Treatments

30 March 2018

Migraine and Headache and Pregnancy Q&A

We have talked about headaches and migraine and pregnancy frequently at Headache and Migraine News. For example, don’t miss The Myth-Busting Guide to Migraines and Pregnancy for a good overview. We’ve also looked at some fascinating statistics about migraine during and after pregnancy.

We’ve also talked about the hot topic – How Dangerous are Migraine Drugs during Pregnancy?

For more information, just do a search here.

It’s always good to get another perspective, and NeurologyAdvisor recently published a Q&A on the topic with Dr. Matthew Robbins, associate professor of neurology at Albert Einstein College of Medicine, and director of inpatient services at Montefiore Headache Center New York.

I’ll let you read the article yourself, but I especially appreciated Dr. Robbins simple but helpful advice near the end.

I think some of the commonsense strategies of avoiding triggers is critical. Pregnancy is a time when usual routines can be disrupted, so the normal lifestyle strategies to help migraine should be especially emphasized during pregnancy. These include staying well hydrated (especially in early parts of pregnancy if someone has morning sickness), and getting regular sleep and maintaining low-grade or normal-level exercise. Nonpharmacologic treatments that are strongly evidence based for migraine, including biofeedback and relaxation training, certainly are good treatment strategies as well as preventive measures.

Your schedule is naturally disrupted during pregnancy. So – this is a great time to stop and evaluate your habits. And it’s important to develop healthy, regular habits that will help you avoid headache attacks.

Read the full article here: Managing Headache in Pregnancy: Q&A With Matthew Robbins, MD

19 February 2018

Another Link between Alzheimer’s and Migraine?

James Discoveries & Stats, Treatments 0

A recent study has uncovered a possible link between migraine and dementia.

As we’ve talked about before, most doctors and researchers will tell you that there is no connection between migraine and Alzheimer’s. At least, no solid connection.

A link between Alzheimer’s and Migraine? In other words, you probably don’t have to be afraid that your migraine attacks will lead to Alzheimer’s later in life. Read more here: Alzheimer’s and Headaches

However, there are enough similarities between the two – symptoms and related conditions – to make you wonder if there may be a connection somewhere.

This study was about dementia in general (Alzheimer’s is a type of dementia). The researchers looked at magnesium levels in 10,000 patients, finding that those with low – and high – magnesium levels were more likely to develop various types of dementia.

Now we don’t know why high magnesium levels would relate to dementia. Hypermagnesemia, as it is called, is quite rare – in fact, only two of the patients who developed dementia had high magnesium levels – that’s only 0.24%, so that makes it hard to develop any strong conclusions.

However, patients with low magnesium made up over 13% of the dementia patients.

There are various theories about why low levels of magnesium would be related to dementia, but we do know that many migraine patients have low magnesium levels, and many benefit from taking magnesium supplements.

Although the researchers emphasize that more study is needed, the bottom line for us is that it is wise to keep your magnesium levels in the normal range. In the study, the researchers used a blood test that checks serum magnesium levels. You can also try the magnesium RBC blood test, which seems to be more accurate.

For some important notes about the RBC test, see Magnesium RBC Blood Test from Dr. Carolyn Dean (author of the very highly rated The Magnesium Miracle).

For more on this study from the migraine perspective, see Dementia and magnesium levels.

To see the abstract of the study, visit: Serum magnesium is associated with the risk of dementia

15 February 2018

Sleep, Bruxism, Headache and … Botox?

James Discoveries & Stats, Treatments 0

Often, seeing connections between two conditions can help us find better treatments for a particular patient. And a recent study on Botox and bruxism may lead to better treatments for migraine.
Bruxism and Migraine
Bruxism refers to the clenching or grinding of your teeth at night. You can do it, and not even know it. But it could be a trigger for migraine attacks, or tension type headache.

There are some effective treatments that can help with bruxism – and are likely to help with headaches too – such as the NTI-tss device.

But a recent study suggests that onabotulinumtoxinA, well known under the brand name Botox, may help with bruxism as well. (Abstract: Onabotulinum toxin-A injections for sleep bruxism)

In the (small) study, some patients were given a placebo, and others Botox injections. Those who received the injections were more likely to improve over the next few weeks.

Although only a small introductory study, these results may tell us a couple of things. First, if you have migraine and bruxism, it may be more likely that Botox will work for you.

