The analysis, which combined the results of 21 previous studies, confirms a connection between migraines and ischemic stroke — the most common form of stroke, occurring when a clot disrupts blood flow to the brain.

Across the studies, migraine sufferers were about twice as likely to suffer an ischemic stroke as people without migraines, according to findings published in the American Journal of Medicine.

Experts are not sure why the relationship exists, and it is not yet known whether the migraines themselves directly lead to strokes in some people.

It’s likely, however, that a common underlying process contributes to both migraines and stroke risk, said Dr. Saman Nazarian, the senior researcher on the new study and an assistant professor at Johns Hopkins University School of Medicine in Baltimore.

For now, he told Reuters Health in an email, the bottom line for migraine sufferers is that they should be particularly vigilant about controlling any modifiable risk factors for stroke that they may have.

Some of those risk factors include high blood pressure, smoking and diabetes.

“The main thing I would want (people) to take away from this is that if they get migraines, they should address stroke risk factors,” Nazarian said. “They should not smoke and they should watch their blood pressure and have it treated if it is high.”

Experts also generally say that people with migraines should remember that while the headaches are linked to a relatively increased risk of stroke, the absolute risk to any one person remains fairly low.

In one recent study of 6,100 adults with migraines, for example, 2 percent reported a history of stroke, versus 1.2 percent of 5,243 adults who did not suffer from migraines.

The current findings are based on 21 international studies conducted between 1975 and 2007 and involving more than 622,000 adults with and without migraines.

Most of the studies took into account a number of factors that might help explain any connection between migraine and stroke risk — such as age, high blood pressure, diabetes, smoking habits and weight.

Even with those factors considered, migraines themselves were linked to a two-fold increase in stroke risk when Nazarian’s team combined the results of all 21 studies.

The precise cause of migraines is not fully understood, but the pain involves constriction, and then swelling, of brain blood vessels. One theory is that people with migraine may have dysfunction in the blood vessels throughout the body, which may explain the increased risk of stroke and, as some previous studies have found, heart attack.

No one yet knows whether treating and preventing migraine attacks can do anything to affect people’s risk of cardiovascular problems.

On one hand, researchers have noted, drugs that prevent migraine attacks could theoretically lower the risk of cardiovascular problems. On the other hand, certain medications might have negative effects; some anti-inflammatory painkillers have been linked to cardiovascular risks, while migraine drugs known as “ergots” tend to constrict blood vessels throughout the body.

The current study received no drug industry funding, according to Nazarian’s team, and none of the researchers reports any industry ties.

A hand-held device that delivers a magnetic pulse to the head may offer relief for some migraine sufferers, researchers report.

The findings, which apply to migraine sufferers who experience “aura,” expand on previous research by using a device that could work at home instead of only at the doctor’s office.

It’s unclear, however, how expensive the treatment will be and how it should be administered for optimal effectiveness. And some patients didn’t seem to benefit from the treatment.

At stake are patients who suffer from migraine with aura, meaning they experience visual disruptions, tingling, numbness and weakness before a headache begins.

The device uses single-pulse transcranial magnetic stimulation, which is thought to prevent aura by disrupting the brain’s electrical system.

In the new study, Richard B. Lipton, of the Albert Einstein College of Medicine in New York City, and colleagues randomly assigned 201 patients to take home a fake stimulation device or a real one.

Those who used the real device had less pain and recurring headaches and were less likely to need medication. Of 164 patients who treated at least one attack with the real or fake stimulation devices, 39 percent of those who used the real device reported no pain after two hours compared to 22 percent of those who used the fake device.

The researchers also report that the real stimulation device didn’t make symptoms worse or cause serious side effects.

In an accompanying commentary, Hans-Christoph Diener, of University Hospital Essen in Germany, wrote that the research suggests the technology “could be a major step forward in the treatment of migraine with aura, particularly in patients in whom presently available drug treatment is ineffective, poorly tolerated, or contraindicated.”

The study was published online in advance of print publication in the April edition of The Lancet Neurology.

By Ed Edelson
February 10, 2010

(HealthDay News) — People with migraines are more likely to have heart attacks, a new study shows, but the exact reason why the two conditions are linked is still unclear.

The incidence of heart attacks in people with migraine is almost double that of people who don’t suffer the headaches, according to a report in the Feb. 10 online edition of Neurology by a group including Dr. Richard B. Lipton, a professor of neurology at Albert Einstein College of Medicine in New York City.

The study, which compared 6,102 people with migraine and 5,243 without the headaches, found a 4.1 percent incidence of heart attacks in the migraine patients, compared with 1.9 percent in those without the debilitating headaches.

Previous studies have found an association between migraine and cardiovascular problems including heart problems and stroke, Lipton noted. One study, which looked at only women, found an increased incidence of stroke, especially for migraine with the visual disturbances called aura (women are up to four times more likely than men to have migraines). Another study, which looked only at men, found an increased risk of heart disease.

“The strength of this study is that we have a very large number of migraine sufferers, data to distinguish between migraine with and without aura, and longitudinal data on men and women in the same study,” Lipton said.

The new study did find a higher incidence of heart attack for migraine with aura — three times that of the migraine-free group. It also found that people with migraine were more likely to have the classic risk factors for heart attack, stroke and other cardiovascular problems: diabetes (12.6 percent versus 9.4 percent), high blood pressure (33.1 percent versus 27.5 percent) and high cholesterol (32.7 percent versus 25.6 percent).

But those risk factor differences did not account for the increased migraine-associated risk, Lipton noted. “The risk remains elevated even after we adjust for the known cardiovascular risk factors,” he said. “There have been suggestions of a genetic link, but the nature of the link is not entirely clear.”

Even so, Lipton added, “Cardiovascular risk reduction is important for everybody. If you have migraine, it might be more important for you than for the general population. They should be particularly vigilant about controlling body weight, keeping blood pressure low, modifying all the risk factors that are within their control.”

Studies are underway to see whether better control of migraine can reduce the cardiovascular risk, said Lipton, who is conducting one such study. “That is something we don’t know yet,” he stated. “But if you have four or five disabling migraine days a month, it makes sense to take the medications that control them. If they reduce the risk of heart attack and stroke, so much the better.”

Results of those studies are expected “over the next couple of years,” Lipton said.

Cardiologists, especially those who treat women, should pay attention to those results and the current study, even though they appear in a neurology journal, said Dr. Holly Andersen, director of the Ronald O. Perelman Heart Institute at New York-Presbyterian/Weill Cornell Medical Center in New York City.

“Clearly, the majority of people who have migraines are women, often young women,” Andersen said. “This is a marker that might help prevent cardiac disease. There have been several large population studies that show women with migraines have an increased risk of cardiovascular events. These are the women we should be intervening with. If they use oral contraceptives there should be a concern, because they can form blood clots, particularly if they smoke.”

