Treatments

5 May 2009

Omega 3 and Migraine

I’ve been reviewing some information about omega 3 and migraine, hoping to give you a little more information about taking an omega-3 supplement for prevention of migraine. My initial conclusion is that the research on this one is still in its infancy.

Studies on omega 3 and migraine have generally been infrequent and small, and they leave us with a lot of questions.

Take for example the 2001 study, done in France. 196 patients took 6g per day for 16 weeks. Though the migraine attacks themselves didn’t change a lot, frequency did, with 7.05 attacks in the placebo group and 5.95 attacks in the omega-3 group. That meant a 55% reduction in attacks – but wait! The placebo group also had a 45% reduction in attacks.

Take as another example this study from the USA of 27 adolescents. This one compared fish oil with olive oil (which is, by the way, also high in omega-3 fatty acid, but a different kind).

Fish oil	Olive Oil
74% had shorter attacks	70% had shorter attacks
83% had less intense attacks	65% had less intense attacks
87% had fewer attacks	78% had fewer attacks

It would seem that there is a strong placebo effect again – but remember, olive oil also has omega-3. Still, there was a significant difference between the fish oil and olive oil.

Why do these studies leave us with a lot of questions? For one thing, I would like to see improvement over time – a longer period of time. Unlike a drug that you take once and see your pain go down, omega-3 fatty acids are more likely to give improvement over time.

Also, we could go a long way trying different types of omega-3 supplements, and trying different dosages. Or, just eating more foods high in omega-3, such as certain types of fish, and flax oil.

Why Omega-3 is a good idea

There is still a lot of controversy over omega-3. Part of this is because the research is so new – it’s the "new super-food" and everyone is rushing to prove it or disprove it.

So for a while yet you can expect to see regular studies proving that omega-3 is great, or not so great.

But the general consensus seems to be that omega 3 is a good thing. And even though the omega 3 and migraine field is still largely unexplored, I suggest you talk to your doctor about an omega 3 supplement, or, better yet, try to get more omega 3 in your diet. Why?

Taken in moderation, there are rarely downsides
There is evidence in omega 3 and migraine studies that there is a benefit
There are other likely benefits of interest to migraineurs. Migraine often comes along with heart disease and depression, for example. Some omega-3s have strong anti-inflammatory properties. Omega 3 seems to be great for your heart health and also for mood disorders.

So go ahead – add some more fatty fish to your diet (such as salmon), flaxseed oil and olive oil. If you want to try a supplement, fish oil seems to be best, with about 1-3 grams of DHA and EPA combined. Often 1g is recommended, but always talk to your doctor about taking a new supplement. One good brand is Nordic Naturals Ultimate Omega, which uses fish oil and carefully filters out impurities.

Remember, don’t expect instant results. But taking fish oil for several months has helped many people, and seems to have health benefits beyond just cutting back on migraine attacks.

6 April 2009

When Menstrually Related Migraine isn’t Alone

James Discoveries & Stats, Treatments 4

Menstrual Migraine is usually split into two categories. First, True Menstrual Migraine which, at least 90% of the time, hits during your period. Second, Menstrually Related Migraine (MRM), which can occur other times of the month, but do seem to be related to hormonal changes.

Obviously the second category is a lot more vague. Are all the attacks you’re getting really related to hormonal changes? Most often, the answer is probably no. Many attacks may be triggered by other things, and so it’s hard to know where to start when it comes to fighting migraine attacks.

One common way to treat menstrually-related migraine is to use hormonal therapy. That might include extended-cycle oral contraceptives, or more often some form of estrogen supplement (this is a simplification – these are sometimes complex treatments of many different varieties). The problem is, there’s no evidence that these treatments will help eliminate migraine attacks that aren’t menstrually related.

A 2008 study from the Department of Neurology at the University of North Carolina set out to discover if treating MRM with hormonal therapy would also cut back on other attacks. They were concerned about chronic migraine and medication overuse headache.

Their study of 229 women found that generally there was a good response to hormonal therapy. Also, a large percentage got over the chronic migraine attacks, and were able to get out of the cycle of medication overuse.

It makes sense that cutting back on even some migraine attacks would help with cutting back medication in general. But it’s even more encouraging that the chronic pattern could be broken, though we’re still not talking about everyone here (59% of women who were helped by the hormonal treatment also went from chronic migraine attacks to episodic – less frequent).

Still, it may be that hormonal treatments have a wider benefit than was previously believed.

