Treatments

11 February 2011

Dr. Guyuron’s Migraine Surgery, 5 Years Later

Back in June of 2005 we were talking about a surgery for migraine disease being pioneered by Dr. Bahman Guyuron. Dr. Guyuron has been involved in surgical procedures in the USA and Canada for many years, most notably in the area of plastic surgery. It was while he was doing plastic surgery that he discovered that some of his patients were finding relief from their migraine attacks.

So he tested a surgical technique to target some trigger areas for migraine. First, each patient is "tested" with botulinum toxin A (Botox). The Botox treatment confirms the target sites.

Then comes the main surgery. The surgery removes tiny bits of muscle or nerves in the head, to relieve the pressure on certain nerves, thus eliminating triggers in some people. Sometimes other minor procedures are used.

69 of Dr. Guyuron’s patients were followed up throughout the following five years. The results are looking good.

These are, of course, very good results. Now, it should be noted that only certain patients would be approved for this type of surgery. However, it is likely that most of these patients had tried many other things without success.

Also, 10 patients (out of 79) were removed from the study because they required further surgery (they’re not included in the above chart).

Usually, surgery is not recommended for migraine. You will try many of the other options available before you should even consider surgery. Dr. Guyuron himself looks for people who have at least two or three severe attacks each month that do not respond to medications.

The recovery time for this surgery is about two to three weeks. As with any surgery, there is some risk, but problems with procedures like this tend to be rare.

Incidentally, we recently talked about Dr. Guyuron for another reason. He’s the man behind Innovative Medical Equipment, the company that has developed the SootheAway Continuous Thermal Therapy Device.

Read more about Dr. Bahman Guyuron here. If you want to read more about this particular study, check out this article at WebMD – Cosmetic Surgery May Also Treat Migraines.

10 February 2011

1% Thursday: Biofeedback

James Tips, Treatments 0

This week, look and see what options there are in your area for biofeedback treatment.

Frankly, we probably haven’t discussed biofeedback enough here. Increasingly popular since the 1960s, it’s one of the safest treatments available. With good scientific evidence behind it, it’s one of the few treatments that just about anyone can use. That’s why it’s often recommended for children and pregnant women, who tend to have fewer options.

But it’s not just a "last ditch" effort – something to try when everything else has failed. It’s actually something that should be tried early on, and can very well be a continuing part of your treatment while you’re trying other things. It’s not something that should be put off.

You can read a brief summary of biofeedback treatment here, but I encourage you to listen to the podcast on biofeedback for more information.

What is 1% Thursday?

Every Thursday at Headache and Migraine News (weather permitting) we’ll talk about one measurable, practical thing we can do to make our lives just 1% better. Usually it will be something very easy, sometimes it will be a challenge. Let us know if you try it, or share an idea of your own – and maybe a year from now we’ll see that things have really changed for the better!

4 January 2011

Melatonin and Migraine Study – and the investigation continues…

James Discoveries & Stats, News, Treatments 3

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.

9 November 2010

Patients Recognize a Wide Variety of Treatments

James Discoveries & Stats, Medications, News, Treatments 2

Our latest poll asked the question: Which of these (ie medications, supplements, other treatments) have been the biggest help to you?

At first the results may sound like a big yawn – predictably, medication was the runaway winner. So, it seems, more people have found help through medication than through anything else.

But wait – the news is both better and worse for medications. First, you can see right away that either medications, or medications combined with something else, were the runaway winners. 86% included medication as something that has helped.

But another interesting point – most people were not helped by medication alone. Let’s look at the chart that way:

So in actual fact, most people were helped by medication plus something else, or else by something other than medication.

Of those, the biggest chunk were helped by medications + supplements + another treatment!

Let’s look at this one more way. What percentage of people found either supplements, medications, or other treatments, to be helpful? Here’s what the results look like:

It’s tempting to say,"Oh, medications help the most people – I’ll focus on those!" But here’s the thing – there really is no clear winner here. If anything, the winner is variety. For example, let’s see how it looks if we do combinations vs single treatment:

Now you could argue that certain things may skew the results. After all, the millions of dollars of promotion in the medical wold goes to the medications. Then again, supplements (like magnesium, probiotics) and other treatments (like acupuncture, biofeedback) have a huge popular following.