And since the risk of stroke in women who have migraine is clear, “it’s not too much of a stretch to think they have a threat with heart disease,” said Dr. Dara Jamieson, director of the headache center at New York-Presbyterian/Weill Cornell. “But this is an observational study that needs to be expanded to get a better understanding of mechanisms,” Jamieson added.

March 25, 2009

(NaturalNews) Increased intake of folic acid and other B vitamins may reduce the frequency and severity of migraine attacks, according to a study conducted by researchers from the Genomics Research Center at Australia’s Griffith University.

Migraine attacks are characterized by severe headaches, often accompanied by sensitivity to lights, sounds or smells; nausea; vomiting; and pins and needles sensations. Eighty percent of migraine patients suffer from at least one attack per month. Attacks can last up to 72 hours, and may be so debilitating that patients become unable to function.

Currently, migraines are treated with potent painkillers or anti-nausea drugs, with mixed results. Other treatments include antidepressants and beta-blockers, both of which carry the potential for severe and even dangerous side effects.

In the current study, researchers gave 50 migraine patients supplements of folic acid and vitamin B. According to researcher Lyn Griffiths, they observed “a drastic improvement in headache frequency, pain severity and associated disability for those treated.”

The researchers suspected that B vitamins would prove effective because they are known to help regulate levels of the amino homocysteine. Genetic research has shown that a mutation or malfunction of the gene MTHFR results both in elevated homocysteine levels and an increase risk of migraine. High levels of homocysteine have also been linked to a higher risk of cardiovascular disease and stroke.

The Griffith University team is now preparing to carry out a larger study to find out what doses work best for individual migraine patients, also taking into account any genetic predisposition to migraine that they might have.

Migraine is the most common neurological condition in the world, with approximately 6 to 15 percent of adult men suffering at least one attack per year and 14 to 35 percent of adult women. Between 12 and 28 percent of people will suffer at least one attack in their lifetime.

Mon Dec 1, 2008

WASHINGTON (Reuters) – Acupuncture works better than drugs like aspirin to reduce the severity and frequency of chronic headaches, U.S. researchers reported on Monday.

A review of studies involving nearly 4,000 patients with migraine, tension headache and other forms of chronic headache showed that that 62 percent of the acupuncture patients reported headache relief compared to 45 percent of people taking medications, the team at Duke University found.

“Acupuncture is becoming a favorable option for a variety of purposes, ranging from enhancing fertility to decreasing post-operative pain, because people experience significantly fewer side effects and it can be less expensive than other options,” Dr. Tong Joo Gan, who led the study, said in a statement.

“This analysis reinforces that acupuncture also is a successful source of relief from chronic headaches.”

Writing in Anesthesia and Analgesia, they said 53 percent of patients given true acupuncture were helped, compared to 45 percent receiving sham therapy involving needles inserted in non-medical positions.

“One of the barriers to treatment with acupuncture is getting people to understand that while needles are used, it is not a painful experience,” Gan said. “It is a method for releasing your body’s own natural painkillers.”

They found it took on average five to six visits for patients to report headache relief.

Other studies have shown that acupuncture helped alleviate pain in patients who had surgery for head and neck cancer, can relieve hot flashes and other menopausal symptoms and can reduce chemotherapy-induced nausea.

(Reporting by Maggie Fox; Editing by Julie Steenhuysen)

LONDON (Reuters) – Warmer weather and changes in atmospheric pressure may trigger headaches and migraines, rather than pollution, researchers said Monday.

A U.S. research team showed that each temperature increase of 5 degrees Celsius — about 9 degrees Fahrenheit — appeared to increase the risk of severe headaches by nearly 8 percent compared to days when the weather was cooler.

Air temperature, humidity and barometric pressure are often cited as a reason for headaches but until now there has been little concrete evidence to back this, Kenneth Mukamal of Beth Israel Deaconess Medical Center in Boston and colleagues said.

His team studied than 7,000 men and women diagnosed with a headache or migraine at the hospital emergency room between May 2000 and December 2007.

They used meteorological and pollutant monitors to analyze air temperature, barometric pressure, humidity, fine particulate matter, black carbon and sulfur dioxides during the three days prior to the hospital visits and then later on.

“In other words, our study design was able to directly compare weather and air pollution conditions right before an emergency room visit with those same factors measured earlier and later the same month,” Mukamal said.

The study found that of all the environmental factors tested, higher air temperature in the 24 hours before a hospital visit was most closely associated with headache symptoms.

Lower barometric pressure also appeared to be a trigger, though the association was not as strong. There was no evidence that air pollutants played a role in sparking headaches, but bigger studies are needed to exclude this as a problem, the researchers added.

The findings published in the journal Neurology suggest the weekly forecast could help people ready their medication to ward off headaches.

“We wanted to find out if we could verify this ‘clinical folklore,’” Mukamal said in a statement. “These findings help tell us that the environment around us does affect our health, and in terms of headaches, may be impacting many, many people on a daily basis.”

The reason is unclear but researchers know warmer weather leads to lower blood pressure, and there is good evidence migraines are related to changes in blood flow around the brain, Mukamal added in a telephone interview.

(Reporting by Michael Kahn, Editing by Maggie Fox and Dominic Evans)

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.
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Studies link deficiencies of vitamin D to as many as 18 different cancers.

Vitamin D also protects against multiple sclerosis and rheumatoid arthritis, according to columnist Dr. Andrew Weil. In addition, vitamin D normalizes insulin secretion; and insulin, heart and blood-pressure regulation. According to a recent study, those who ate a Mediterranean diet supplemented with three nuts – primarily walnuts – showed a 13.7 percent decrease in metabolic syndrome. According to the American Heart Association, 47 million Americans have metabolic syndrome, which is defined as having three or more of the following conditions: abdominal obesity, high triglycerides, low levels of good cholesterol (HDL), high blood sugar and high blood pressure.

NEW YORK (Reuters Health) – A product that combines extracts of Tanacetum parthenium, commonly known as feverfew, with Salix alba, also called white willow, appears to be effective in reducing the frequency, severity and duration of migraine attacks, according to the results of a small study reported by a research team based in France.

The herbal combination goes by the commercial name of Mig-RL and is marketed by Naturveda-VitroBio Research Institute, the French company that sponsored the study. Recent reports have suggested that these products affect some of the same cell targets as conventional medications do.

In the study, reported in the Journal Clinical Drug Investigation, Dr. R. Shrivastava, from Issoire, and colleagues enrolled 12 patients with migraine who were treated with Mig-RL for 12 weeks. Two Mig-RL capsules were given twice daily. Two patients dropped out of the study – one had almost continuous headache and was referred for neurologic evaluation, the other refused to comply with the study protocol.