31 March 2009

More on the NTI-tss device (with video)

James Treatments 0

The NTI-tss device continues to be a valuable tool in the fight against migraine. It doesn’t involve any drugs – just a custom made device that you wear in your mouth through the night. For many people, the results have been very good.

Migraine attacks are often triggered by excessive clenching and/or grinding of your jaw at night. Not only can this increase migraine attacks, it also lowers quality of life by adding often daily dull headaches. The NTI-tss device is designed to help people in this category, as Dr. Andrew Blumenfeld explains in this video:

The information on migraine may be nothing new to you, but the video is a good reminder that often migraine patients have constant pain that is ignored because of the more obvious flashes of migraine pain.

How the NTI-tss device works

The idea behind the NTI-tss device is this. By keeping the teeth slightly apart, particularly the molar and canine teeth, the device makes it physically impossible for you to clench as intensely. The muscle activity (hyper-activity) is drastically reduced.

For many people, this eliminates a major migraine trigger, and also reduces or eliminates the daily, dull headache that they wake up with.

The research around the NTI-tss device has gone forward quite a bit since we last talked about it. Depending on your response to an initial fitting, or depending on your particular issues, you may be fitted with slightly different devices in different ways.

Talk to your dentist and find out if they are using the NTI-tss device, and if they have used it to treat migraine patients. If you’re in Canada, there’s a directory of dentists here.

Let me leave you with a video of someone being fitted with the device. It’s a very easy process (I’ve had it done myself).

9 March 2009

Trigger Points: Identification, Myths, and Preparing to Fight them

James Information, Treatments 1

This is the third in our series on mayofascial trigger points, headache, and migraine. We started with Trigger Points and headache – Fakery or Fact? Then we tried to figure out if they’re a factor when it comes to headaches and migraine with Trigger points – do they trigger headaches? (I know, I’m taking a long time to get through the series. But a significant amount of research is going in to this one!)

So what’s next? Well, we’re going to find out how to treat them, of course. But before we get into specifics (in the next post in the series), we’re going to get some background on trigger point treatment – things you need to know before you’ll see it really work for you.

Blasting Myths about Trigger Points

Trigger Points - causing you a headache?

First, let’s clear up some common myths about mayofascial trigger points (MTPs):

Trigger points are not consistent. Some people think they always get them in the same pattern causing the same pain – sometimes there can be consistency, and there are patterns, but you can’t rely on them. Just when you think you have it figured out, something changes.
MTPs are not always in the same location as your other symptoms. In other words, just because you have a headache in your temples, that doesn’t mean that the MTP is in your temple.
You can’t necessarily feel a trigger point. Some people associate MTPs with muscles that feel "tight", or little "lumps" or "knobs" in muscle tissue. That could be a MTP, but some are small enough (or hidden enough) that you can’t feel them, but big enough to cause problems.

Are Trigger Points causing YOU problems?

Sometimes it’s very hard to tell. I’m willing to bet, however, that if you’re having any kind of consistent headache, or migraine attacks, or cluster headaches, that MTPs are a factor. Sometimes they’re a hidden factor, but other times they’re quite obvious. When they are more obvious:

Part of your muscle is intensely sensitive when moderate pressure is applied
Pressing on some MTPs make the muscle twitch
You might feel muscle "tightness"
The pain you feel when applying pressure on the trigger point may be "good pain" – in other words, it hurts, but feels like something that is "needed"
Your body often makes more "noise" where trigger points are – such as popping, crunching noises
Your muscles feel tired and heavy, or stiff, or there is a dull, nagging pain
Heat makes it feel better

On the other hand, if the pain is due to a recent injury, or it comes on suddenly, it’s extremely sensitive to light pressure, the muscle is sore all over, or you have consistent sharp pain – that’s probably not a trigger point (and may be a reason to see your doctor!).

You should especially see your doctor if you have pain that is consistently getting worse and worse. Trigger points tend to come and go, or stay the same.

How to make Trigger Points worse

We’ll talk more about the practical side of treating trigger points in the next article. But today, let’s see a few things that can make the problem worse, and stop treatment from being as effective as it could be.

