Screening tool available for chronic migraines

This article describes a new screening questionnaire for chronic migraines.

Researchers have developed a new tool that can accurately identify patients with chronic migraine (CM).

The screening questionnaire — called the ID-CM — can potentially be used by physicians or by patients themselves.

"The way we imagine it in clinical practice is that someone completes this questionnaire in a physician's office and it provides a suggestion that the patient may have chronic migraine," said researcher Dawn Buse, PhD, director of Behavioral Medicine, Montefiore Headache Center, Bronx, New York. "The physician would still go through a careful history and physical and complete the diagnostic criteria."

"It may be helpful for people living with chronic migraine who don't realize there's a term for what they're living with," she said. "It might help connect them with specialist health care professionals who can treat them well, and it may help connect them with the right treatment."

The only treatment approved by the US Food and Drug Administration for chronic migraine, defined as having 15 or more migraine days a month, is onabotulinum toxin A (Botox, Allergan Inc), although patients do use other migraine therapies, including triptans.

Dr. Buse presented the research, funded by Allergan, here during PAINWeek.

Rigorous Process

Developing the tool took almost 3 years and involved a rigorous multi-step process. The research team reviewed existing instruments, sought input and consensus from headache physicians and research scientists from around the world, and had a group of people with CM assess the relevance of the questions being developed.

Another important step in the development process was psychometric validation. "This is where we look at someone with chronic migraine, someone with episodic migraine, and someone with no headache and see how well a particular item (for example, whether the pain is pulsating or how often the pain is severe) identifies or separates the different groups," explained Dr. Buse.

As well, headache experts used a semi-structured clinical interview to provide their own diagnosis, which was used as the gold standard. Compared to this gold standard, the screening tool had a sensitivity of 82%, a specificity of 87%, a negative predictive value of 77%, and a positive predictive value of 90%.

Among other things, the final 12-item screening tool asks respondents how often their pain is moderate or severe, how often they're unusually sensitive to light and sound, how often they feel nauseated or sick to their stomach, and how often they worry about missing work, school, or social events because of headaches.

Despite its substantial economic and quality-of-life burden, chronic migraine remains underdiagnosed and undertreated.

Dr. Buse and her colleagues hope to have the screening tool available in the next month or 2 and are working on a manuscript for possible publication.

Findings Relevant

Asked to comment, pain expert Lynn Webster, MD, vice president, scientific affairs, PRA Health Sciences, Salt Lake City, Utah, said he thought Dr. Buse's presentation was "very interesting" and relevant to the average physician who sees many patients with headaches in his or her daily practice.

"An accurate diagnosis is challenging for many physicians and a tool to help make that diagnosis would be welcomed," said Dr. Webster.

The tool appears to be reasonably accurate and sensitive, "which is always a challenge in developing such tools," added Dr. Webster.

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What to do about chronic headaches

This article discusses chronic headaches and what you can do about them.

From drinking too much last night to stressing out about finances or family concerns, there are so many possible causes of the common headache. However, when headaches go from being few and far between to frequent and long-lasting, it may be time to make an appointment to see your primary care physician.

"Practical clinical criteria defines chronic migraine as a headache that occurs greater than 15 days a month with each headache episode lasting longer than four hours for at least three consecutive months," said Dr. Denis G. Patterson, medical director of the Northern Nevada Pain Center and founder of Nevada Advanced Pain Specialists. "It does not matter how severe the headaches are — the medical term for chronic headaches is migraine headache."

According to Patterson, who is board-certified in pain medicine and physical medicine and rehabilitation, common headache triggers include hormonal changes in women, stress and changes in sleep patterns. Certain foods, such as alcohol, aged cheeses, chocolate, aspartame, too much caffeine, monosodium glutamate, processed and salty items, also may set off headaches. Among other potential triggers are bright lights, loud sounds, unusual smells, changes in the weather or barometric pressure, intense physical exertion or sexual activity.

"The causes of chronic headaches are not well understood," Patterson said. "Medical experts believe that genetics and environmental factors seem to both play a role."

No matter the cause, if you find that you're hampered by headaches a little too often, experts suggest first making an appointment with your primary care physician. If unable to alleviate the headaches, this doctor may then refer you to a headache specialist, such as a neurologist or pain management physician.

"A physician trained in treating headaches will likely diagnose the condition on the basis of your medical history, a review of your symptoms, and a physical and neurological examination," said Patterson, who specializes in common and complex neurological disorders, as well as musculoskeletal issues. "Your doctor may also recommend a variety of tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe."