Migraine frequency was reduced by 57.2 percent at 6 weeks and by 61.7 percent at 12 weeks in 9 of 10 patients. Seventy percent of the patients experienced a 50 percent or greater reduction in headache frequency.

Reductions in attack intensity of 38.7 and 62.6 percent were noted in 10 of 10 patients at 6 and 12 weeks, respectively. Similarly, treatment with Mig-RL led to significant reductions in attack duration.

Mig-RL therapy was also tied to improvements in quality of life and the medicine was well tolerated and not associated with any side effects.

The encouraging results suggest that a larger, placebo-controlled randomized trial of Mig-RL is warranted, the authors conclude.

SOURCE: Clinical Drug Investigation, May 2006.

Acupuncture, as practiced in traditional Chinese medicine, may offer some relief from migraine pain, a new study suggests.

Italian researchers found that regular treatments with “true” acupuncture helped improve symptoms in 32 patients whose migraines had been resistant to standard preventive medication.

Moreover, the therapy worked better than two forms of “sham” acupuncture used for comparison, the researchers report in the medical journal Headache.

Past studies have yielded conflicting results as to whether acupuncture can aid in migraine treatment. Some research has suggested that sham acupuncture, using blunted needles that do not pierce the skin, is as likely to bring relief as is the real therapy — calling into question the actual biological effects of acupuncture.

However, a problem with this research is that studies have had inconsistent designs, and many have used acupuncture points that are “inappropriate” based on Chinese medicine, according to the authors of the new study.

Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi (“chee”), and stimulating these points with a fine needle promotes the healthy flow of qi.

For the current study, Dr. Enrico Facco, of the University of Padua, and his colleagues looked at how traditionally performed acupuncture stood up against two sham forms for preventing migraines.

They randomly assigned 160 migraine sufferers to one of four groups:

in one, patients received twice-weekly sessions of acupuncture using traditional acupuncture points; a second group received sham acupuncture as it is usually performed in studies; a third group also underwent sham acupuncture, but with the blunted needles touching traditional acupuncture points; the fourth served as a control group, in which patients received no acupuncture or preventive medication.

The participants in all the groups were given medication to treat any migraine attacks.

Over six months, Facco’s team found, only the group receiving true, traditional acupuncture showed lasting improvement in migraine disability measured on a standardized scale, compared with the control group.

The “main novelty” of the study, Facco told Reuters Health, is that the therapy was based on traditional Chinese medicine, but studied using the modern, “Western” scientific method.

The results are promising, he said, but more studies are needed to confirm the benefits of traditional acupuncture for migraine. However, Facco added, since the therapy carries little risk of side effects, it could be worth a try for migraine sufferers who are not adequately helped by standard preventive treatment.

It’s not completely clear why acupuncture might ease migraine pain. In addition to the traditional theories on qi, modern research has suggested that acupuncture may work by altering signals among nerve cells or affecting the release of various chemicals of the central nervous system.

NEW YORK (Reuters Health) – Several types of nonpharmacologic treatment, including physical exercise, relaxation training, and acupuncture can provide long-lasting improvements for patients with chronic tension-type headaches, physical therapists in Sweden report.

Because the frequent use of pain medications can lead to chronic headaches, it is important that analgesics are discontinued as a first step in treating tension headaches, Dr. Elisabeth Soderberg and her associates report in the current issue of the journal Cephalalgia.

The research team, at Sahlgrenska Academy, Goteborg University, designed a study in which 90 patients, who had chronic tension-type headaches for an average of 7 years, were randomly assigned to physical training, relaxation training, or acupuncture. Chronic tension-type headache was defined as headache occurring at least 15 days per month for at least 6 months.

The trial began with a 4-week pretreatment period, during which time the subjects used diaries to document headache characteristics. They also kept diaries in the 4 weeks immediately after the training sessions and again 3 and 6 months after treatment.

Acupuncture was administered at recommended sites using 10 to 12 needles during 30-minute weekly sessions for 10 to 12 weeks.

Physical training included five exercises focused on the neck and shoulder muscles, repeated about 100 times each, along with ergometric cycling and stretching.

The patients who were taught relaxation also learned “breathing techniques, stress coping techniques, how to relax during activity and how to relax in everyday living.”

Immediately after the last treatment, the only significant between-group difference was a higher number of headache-free periods in the relaxation group compared with the acupuncture group. Otherwise, “there were no long-lasting differences between the interventions.”

Compared with initial measures, acupuncture significantly reduced headache intensity at 3 months and 6 months. Physical training was associated with reduced headache intensity and more headache-free periods immediately after the last treatment and after 6 months. Relaxation training led to significant improvements in headache intensity and frequency immediately after the training and at 3 and 6 months.

Soderberg and her associates suggest that a combination of all three techniques may provide the best outcome.

SOURCE: Cephalalgia, November 2006.

(NaturalNews) A device that delivers two short magnetic pulses may help decrease the severity of migraines, according to a study conducted by researchers from Ohio State University-Columbus and presented at the annual meeting of the American Headache Society in Boston. The study was funded by NeuraLieve, manufacturer of the device.

Researchers studied 164 patients who suffer from migraine with aura, a specific type of migraine that is foreshadowed by certain sensory effects including tingling, numbness, or visual disturbances such as flashes of light or zigzags. The participants were instructed to hold a device, approximately the same size and weight as a hair dryer, to their heads and pull the trigger when they experienced an aura coming on. For half the participants, this was a sham device that did nothing. For the other half, it was a device that delivered a magnetic pulse known as transcranial magnetic stimulation (TMS). Patients recorded the symptoms and intensity of their migraines, with follow-up entries at 30 minutes and one, two, 24 and 48 hours after that.

Two hours after aura onset, 39 percent of participants who used the TMS device reported being pain free, compared with only 22 percent of those in the placebo group.

“This is very significant,” said researcher Yousef Mohammad, who sits on the board of NeuraLieve. “This is a much better response than is achieved with any other method or medication that we have.”

Previous studies have found TMS to be effective when applied by health professionals, but the current study is the first to show that a TMS device can be effectively used by the patients themselves, such as in their own homes.

“I believe that TMS will become an important treatment option, particularly for migraine with aura sufferers who want to avoid medications,” said researcher Richard Lipton.

Researchers believe that TMS functions by suppressing the abnormal electrical brain activity that causes migraines.

NEW YORK (Reuters Health) – People with chronic migraines who overuse pain relievers may have abnormalities in certain hormonal responses, a small study suggests.

It’s known that overusing migraine medications can sometimes cause periodic migraines to become chronic, and the new findings suggest that altered hormone regulation may be one reason, the study’s lead author, Dr. Innocenzo Rainero, told Reuters Health.

