Botox helps those with depression

A study shows that depressive symptoms are improved by Botox injections.

"Study author M. Axel Wollmer, a psychiatrist at the University of Basel in Switzerland, believes the treatment “interrupts feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotions.” Past studies have shown that Botox impairs people's ability to identify others' feelings, and the new finding adds more evidence: the muscles of the face are instrumental for identifying and experiencing emotions, not just communicating them." JR

In the largest randomized, double-blind, placebo controlled study to date on the effect of OnabotulinumtoxinA (as known as Botox) on depression, researchers found that more than half of subjects suffering from moderate to severe depression showed a substantial improvement (greater than or equal to 50% of baseline) in their depressive symptoms as measured by the MADRS scale.

The study, conducted by Dr. Eric Finzi, MD, PhD and Dr. Norman E. Rosenthal, MD and published in the Journal of Psychiatric Research, included 74 depressed subjects injected with a single treatment of either onabotulinumtoxinA (OBA) or a placebo to the corrugator and procerus muscles between the eyebrows. Results showed that depressive symptoms (as assessed by the MADRS scale) in the OBA treatment group decreased 47 percent after six weeks, compared to 21 percent in the placebo group. This study is the first to show a significant difference in remission rate with OBA in depressed patients (27% OBA vs. 7% placebo).

Study co-author Dr. Norman E. Rosenthal, MD, Clinical Professor of Psychiatry at Georgetown Medical School, commented, "This research is groundbreaking because it offers those who suffer from depression and their doctors an entirely new approach to treating the condition -- one that doesn't conflict with any other treatments."

The study showed that Botox may help relieve depressive symptoms both as a stand-alone and an adjunctive treatment.

"This new research supports earlier facial feedback theory of Charles Darwin and William James which suggests that facial expressions influence mood," added Dr. Eric Finzi, Dermasurgeon and co-author on the paper that first reported that inhibition of frowning by facial injection of OBA could help depressed patients in a pilot study published in 2006.

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How Botox can help with Cluster Headaches

This article discusses research that is currently being done to turn Botox into a treatment for cluster headaches.

Botox is best known as a facial wrinkle remover, but if all goes well with the research, someday soon it may be a treatment option for cluster headache. At least that is the hope of a team of scientists at the Norwegian University of Science and Technology (NTNU).

Why Botox?
Botox (onabotulinumtoxinA) is a neurotoxin and a drug that uses a potent poison called botulinum toxin, which is derived from the bacterium Clostridium botulinum. When it is injected into facial muscles, it paralyzes them temporarily and causes wrinkles to disappear for several months.

Similarly, injections of the toxin are used to block nerve signals that cause muscles contractions in cerebral palsy and bladder spasms, to block postsurgical pain and foot pain, and to temporarily relax eye muscles in people with strabismus (misaligned eyes). Botox also is sometimes used to treat migraine.

Cluster headache and Botox
Cluster headache pain is more severe than migraine pain and can drive patients to perform desperate acts, even suicide, to avoid it. Therefore finding effective treatments for this devastating condition, which affects an estimated 53 people per 100,000 per year, is essential.

That’s why Erling Tronvik, NTNU senior consultant and researcher, along with two colleagues, are about to undertake a study of the impact of Botox on cluster headache sufferers. This team has devised a treatment device that will allow them to shoot Botox through a hole in the nasal wall into a nerve bundle located behind the sinuses.

Clinicians will use magnetic resonance imaging (MRI) scans to accurately identify the location of the nerve bundle in each patient before treatment is initiated. According to Tronvik, this unique approach should (in theory) reduce or eliminate the flow of signals in this area for three to eight months, after which time patients would need to get another treatment.

“We designed the equipment ourselves, and Botox has never been used for this anywhere else,” noted Tronvik. Soon, 10 patients will enter the first pilot study of this treatment method.

If the results of the pilot study are positive, the team plans to enroll 30 to 40 patients who suffer with cluster headache and about 80 migraineurs as well.

Are there any side effects? Tronvik explained that use of MRI is a highly accurate way to locate the exact spot to inject the Botox. However, he also noted that if the toxin were to slightly miss the mark, patients could experience a weakened ability to chew or temporary double vision.

In the meantime, there’s some good news regarding chronic migraine. Botox has been shown to be helpful in relieving chronic migraine, as seen in the results of the PREEMPT (Research Evaluating Migraine Prophylaxis Therapy) clinical program.