As for treating chronic headaches, there are quite a few options for today's patients. Your doctor may advise starting with noninvasive and nonpharmacological solutions to see if the migraines can be reduced naturally. For example, you may be encouraged to engage in muscle relaxation exercises and commit to getting enough sleep. Other treatment options may involve alternative medicine, such as acupuncture or massage therapy.

Pain-relieving medications or preventive medications also might be prescribed to address chronic headaches. Finally, certain patients may need injections to ease or prevent the pain. This might involve the use of nerve blocks, nerve stimulators or Botox injections.

"Botox is the first and only preventive treatment approved by the FDA for adults with chronic migraine," Patterson said. "It may reduce the number of headache days a month and/or decrease the severity of headache episodes."

Without treatment, the frequent pain of chronic headaches can lead to decreased quality of life. If you find that your headaches go beyond the occasional hangover or tension-filled day, reach out for relief.

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Chronic migraines affect the whole family

A study shows how chronic migraines can affect the whole family.

Suffering chronic migraines takes a huge toll on family life, a new study suggests.

Researchers found that more than two thirds of patients with chronic migraine feel their condition affects their sexual intimacy and that it makes their spouse's life difficult. Patients also report feeling guilty and worried about the effect their headaches have on their partner and children.

"Our research team believes it's very important to bring these data to light, to show that chronic migraine is a burdensome and difficult condition, not only for the people who live with it, but also for the people they love," said lead researcher and clinical psychologist, Dawn Buse, PhD, Department of Neurology, Albert Einstein College of Medicine, and Montefiore Headache Center, Bronx, New York.

"We hope that these data will raise awareness among family members, coworkers, society, healthcare providers, insurers, and government agencies who fund research, so that the magnitude of the effects of chronic migraine is more fully understood."

Dr. Buse will present the research here at the American Headache Society (AHS) 56th Annual Scientific Meeting.

Pulsating Headaches

Chronic Migraine Epidemiology & Outcomes (CaMEO) was a prospective, Internet-based study. People with chronic migraine (experiencing 15 or more headache days a month) and their spouses and children completed questionnaires to provide data on the burden of migraine.

This first analysis included 994 patients with chronic migraine who were assessed by using the validated American Migraine Study/American Migraine Prevalence and Prevention screener, a modification of International Classification of Headache Disorders 3b. They therefore experienced headaches that were pulsating, were of moderate to severe pain intensity, and worsened with routine activity, accompanied by nausea, phonophobia, and photophobia.

The analysis showed that:

• 64.1% of respondents feel their headaches make their partners life difficult;
• 72.5% feel they would be better partners if they didn't have headache;
• 70.2% are easily angered or annoyed by their partners because of headache;
• 67.2% avoid sexual intimacy because of their headaches;
• 64.4% feel guilty about how their headaches affect their partner;
• 59.1% believe they would be better parents if they didn't have headaches;
• 20% missed planned family vacation within the previous year; and
• 53.6% had less enjoyment while on vacation because of headaches.

Compared with men, women, who made up 81.7% of the study sample, cancelled plans 23% less often in the previous month because of headache (relative risk [RR], 0.77; 95% confidence interval [CI], 0.61- 0.98; P = .03) and missed 49% fewer holiday/religious events (RR, 0.51; 95% CI, 0.32 - 0.80; P = .003) and 52% fewer weddings/important events (RR, 0.48; 95% CI, 0.30 - 0.79; P = .004).

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How to help children with migraines

This article looks into how parents can help their children who have migraine headaches, and discusses the benefits of cognitive behavioral therapy.

Nearly 2% of the pediatric population suffer from chronic migraine. Yet, the Food and Drug Administration (FDA) has not approved a therapy for treatment of chronic migraine in children or adolescents. So, how does your child's neurologist or headache specialist treat your precious one's head pain?

One study in JAMA suggests a combination treatment regimen of both medical and behavioral therapy. Before reviewing this study, let's understand the basics of what a chronic migraine is.

What is a chronic migraine?

According to the second edition of the International Classification of Headache Disorders (ICHD-II), chronic migraine is defined as a migraine headache that occurs at least 15 days a month for more than 3 months. Additionally, the headaches of chronic migraineurs must have at least two of the following features:

• One-sided location
• Pulsating
• Moderate or severe intensity of pain
• Head pain is exacerbated by daily physical activity (i.e. walking around your home)

During a migraine attack, an individual must have at least one of the following:

• nausea and/or vomiting
• photophobia AND phonophobia

Study Overview

Purpose: To compare two regimens for treating children and adolescents with chronic migraines.