Migraines are usually episodic attacks of head pain, often accompanied by nausea and sensitivity to light and sound. Chronic migraine is diagnosed when people suffer attacks at least 15 days a month for more than three months.

Though it’s not clear why migraines sometimes become chronic, medication overuse has been considered a risk factor.

In addition, lab research has shown that the drugs used to treat migraine attacks — including certain non-steroidal anti-inflammatory drugs ( NSAIDs), ergot alkaloids and triptans — may change the body’s secretion of hormones such as growth hormone and the stress hormone cortisol.

Knowing this, Rainero and his colleagues at the University of Turin in Italy tested several hormonal responses in 18 adults with chronic migraine and 18 healthy comparison subjects.

All of the migraine sufferers were overusing some medication, most often NSAIDs. But none was taking any of the drugs used to prevent migraine attacks.

To test study participants’ hormonal function, the researchers injected them with specific “releasing” hormones that trigger the secretion of growth hormone, cortisol, thyroid-stimulating hormone and adrenocorticotropic hormone.

The results are published in the medical journal Headache. Compared with healthy adults, chronic migraine sufferers showed either reduced or heightened secretion of three of these hormones.

According to the researchers, this appears to be the first study to test these hormonal responses in people with chronic migraine and medication overuse, and it’s not clear that medication abuse is responsible for the altered hormonal function.

Migraine itself involves a “chronic stress condition,” the researchers note, and could have impaired hormonal activity in the study patients.

However, Rainero said, the findings do strengthen the belief that abuse of anti-migraine drugs is a “serious medical condition.” They also support the use of preventive medications, he added, as these drugs may head off both migraine attacks and overuse of migraine-relieving medications.

SOURCE: Headache, April 2006.

Overall, 51.3 percent of interviewees had a normal body mass index (BMI), the ratio of weight to height used to estimate obesity, whereas 30.6 percent were overweight, 10.4 percent were obese and 4.6 percent were morbidly obese. Only 3.1 percent of subjects were underweight.

Sixty-five percent of those interviewed were women and the average age of participants was 38.7 years.

No association was observed between BMI and the prevalence of migraine, Dr. Marcelo E. Bigal, of Albert Einstein College of Medicine, Bronx, New York, and colleagues report in the journal Neurology.

However, as BMI increased, so did the frequency of migraine attacks. The team notes that 4.4 percent of the normal weight group had 10 to 15 headache days per month. This increased to 5.8 percent in the overweight group, 13.6 percent in the obese group and 20.7 percent in the morbidly obese group.

The percentage of subjects who reported severe migraines also increased with BMI group, from 53 percent in subjects of normal weight to 57 percent in the overweight group, 59 percent in the obese group and 65 percent in the morbidly obese group, Bigal and colleagues report.

A similar relationship was observed between BMI and migraine-related disability, light and sound sensitivity, which increased as weight increased.

The next step, investigators note, will be a prospective study to see if weight reduction can improve symptoms in obese migraineurs.

SOURCE: Neurology February 2006.

The study led by Dr. Christopher I. Li from the Fred Hutchinson Cancer Research Center in Seattle showed that women who had migraine were at 30 percent lower risk for breast cancer than those who did not have the condition.

The study was involved 3,412 postmenopausal women of whom 1,938 had been diagnosed with breast cancer and 1,474 had no history of the disease.   The researchers wanted to see the incidence of migraine in these two groups.

One possibility for this link is that according to the researchers those who experienced migraine had lower levels of estrogen, which at a higher level is a risk factor for breast cancer.

Dr. Ellen Drexler at Maimonides Medical Center in Brooklyn, N.Y., does not buy such an explanation saying cited by healthday.com that migraine brains are more sensitive to many exogenous and endogenous factors.

Although falling estrogen levels are one of the causes, but it is not known that female migraine suffers always have lower levels of estrogen than those who do not experience thid condition, Dr. Drexler was cited as saying.

Dr. Len Lichtenfeld of the American Cancer Society was cited as saying that this study would result in no implications implying that you can use migraine to reduce breast cancer even if migraine is the cause for the reduction in breast cancer.

Dr. Stephen Silberstein at Thomas Jefferson University Hospital in Philadelphia said flatly that the study was flawed because the migraine data were self-reported and they were not trustworthy enough to be used in a study anyway.

Regardless, the current study merely established an association between the incidence of migraine and risk of developing breast cancer.   The results did not mean to say the association is a causal relation.

The study was published in the November 2008 issue of Cancer Epidemiology, Biomarkers & Prevention.

A health observer who did not want to be named suggested that the association could really mean something.   He agreed that women who experienced migraine are more sensitive to some environmental factors that trigger the episodes of migraine.   Because of these women may be more likely than others to avoid some risk factors for migraine which may happen to be also risk for breast cancer.

For instance, we know migraine may be caused by a number of risk factors including stress, alcohol, caffeine, nitrates in hot dogs and lunch meats, MSG, tyramine in aged cheeses, soy products, fava beans, hard sausages, smoked fish and aspartame in Nutrasweet and Equal. Some of these factors are recognized risk factors cancer.

According to a new study, more than four out of five Canadian and Mayo Clinic neurologists have had a headache in the past year and 50 percent of them have had a migraine.

In terms of headaches, those results put neurologists on par with the general population. But when it comes to migraines, neurologists appear to suffer them far more often than other people. Studies indicate that about one in eight adults in Canada and the United States experience migraines.

Why the difference? Do neurologists get migraines from treating people with headaches or do they choose to go into neurology because they suffer migraines?

“A recent study demonstrated that for the vast majority of neurologists, having migraines did not influence their decision to become a neurologist,” lead investigator Dr. Jonathon Gladstone, a headache fellow at the Mayo Clinic in Scottsdale, Ariz., and a neurology resident at the University of Toronto, said in a prepared statement.

“Rather, neurologists are armed with more knowledge about headache types, and are better able to understand and appreciate the spectrum of migraine. As a result, neurologists are better able to recognize that their own headaches are migraines,” Gladstone said.

He sent a questionnaire to 75 neurologists in the Toronto area and to 60 neurologists at three Mayo Clinics. Two out of three neurologists reported having at least one migraine in their lifetime.

“We believe this indicates that migraines are much more common than previous general population studies have suggested,” Gladstone said.

The study was presented June 10 at the annual scientific meeting of the American Headache Society in Vancouver, British Columbia.

More information

The American Academy of Family Physicians (news – web sites) has more about migraines.

Researchers were not surprised by the findings, as previous studies have linked obesity to migraine headaches in adults as well.

“The numbers tell us that being overweight may contribute to kids having more headaches, most often migraines,” Dr. Andrew D. Hershey, director of the Headache Center and a pediatric neurologist at Cincinnati Children’s Hospital Medical Center, said in a prepared statement. “There are likely a number of causes, including poorer general health, body stress, lack of exercise and nutrition. It may not be that being overweight directly causes migraine, but that the reasons for being overweight cause these children to have worsening headaches.”

