Treatments

20 February 2013

20 minutes a day with an anti-migraine device…

It’s the latest migraine gadget that everyone is talking about. It’s the Cefaly Anti-migraine Device!

The Cefaly device is another application of neuro stimulation technology. Specifically, it’s transcutaneous electrical nerve stimulation (TENS), which delivers an AC electrical pulse to the supraorbital nerve.

How do you use it? In this case, the device is used as a preventative. It’s placed on your forehead for a few minutes each day.

A study published this month in the journal Neurology tried the device or a placebo (sham device) on 67 patients. The patients who used the real Cefaly device (group 1 below) showed a significant decrease in “migraine days” each month:

Now that may not look like a major improvement, but it did mean a decrease of 30%. And that’s an average – some saw a much greater improvement (38% had a drop of 50% in migraine days or more).

Convenient? The device has been compared to the visor worn by Geordi La Forge in Star Trek the Next Generation. I must protest – it looks more like the crown of an alien princess. It’s a band that goes on the forehead – small, easy to use, and drug-free.

Currently it comes with a significant price tag – US$368 on amazon, and $239.99 at Costco in Canada, for example. This will certainly keep a lot of people from giving it a try.

On the other hand, the initial results are encouraging for a device that’s non-invasive and not likely to give you the side effects that drugs would. If it works for you, several more pain-free days each month would probably be worth the cost.

But it is good news to see more of these devices being tested and hitting the market, because we’re learning more and more about what works best and for whom.

Study: Migraine prevention with a supraorbital transcutaneous stimulator
Cefaly website (international)
Cefaly Canada website

30 January 2013

Sex Headaches

James Information, Medications, Tips, Treatments 0

Orgasm headaches or sex headaches are technically called primary headache associated with sexual activity. But that should only be after careful tests are done – as soon after the headache as possible – to rule out more serious (in rare cases life-threatening) causes.

This graphic is a reminder to see a doctor right away, and that treatments are available. Read more about orgasm headache here.

8 January 2013

Zap the Brain? Electric Stimulation and Pain

James Discoveries & Stats, Information, Treatments 7

Ever since Dr. Frankenstein first saw his monster come to life, the world has been fascinated with the use of electricity in medicine.

Though crude methods have been made famous in the movies, in the last few years transcranial direct current stimulation (tDCS) has become a serious science that has helped people with migraine, chronic facial pain, depression, post-stroke rehabilitation, and more.

It could be argued that this form of treatment is still in its infancy. After all, we still know very little about how it works and how to best use it to treat specific patients.

However, it’s a lot less brutal than you might imagine if you’re thinking of a horror film.

Let’s take for example amperes, the measurement of electrical current. A toaster may have anywhere from 9-16 amps. Electroconvulsive therapy (ECT), on the other hand, which is used to treat issues such as severe depression, typically uses 200 to 1600 milliamperes, or .2 to 1.6 amps.

The current delivered for a lot of the pain treatment we’re talking about today is typically in the range of 1-2 milliamps, or about 0.0015 amps.

Amps comparison

Research by Dr. Alexandre DaSilva at the Headache & Orofacial Pain Effort (HOPE) Lab is giving us new insight into how tDCS may fight chronic pain issues such as migraine.

We do know that tDCS treatment can reduce migraine and headache pain. A recent study published in Frontiers In Psychiatry demonstrates how tDCS might work to reduce pain.

Researchers watched what happened during treatment using a specially designed radiotracer and a PET scan. The idea was to measure µ-opioid release.

Without getting into too much detail, you might already be able to guess how this works in the end. Opiates such as morphine impact the same system in the brain, and help fight pain. In short, the plan is to use tDCS to stimulate the natural systems of the body to alleviate pain.

Dr. DaSilva says (as quoted in ScienceDaily):

This is arguably the main resource in the brain to reduce pain. We’re stimulating the release of our (body’s) own resources to provide analgesia. Instead of giving more pharmaceutical opiates, we are directly targeting and activating the same areas in the brain on which they work. (Therefore), we can increase the power of this pain-killing effect and even decrease the use of opiates in general, and consequently avoid their side effects, including addiction.

Dr. James Fugedy has been using tDCS to treat pain for the past few years. He started with fibromyalgia, and has since helped patients with migraine, depression, and chronic daily headache. He writes:

Transcranial direct current stimulation (tDCS) is the most exciting innovation I’ve experienced in 30 years of practicing medicine. … The tDCS procedure itself is simple, but protocols have evolved and results have improved. The numerous but small studies done thus far indicate, but do not yet conclusively prove benefit. Large multi-center studies need to be done to verify outcomes. Still, there is enough evidence at this time to justify clinical use for the treatment-resistant patient, particularly when you consider that there are no negative side effects with tDCS.

Future studies will be designed to provide more solid evidence of benefit, and show us which type of treatment works the best for which type of patient.

We also need to know more about how to help patients long term. How frequent do treatments need to be for patients with chronic headache? For example, could a six-week treatment regime lead to permanent results?

Meanwhile, some doctors are increasingly using tDCS to treat chronic pain. So far, this treatment has an excellent track record. Patients need to start asking their doctors about it, and pushing for further research.

9 November 2012

An Update on the NTI-tss Migraine Fighter (video)

James Treatments 1

It’s been a while since we’ve talked about the NTI Tension Suppression System, or NTI-tss device for migraine treatment. The device now comes in a variety of forms to better suit individual patients, and is available in more countries than ever. A new agreement for distribution was signed in Germany, Switzerland, Austria and the Netherlands this fall.

The video below actually gives a really good overview of how the device works, and how your dentist will customize it just for you.

When you watch the video, notice how the action of the jaw hits key muscles and nerves in the face. This is where migraine attacks may be triggered in some people.

You’ll need to find a dentist who is familiar with the NTI-tss. In the USA, check this page for a list of certified labs around the country.

Meanwhile, if you’re considering the NTI-tss device, you’ll find this video very helpful.

6 November 2012

Triptans (and more) for Children with Migraine

James Medications, Treatments 1

I think parents will appreciate a recent post from Dr. Alexander Mauskop regarding treatments for children. Here is a summary of his suggestions:

Try wafer medications (that melt under the tongue) or nasal sprays. Rizatriptan is approved in the USA for children, and Maxalt MLT is a “wafer” medication. Imirex NS (sumatriptan) is a nasal spray approved in Europe, and Zomig NS is another available in the USA.
Some common triptans used for children include rizatriptan (in the USA approved for children as young as 6), almotriptan, sumatriptan, and zolmitriptan.
Rizatriptan will be available in generic form around the end of 2012.
Child migraine attacks tend to pass quicker than adult attacks. This is another reason why faster acting medications are helpful (such as nasal sprays), but may also explain why some children tend to get over the attack quickly (in an hour or two) no matter what they take.
Triptans should not necessarily be the first choice for children with migraine. Other options include ibuprofen and paracetamol/acetaminophen, lifestyle changes (regular sleep/meals/exercise), biofeedback, magnesium, CoQ10, etc.

For more tips for treatment of children with migraine, read Triptans for pediatric patients

Another reminder or two – just because a triptan hasn’t been “approved” for children in your country does not mean that it won’t be effective. It just mean that the required studies haven’t been completed. However, always talk to your doctor before giving your child a triptan medication (or any medication, for that matter) for migraine!

Also, don’t be surprised if your doctor isn’t quick to recommend a pill. There are excellent, well proven non-drug treatments for children (some are mentioned above).

Read more about Pediatric Migraine Medication here.