• Cognitive-Behavioral Therapy (CBT) + amitriptyline
• Health education + amitriptyline

Amitriptyline (Elavil)  is an tricyclic antidepressant that works by blocking the re-uptake of two neurotransmitters in the brain, serotonin and norepinephrine.  It is a sedating medication and typically taken at bedtime. It is FDA approved as a migraine preventive medication for adults.Cognitive-behavioral therapy entails learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner.

Methods: 135 children and adolescents, between the ages of 10 and 17, who suffered from chronic migraine and scored greater than 20 on the Pediatric Migraine Disability Assessment Score (PedMIDAS) participated in the study.

The participants were randomly assigned to either the CBT + amitriptyline group or the health education + amitriptyline group. Each participant underwent 8 weekly therapy sessions that were one-hour in duration. The participants and their parents were blinded as to whether they were receiving CBT versus health education during these sessions. All of the participants were given a dose of amitriptyline of 1mg/kg/day at dinner time. The children and adolescents were allowed to take medication for acute migraine abortion, like NSAIDs and triptans. They were not allowed to use them for more than 3 times per week. Finally, the participants maintained a headache diary to record various headache measures such as headache occurrence, duration, and associated symptoms.

Results: The two main outcomes measured were number of days per month of headache occurrence and headache disability. By 20 weeks, participants in the CBT + amitriptyline group achieved a ≥50%percent reduction in days with headache when compared to the health education + amitriptyline group (66% versus 36%). This also held true at the 12 month follow-up, with 86% in the CBT + amitriptyline group having a ≥50% reduction in headache frequency versus 69% of the health education + amitriptyline group.

In terms of migraine disability, by the 12 month follow-up, 88% of the CBT + amitriptyline participants had a PedMIDAS of less than 20 points versus 76% of the headache education + amitriptyline group.

What Does This Mean?

The use of cognitive-behavioral therapy with amitriptyline in children and adolescents with chronic migraine reduced migraine frequency and disability, when compared to health education with amitriptyline. This suggests that CBT be considered as a reasonable and effective treatment for chronic migraine in the pediatric population.

If your child suffers from chronic migraine, discuss the use of a behavioral intervention, like CBT, with his or her healthcare provider so you can be an informed parent and remain proactive in your child's health.

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Study: Cognitive behavioral therapy can help kids with migraines

A study shows that symptoms of chronic migraines in children are reduced with cognitive behavioral therapy (CBT).

Among children and adolescents with chronic migraine, the use of cognitive behavioral therapy (CBT) resulted in greater reductions in headache frequency and migraine-related disability compared with headache education, according to a study appearing in the December 25 issue of JAMA.

"In adults, more than 2 percent of the population has chronic migraine and in children and adolescents the prevalence is up to 1.75 percent. In pediatric patients who seek care in headache specialty clinics, up to 69 percent have chronic migraine; however, there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraine in young persons. As a result, current clinical practice is not evidence-based and quite variable," according to background information in the article.

Scott W. Powers, Ph.D., of Cincinnati Children's Hospital Medical Center, and colleagues randomized 135 participants (79 percent female) 10 to 17 years of age diagnosed with chronic migraine (≥ 15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points (disability score range: 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe) to CBT (n = 64) or headache education (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 participants completed 20-week follow-up and 124 completed 12-month follow-up. The interventions consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, modified to include a biofeedback component. Each group received amitriptyline; follow-up visits were conducted at 3, 6, 9, and 12 months.

On average, at the beginning of the trial, participants reported 21 of 28 days with a headache and a PedMIDAS of 68 points, indicating a severe grade of disability. From pretreatment to posttreatment, CBT resulted in a decrease of 11.5 headache days vs. 6.8 days with headache education. At 12-month follow-up, 86 percent of CBT participants had a 50 percent or greater reduction in days with headache vs. 69 percent of the headache education group; 88 percent of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) vs. 76 percent of the headache education group.

"Now that there is strong evidence for CBT in headache management, it should be routinely offered [to younger people] as a first-line treatment for chronic migraine along with medications and not only as an add-on if medications are not found to be sufficiently effective. Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier," the authors write.

System barriers may affect the likelihood of CBT being implemented as a first-line treatment for pediatric chronic migraine, writes Mark Connelly, Ph.D., of Children's Mercy Hospitals and Clinics, Kansas City, in an accompanying editorial.