Not dealing with stress. If you’re letting yourself get stressed-out, this could make MTPs flare up
Shallow breathing. Deep breathing from time to time can help keep MTPs away.
Awkward positions. Especially those you stay in for a long time. Weird sleeping positions, sitting standing…
Actually, staying in one position for a long time, even if it’s not awkward.
Muscle relaxants. Actually, they don’t make the situation worse so much, they just don’t help.
Over exertion. Over exercising, or trying to do something that’s just over the top.
Not treating another problem. Yes, treating trigger points may help cut down your migraine attacks. However, you will likely still need to treat migraine itself, especially if you’re in a bad cycle. You may need to break the cycle first, then in the future trigger point therapy may be all you need. This goes for any headache or condition that may cause a pain cycle, or make your MTPs worse.
One more great way to make MTPs worse. Don’t be flexible in your treatment. Learn one way from Uncle Joe, then stick to it forever, no matter what your body is telling you.

Coming up…

What if I told you that trigger point therapy is better than Botox? Many of you know that Botox has become a treatment for more than wrinkles. Some migraine patients have found that it helps (more on Botox for migraine).

The amazing thing about Botox is that it kills MTPs – temporarily. Sounds great, right?

Well, it’s pretty good for that one trigger point. But MTPs that are setting off your headaches or migraine attacks could be almost anywhere on your body – and it’s different for everyone! An invasive procedure, such as a Botox treatment, is still a lot of guesswork when it comes to an individual. You’re only treating a few specific locations.

Mayofascial Trigger Point therapy has some advantages. You can treat more areas with a less invasive treatment. You can learn over time where the offending MTPs are.

And best of all, it’s usually a lot cheaper. Very often you can do trigger point therapy all by yourself!

And that’s what we’re going to look at in the next article – how to start knocking out those trigger points on your own, to cut back on those headaches and migraine attacks.

Once again, this information comes from a variety of sources, but I’m especially indebted to Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief by Valerie Delaune and Save Yourself from Trigger Points and Myofascial Pain Syndrome! by Paul Ingraham.

23 February 2009

A Sleep Apnea Mystery Solved?

James Discoveries & Stats, Tips, Treatments 7

Dr. Bradley was puzzled. These patients with heart and kidney failure often had something else in common. Sleep apnea. Why?

In the most recent edition of HeadWay, we were exploring the connection between sleep apnea (or sleep apnoea) and migraine, headaches and cluster headache. There’s good evidence for a strong relationship. It seems many people with headache and migraine also have sleep apnea, and we know that sleep patterns are closely related to an increase in these other attacks.

Sleep apnea interrupts sleep, and can make you drowsy during the day. It can also lead to serious heart problems and diabetes.

But the underlying cause of sleep apnea is not easy to explain. We know that, for example, obesity is a risk factor. But many people with sleep apnea are not obese, and are otherwise fairly healthy. So what’s the problem?

Dr. Douglas Bradley, who we mentioned earlier, noticed that his patients did have something else in common. Fluid retention (oedema).

Could fluid retention be causing the sleep apnea?

Dr. Bradley and his team set out to study 23 non-obese men. When these men got horizontal to sleep, the fluid shifted in their bodies, and the circumference of their necks actually increased. For the control group, it was an increase of 1/2 a centimetre. But for those with sleep apnea, it was double that, 1 centimetre. Why? You guessed it. Fluid.

So what’s happening? Dr Bradley explains:

Gravity forces fluid down to the bottom of the body when you are sitting and your legs are inactive. Standing and walking cause the calf muscles to contract, pumping fluid from the legs up through the veins toward the heart.

When you lie down to sleep, that "extra" fluid gets redistributed, causing the increase in neck circumference, which may be causing blockage leading to some sleep apnea. (Read the story at Groundbreaking study results could help reduce the incidence of obstructive sleep apnea)

This surprising turn of events leads to some interesting treatments for sleep apnea, and so for the headaches it causes.

The first, best, and most obvious? Move around!

If you tend to sit or even stand a lot of the day, try changing position, going for walks, getting your leg muscles working. This keeps the fluid moving through your body the way it’s supposed to.

Dr. Bradley also suggests that elevating your upper body while you sleep may help, interestingly enough something that was recently discussed in a blog carnival entry Sleeping off my headacheâ€¦.

Other common treatments for fluid retention? Don’t eat too much salt. Drink plenty of water. And how about this – one treatment for decreasing fluid retention that comes with the menstrual cycle is magnesium. We keep coming back to that, don’t we?

One more interesting note. Some drugs can increase fluid retention, such as NSAIDs (ie naproxen, oxaprozin and ibuprofen), and calcium channel and beta blockers, all commonly used for migraine, and often various types of headache.

Often sleep apnea is treated with special masks worn at night, implants, and even surgery. But for many, this discovery may lead to solutions that are much less drastic. And that means a lot less headaches.