In that study, nearly 70 percent of patients treated with Botox experienced at least a 50 percent reduction in the frequency of headache days. Other research has shown Botox to be effective as preventive treatment for chronic migraine and to provide a reduction in severity and intensity of pain as well as the number of days with disability.

If you suffer with cluster headache, a new effective treatment can’t come soon enough. Hopefully Botox or another option in the pipeline will prove beneficial in the near future.

Study References
Alvaro-Gonzalez LC et al. Botulinum toxin A in chronic refractory migraine: premarketing experience. Revista de Neurologia 2012 Oct 1; 55(7): 385-91
Aurora SK et al. OnabotulinumtoxinA for chronic migraine: efficacy, safety, and tolerability in patients who received all five treatment cycles in the PREEMPT clinical program. Acta Neurologica Scandinavica 2014 Jan; 129(1): 61-70

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Botox helps rats lose weight

A study using rats showed that botox can be used as a weight loss aid.

Researchers from the Norwegian University of Science and Technology have had promising experimental results from using Botox as a weight loss tool in rats. The research group hopes to win approval for human testing in the near future.

You may know Botox from its use by the rich and famous to eliminate facial wrinkles. But now Helene Johannessen, a PhD candidate at the Norwegian University of Science and Technology (NTNU), is studying whether or not Botox could be used as an alternative to treating morbid obesity, replacing costly and dangerous operations.

Tests on rats have shown that treatments with Botox injected into the vagus nerve in the stomach can lead to weight loss. When Johannessen injected rats with Botox, the animals ate less and lost 20-30 per cent of their body weight over five weeks. The treatment effectively paralyzes the vagus nerve, which triggers the sense of hunger and controls the passing of food through the intestines.

Paralyzing the nerve paralyzes muscles in the stomach, which appears to slow the passage of food through the stomach. This effect might one day lead to treatments that cause people to feel fuller for longer.

EU project fights obesity
The hope is that the use of botox can be developed into an alternative to gastric bypass surgery. Johannessen and her research are part of the Experimental Surgery and Pharmacology research group, which is exploring alternatives to gastric surgery. The Botox treatment study is part of an EU project called Full4Health.

Botox is actually botulinum toxin, which when ingested in spoiled foods can lead to both paralysis and death. Nowadays Botox is used in the medical treatment of dystonias and spasms, as well for its more famous cosmetic use. If Johannessen and her colleagues succeed in their efforts, it might also become useful in giving people a healthier and less weighty life.

Clinical studies coming
Johannessen told the Norwegian Broadcasting Corporation (NRK) that her research team will start human clinical studies as soon as Norwegian medical ethics authorities give their approval.

"As a start, we will be inviting patients who are candidates for obesity operations but who, for one reason or another, cannot undergo one,"  Johannessen told NRK.

Obesity is a growing problem across the globe. Being overweight can lead to severe diseases and conditions including diabetes and heart problems. The World Health Organization estimates that obesity is responsible for 2-8 percent of health care costs and 10-13 percent of deaths in different parts of Europe.

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Medical uses and stigma associated with botox

Botox can be used to help with migraines, cerebral palsy, and overactive bladders. However, Botox users face the stigma attached with using a cosmetic product for medical purposes.

A cosmetic procedure popular among Hollywood stars can now be used to supposedly cure chronic migraines.

Botox, which is used to reverse the signs of aging is now being used to treat the neurological disorder.

More than 42,000 Kiwis suffer from chronic migraines every year and when it strikes the sufferer can be out of action for up to 72 hours.

But Botox has been proven to successfully treat the debilitating condition as well as other medical conditions.

"We can use it for cerebral palsy children, it can help them to walk again, for people who have spastic syndromes in their neck where they have chronic pain in their neck," Dr Garsing Wong from Sapphire Migraine Clinic told ONE News.

"It can even be injected into bladders, for people who over-active bladders now."

Botulinum Toxin or Botox is one of the most poisonous substances known to man, but the small dose used for treatment are less toxic than drugs you can buy over the counter.

Injections are applied to places that hold a lot of tension and through paralysing the muscle or relaxing it the treatment is able to reduce the pain at the trigger points.

But the stigma attached to Botox remains.

"The first thing, I think, that pops into your head are all those people in LA and stuff and their foreheads are literally frozen and first of you all you think; everyone's going to judge me," said Thea Lyle, Migraine Sufferer.

Ms Lyle said when she was first going to have botox to help with her migraines she was quite apprehensive about it.

