We’ve talked a lot about the pros and cons of Botox for migraine here. One of the biggest challenges with Botox treatment is that it is, in many ways, still in its infancy.
Photo courtesy Armin KübelbeckThat is, we still have a lot to learn about who will benefit most, what dosage to use, and where the injection sites should be. But we do know that treatment should vary depending on the patient.
After a frustrating experience trying to pass on the treatment of an 83 year old woman, Dr. Alexander Mauskop at the New York Headache Center takes the time to VENT – and to remind doctors that there is no such thing as a one-size-fits-all Botox treatment.
Doctors, it’s worth whie to read a little about Dr. Mauskop’s experiences. He has used Botox with many patients for 22 years, and takes the time to keep track of how well it works, how often it should be administered, and how.
Although more clinical trials do need to be done, it’s helpful to at least read about the experiences of other doctors.
A new report suggests that doctors should take women seriously when new headache symptoms crop up late in pregnancy.
As we’ve talked about before, migraine symptoms in particular tend to either stay steady or even lessen during pregnancy – although sometimes they get worse (see Migraine During and After Pregnancy).
While headache symptoms anytime during pregnancy should be a concern, a recent report suggested special caution if there are headaches late in pregnancy, or even right before/after the birth of the baby.
Researchers at Icahn School of Medicine and Weill Cornell Medicine (both in New York, USA) suggest that brain and/or vascular imaging may be necessary to rule out urgent concerns. They write:
There is considerable overlap between the cerebrovascular complications of pregnancy, including preeclampsia/eclampsia, posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), and both hemorrhagic and ischemic strokes; although, their imaging may be distinctive. Imaging is necessary to distinguish between arterial and venous pathology causing headache in the peripartum patient, as there can be similar presenting symptoms. Mass lesions, both neoplastic and inflammatory, can enlarge and produce headaches and neurological symptoms late in pregnancy. Imaging of Headache in Pregnancy.
So basically, there are a variety of conditions that may “look” the same in the doctor’s office. Imaging techniques will help to narrow down exactly what is going on so that you can get the treatment you need.
Your doctor can help guide you and tell you the type of testing you may need. Whatever the case may be, remember that any new headache symptoms during pregnancy are a reason for concern, and should be discussed with a doctor who takes your concerns seriously.
It’s been a while since we talked about SpringTMS, so it’s time to bring it up again. SpringTMS is a transcranial magnetic stimulation (TMS) device which you use as soon as you feel a migraine attack coming on.
Devices like SpringTMS are increasingly popular because they lessen your need for medication, they’re easy to use, and there are few if any side effects. Of course the main benefit is that, in many patients, it stops the symptoms of migraine. Read more about SpringTMS here.
The device is currently available in the USA and the UK. I’m not sure about its availability or the logistics of getting it elsewhere, but if you have experience outside of the UK or US leave a comment.
In the UK, SpringTMS is available by prescription through a cost sharing program. It’s available at certain clinics in London and other locations in England. For more information, visit the official UK website here. The company is eNeura.
In August, Kerrie Smyres did the legwork for us to get information about obtaining (and paying for!) the device in the USA. Essentially, SpringTMS is available by prescription under a rental program, and so the price will vary depending on the rental plan. There may be reimbursement through your insurance plan.
But I will let you read Kerrie’s post for more details. Some of the information is applicable in the UK as well, so check it out if you’re interested: Your Guide to Getting a Spring TMS
We’ve talked often about magnesium for migraine, as one of the best treatments for migraine available today. As with any treatment, however, it works for some people and not for others.
Of course, in spite of our clumsy comparisons of the body with a machine or a computer, each human body is actually incredibly unique and complex. So nailing down the “whys” is sometimes almost impossible.
Fatigue: An early sign of magnesium deficiencyPart of the reason may have to do with the level of deficiency in each person. A magnesium deficiency may contribute to migraine attacks in some patients, but not all actually have a deficiency.
There are many other factors as well. The type of magnesium, when you take it, what you take it with (for example, if you’re taking magnesium for migraine, avoid taking it along with calcium) (more tips here).
Dr. Alexander Mauskop at the New York Headache Center has shared some interesting observations, which point to the need for further research into magnesium for migraine.
Here are some of his thoughts:
Magnesium seems to help less than 50% of migraine patients (Dr. Mauskop feels that this is because the rest do not absorb the magnesium).
About 90% of patients with an actual magnesium deficiency improve with magnesium supplements.
The other 10% require regular infusions of magnesium, and “these infusions are often life-changing”.
Now there is another interesting new observation here. Of these last 10%, two patients recently noticed a significant difference between two methods of infusion. Dr. Mauskop explains:
These patients tell me that when we give them an infusion of magnesium by “slow push” over 5 minutes they get excellent relief, but when they end up in an emergency room or another doctor’s office where they receive the same amount of magnesium through an intravenous drip over a half an hour or longer, there is no relief.
A likely explanation is that a push results in a high blood level, which overcomes the blood-brain barrier and delivers magnesium into the brain, while during a drip, magnesium level does not increase to a high enough level to reach the brain.
Essentially, and this seems to be the case sometimes with sumatriptan as well, two patients may take the same amount of medication or magnesium, but one has a “quicker” dose. The one who has the “quicker” dose responds better than the other patient.
While we wait for more studies to be done (and a good question is – does generic plain old inexpensive magnesium get the funding that the fancy new medications do?), how can we use this information?
First, if you have tried some magnesium supplements without success, consider actually being tested for a magnesium deficiency. If you are deficient, it will definitely be worth trying more magnesium options, even if it takes time.
Second, remember that there are a lot of options when it comes to magnesium treatments. Try some different supplements, and consider talking to your doctor about infusions.
Finally, if you do receive infusions, ask about the 5 minute “slow push” method that Dr. Mauskop mentions. It may do more to stop those symptoms than the slow-drip method.
Every once in a while it’s good to be reminded that a lot of the advice we’re given is, sadly, not worth a lot. Teri Robert, in her book Living Well with Migraine Disease and Headaches, gives these “great” examples:
“It’s all stress. Learn to relax.”
“Get pregnant. Your headaches will stop.”
“Have a hysterectomy. Your Migraines will go away.”
“Congratulations. You’re an intellectual and have Migraines. Take some acetaminophen.”
“Just wait for menopause. Then they’ll stop.”
“You’re too high-strung and have a headache personality. See a psychiatrist.”
“It’s a woman thing.”
“If triptans don’t work, it’s not a Migraine.”
“It’s just something you’ll have to learn to live with.”
“Just take a nap when you get a headache.”
“Stop taking everything so seriously.”
Ouch. In case we don’t believe it, Teri notes beside the fourth one on the list that she personally actually did have a doctor tell her that once!
Have you ever been told any of the above? Or do you have another not-so-brilliant piece of advice that you’ve been given? Share it in the comments.
Incidentally, you can read some good advice if you get Teri’s book, but she does remind us in this chapter that hitting the person who says something like this probably isn’t the best. Instead, “Politely tell the doctor that his or her services will no longer be needed, then leave.”
The device is currently available in the USA and the UK. I’m not sure about its availability or the logistics of getting it elsewhere, but if you have experience outside of the UK or US leave a comment.