Researchers evaluated 440 children between the ages of 3 to 18 who visited one of seven pediatric headache centers. Of the entire population, just over 91 percent were diagnosed with migraine headaches and close to 9 percent had other types of headaches. While 15.5 percent of U.S. children are considered overweight, more than 21 percent of headache-prone children in the study were overweight, the researchers said.

Severity of headaches was also examined and calculated on a scale where a score of between 30 and 50 signified moderate disability due to headache. Children who were overweight had an average score of 41.9, those at risk of being overweight a score of 42.9, and children of normal weight a score of 28.7.

Results of the study were to be presented at this week’s annual meeting of the American Headache Society, in Los Angeles.

“Obesity is a state of chronic, low-degree systemic inflammation,” study author Dr. Marcelo E. Bigal, director of research at the New England Center for Headache in Stamford, Conn., said in a prepared statement. “Most of the inflammatory markers that are elevated in obese people also play a role in the inflammation of blood vessels in the brain that occurs during migraine attacks. Being a pro-inflammatory state, obesity may increase the chances of migraine attacks in people who are biologically predisposed to suffer from migraines.”

They found that the number of American adults who abuse alcohol or are alcohol dependent rose to 17.6 million or 8.46 percent of the population in 2001-2002 from 13.8 million or 7.41 percent of the population in 1991-1992.

The researchers cannot say why heavy drinking is up. “The fact that alcohol disorder rates are highest among young adults underscores the need for concerted research on drinking patterns that initiate in adolescence,” said Dr. Ting-Kai Li, Director of the National Institute on Alcohol Abuse and Alcoholism.

The NIAAA study defines alcohol abuse as causing a failure to fulfill major role obligations at work, school, or home; interpersonal social and legal problems; and/or drinking in hazardous situations.

Alcohol dependence, also known as alcoholism, is characterized by impaired control over drinking, compulsive drinking, preoccupation with drinking, tolerance to alcohol and/or withdrawal symptoms.

Across the decade, the rate of alcohol abuse increased to 4.65 percent of the general population from 3.03 percent, while the rate of alcoholism fell to 3.81 percent of the general population from 4.38 percent, Li’s team reported in the journal Drug and Alcohol Dependence.

The survey was done by the U.S. Census Bureau (news – web sites), which interviewed more than 43,000 people face to face.

The survey found men more likely to abuse alcohol than women and people aged 18 to 44 were more likely to abuse alcohol than older people.

“Alcohol abuse is more prevalent among whites than among Hispanics, Blacks, and Asians. Alcohol dependence is more prevalent among Native Americans, Hispanics and whites than among Asians,” the NIAAA, one of the National Institutes of Health (news – web sites), said in a statement.

“That rates of dependence overall decreased is not surprising in light of other surveys that indicate a decline in heavy drinking,” said Bridget Grant, who led the study.

“That alcohol abuse seems to be increasing presents intriguing questions. What is clear is that no single environmental cause can explain the increase. Further research is an important public health priority.”

WASHINGTON (Reuters) – People with migraines also may be suffering from some brain damage as brain cells swell and become starved of oxygen — a finding that may help explain why migraine sufferers have a higher risk of stroke, researchers reported on Sunday.

Similar brain damage can occur with concussions and after strokes, the researchers said in this week’s issue of the journal Nature Neuroscience.

They said their findings suggest that migraine sufferers should not simply get pain relief but should take drugs that prevent the migraine, which is often preceded by “aura” — a series of visual disturbances that can include flashes of light or black spots.

The research, which was done in mice, also suggests giving oxygen may help reduce the damage, said Takahiro Takano, Maiken Nedergaard and colleagues at the University of Rochester in New York, working with a team at the Danish pharmaceutical group Novo Nordisk.

They studied a process called cortical spreading depression, known as CSD, a wave of changes in cells associated with migraine, stroke and head trauma.

They used a precise two-photon microscopic and oxygen sensor microelectrodes to look at the brains of live mice while they caused this process.

They saw a swelling occur and the brain cells became starved of oxygen. The nerve cells were damaged — specifically the dendrites, the long, thin spikes that stretch from one nerve cell to another.

28 MILLION SUFFERERS IN U.S.

“This observation may have direct clinical implications, as several lines of work support the notion that cortical spreading depression constitutes the neurological basis of migraine with aura, and spontaneous waves of CSD may contribute to secondary injury in stroke and traumatic brain injury,” the researchers wrote.

Migraine is a severe and debilitating form of headache, affecting 28 million people in the United States alone.

Two studies, including one published last week in the Archives in Internal Medicine, show that people who have migraines are more likely to have heart attacks.

A 2004 study in the British Medical Journal found that migraine sufferers are twice as likely to suffer a stroke as people who do not have the headaches.

Women are much more likely to suffer the characteristic pain of a migraine.

Usual pain medication often has little effect on migraine but a class of drugs called triptans, also called serotonin agonists, and ergotamine drugs, can be used to prevent the worst effects if patients take them at the first sign.

Giving the mice rich doses of oxygen seemed to shorten the duration of the wave of brain effects seen in CSD, the researchers said. They noted that migraine and cluster headache patients are sometimes treated with high-pressure oxygen.

It is not clear if the effects of migraine are permanent, the researchers said. Some studies have suggested they are while others have shown no difference in memory and other cognitive effects in migraine patients.

The study, presented the annual meeting of the American Headache Society in Vancouver, found that 51 percent of the migraine sufferers studied were sensitive to changes in the weather, such as temperature and barometric pressure.

“Most people in the study thought they could predict which type of weather factor triggered their migraines, but they really couldn’t,” researcher Marcelo Bigal of the New England Center for Headache said in a statement.

The study compared the personal headache records of 77 migraine sufferers over two years with data collected by the U.S. National Weather Service (news – web sites).

Temperature or humidity changes sparked pain in 34 percent of sufferers, while 14 percent were hit when a weather pattern changed and 13 percent when it was a pressure change. About 10 percent had their pain triggered by more than one type of weather change.

Previous reports have linked migraine to an elevated risk of having a stroke. In the present study, Dr. Ann Scher, from the National Institutes of Health in Bethesda, Maryland, and colleagues examined the possibility that this was because migraine patients have a higher cardiovascular risk profile.

In the study, published in the medical journal Neurology, the risk profiles of 620 patients with migraine were compared with those of 5135 “control” subjects without migraine.

Migraine patients were more likely to be smokers, but less likely to be alcohol drinkers than controls. In addition, a parental history of heart attack at a young age was more common among migraine patients.