But Ms Lyle is only one of hundreds of people who have had the procedure at the Sapphire Migraine Clinic.

For those who combine it with intensive physiotherapy there is a 90% success rate.

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How to get rid of migraine headaches

This article discusses a few ways to reduce or get rid of migraine headaches.

Migraines are more than an occasional nuisance for some. Those suffering from chronic migraines know all too well the nausea, sensitivity, and unbearable pain that comes along with frequent attacks. Luckily, there are treatments available to reduce the frequency and severity of migraines.

 

Migraine treatment can be broken down into two categories; those that ease symptoms that have already started, and preventative measures that stop migraines before they start.

 

Pain-relieving medications can be taken during migraine attacks and are designed to stop symptoms that have already begun. These medications can include over-the-counters like ibuprofen and acetaminophen, but also prescription pain relievers such as indomethacin.

 

Preventative means can stop migraines from starting. Those suffering regularly from migraines might want to consider the following treatments.

 

Botox Treatments

Approved by the FDA for treating chronic migraines, injections are given around the head and neck once every 12 weeks. The Botox blocks pain signals as well as causes head and neck muscles to relax. By working on sensory pathways it reduces the sensory traffic from the head to the consciousness. 

 

Magnesium Deficiency

Studies have shown that up to 50 percent of migraine patients have lowered levels of magnesium during an attack, and an infusion of the mineral can provide rapid and sustained relief. Routine supplements can reduce the frequency and severity of such attacks. Eating magnesium-rich foods (such as nuts, whole grains, legumes, and chlorophyll-rich vegetables) can assist the body without overwhelming it. A magnesium supplement can also provide the needed boost.

 

As always, consult a certified pain physician before beginning any new treatment regimen.

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Child finds migraine relief from Botox

This article discusses a succes story about a child whose chronic migraines were treated by botox injections.

There is nothing worse than a bad headache, but now imagine living with debilitating migraines.

Turns out that's the reality for 5 to 10 percent of all children in the United States. But now there is hope and it's coming in the form of a very popular beauty treatment.

Valerie Portolano, 17, is no stranger to migraines.

"I'm not really a headache, I'm a chronic migraine," she said. "I have a headache every single day of my life."

Portolano has tried just about everything to relieve her pain but today she's trying something new. The treatment is Botox!

Portolano hopes, "I will have some less pain and also get to live a little."

Sixteen-year-old Delanie Mattson is proof of that.

"Yeah it's weird but it works," she said.

Mattson's had migraines since she was 13.

"It was sad," said her mother, Carrie Mattson. "She lost out on a lot of life because of her migraines."

Mattson was home-schooled and had to give up her passion for playing softball all because of her migraines. She was even taking Vicodin nightly just to sleep. That is until she started getting Botox injections last summer.

"It's a relief knowing I'm not going to get a migraine," she said.

Botox has been widely used to treat migraines in adults since 2010.

"This is definitely an off-label use," said Dr. Marcy Yonker, a pediatric neurologist headache specialist with Phoenix Children's Hospital. "There's no indication for this in treating children."

Yonker is one of only about 20 pediatric headache specialists in the nation.

"In children in whom I thought nothing would ever help them, headache free, so I was really shocked," she said.

The kids first have numbing cream applied that helps take the edge off the 31 shots of Botox they get in their forehead, scalp and shoulders.

"As the medicine goes in it sort of burns, so it does hurt but it's worth it," said 17-year-old Tatum Amato.

"It seems to change the activity of the pain fibers that tell people they have a migraine," Yonker explained.

But she points out this isn't necessarily a cure.

"We don't know whether it is stopping the migraine or if they are not feeling the migraine," she said.

Regardless, the Botox seems to be breathing new life into these kids' lives. Like Amato, who was once a competitive cheerleader but her migraines robbed her of that.

Now, just after one round of Botox, she said, "I don't get migraines as often and if I do they are not as severe."

The long-term effects of this headache treatment are still unknown, especially in children.

"Is there going to be muscle wasting for them? Are they going to develop some numbness? That's something we really need to look at," Yonker said.

To qualify for this treatment in the headache clinic at Phoenix Children's Hospital, kids must have chronic migraines, meaning they have headaches 15 days a month that last more than four hours a day.

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Botox helps 3-year old with cerebral palsy walk

This article discusses the beneficial effect botox injections had for a 3 year old with cerebral palsy. The botox injections helped him walk for the first time.