"Creative means of delivering CBT for pediatric chronic migraine (e.g., via telehealth or Internet-based programs, using behavioral health consultants in primary care offices) will be necessary for reducing current access and referral barriers that could be encountered by many families and physicians. Widening the availability of interdisciplinary models of training and treatment delivery also will be important for helping ensure that children with chronic migraine routinely receive combination therapies rather than being referred for psychological therapy only after other approaches fail."

"Ideally with the efforts of the health care community and other relevant stakeholders, the suggestion by Powers et al to consider CBT along with medication as a first-line treatment for chronic migraine in children will be implemented into practice well before the typical translation gap. Additional studies are warranted, however, to identify methods of preventing chronic migraine development and to determine the medications and combination therapies that further maximize improvements in health and quality of life outcomes for children and adolescents with chronic migraine."

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Long-term treatment for headache sufferers

Electric stimulation of the peripheral nerve has shown long-term effectiveness for reducing the intensity of headaches for chronic headache sufferers.

For the more than 45 million Americans who suffer from chronic headaches, relief may be on the way in the form of an electric pulse, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. Electric stimulation of the peripheral nerve reduced average headache intensity by more than 70 percent.

With electric stimulation of the peripheral nerve, a thin insulated wire is implanted in the back of the head (occipital nerve) or in the forehead above the eyebrow (supraorbital nerve) and delivers electric pulses to block pain. The study looked into the safety and long-term usefulness of this treatment.

"Despite advances in headache treatment over the past two decades, many people do not get adequate pain relief from current treatments, or they cannot tolerate the side effects of the medications," said Billy K. Huh, M.D., Ph.D., professor and medical director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and adjunct professor of the Department of Anesthesiology at Duke University Medical Center, Durham, N.C. "This treatment offers hope to those patients and a chance for a major improvement in quality of life."

The study monitored 46 patients who received peripheral nerve stimulation between 2005 and 2012. Follow-up phone interviews were conducted to determine subsequent headache intensity, frequency of headaches per month, complications and overall satisfaction with the treatment.

The study found that both headache intensity and frequency decreased significantly. The average headache intensity was reduced by more than 70 percent. The average number of "headache days" decreased from 28 to 14 per month. Ninety percent of patients were satisfied with the treatment, with one reporting more than eight years of reduced headache intensity and frequency.

A drawback of the treatment is its relatively high level of complications, which include electrode migration, equipment problems and infection. The study authors state that as physicians gain experience with implantation techniques, complications will decrease.

"This is a real breakthrough for chronic headache sufferers," explained Dr. Huh. "For patients with no other options to relieve their pain and suffering, this treatment is a way for them to get their life back."

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Migraine medication overuse

A report claims that people with chronic migraines often overuse their migraine medication, which can make headaches worse over time.

As anyone who has ever suffered from migraines can tell you, the pain in unbearable and they will do almost anything to make it go away. But some medications designed to alleviate the suffering may be doing more harm than good.

Speaking at the Congress of the European Pain Federation in Florence, Italy, Professor Paolo Martelletti – one of the world’s foremost experts on headaches — said the high frequency of medication overuse is a common problem associated with migraine treatment.

“Between 50 and 80% of chronic migraine patients seen in headache clinics overuse acute medications. Although these drugs provide relief from the pain and other symptoms associated with migraine, overuse can actually make headaches worse,” said Martelletti, who is President of the Italian League of Headache Sufferers and a Professor of Internal Medicine at the School of Medicine, Sapienza University of Rome.

There are two types of medication treatment options that can help patients manage their headaches and migraines. Preventive medications, which help stop headaches or migraines from occurring, and acute medications that help stop the pain once the headache or migraine has begun.

While migraine patients are all too familiar with the intense pain caused by the neurological condition, those who have not experienced a severe headache or migraine may not be able to appreciate the wider, unseen impact that the problem can have, Martelletti explained.

“The disruptive nature of regular attacks can affect those around them and can prove detrimental to many aspects of everyday life, bringing about high levels of stress and depression,” he said.

Medication overuse can also influence the onset of comorbidities such as psychiatric and cardiovascular disorders or gastrointestinal complications.

Medication overuse is defined as the regular use of analgesics, ergotamines, triptans or opioids on ten or more days per month for more than three months; or regular use of simple analgesics or any combination of these drugs on more than 15 days per month for more than three months.

“An attempt should be made to limit the use of acute medication to treatment of no more than two or three headaches per week, and with no more than two doses per headache,” said Martelletti.

“Medication overuse should be treated by withdrawing acute medications, and with the use of preventives,” he added.