Compared with controls, people who experienced migraine with aura were more likely to have unfavorable cholesterol profiles, elevated blood pressure, and to report a history of early onset heart disease or stroke.

In terms of standard risk scores, migraine patients were about twice as likely as controls to be at elevated risk for heart disease, the investigators report.

Thus, they conclude, “further research is warranted to determine why migraineurs have these risk factors more frequently than nonmigraineurs and the nature of the additional mechanism that predisposes these individuals to early-onset cardiovascular disease.”

WASHINGTON (Reuters) – Men who suffer migraine headaches have a higher risk of heart disease, particularly heart attacks, according to a study published on Monday.

The researchers found a 24 percent increased risk for overall cardiovascular disease in men who experienced migraines compared to those who did not, including a 42 percent increased risk for heart attacks.

The study, published in the Archives of Internal Medicine, follows similar findings among women.

Dr. Tobias Kurth of Harvard Medical School and Brigham and Women’s Hospital in Boston and colleagues tracked 20,084 men aged 40 to 84 who had no history of heart disease from the early 1980s through 2005. About 7 percent of the men reported having migraines.

Kurth said it is unclear what it is about migraines that is increasing the risk.

“The honest answer is: it’s unknown,” Kurth said. But he noted that people who have migraines tend to have more cardiovascular risk factors such as high blood pressure and high cholesterol.

“At this point, it’s far too early to really say that migraine directly is causing cardiovascular disease,” Kurth said in a telephone interview.

Migraines, a particularly painful kind of recurring headache, often are marked by dizziness, nausea, vomiting or extreme sensitivity to light and sound. Women are three times more likely than men to get migraines.

This study focused on men with migraines. The same researchers last year published a study tracking nearly 28,000 women that showed those who had migraines were more likely to develop cardiovascular disease as well.

Kurth said that, relatively speaking, migraines are associated with perhaps a moderate increase in risk for cardiovascular disease, particularly compared to traditional factors like high blood pressure, smoking, obesity and elevated cholesterol.

People who get migraines should be mindful of these risk factors, he said.

“So if you still smoke, stop smoking. Treat hypertension if you have high blood pressure. Lower your cholesterol. Evaluate your diet. Maintain a lean body weight. Those are things that one can actively do,” Kurth said.

The researchers said overweight people tend to have more frequent and severe migraines along with a higher risk of heart disease. They also said it is possible migraines are an indicator for a buildup of plaque in the arteries.

But they said the increased risk for cardiovascular disease that they observed remained even after they accounted for known major risk factors in the men involved in the study.

In the United States alone, the researchers wrote, more than 28 million people get migraines, including about 18 percent of women and 6 percent of men.

Nov. 1, 2006 — The popular migraine medicine Topamax increases the risk of kidney stones, reports a team of researchers from the University of Texas Southwestern Medical Center (UTSW) in Dallas.

Their study, published in the October issue of the American Journal of Kidney Diseases, confirms what doctors have suspected and what was found in clinical trials of the medication.

But the study adds crucial details, says researcher Dion Graybeal, MD, an assistant professor of neurology at UTSW. “The data out there was pretty poor in terms of what the exact evidence was [of a Topamax-kidney stone link],” Graybeal tells WebMD.

Topamax (topiramate) has become one of the most commonly prescribed medications for migraine, Graybeal says, since it was approved for migraines by the FDA in 2004. It was originally approved in 1995 as an antiseizure medication. Since then, more than 4 million patients worldwide have taken it, according to Ortho-McNeil Neurologics in Titusville, N.J., the drug’s maker. Ortho-McNeil is a WebMD sponsor.

About 28 million Americans suffer from migraine, Graybeal says. Topamax works by stabilizing the brain’s neurons, he says, but it also has an effect on the kidneys.

Study Results

To find out how the urine of those on Topamax changes, the researchers compared 32 men and women already being treated with topiramate for migraines with 50 healthy volunteers who did not have migraine and were not on topiramate. “Patients already on topiramate had been on it for months to years, at a variety of doses — from 25 milligrams a day to up to about 300,” Graybeal tells WebMD.

They did a 24-hour urine collection and found that those on the medication had low excretions of a substance called urinary citrate, which helps inhibit stone formation, and higher pH of their urine, which boosts kidney stone risk. Participants on the medication excreted only a third of the urinary citrate as those not on the medication.

Graybeal’s team also looked at seven other patients before and at least three months after taking the medication at doses of 50 to 200 milligrams a day, and found the same changes to a greater degree.

One of the 32 patients on topiramate in the first study got a kidney stone, Graybeal says.

Measuring Risk

“We can’t say directly, given the size of the study, what the yearly risk for patients on topiramate for migraine is for getting kidney stones,” Graybeal says.

In previous research on the drug when used by seizure patients, the kidney stone incidence was estimated at 1.5%, Graybeal notes in the paper.

In the general population, the incidence is about 0.2%, he says.

Put another way, in the general population, “one of 8 men and one in 15 women in the U.S. will develop a kidney stone in their lifetime,” says Leslie Spry, MD, a nephrologist in Lincoln, Neb., and a spokesman for the National Kidney Foundation.

“It seems to confirm some of the things we already knew,” says Joseph Hulihan MD, vice-president of medical affairs for Ortho-McNeil Neurologics, of the new study.

Dietary Measures

Topiramate provides effective relief for many headache sufferers, Graybeal notes. Unlike some other migraine medications, it isn’t associated with weight gain. In fact, it’s often associated with weight lossweight loss. In the three-month study, those on topiramate lost an average of 8.8 pounds, they found.

Those who stay on the medication can take dietary measures to reduce kidney stone risk, Graybeal says. Drink 32 to 64 ounces of water a day, he advises. Increasing your vitamin C, which lowers the urine pH, can help, he says. Ask your doctor for dose advice.

“We would advise increasing fluid intake when you are taking Topamax,” agrees Spry. He tells patients to drink enough water that they need to get up at night to urinate — and while they are up, to drink another glass.

Curb the salt, too, Spry says. “That means no added salt, not in cooking or at the table.”

“There is also some evidence that if you change your diet a bit, adding more vegetable protein, like tofu, soy, eggs, dairy protein, that will help,” Spry says.

FRIDAY, Nov. 10 (HealthDay News) — The drug topiramate (Topamax), commonly prescribed to treat migraines and seizures, can boost users’ risk of kidney stones, a new study finds.

“The widespread and escalating use of topiramate emphasizes the importance of considering the long-term impact of this drug on kidney stone formation,” study senior author Dr. Khashayar Sakhaee, chief of mineral metabolism at the University of Texas Southwestern Medical Center at Dallas, said in a prepared statement.

There were two parts to the study. In one, 32 people being treated with topiramate and 50 people in a control group had their blood and urine tested for kidney stone risk. The other part included 7 people whose kidney stone risk was assessed before and three months after they took topiramate.