Brave tot Aiden Farrell has taken his first steps after having Botox injections in his legs.

3-year-old Aiden was born with crippling cerebral palsy and his muscles tightened up so much so he was unable to straighten his legs without pain.

The toddler's parents Sara and Gevun scoured the Internet for treatment and discovered that Botox could be the answer.

The injections, most commonly used cosmetically to prevent wrinkles, work for Aiden by unblocking nerve impulses which restrict his movement.

Mom of four Sara, 31, said: "Seeing Aiden take his first steps is something I never dreamed would be possible.

"I noticed as soon as we got home after having the treatment the difference was amazing.

"Usually he would sit on the sofa with his legs bent up but his legs were normal, like ours would be when we sit on the sofa.

"It may sound unusual but if it helps my little boy walk I do not care.

"It is about trying to build up strength in his length and walk more. He is using muscles he has never used before.

"The difference in mobility is unbelievable."

Aiden has suffered health problems all his young life after being born prematurely at 29 weeks.

He weighed just 3 lbs. and had to be kept alive on a ventilator.

Full time mom Sara and builder Gevun of Hampshire, UK, first feared there could be something seriously wrong with him when he struggled to sit up aged eight months.

Sara added: "When I was told Aiden had cerebral palsy we grieved every day, especially because we have other children and could see them running around the house.

"It was difficult because we wanted Aiden to do the same things they could do.

"Over time his legs tightened up so much he was unable to straighten them. He would cry with any physiotherapy exercises he was given to strengthen his legs.

"I felt useless because all I could do was massage them to make his pain go away."

After Sara and Gevun read about the Botox treatment online Aiden was placed on an 18-month waiting list and in 

December last year was given 12 injections, two in each of his calves, hamstrings and groin.

The family were told there was only a 50 per cent chance of it being successful.

Sara added: "I was really nervous taking him to the hospital that morning.

"When it's your own child you really want it to work but of course you have your doubts about what will happen if it doesn't.

"He was put to sleep and we were originally told he would be down for four minutes but it was an hour by the time we got called to see him.

"But when we did he asked for a sausage roll - which made everyone laugh."

The unconventional treatment has had a life-changing effect on the family.

For the first time Aiden is able to stand, walk with his legs straighter on his walking frame, stand with his legs apart and even take a few steps on his own.

Sara was finally able to fulfil her dream of being able to push toy cars through his legs, like she had done with her other children.

Botox uses tiny amounts of botulinum toxin, derived from the bacteria that cause botulism food poisoning.

The deadly nerve agent kills by paralysing the muscles used for breathing.

In tiny doses it relaxes the contraction of muscles in some people with cerebral palsy by blocking nerve impulses.

This allows better control of movement and reduces the risk of muscle and tendon shortening. The effects last between four and six months.

The family are now hoping Aiden will be eligible for selective dorsal rhizotomy surgery - a five-hour operation which will cut the nerves in his lower back and provide a permanent cure.

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Botox and how it helps cerebral palsy, chronic migraines, and excessive sweating

This article discusses how botox can help ease symptoms of cerebral palsy, chronic migraines, excessive sweating, and other conditions.

Botox isn’t reserved solely for reducing fine lines and wrinkles.

The most potent naturally occurring neurotoxin known to man can be used to treat symptoms of medical conditions such as cerebral palsy, chronic migraines and excessive sweating.

And it’s effective.

“It’s just like with many other medications that are actually poisons – it’s how we use them and where we use them that make the difference,” says Sanford Health’s Dr. William Klava.

Although Botox isn’t a “cure” for any of these conditions, it can prevent the social embarrassment of excessive underarm sweat, reduce hours of work missed because of migraine pain, and improve a young athlete’s pitching stance.

Cerebral palsy

Klava says Botox almost revolutionized the care of children with cerebral palsy because it forces muscle relaxation and improves limb function.

Symptoms include spastic movement of the arms and legs and sudden muscle stiffness and contraction caused by miscommunicated signals between the brain and the limbs.

Botox interrupts the communication between the spinal cord and the nerves, which stops the sudden jerking movements.

“When I use it, I’m relaxing the muscle so the child can stretch out better and achieve motor functions and activities that they couldn’t achieve because certain muscles were too tight or too spastic,” Klava says.

He’s used it on kids as young as 2 months and adults as old as 90, and results typically last between four and six months.

“One of the beauties of it as a medication is that if the result you get is not exactly what you want, don’t worry, because it wears off,” he says.