Martelletti says one promising new treatment for migraines is Botox injections in the muscles of the head, face and neck.

“Botox injections provide a valuable, evidence-based approach to the treatment of chronic migraine. Regular treatments with Botox provide an effective approach to the long-term management of chronic migraine and may have a disease-modifying effect in some cases where the chronic condition, though not entirely cured, may revert to its episodic form,” he said.

According to the World Health Organization, migraines are the third most common condition in the world and more prevalent than other common disorders such as diabetes and asthma.

Worldwide, headaches affect nearly 50% of adults each year. Approximately 11% of cases meet the criteria for migraines. Women are twice as likely to get migraines as men.

Like obesity, high blood pressure and anxiety disorders, migraines have high prevalence rates in the general population, so it’s possible that patients with chronic migraine may be visiting their doctor to discuss these disorders and not their migraines, said Martelletti.

That is why an accurate diagnosis of chronic migraine is crucial.

“Understanding the current medical and emotional state of the patient – as well as having a thorough understanding of patient’s current medication use – is of paramount importance to designing effective therapy.”

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Study: Obesity increases migraine risk

A study claims that obesity increases the risk for episodic migraines and explains why this link may exist.

Obese people may be at higher risk for episodic migraines, a new study suggests.

Episodic migraines -- the more common type of migraine -- occur 14 days or fewer per month, while chronic migraines occur at least 15 days per month.

Migraines involve intense pulsing or throbbing pain in one area of the head, according to the American Academy of Neurology. Symptoms can include nausea, vomiting and sensitivity to light and sound. Migraines affect more than 10 percent of the population.

In the study of more than 3,800 adults, those with a high body-mass index (BMI) -- a measure of body fat determined using height and weight -- were 81 percent more likely to have episodic migraines than those with a lower BMI. This was particularly true among women, whites and those under the age of 50.

The cross-sectional study doesn't prove that obesity causes episodic migraines, but it does demonstrate that people who are obese have an increased risk of having more of them, even low-frequency ones, said lead author Dr. Barbara Lee Peterlin, director of headache research at Johns Hopkins University School of Medicine, in Baltimore.

"These results suggest that doctors should promote healthy lifestyle choices for diet and exercise in people with episodic migraine," Peterlin said in a statement. "More research is needed to evaluate whether weight-loss programs can be helpful in overweight and obese people with episodic migraine."

The study was published in the Sept. 11 issue of the journal Neurology. The researchers also presented the findings in June at the International Headache Congress in Boston.

Dr. Gretchen Tietjen, director of the headache treatment and research program at the University of Toledo, in Ohio, said she found the findings interesting because previous studies had looked for connections between obesity and chronic migraines.

"That the researchers were able to show an association between obesity and episodic migraine lends more credence to some of the earlier studies that found similar things," she said.

She pointed out, however, that it still isn't known which came first -- the obesity or the migraine. There are many possible scenarios, Tietjen said. "Maybe the person had the migraines first and then started taking medications like amitriptyline or valproic acid," she said. "Those medications are associated with weight gain."

The possible connection between obesity and migraines is still under debate. One theory supporting the link centers on inflammatory substances from fat tissue (adipose) that are released into the system, Tietjen said.

Premenopausal women have more total adipose tissue in general than men, and women have more superficial and less deep adipose tissue, Peterlin said. But after menopause, adipose tissue is more similar between the two sexes.

Adipose tissue secretes different inflammatory proteins based on how much tissue there is and where it is located. Since younger women and obese people have more adipose tissue, this could, at least in part, explain why they get more headaches.

On the other hand, Peterlin also suggested that a possible connection may be related to the brain. "Previous imaging data in migraine patients have shown activation of the hypothalamus, a part of the brain that controls the drive to feed," she said. Alternatively, it could be that people who have migraines may be more inclined to behaviors associated with weight gain, such as being less active.

Would losing weight mean migraines will decrease in frequency? Although weight loss is generally encouraged for people who are obese, that won't necessarily result in migraine relief, Peterlin and Tietjen said.

At least two small studies have evaluated migraines in people who were obese and underwent bariatric surgery to lose weight, Peterlin said. Although these studies did find that some patients experienced fewer headaches, the studies were small and more research needs to be done to see if this is consistent.

It's possible that the lifestyle changes needed for weight loss cut the migraine frequency, rather than the weight loss itself, the experts said. People who eliminate processed foods, high-calorie foods and alcohol -- all of which can be migraine triggers -- could end up experiencing fewer headaches.