The study found that patients who took topiramate on a long-term basis (about a year) experienced systemic metabolic acidosis — a buildup of excessive acid in the blood — as a result of the inability of the kidney to excrete acid.

Long-term use of topiramate also increased urine pH and lowered urine citrate, which inhibits kidney stone formation.

These changes increase the risk of calcium phosphate kidney stone formation,

Short-term use of topiramate did not increase the risk of kidney stones.

The findings were published in the October issue of the American Journal of Kidney Diseases.

Topiramate is one of the most commonly prescribed and effective medications for migraines, noted study co-author Dr. Dion Graybeal, assistant professor of neurology. Migraines affect more than 29 million Americans, according to the National Headache Foundation.

Magnesium May Ward Off Migraines

(HealthNewsDigest.com)…Stress, caffeine, bright lights, and cigarette smoke are just a few of the many triggers that can provoke migraine headaches. Approximately 28 million Americans suffer from migraine headaches with debilitating effects that can last for hours or days.

Dr. Barbara Levine, Director of the Nutrition Information Center and Associate Professor of Nutrition in Clinical Medicine at Weill Medical College of Cornell University states, Studies have shown a relationship between migraine headaches and low brain magnesium levels; therefore, magnesium supplementation may be effective in warding off migraines.

To learn more about these dietary supplements and others, including research citations, information on basic use, dosage, and contraindications, written in laymans terms, visit the DSIB Web site at www.supplementinfo.org. Finding the information is as easy as clicking on the name of a supplement or condition.

Date: July 13, 2004

Melatonin is secreted by the pineal gland in the brain and is involved in regulating the circadian cycle. There is increasing evidence that melatonin secretion is related to headache disorders, Dr. Mario F. P. Peres, of Hospital Israelita Albert Einstein, in Sao Paulo, and colleagues note in the medical journal Neurology.

“Altered melatonin levels have been found in cluster headache, migraine with and without aura, menstrual migraine, and chronic migraine,” the researchers write.

The team tested the effectiveness of melatonin for preventing migraine, with or without aura, in 34 sufferers. The participants were given 3 milligrams of melatonin 30 minutes before bedtime.

Among the 32 subjects who completed the study, 25 experienced at least a 50 percent reduction in headache frequency after three months of treatment.

Specifically, eight patients had a complete response, seven had more than a 75 percent reduction in headache frequency, and ten had between 50 percent and 75 percent reduction.

No increase in headaches was seen.

Melatonin also decreased headache intensity and duration, and overall use of painkillers and drugs to treat a migraine decreased, Peres and colleagues report.

“This is the first study to assess melatonin efficacy in migraine prevention,” the researchers point out. Based on these findings, they suggest that a “controlled study may be worthwhile,” in which melatonin would be compared with a placebo treatment.

NEW YORK (Reuters Health) – A traditional Mediterranean diet that includes a healthy serving of nuts each day may help reverse a cluster of risk factors for heart disease, researchers reported Monday.

In a study of more than 1,200 older adults, Spanish researchers found that those who followed the diet had lower rates of metabolic syndrome — a clustering of risk factors for heart disease, diabetes and stroke, which includes high blood pressure, abdominal obesity, elevated blood sugar and unhealthy cholesterol levels.

The prevalence of metabolic syndrome among the men and women who followed the nut-enriched Mediterranean diet fell by nearly 14 percent over one year compared with roughly 7 percent among study participants who followed a traditional Mediterranean diet rich in olive oil.

In a third study group that received advice to follow a low-fat diet, the prevalence of metabolic syndrome dipped by only 2 percent.

The findings suggest that the Mediterranean diet can help manage metabolic syndrome, even without weight loss or exercise, the researchers report in the Archives of Internal Medicine.

They also imply that the benefits may be greater when people use nuts as a major fat source, according to the investigators, led by Dr. Jordi Salas-Salvado of the University of Rovira i Virgili in Reus.

Both study groups on the Mediterranean diet increased their intake of extra- virgin olive oil, and research has shown olive oil to have cardiovascular benefits.

However, the researchers point out, unlike olive oil, nuts are “whole foods” that provide nutrients other than healthy fats — including fiber, potassium, calcium and magnesium. Walnuts also contain substantially more of heart-healthy omega-3 fat than olive oil does.

Those nutrients have been shown to reduce blood pressure, cholesterol and inflammation, and improve the body’s use of insulin, a hormone that regulates blood sugar.

The study involved 1,224 older adults at high risk of cardiovascular disease, 61 percent of whom had metabolic syndrome at the study’s start. The participants in both Mediterranean groups also participated in periodic sessions on how to change their diets — including advice on cooking with olive oil, replacing red meat with white meat and fish, and eating more fruits and vegetables.

After one year, Salas-Salvado’s team found, there were no significant weight changes in any of the groups, on average. However, there were reductions in the various components of the metabolic syndrome — most apparent in those who boosted their nut intake.

A longer-term follow-up is now needed, the researchers say, to see if the Mediterranean diets prevent heart attacks and other complications of metabolic syndrome.

SOURCE: Archives of Internal Medicine, December 8, 2008.

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The transcranial magnetic stimulation (TMS) device, about the size of a hair dryer, was able to interrupt the development of migraines, according to data to be presented Thursday at the American Headache Society’s annual meeting, in Los Angeles.

The study was funded by the device’s maker, NeuraLieve, of Sunnyvale, Calif.

About 28 million Americans suffer migraine headaches and about 20 percent experience migraine with aura, characterized by changes in vision before the actual pain begins.

Scientists now believe that migraine attacks start because of nerve cell hyper-excitability, which is followed by fatigue and malfunction of the nerve cells, or neurons. These phases seem to correlate with the aura.

“This process spreads throughout the brain and the end result is the throbbing headache,” said Dr. Yousef Mohammad, principal investigator of the study and an assistant professor of neurology at Ohio State University Medical Center.

“If we can interrupt this with two pulses of magnetic stimulation, we can abort the headache,” he added.

The TMS device used in this study is approved by the U.S. Food and Drug Administration as an investigational device. It sends an electric current through a metal coil, creating a magnetic field that activates nerve cells in the brain.

The study involved 43 people who had migraines with aura and were randomly picked to receive either TMS or treatment with a placebo device. Participants were instructed to give themselves two pulses to the back of the head at the first sign of an aura.

Seventy-four percent of people in the TMS group said they had no or only a mild headache two hours after using the device, compared with 45 percent in the control group. Participants also reported a reduction in noise and light sensitivity: 74 percent of people in the TMS group experienced a reduction in light sensitivity while 75 percent experienced less noise sensitivity. In the placebo group, only 20 percent or so experienced such reductions.