Although it can be used “almost anywhere you have muscle,” Klava says it’s most commonly used in cerebral palsy patients’ bicep, forearm, hamstring and calf muscles.

“We keep expanding what we utilize it for and how we utilize it as we gain more experience with it,” he says.

Chronic migraines

Last spring, after reading an article in The Forum about Botox treatment for migraines, Sara Eeg of Greenbush, Minn., asked her doctor if she was a candidate.

The 36-year-old mother of four had suffered from chronic migraines for as long as she could remember, and she’d tried everything, including anti-seizure medication.

“My headaches were just constant. I would have a headache when I woke up in the morning, and I’d have a headache when I went to bed at night,” she says.

So far, Eeg has had three series of injections spaced three months apart.

“Each time I’ve gotten the injections, the pain relief has lasted longer and longer, whereas the first time it kind of wore off after a while,” she says.

She says the shots – 29 the first time, then 31 and most recently 33 – “just pinch a little.”

“The benefits are way worth it. I told her the other day, ‘I would do it every week if I could,’ ” Eeg says of the treatments with Dr. Cynthia Knutson.

Since she started treatment, Eeg says she’s had more energy, she’s more focused, and she’s more interested in life.

“It’s unreal. I feel like I’m better at everything,” the home care administrator says. “My brain isn’t so focused on hurting.”

Knutson, a neurologist with Sanford Health in Fargo, says she’s been seeing plenty of new chronic migraine patients seeking Botox treatment.

“I do Botox one whole day a week, and I’m actually adding another half-day because I’m getting more requests,” she says.

Chronic migraine patients develop a lot of tension in the head, neck and shoulder muscles, and when Botox injections relax those muscles, the headache pain fades.

Injections go in the forehead, above the ears, along the base of the skull, at the top of the neck and into the top of the shoulders.

“It doesn’t work for everybody, but it works for a large majority of patients who have this type of migraine,” Knutson says.

Excessive sweating

Dr. Yulia Khan, dermatologist with Sanford Dermatology & Laser Clinic, says Botox is a last-resort treatment for hyperhidrosis, or excessive sweating.

“A lot of people say it’s lifesaving because they’ve tried a lot of different things,” she says.

The injections – usually about 20 – into the superficial layer of the skin in the underarms (and sometimes the forehead, back of the head, hands or feet) stop most sweating at the site for six to eight months at a time.

“With each repeated treatment, that period extends more and more,” Khan says.

Results are reversible, so sweating returns over time, and most hyperhidrosis patients know when they’re due for an appointment.

“Instead of affecting muscles, like in the case of spasticity, or for cosmetic rejuvenation, it works on the nerves that affect the sweat glands,” she says.

Most of Khan’s patients, both male and female, are between the ages of 15 and 35.

“It tends to be younger adults because excessive sweating becomes more prominent after puberty,” she says.

Other uses of Botox

• Crossed eyes

• Eye twitching

• Gummy smile

• Teeth grinding

• Vocal cord dysfunction

• Urinary incontinence or overactive bladder

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Botox Injections Can Help Reduce Chronic Neck and Cervical Muscle Pain

A new study shows that Botox injections can help make certain pains in the neck and shoulders less severe. The study also showed that those who received botox injections had less frequent headaches.

A study presented at the Anesthesiology 2012™ annual meeting revealed Botulinum toxin type A (BOTOX) injections significantly improve pain and quality of life in people with chronic bilateral posterior neck and shoulder myofascial pain syndrome.

Traditional therapies for the treatment of myofascial pain syndrome include medications such as anti-inflammatory drugs (such as ibuprofen or naproxen), steroids and muscle relaxants, physical therapy and behavioral modification.

"At best, long-term benefit with traditional therapies is transient and unpredictable," said Andrea L. Nicol, M.D., M.S., Director of Research -- UCLA Pain Management Center, Assistant Clinical Professor, Department of Anesthesiology -- Division of Pain Management, David Geffen School of Medicine at UCLA. "Even with these treatments, some people with myofascial pain syndrome get incomplete benefit or no benefit at all."

BOTOX is used commercially to treat multiple painful medical conditions, including migraine headaches, spasticity and cervical dystonia. It is also used cosmetically as a means of reducing the appearance of frown lines and wrinkles.

"BOTOX is in a class of medications called neurotoxins and when injected into muscles, blocks the nerve signals that cause the tightening of muscle, leading to muscle relaxation. Thus, BOTOX may offer advantages over traditional therapies for myofascial pain syndrome due to its prolonged and sustained effects," Dr. Nicol confirmed.

