Discoveries & Stats

20 March 2017

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 â€“ 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 SphenoCathÂ® 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.

17 March 2017

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

James Discoveries & Stats, News, Treatments 0

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 Migra Recently 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

9 March 2017

Transient Global Amnesia: Risk of Related Problems?

James Discoveries & Stats 0

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

13 February 2017

Migraine and Epilepsy: A Common Target?

James Discoveries & Stats 0

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 Target One 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

9 February 2017

Women, Migraine, and Stroke

James Discoveries & Stats, Information 1

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.

RISK For 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