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War Veterans and Migraine

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Soldiers with migraine.  It may not be a new problem, but it’s a problem that is slowly being recognized.

Sadly, the chronic headaches and migraine in veterans is an issue that is still little understood.  We do know that the problem is a large one.  Many soldiers in particular who have been exposed to blasts and head injuries of various kinds are dealing with serious pain even after the injury has "healed".

Soldier migraine

It has been estimated among soldiers from the USA that 1 in 5 or more returning from Iraq have migraine.

In the United States the problem has caught the attention of the National Headache Foundation.  They’ve set up a special area on their website focused on providing resources for war veterans.  Partnering with other organizations, they’re introducing veterans to quality products, such as SootheAway, links to specific associations that can provide help, such as The Brain Injury Association of America, and more.

War veterans can also become members of the National Headache Foundation for one year for free.

It’s good to see organizations like the National Headache Foundation providing resources for special groups like this, that are at high risk of headache and migraine.

I would love to know of other countries that are providing some kind of specific help to war veterans.  If you’re aware of similar programs in your country, leave a comment!  Or, if you wish there were, you might also want to leave a comment!

Calcium Channel Blockers and Antibiotics – Dangerous Combination

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Researchers at the Sunnybrook Research Institute in Toronto, Canada, warn that taking calcium channel blockers (calcium antagonists) along with certain antibiotics could lower blood pressure, and be dangerous to high risk patients.

It’s always wise to keep up with the latest research on drug combinations, since patients seem to be taking more and more medications together.  This recent research could impact migraine and cluster headache patients, who often take calcium channel blockers (CCBs) as preventatives.

CCBs that are commonly taken for migraine or cluster include diltiazem (Cardizem, Dilacor and Taztia), nifedipine (Adalat, Procardia, Nifediac and Nifedical), nimodipine (Nimotop) and verapamil (Calan, Verelan, Covera-HS and Isoptin).

Now CCBs are actually prescribed in order to lower blood pressure.  So we’re already aware that this can happen.  The concern, however, is that taking the CCB along with certain antibiotics could actually increase the effect to dangerous levels.

The antibiotics we’re talking about are macrolide antibiotics.  These antibiotics include erythromycin, clarithromycin, spiramycin, josamycin and azithromycin, and they’re very widely used, with millions of prescriptions being written each month.

The research involved elderly patients only, the ones who would be at the highest risk.  Using public health records, the researchers discovered that patients on CCBs who had received the antibiotic erythromycin were six times as likely to be hospitalized for hypotension.

Would the same hold true for younger patients?  Likely there will be a drop in blood pressure, though younger patients would be at a lower risk overall.  The important thing to remember is that you need to let your doctor know what medications you’re taking.  It’s easy to get a quick antibiotic when you’re feeling terrible, not thinking about other conditions that don’t seem to be related.

Being simply a survey of public health records focused on a certain group, more research needs to be done to understand the impact on migraine and cluster headache patients of various ages.  In the mean time, this is another reminder that your doctor needs to know if you’re at high risk for other condition, and she needs to know what medications you’re taking.

Read more:  Calcium channel blockers and antibiotics might be a bad combination in the elderly, study says

How Do We End the Pain of Migraine? (Guest post)

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Cathy Glaser, President of the Migraine Research Foundation, was kind enough to write this note to you all.  Feel free to share it with family and friends.  Thank you so much for your support of migraine research!

How Do We End the Pain of Migraine?

The Migraine Research Foundation

Recently, I attended a lecture given by a prominent neurologist on new advances in migraine research.  Speaking to an overflow crowd, the doctor was bombarded with questions from the audience – all sufferers or family and friends of sufferers – about what can be done to end the debilitating pain of migraine.  The audience’s hunger for information was reflective of a frustrating fact of life for sufferers.  While much of the conversation about migraine centers on symptoms and treatment options, there is insufficient knowledge about the underlying causes of migraine.  Without this, how are we to end the suffering of the 36 million Americans afflicted by it?  The reason?  Migraine is one of our nation’s most overlooked, misunderstood, and under-funded illnesses.  Though migraine affects 1 in 10 – including children and a disproportionate number of women – and ranks in the top 20 of the world’s most disabling illnesses, funding for research into its causes is shockingly low.

Part of the explanation is that because migraine has no outward physical expression and is not usually life-threatening, many people don’t realize how serious and debilitating it can be.  But the consequences can be extremely severe.  In addition to living with the pain itself, many sufferers miss work, school, and social activities, and sometimes must sacrifice their careers and livelihoods.  Every 10 seconds someone goes to an emergency room with headache or migraine.  And 14 million Americans live with chronic migraine, a condition much more difficult to treat than the more common episodic migraine.  Almost everyone, it seems, either suffers from migraine or knows someone who does.

Sharing experiences about triggers and treatments is one way to provide support to sufferers, but the only way that we will ever make real progress against this scourge is through funding migraine research.  We must support scientists so that they can continue to investigate the links between hormones and migraine, the causes of pediatric migraine, the effects of medication overuse, the reasons for the transformation of episodic to chronic migraine, the role of genetics, and many other inquiries.  Migraine research has lacked for funding and support for far too long.  Only by helping research scientists discover migraine’s causes will we eventually find effective treatments that will enable sufferers to live healthy, happy, and productive lives.  But effective treatments shouldn’t be our only goal.  We must work to find ways to prevent migraine, and even to cure it.

Cathy Glaser, President
Migraine Research Foundation

Find out more about the Migraine Research Foundation here.