About the Study

The study was conducted at the University of California, Los Angeles by Chronic Pain Management Specialists F. Michael Ferrante, M.D. and Andrea Nicol, M.D. All subjects who enrolled in the study were given injections of BOTOX into the painful muscles of the neck and shoulder area during the first phase of the study. Subjects with significant improvement to BOTOX treatment moved on to the second phase of the study and were randomized into two groups. Subjects in the treatment group had BOTOX injections into the painful muscles of the neck and shoulder area. Subjects in the control group received a placebo injection (salt water) into the painful muscles of the neck and shoulder.

Those enrolled in the study were monitored intermittently to assess their response to the injections. Pain scales and questionnaires were administered to document response and perform data analysis.

Analysis of the results revealed subjects who received BOTOX injections had:

• A significantly greater reduction of their pain scores compared to those subjects who had received placebo injections.
• A significant reduction in the number of headaches they experienced on a weekly basis.
  • The severity of the subjects' headaches (numerical pain score rating) was reduced.
• A significant reduction in the interference of their pain with regards to general activity, sleep and enjoyment, indicating an overall improved quality of life.

Given the findings of this study, BOTOX may be an option for those who have been suffering with myofascial pain syndrome and have yet to find relief with traditional therapies.

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Migraines affect as many as 36 million Americans

Imagine having a terrible, throbbing headache, maybe so bad you're nauseated or even vomiting, perhaps unable to tolerate the touch of a comb to your head or a bright light or noise. Now imagine that happening not just once in a while, but regularly, maybe even 15 or more times per month.

That's what life can be like for someone who gets migraine heachaches, a regularly occurring, frequently inherited and incurable brain disturbance that affects as many as 36 million Americans, including children.

"Simply, it is characterized by headaches that at some times become disabling," said Robert G. Kaniecki, a neurologist who serves as director of The Headache Center at UPMC. "We're dealing with the three 'S's': Severity, Sickness -- nausea or vomiting, Sensitivities, mainly to light or noise. Typically they last between four hours and three days untreated and possess one or all three of those attributes."

Migraine facts:

• Between nearly 30 million and 36 million Americans, including children, suffer from migraine headaches. That's more than 10 percent of the population and more than the number of people with diabetes and asthma combined.

• Nearly one in four U.S. households includes someone with migraines.

• Migraines disproportionately affect women. As many as 27 million women in the United States suffer from migraines, three times as many as men.

• American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

• Migraine ranks in the top 20 of the world's most disabling medical illnesses.

• Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine.

• Medical research of migraines is poorly funded. In 2007, it is estimated, the National Institutes of Health granted only $13 million for migraine research, equal to only 36 cents per person with migraine, compared to more than $1 billion for diabetes ($49.38 per person with diabetes) and $294 million for asthma ($12.25 per person with asthma).

Source: National Headache Foundation and the Migraine Research Foundation

Migraine headaches differ from tension headaches, which aren't severe, do not make one sick and do not leave the sufferer sensitive to light or noise. They also differ from sinus headaches, which Dr. Kaniecki said are rare. "Ninety percent of the time it is [instead] a form of migraine," he said. "It turns out a sinus infection can cause a sinus headache. There's no pattern to that, whereas migraine is characterized by multiple episodes."

Less than half of all migraine sufferers have been diagnosed with migraine by their healthcare provider, according to the Migraine Research Center. "About half the time, they go to see a physician and get a non-migraine diagnosis, and almost always it's [diagnosed as] tension or sinus," Dr. Kaniecki said.

What causes migraine?

"It's a mixture of things," said neurologist Lara Kunschner Ronan of Allegheny General Hospital. "Most migraines have environmental triggers. It varies from person to person. About half have family history. There are families that have very strong generational predisposition, probably multiple genes."

"Migraine results from a biological disturbance in the brain," Dr. Kaniecki said. "Often individuals will have a first-degree relative, a parent or sibling or a child with similar headaches. A common thread is a heredity of a nervous system that is more sensitive.

"They're much more likely to have motion sensitivity -- car sickness, more likely to have temperature sensitivity -- ice cream headaches. That brain sensitivity is relatively persistent: flashing light, bright light, noise, strong odors."

The brain pushed past a threshold of tolerance, different for each patient, will respond with a brain storm, a chemical disturbance in the brain, he said.

