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 [sorry, video no longer available].
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.
Illustration courtesy PruebasBMABut 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.
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?
Cluster headache has the very appropriate name “suicide headache”. It’s rare enough that we haven’t studied it nearly enough, and yet common enough to affect our communities in a big way, and individuals in a huge way.
With a shortage of good treatments, you would think that doctors would prescribe whatever will work that’s not a huge risk. So why is one treatment often overlooked?
That treatment is oxygen therapy.
Oxygen therapy for headache was first mentioned in literature almost 80 years ago, so this is not a new therapy. It’s also considered to be a fairly safe, stable option. As the Migraine Trust says:
Oxygen is one of the safest ways to treat cluster headache. You need to breathe the oxygen in at a rate of between 7 and 12 litres per minute. The treatment usually starts to work within 15 to 20 minute. For some people the attack is delayed rather than stopped altogether. [source]
An article from the National Headache Foundation last month lamented the fact that oxygen therapy is still underutilized for cluster headache:
Despite treatment guidelines recommending the use of oxygen for the acute therapy of cluster headache, oxygen remains underutilized. A recent study looking at the cost of oxygen for cluster headache found the reason for its lack of use may be because of poor physician awareness of the treatment, as well as the lack of understanding for how to write and fill a prescription for high-flow oxygen.
According to a recent study, the price of oxygen therapy varies quite a bit, but averages out at around $1000 per year in the USA. Most private insurance plans will cover it. So – why not make use of it?
It’s time for an update on our discussion of pillows for migraines. You may remember, this was the topic of a podcast six years ago – The Practical Pillow Podcast. Since then, there has been a lot more written on the topic.
Unfortunately, if you’re simply looking for the “best pillow for migraine” you’re going to be disappointed. Yes, there is a lot of advice out there. But a pillow is a very personal thing. And a pillow that works for your friend may not work for you. You don’t sleep the same way, your headache condition may be different, even simple things like room temperature, or your weight, could make a difference.
So here are some of the most popular pillows for migraines today, and some quick facts about them.
Memory Foam Pillows: Let’s start with the simple memory foam pillow. These have gained in popularity over the past few year, and have helped a lot of people. There are variations on the memory foam pillow, which we’ll see below.
If you haven’t looked at pillows for a few years, you’ll see that things have changed. The technology has improved quite a bit, and there is much more variety. One of the most popular today is the Z Zoned Memory Foam Pillow, which is supposed to be a lot softer than similar pillows from past years. They also make a travel pillow.
A common complaint of these pillows is that they tend to have a manufacture-chemical smell at first. The smell does fade, but migraine patients find they need to leave the pillow out for a while before using it.
Still, many migraine patients used them. One reviewer writes:
I suffer with regular migraines and I quickly learned that the pillow I slept with was a huge factor on whether or not I was going to wake up with a migraine or not so I am very picky, so lets say, used to suffer with regular migraines! Basically I need my head to feel it is floating on a cloud of nothing or I will be miserable when I wake up. I chose the high loft so my head doesn’t “bottom out” and kinda just suspends in this middle of cloudy softness… call me weird in the comments if you want but once you try an amazing high loft pillow you’ll understand what I mean 🙂 [source]
Countoured Neck Support Pillows: Many looking for pillows for migraines immediately think of contoured pillows. Many of these are memory foam as well (which is why I spent extra time talking about memory foam above). A typical example is the inexpensive MEJOY Memory Foam Pillow. If you’re looking to avoid memory foam, check out the Snuz Neck Support Pillow (there is an extra-firm option).
Buckwheat Pillows: Buckwheat pillows have a number of advantages. They provide premium support, being very firm. They have no chemical-smell. They adjust to the shape of your head. And they’re cool. You can even put them in the freezer for an hour before you use them to really cool your throbbing head.
I’ve often talked about buckwheat pillows for migraines. If there is a downside, it’s that they are very firm. It really depends on how you sleep. Also, if you move around a lot, you can hear the shifting of the buckwheat hulls.