Also, doctors who know that their patients are dealing with migraine and/or tension-type headache may find that they can treat both with Botox. Will this also inform which injection sites are used in various patients – that is, what type of Botox treatment they get? It could very well be.

Have you found Botox helping you with bruxism, or at least helping you get a better sleep? Leave a comment!

For more on the study, see

12 February 2018

Device Approved for Migraine in the USA: gammaCore

James Treatments 0

Two weeks ago, the gammaCore device was finally approved for migraine treatment by the FDA. You can read the press release from the company here: gammaCore® Receives FDA Clearance for the Acute Treatment of Pain Associated with Migraine Headache in Adult Patients

The device is not new – it’s been used for migraine and cluster headache for quite some time. It’s a non-invasive vagus nerve stimulator, which means no implanted devices.

Kerrie Smyres over at The Daily Headache has put up some excellent information about the device, so I’ll link to our previous information here, and her newer info, which also discusses cost and insurance (brace yourself – this treatment is not cheap right now!). But first, here’s a video from the makers of gammaCore:

26 January 2018

CPAP and Headache: for Better or for Worse?

James Discoveries & Stats, Information, Tips, Treatments 3

Most people know CPAP (Continuous Positive Airway Pressure) as a treatment for sleep apnea. Essentially, a machine connect to a mask, which pumps air under pressure to the lungs, keeping the windpipe open while you’re asleep. The windpipe remains “unobstructed”, thus helping with obstructive sleep apnea.

CPAP and Headaches — Illustration courtesy PruebasBMA

But over the past few years, patients and researchers have become interested in another aspect of CPAP machines. That is, their relation to headaches.

There are three aspects to this question:

Could CPAP machines actually cause headaches, or at least make them worse?
Is sleep apnea related to headaches and migraine? In other words, could treating sleep apnea also fight headaches?
Could CPAP machines be a treatment for headaches, migraine, and even cluster headache?

Let’s start with #1. Yes, some people have noticed an increase in headache symptoms when they use the CPAP machine. This shouldn’t be surprising – any significant change can certainly trigger an attack in people with migraine disease.

However, there may be some good solutions (besides avoiding CPAP treatment). One would be “giving it time”, of course, but one business focused on sleep related medical equipment reports that there could be a simple solution:

Sinus systems extend behind your ears. When a CPAP is used and part of the sinus cavities are blocked, a situation is created where there is a pressure differential between the sinus cavities affected. These pressure differences can sometimes be felt as sinus headaches or just plain headaches, even though they are caused by sinus blockages. These can be treated using over the counter medications to open the sinus. CPAP heated humidifiers can also open and maintain sinus systems. If you do not use a heated humidifier, we strongly suggest using one. If this does not correct the problem, visit your ENT. [Why do I have a headache when I wake up?]

These are common recommendations from both companies with experience and doctors. Check if a pressure adjustment is needed, and consider a CPAP heated humidified (and make sure it’s working properly).

Also, you may have a reaction to the straps used for the mask. See if you can loosen them or try a different type of mask/strap.

While a temporary increase in headache symptoms may be common, it’s also common that headache symptoms decrease – or disappear – when a patient starts using a CPAP.

A few people from our community have shared their stories of unexpected success – see Sleep Apnea and Migraine – Comments from You!

It seems that sleep apnea (sleep apnoea) is a significant trigger for headache attacks, such as those from migraine. In 2013, for example, a study was released that showed significant improvement in migraine patients with sleep apnea who started using CPAP (CPAP Improves Migraine Burden in Patients With Sleep Apnea). Another study also found that patients with obstructive sleep apnea and migraine often improved significantly if they were committed to CPAP treatment.

Could CPAP work specifically as a treatment, even if patients aren’t diagnosed with sleep apnea? And which patients are most likely to benefit?

Much more study is needed, and some studies are beginning. For example, a CPAP study in Norway will be evaluating the use of CPAP for cluster headache treatment.

In the mean time, it’s very important for doctors to pay attention to the sleep patterns of headache patients. There are probably a high number of patients with headache symptoms who have undiagnosed obstructive sleep apnea. In fact, doctors could make a lot of headway just by asking a simple question – When you woke up this morning, did you feel refreshed?

For more on sleep apnea and migraine in particular, listen to this podcast.