Serotonin is released; nerve endings on the surface of the brain emit chemicals that are irritating and inflammatory to the brain and blood vessels start to swell, resulting in throbbing pain, he added.

Triggers -- or things that set off migraines -- include stress, the menstrual cycle, sleep deprivation, meal irregularities, weather change, overstimulation, light, noise, odor, certain foods like red wine, smoked cheese and aged and fermented products of any kind, caffeine and food additives such as MSG.

There are many treatments.

At UPMC's Headache Clinic, the initial approach is natural, or "anything to keep the nervous system in balance. It's like driving a very sophisticated vehicle versus a simple car. It needs more maintenance," Dr. Kaniecki said. The clinic stresses a regular schedule for sleep patterns, meal patterns, exercise patterns, patterns of hydration, and school or work attendance because the brain is very sensitive to change.

"The menstrual cycle, the weather, common triggers for migraine, there are a number of things we can't control, but those we can control, we try to," he said.

Next, patients are encouraged to avoid the common triggers listed above. The clinic then uses "a whole host of supplements," including magnesium and the root of the butterbur plant.

"There are vitamins that have shown benefits," Dr. Kunschner Ronan said.

Many migraine sufferers take over-the-counter medications, she added. The Food and Drug Administration has approved three products for migraine: Excedrin Migraine, Advil Migraine and Motrin Migraine Pain, according to the Migraine Research Foundation.

"Most doctors see those who don't get relief from over-the-counter [products]," Dr. Kunschner Ronan said.

"If [the migraines are] frequent, we'll prescribe daily medications, and that's 25 to 35 percent who require medications daily, and then the majority will require something for attacks when they come -- [there are] multiple products over the counter and multiple prescription products for when they strike," Dr. Kaniecki said.

For preventive use, there are well over 20 medications to choose from, and for when they occur, well over 30, he added. One family of drugs designed to treat migraine attacks is triptans, which include Maxalt (rizatriptan), Axert (almotriptan), Amerge (naratriptan), Zomig (zolmitriptan), Frova (frovatriptan) and Relpax (eletriptan). Preventive medications include Inderal (propranolol), Blocadren (timolol), Topamax (topiramate) and Depakote (divalproex sodium).

Medications usually work, Dr. Kaniecki said.

When they don't, there are alternative methods to try, including biofeedback, which is poorly covered by insurance; acupuncture, which is still under study; special diets, surgery and Botox, which was just approved by the Food and Drug Administration within the past year for people who have a minimum of 15 migraines a month and who have failed more traditional options. There also are trials of nerve stimulator devices in progress.

It is not known exactly how Botox works, but Dr. Kunschner Ronan said it has helped more than two-thirds of her patients treated with the injections.

"What it does, it settles the nerve endings down, the ones that let go of chemicals," Dr. Kaniecki said. "It intervenes in that stage of the migraine attack."

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Certain 'triggers' may initiate migraines

This is a nice summary. Triggers are often elusive in people having near-daily headache. And, I have had excellent response to botox injections in young adults teenagers with refractory headache. JR

Next time a migraine forces you to cancel your plans and retire to a cold, dark corner, remember that there are ways to alleviate, maybe even prevent, the throbbing pain, nausea and light sensitivity these headaches-from-hell can cause.

It may be as easy as removing certain foods from your diet.

Eighty percent of migraine sufferers are genetically predisposed to the condition, but other factors can increase migraine risk.

These include lack of sleep, poor nutrition, dehydration, inadequate exercise, stress and excessive drinking.

Diets heavy in cured or aged meats and nitrates found in red wine can, for some, lead to migraine pain.

Find your triggers

Finding your personal trigger can take some time. Dr. Deborah Carver-Hodges, assistant professor of neurology at the University of Texas Health Science Center at San Antonio, suggests keeping a daily headache journal.

Jot down all the food and alcohol you consumed and any weather changes to the area; Women are also encouraged to track their menstrual cycles.

The journal may help you identify your triggers, so you can stay away from them.

But if migraines persist, there are treatments that can alleviate and help prevent the pain.

Supplements

Magnesium and riboflavin (vitamin B2) supplements have both shown success in treating migraines, according to Dr. E. Swann Van Delden of the Neurology Institute of San Antonio.

She recommends taking 200 milligrams of riboflavin a day with meals and 400 to 800 milligrams of magnesium a day for migraine relief.

Another supplement Carver-Hodges recommends is butterbur, which can be found in health food stores.