But when push comes to shove, it’s clear that there is no one thing that works for everyone when it comes to migraine and chronic headache. It’s often medication, but not always. It’s often one thing, but often a combination (I would argue that it has to be a combination, if you’re working toward total health).

When we talk about the hundreds of treatments for migraine (for example), we’re not just talking about drugs (though there are a lot of those!) or supplements (lots of those too, well researched and effective) or other treatments (lots of those, including lifestyle changes). We’re also talking about combinations.

That’s why you can never try every possible treatment in your lifetime. And I’m not talking about quack treatments – I’m talking about well researched treatments that are helping real people.

Of course there are a lot of issues wrapped up in that – how to chose good treatments and not waste time and money on bad ones, how to safely combine treatments, and so on. But when all is said and done, that is the state of headache and migraine treatment, and this poll reflects it. There’s no silver bullet – but there are good treatments. Don’t give up!

Here are the full results:

Medications alone: 44%
Meds, supplements and other treatments combined: 21%
Meds and Supplements combined: 11%
Other treatments with meds: 10%
Other treatments alone: 9%
Supplements alone: 4%
Other treatments with supplements: 1%

25 October 2010

8 Reasons why Menstrual Migraine is “different”

James Information, Medications, Treatments 4

Menstrual migraine (including menstrually related migraine, true menstrual migraine, etc, and sometimes called a period headache) certainly isn’t the only type of migraine out there. But it is a common type. And it is… well, different!

Until recently, menstrual migraine often wasn’t distinguished in diagnosis and research from other types of migraine. But now we’re starting to study it as something unique, and because of that we’re learning more about it than ever before. Some recent studies are shedding more light on the uniqueness of menstrual migraine. For example, did you know:

Menstrual migraine attacks tend to last longer than other migraine attacks. A recent study suggests that they last more than 30% longer, on average, than other migraine attacks. (Pinkerman and Holroyd 2010)
Menstrual migraine responds better to certain treatments. More on that below.
Menstrual migraine doesn’t respond as well to short term treatment, such as abortive drugs. Often preventative treatment is the answer (menstrually related migraine may happen at various times of the month, in an unpredictable pattern). (Pinkerman and Holroyd 2010)
Menstrual migraine is more likely to be disabling. Of course, other types of migraine may disable more, but on average menstrual migraine seems to often be worse than average. (Pinkerman and Holroyd 2010)
Menstrual migraine is more likely to return. A recent study demonstrated that the pain was far more likely to come back after four hours being pain-free. (Pinkerman and Holroyd 2010)
Menstrual migraine may have distinct biological differences, beyond "hormones". Recent research is looking into the various factors that may cause menstrually related migraine, including genetics. (Colson et al 2010, Aurora 2008 in Menstrual Migraine)
Monthly attacks are more likely to be migraine without aura or tension type headache. Migraine with aura is less likely to be linked to your period. (Stewart et al. 2000)
Menstrually related migraine affects up to 60% of female migraineurs (Lay and Payne 2007)

Treatment!

Menstrual migraine may be severe and hard to treat, but it has been treated successfully in many, many women. However, doctors are realizing more and more how important it is to get a proper diagnosis, and to treat menstrual migraine specifically, not just the same way any type of migraine is treated.

Although this type of migraine may not respond as well to short term treatments, some women find that an abortive drug is all they need. Usually this is a triptan (commonly sumatriptan, rizatriptan or frovatriptan), and/or NSAIDs such as mefenamic acid or naproxen. Sometimes something is given for the nausea as well. Dihydroergotamine (DHE) is also an option.

If one triptan doesn’t work, try another. There are several others that have helped many with menstrual migraine.

On the preventative front, one common approach is hormone therapy. Magnesium therapy also seems to be particularly effective for menstrual migraine. There is some evidence that vitamin E may help with some symptoms.

Preventative medication may also be tried. Typical migraine preventatives have met with some success, such as verapamil (a calcium channel blocker), topiramate (particularly for patients who don’t take oral contraceptives) and valproate, propranolol (a beta blocker), and fluoxetine (an anti-depressant).

For more, check out Menstrually Related Migraine from the National Headache Foundation, Menstrual and nonmenstrual migraines differ in women with menstrually-related migraine. (study from 2010), Prevention and treatment of menstrual migraine. (study from 2010), and Menstrual Migraine (2008).