The International Classification of Headache Disorders 2nd Edition

The classifications are useful because they help us to communicate using the same language. But they’re not meant to be eternal truth. They change as we learn more, and find better ways to get directly to the best treatment for people who have the symptoms.

And this new study, and other past studies, are doing exactly what the ICH2 authors wanted. They’re studying NDPH.

Dr. Alexander Mauskop at the New York Headache Center believes that the diagnosis is simply an “unhelpful myth”. Why the strong language? Here’s what he says:

New daily persistent headache (NDPH) is one of the dozens of types of headaches listed in the classification of headaches. This particular listing causes more harm than good. NDPH is defined by the single fact that the headache begins on a certain day and persists without a break. The classification says that NDPH may have features suggestive of either migraine or tension-type headache.
There are no parallels to NDPH in medicine. There is no new daily persistent asthma, or new daily persistent colitis, or any other “new daily” disease.
There does not appear to be any justification for having NDPH as a distinct condition. It does not have a typical clinical presentation and it has not led to any research or treatment. When you search for this condition on the internet, you will not find any effective treatment for it. The suffering of many patients is magnified by the loss of hope, worsening depression, and flagging will to live.
Most importantly, some patients with NDPH do respond to treatment. According to anecdotal reports and in my experience, Botox injections, intravenous magnesium, preventive drugs for migraines, and other treatments can be effective.
New daily persistent headache (NDPH) is an unhelpful myth

Please note that Dr. Mauskop is not suggesting that NDPH “doesn’t exist” or is “all in the patient’s head”. What he’s saying is that separating this as a different diagnosis from migraine or tension-type headache is not getting any better treatment for the patient. Because the evidence that this is a “different disease” is not holding up well under new research.

The good news is that the New York Headache Center, and other doctors and specialists, have found that NDPH can be treated. Like migraine or tension-type headache, it depends on the patient. But just have a NDPH diagnosis should not lead you to give up on treatment.

What do you think? Is this a useful diagnosis? It would be especially helpful to hear from those who have been diagnosed with NDPH.

3 November 2020

Nerivio Device: New Approval and Real World Evidence

James Discoveries & Stats, News, Treatments 0

More good news about Nerivio (formerly Nerivio Migra), an electrical neuromodulation (REN) device to fight migraine attacks. We have some new information from real-world usage, and we have a new approval in the USA thanks to some other positive trials.

Nerivio is a clever device that hit the market about a year ago. It’s a patch that goes on your arm, which is controlled by your smart phone. It’s used to fight your migraine symptoms when an attack has started.

Originally approved for episodic migraine, researchers went on to see how it would work for chronic migraine. Two new studies – open label – showed that half or more patients had some relief from pain after two hours, and 20% or more were completely pain free after two hours (and the vast majority of those remained pain-free).

Although there is likely to be a high placebo effect in an open-label study, there’s more good news – the device seems to be very safe and well-tolerated. Read more here: Nerivio Device Cleared for Use in Patients With Chronic Migraine

And so the FDA in the USA has approved Nerivio for use with chronic migraine patients, not just episodic. This is great news for those who want to try Nerivio, even if they have more frequent attacks.

But after a year, how is Nerivio working for patients with episodic migraine? Patients were checked from two groups. One group had in-person visits with a migraine specialist, another had virtual visits with a non-headache specialist.

In the first group, 58.9% were pain free at the two hour mark in at least 50% of their attacks, and in the second group 74.2% were pain free at two hours in at least 50% of their attacks. (Before you decide to never visit a specialist again, these were not groups the researchers divided up. It’s likely that the headache specialist group were simply patients with harder to treat migraine – meaning that 58.9% headache-free is actually a really good number!) A large number were not pain-free, but had significant pain reduction. (Details here – Real-world Experience with Remote Electrical Neuromodulation in the Acute Treatment of Migraine.)

Once again, perhaps the best news of all – only 0.5% experienced a side effect from the device. That’s really low, if you compare it with most of the drug treatments available.

So in short – Nerivio is now officially approved for chronic migraine in the USA, it works well for some patients, and seems to be very safe and well tolerated so far.

Dr. Alexander Mauskop at the New York Headache Center adds an extra tip for patients and doctors – that they take the time to relax during the treatment. He also notes that many patients find the treatment itself to be relaxing.

Have you tried Nerivio? What’s your experience so far?