Vasodilation and Migraine – The fall of a theory

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Blood vessels have sometimes been described as "smart pipes".  Not only does blood move through them, they are also involved directly in controlling the rate of flow.  They can get bigger and smaller, processes known as vasodilation and vasoconstriction.

Once upon a time, migraine was known as a "vascular" disorder.  In fact, some form of this theory has been around for 350 years.

Migraine and Vasodilation in The Lewiston Daily Sun 1974
The Lewiston Daily Sun, May 1974

The idea was that the dilation of blood vessels directly led to the pain of migraine.  And so, some treatments focused on constricting the blood vessels.

There were various clues that led researchers to buy into the theory.  For example, ergotamine treatments also seemed to constrict the blood vessels, as it calmed the migraine attack.  And, in fact, the very popular Triptan drugs were developed as vasoconstrictors!  Now we believe that they work for a totally different reason.

But in recent years, the vasodilation theory has been falling apart.

First, we discovered that the migraine process was much more complex.  Though vasodilation may happen, there’s much more to a migraine attack than just changes in the blood vessels.

So vasodilation is not the key element of migraine.  It’s not enough to explain migraine symptoms.

Not only is this not a sufficient cause, we now know it’s not even necessary.

Migraineur advocate Teri Robert, reporting on a presentation of the American Headache Society in November, summed it up this way – Vasodilation may occur as part of the disorder, but is not required for Migraine pain.  (Read Vasodilation Not Necessary for Migraine)

In other words, vasodilation may not happen at all in a migraine attack!

That doesn’t mean it doesn’t happen commonly, simply that it’s not required.  It may often still be a part of the process, but it’s not they key aspect, and certainly not the cause of all migraine pain.

The report at the AHS meeting, presented by Dr. Andrew Charles, also pointed out that some drugs that cause vasodilation do not cause migraine attacks.

What does this mean for the patient?

  1. We can now know that information claiming migraine is a "vascular disorder" caused by vasodilation of the blood vessels is out-dated.
  2. We can give a lower priority to treatments that claim to stop migraine by vasoconstriction.
  3. We don’t need to be afraid of medication just because it may cause vasoconstriction.
  4. We can be glad that the medical community is being freed from this erroneous idea.  This is actually opening the doors to new treatments that focus on other more foundational aspects of migraine.

Further reading: The vascular theory of migraine—a great story wrecked by the facts

Melatonin and Migraine Study – and the investigation continues…

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Another study on melatonin is out – this time telling us that it’s not helpful for migraine.  But, as usual, that’s not the end of the story.

The study published in Neurology wasn’t huge, but it was a randomized, double-blind, placebo-controlled crossover study.  Both men and women with 2-7 migraine attacks per month were a part of the study, and 46 people completed the study.

This time 2mg of extended-release melatonin was given 1 hour before bedtime for 8 weeks.  To find out more about the details of the melatonin study, read here.

Melatonin and Migraine - the Investigation Continues

Migraine frequency decreased quite a bit – on average, the patients had one or two fewer migraine attacks per month.  But… that includes all the patients.  The results were almost the same for the patients taking a placebo.

So, we have another study confirming the placebo effect, which has been much in the news lately.

But does this study tell us that melatonoin doesn’t work for migraine?

As with any good scientific study, this one tells us something, but it has boundaries – it’s limited.  Questions such as,"would melatonin be a help to certain subgroups of migraine patients?" remain unanswered.

But the bigger debate at the moment is about the quantity of melatonin.  For example, a 2004 study suggested that 3mg (instead of 2) would be helpful.  Others have suggested that 0.3mg of melatonin is as good, or better, than a higher dose.

Why are we even having this discussion about melatonin?  There are many reasons, actually.  We do know that sleep cycles are closely related to disorders like migraine.  Melatonin may also be helpful in comorbid conditions such as fibromyalgia, and related conditions such as cluster headache.  Melatonin is also a part of the chain reaction in the body that involves serotonin, which has long been linked to migraine.

But the connections are complex, and because we don’t understand exactly how melatonin may help with migraine attacks, it takes a lot of time and trial and error to find out if it could actually be an effective treatment.

So, this trial doesn’t invalidate the use of melatonin for migraine prevention – it just suggests that 2mg may not be the best dosage for many (most?) people.

So, should you try it?  Here are a few things to think about if you’re considering it:

  • As with any natural treatment, be sure to discuss it with your doctor (preferable a migraine specialist) before you start.  This should be a doctor that knows your medical history.
  • The good news is, melatonin is fairly mild in the doses we’re talking about.  You should experience very few problems trying it for a short period of time under a doctor’s care.
  • Be extra sure that your doctor knows what medications you’re taking.  Taking melatonin with antidepressants and antipsychotics, sedatives, anticonvulsants (such as topamax), and certain other drugs, can be dangerous.
  • Investigation has found significant impurities in some brands of melatonin, and related products suchs as L-tryptophan and 5-hydroxytrytamine.  Use a well recognized brand you trust. (see Cauffield JS, Forbes HJ. 1999)
  • If you’re simply having trouble sleeping (or, I should say, "only" or "mainly" – sometimes insomnia isn’t so simple!), talk to your doctor about other methods – other medications, and better yet lifestyle changes (a darker room, less caffeine, a better rhythm of life in the evening, exersize, etc).

I continue to hear about migraineurs that have been helped by melatonin.  It’s still worth considering, though it won’t be at the top of your list.

Read more about melatonin
A specialist’s opinion on the new study

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.