An herb, butterbur contains a chemical that helps relieve spasms and inflammation.

Cost: No more than $20 for a bottle of 200 pills

Prescription meds

For frequent migraine sufferers, Van Delden and Hodges-Carver prescribe a group of vasoconstrictors known as triptans, which help regulate the balance of serotonin in the brain.

Triptans are found in antidepressants, antiseizure and antihypertensive medications.

Each medication treats neurons, or brain cells differently.

Antidepressants control serotonin receptors, while antiseizure medications help reduce excitability of the neurons and antihypertensive meds help regulate heart rate and stress which can trigger certain migraines.

Cost: Most of these medications are available in a generic form and are usually covered by prescription plans.

Price can range from $4 to $90 for a one-month supply, depending on coverage.

Botox

For patients with chronic migraines, defined as 15 headache days a month, Van Delden has seen a high success rate while using botox.

Approved for use in 2010, botox is injected into seven areas of the head including the medial brow (close to the nasal bridge), the temples and the back of the head.

Although the mechanism of action isn't known, Van Delden theorizes that when used as a muscle relaxant, botox can help break the loop of tension often seen in migraines.

Treatment must be repeated every 12 weeks.

Cost: Botox treatments are covered by most insurance plans, as long as the patients meet the criteria; price ranges by co-pay.

Read more here

Long-term Treatment Outcomes of Children&Adolescents who have Cerebral Palsy with Secondary Osteoporosis.

Editor's Note:  I start screening my most severe patients and teenagers for osteoporosis when treating cerebral palsy. JR

Curr Med Res Opin. 2012 May;28(5):737-47. Epub 2012 Apr 18.

Long-term outcomes of children and adolescents who had cerebral palsy with secondary osteoporosis.

Iwasaki T, Nonoda Y, Ishii M.

Source

Kitasato University School of Medicine , Sagamihara , Japan.

Abstract

Abstract Objective: To investigate the long-term efficacy and index of treatment with vitamin D alone or with a bisphosphonate in children and adolescents who have cerebral palsy (CP) with secondary osteoporosis. Research design and methods: Thirty patients diagnosed with CP and secondary osteoporosis were analyzed for 5 years, and the efficacy of treatment was compared. Treatment was divided into three groups: The monotherapy group, consisting of patients taking only alfacalcidol (0.03 µg/kg/day); the polytherapy group, consisting of those taking alfacalcidol and risedronate (0.05 mg/kg/day); and the control group, consisting of patients who discontinued taking their medications for reasons unrelated to these therapies. Bone mineral density (BMD), bone-specific alkaline phosphate (BAP), and N-telopeptides of type I collagen (NTX/Cr) were measured on each patient just before and at discontinuation of treatment, after 6 months, and again at 1 and 3 years, respectively. The changes in BMD (ΔBMD), BAP (ΔBAP), and NTX/Cr (ΔNTX/Cr) were evaluated at these intervals, because the normal value of each parameter varies over time during childhood. Results: ΔBMD significantly increased in the polytherapy group at ≥1 year (p = 0.006), and the difference in BMD between the polytherapy and the control groups at ≥1 year was also significant (p = 0.005). ΔBAP was increased in the monotherapy and polytherapy groups at ≥1 year (p = 0.021 and p = 0.033). ΔNTX/Cr decreased in the polytherapy group at ≥1 year, which was consistent with the polytherapy group of the period from 1 month to 1 year (p = 0.033). The relation between ΔBMD to ΔBAP was a positive correlation in the second period in the monotherapy group (r = 0.46). And the relations between ΔBMD to ΔNTX/Cr were not recognized negative correlations in the monotherapy and polytherapy groups. Thus, ΔBMD reflected ossification of secondary osteoporosis in patients with CP, and ΔBAP and ΔNTX/Cr was significantly related to the increase and decrease of ΔBMD. There were no effects of other factors except sexual maturity. Limitations of this study include that each index of examination was the evaluation according to rate of change. Therefore, the results of this study were limited to longitudinal evaluations. Conclusion: Evaluation according to ΔBMD and both methods of monotherapy and polytherapy were useful for CP patient taking antiepileptic drugs (AEDs) and regardless of sex. Especially, polytherapy for longer than 1 year led to improvement in BMD in children who had CP with secondary osteoporosis. BAP and NTX/Cr were useful for the index of the progression osteoporosis with or without these therapies.

Read More: http://informahealthcare.com/doi/abs/10.1185/03007995.2011.645562