A larger study of TMS involving nine medical centers and 200 patients will begin next month, Mohammad said.

Another study presented at the meeting found that the anti-seizure medication Topamax (generic name topiramate) provided relief to people who have migraine headaches virtually every day.

The drug is approved by the FDA for prevention of migraine headaches, but had not been specifically studied in migraine sufferers who also experienced chronic daily headaches.

About 4 percent of U.S. adults, or nearly 9 million people, have headaches 15 or more days a month, known as chronic daily headache.

For this study, more than 300 patients were randomly chosen to receive Topamax or a placebo for 16 weeks. The study was funded by the drug’s maker, Ortho McNeil Pharmaceutical.

At the end of the study period, 41.2 percent of people taking Topamax had fewer headaches or days with headaches, compared to 28.8 percent in the placebo group.

Half of the people in the Topamax group had a 40 percent or greater reduction in migraines or days with migraine. Headache severity was also reduced significantly in the Topamax group.

There were, however, side effects in the Topamax group: 29 percent of these patients experienced numbness or tingling in the hands or legs, compared to 7 percent of those in the placebo group.

“It’s extraordinarily important that not only headache frequency decreased, but also severity,” said Dr. Stephen Silberstein, study author and director of the Jefferson Headache Center at Thomas Jefferson University Hospital, in Philadelphia. “It’s important to have a medication that works for difficult-to-treat patients.”

Researchers found that a daily dose of Petasites hybridus root, commonly known as butterbur, appears to be safe and effective at preventing migraine headaches.

“The 75-mg butterbur dose reduced headache frequency by 48 percent — a substantial treatment effect,” says researcher Richard B. Lipton, MD, professor of neurology at the Albert Einstein College of Medicine of Yeshiva University in New York, in a news release.

“Butterbur is a traditional herbal treatment for migraine prevention,” says Lipton. “Our study shows that butterbur really does reduce the frequency of migraine attacks, so it’s a welcome addition to the therapeutic arsenal we have available to combat migraine.”

The results of the study appear in the Dec. 28 issue of the journal Neurology.

Butterbur May Aid in Migraine Treatment

In the study, researchers compared the effects of 50 or 75 mg twice a day of butterbur extract pills vs. a placebo in preventing migraine headaches in 245 people with frequent migraine. All of the participants reported at least two to six migraine headache attacks per month over the previous three months before the study began.

After four months of treatment, researchers found the 75 mg dose reduced migraine headache frequency by 48% vs. the 26% reduction found with the placebo. The 50 mg dose was associated with a 36% reduction in migraine headache frequency, which according to the researchers is not significantly different from the effects of the placebo.

Significantly more people in the 75 mg dose group had a 50% reduction in migraine attacks per month than those receiving the placebo.

The most commonly reported side effects of treatment with butterbur were gastrointestinal problems, predominantly burping.

Researchers aren’t quite sure how butterbur works to prevent migraine headaches, but previous studies have suggested that the herbal extract has anti-inflammatory properties. Inflammation has been implicated in the cascade of events that trigger a migraine.

Lipton says raw butterbur root contains toxic chemicals that are filtered out during the manufacturing process, which is why he says it’s a good idea to avoid “home-brewed” butterbur extract. Several commercial products containing butterbur extract are available, but manufacturing standards are not uniform for plant extracts.

The results in this study are based on use of the Petodolex brand of butterbur extract. Weber & Weber GmbH & Co., which produces Petodolex, also supported the study.

“Our study focused on migraine patients with chronic daily headache, which is defined as having a headache at least 15 days per month,” lead author Dr. David W. Dodick, from the Mayo Clinic in Scottsdale, Arizona, told Reuters Health. “These patients represent a minority of all migraine sufferers, but they account for at least 50 percent of the patients seen in specialty headache clinics.”

“This is an important group to look at because they are often excluded from migraine studies and because there’re no approved therapies for chronic daily headache,” Dodick explained. “There is a desperate unmet need for agents targeting this group of patients.”

The idea of using Botox as a preventative agent for migraines came in 1992 when a Los Angeles plastic surgeon noticed fewer headaches in a patient who was being treated with the agent for its skin-smoothing effects. Since then, several studies have evaluated botulinum toxin as a migraine preventative.

In the present study, 228 patients with chronic daily headache were randomly allocated to botulinum toxin injections or inactive “placebo” injections of saline every 3 months for 11 months.

Dodick said that the injections are placed primarily in the area of the trigeminal nerve, but may continue into other areas as needed to “follow the pain.” In the current study group, the number of injections during each treatment session ranged from 10 to 25 per patient.

Treatment with botulinum toxin reduced the frequency of migraine attacks per month from 14 to 6 — a reduction of 55 percent. By contrast, with placebo, attacks dropped from 12.9 to 8.4 per month, for a significantly lower reduction of 35 percent.

Dodick said that treatment with Botox “was also linked to a significant reduction in headache severity and with a drop in the use of acute headache medications.”

Botulinum toxin is not currently approved by the US Food and Drug Administration for use against migraines, Dodick noted. “This was an exploratory study. Now, we will embark on registration trials, which will determine whether the FDA approves this drug for migraines.”

Eleven men and women with a long history of migraine did not respond to several type of drugs, including beta-blockers, antidepressants and anticonvulsants, had fewer and less severe headaches, on average, after taking capsules containing an extract of pine bark, vitamin C and vitamin E every day for three months, according to a report in the journal Headache.

There is evidence that damaging molecules known as free radicals, which are produced by normal metabolism, may contribute to the development of migraine, Dr. Sirichai Chayasirisobhon of Kaiser Permanente Medical Center in Anaheim, California notes. Antioxidants neutralize free radicals and could thus help prevent migraine from occurring.

To investigate, he treated 12 patients to 10 capsules containing 120 mg pine bark extract, 60 mg vitamin C and 30 IU vitamin E every day for three months. Study participants completed a test designed to assess the amount of disability caused by migraine, known as MIDAS, before and after the three-month treatment period. Eleven patients completed the trial.

After three months, the patients had an average 50.6-percent improvement in MIDAS scores. In the three months before the treatment, they reported an average of 44.4 days of headache, compared to 26.0 days during the three-month treatment. Before treatment, participants rated their headache severity, on average, as 7.5 out of 10; this fell to 5.5 out of 10 after treatment.

Two patients showed no reduction in disability, headache severity or headache days after treatment. When the analysis was limited to the nine responders, MIDAS scores showed a 67.9 percent reduction.

The findings suggest “that this antioxidant supplementation may mitigate some as yet unknown mechanisms involved in a migraine attack,” Chayasirisobhon writes.

He concludes: “The substantial effect shown by the antioxidant formulation in the present study in lessening the impact of migraine on patients’ daily activities warrants further investigation.”

SOURCE: Headache, May 2006.