“Cooling” Pillows: Because of the pulsing, hot headaches that many of us get, “cooling” pillows are a great option. Now, just a caveat here. Cooling does not necessarily mean that the pillow continually cools you all night. That may be the case if there is constant water flow. But generally it means it doesn’t hold heat in like many traditional pillows do.
One well-known brand is Chillow, but Chillow has changed. Generally what you get today is a “cooling pad” which you can use by itself or with a pillow underneath. You actually put water in the pad. Although some people swear by them, the hassle of adding water and possible leaks have hurt the popularity of Chillow (on the other hand, the price is right if you want to try it!).
A popular and inexpensive example of today’s cooling pillows is the Bluewave Bedding Gel-Infused Memory Foam Pillow. It’s ventilated, and gel-infused, to keep the temperature from rising while you sleep. You can also get very slim versions.
You can also get a pad to put on your favourite pillow, like the Penguin Cooling Pillow Mat. But before you just get a pad, remember you should be changing your pillow every year or two.
As you have probably guessed, there are also combinations of the above. Take for example the ViscoSoft ARCTIC GEL CONTOUR Pillow, which is a hypoallergenic, memory foam, contoured neck pillow!
Changing your pillow can make a huge difference in your health. Many people have found pillows for migraines – that is, pillows that fight migraine, as you’ll see in the reviews for the products above. But sleep remains very personal. You’ll have to try the pillow for yourself to see which one works best.
Final advice? Keep your head cool. If you buy memory foam, be prepared to leave it out of the box for a week or two before you use it. And make sure you make a good pillow a priority. You’ll be spending a lot of time on it!
Some doctors have recommended lipoic acid as a supplement treatment for migraine. So what exactly is it?
Alpha-lipoic acid (also known as thioctic acid or ALA, or there is also RLA, the naturally-occurring version) is a chemical that is found in some plants, and actually is made by your own body. It’s an antioxidant, and so helps keep your body healthy while it fights inflammation. It also helps your body maintain proper levels of vitamin C and vitamin E. Both of these may play a major role in fighting migraine and headache.
Now, we’re all for antioxidants and healthy foods, but why ALA in particular? And why haven’t you heard about it from your doctor?
The evidence for ALA for migraine is still fairly sparse, just because there haven’t been many studies on it. A study in 2007 suffered because not enough patients were recruited for the study. However, the study seemed to show fewer headache days, and less intense headaches, with ALA. This was over 3 months (see A randomized double-blind placebo-controlled trial of thioctic acid in migraine prophylaxis..
600mg was also the amount used in the migraine study.
Because lipoic acid comes from food, your best bet is probably to eat more ALA-rich foods. Broccoli is one of the best all-round foods for a migraine patient. Also try organ meat (liver, heart), spinach, and tomatoes.
So here are some things to consider:
Get ALA from food. This is almost a no-brainer, since we already know that foods like broccoli have so many benefits. Also try adding peas, brussel sprouts, carrots and beets to your diet.
ALA can be taken as a supplement for general health. You could try 50-100mg per day.
If you would like to try ALA specifically for migraine prevention, talk to your doctor about a 600mg dose.
Which supplement? An excellent version of thioctic acid is Country Life R-Lipoic Acid. It contains no gluten or milk or preservatives and is vegetarian. It’s also one of the less-expensive versions of RLA, and was tested and approved by Consumer Lab.
If you’re taking a higher dosage, an even less expensive version (also tested by Consumer Labs) is Vitacost Alpha Lipoic Acid. This would be a good option if you’re going the 600mg route, because you can take it in two doses.
Finally, if you’re looking for one of the highest rated brands on Amazon, Doctor’s Best has a whole series of lipoic acid products to choose from. The reviews themselves are an interesting read, if you want to hear about how this supplement is actually helping people.
That treatment is oxygen therapy.
Now, we’re all for antioxidants and healthy foods, but why ALA in particular? And why haven’t you heard about it from your doctor?