Unfortunately, the opposite could also be true if dieters introduce new foods that are migraine triggers. Some people may develop migraines when they consume certain sugar substitutes, for example. There also is limited data suggesting that people with severe obesity who exercise may have fewer migraines, Peterlin said.

"Our data and previous research serve as a call to researchers in the headache field to identify safe and appropriate treatment options for obese [people with] episodic migraines of all classifications and not just those who qualify for [weight-loss] surgery," she said.

Peterlin also suggested that physicians, in addition to providing lifestyle education to their obese patients with episodic migraines, take into account the weight-gain or weight-loss effect that migraine medications may have on their patients.

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Things you may not know about migraines

This article lists three things you may not know about migraine headaches.

You're familiar with the pain of a migraine—the intense throbbing concentrated mostly on one side your head and often accompanied by nausea, vomiting, or hypersensitivity to light and sound. You know that these recurring headaches can last a while and that a number of factors might trigger an attack. Here's what you might not know about migraines:

Obesity may raise your risk. Researchers at Johns Hopkins recently analyzed data from nearly 4,000 adults and found the odds of episodic migraines (the kind that occurs 14 days or fewer a month) were more than 80% higher in the obese participants. The risk was greatest among women, whites and those under age 50. What might cause the link between obesity and migraines is still up for debate, but experts do know other factors—such as family history and gender, for example—make you more prone to having migraines.

Lightning could spark one. Changes in weather or barometric pressure are known migraine triggers, but results from a study of patients suggest lightning may affect the onset of headaches. Researchers found that people were nearly 30% more likely to experience a migraine on days when lightning struck within 25 miles of their home; they speculate that electromagnetic waves, an increase in ozone or fungal spores caused by the lightning could be the culprits. Another surprising time that could set off a headache? At the start of a weekend or first day of vacation. To help determine your triggers, keep a headache diary: note when your headaches start, how long they last and what, if anything, provides relief.

Poor treatment could lead to more frequent headaches. That's according to research recently presented at a meeting of the International Headache Congress. Scientists found that people with episodic migraines who received inadequate treatment for acute headaches were more likely to develop chronic migraines, defined as 15 or more migraine days a month. Migraines can't be cured, but you can prevent attacks or relieve symptoms with the right mix of meds, behavioral changes and even alternative remedies. Work with your doctor to determine your treatment plan.

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Study claims acupuncture can treat headaches

A study shows that acupuncture can effectively reduce the intensity and duration of painful headaches and may be more effective than migraine medication.

A new study concludes that acupuncture is effective for relieving headaches. Investigators note that acupuncture reduces the intensity and duration of headaches. In addition, they suggest that acupuncture can reduce the need for “drug therapies and is a valuable option for patient suffering from CDH [chronic daily headache].”

In this controlled study, verum acupuncture was compared with sham acupuncture. The verum acupuncture group improved significantly over the control group. Verum acupuncture significantly reduced the frequency, intensity and duration of chronic daily headaches. The research notes that acupuncture is effective for reducing the intensity of pain for chronic tension headaches and migraines. In addition, patients suffering from nausea due to headaches and migraines showed a significant decrease in nausea levels.

In related recent research, acupuncture was found more effective and safer than a migraine medication. Researchers discovered that acupuncture effectively reduced migraine pain intensity levels and no adverse effects occurred. In the same study, patients receiving the medication valproic acid did not have the same level of clinical benefits as acupuncture and with nearly 50% of patients experiencing adverse side effects from the drug.The outcomes were measured six months after the study had been completed. This demonstrates that acupuncture has long term benefits for patients with migraines and that it is both safe and effective.

A massive meta-analysis study measuring patient outcomes of nearly 18,000 patients concurs with the researchers. The study finds that acupuncture effectively treats neck, back, osteoarthritis, headache and shoulder pain. Published in the Archives of Internal Medicine, the researchers concluded that, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.” US Navy sports medicine Dr. Stuessi concurs, “I’ve found phenomenal, off-the-charts results doing acupuncture for sleep, for dizziness and headaches.”

Acupuncture for pain control has received a great deal of attention in modern research. A study conducted at the University of California (San Francisco) discovered that acupuncture provides the same level of pain relief as morphine. The laboratory experiment revealed that needling ST36, an acupuncture point located on the lower leg, significantly reduces jaw pain. After one minute, the pain level reduced by over 20% and after thirty minutes of acupuncture treatment the pain level reduced by 30%. This acupuncture procedure provided the same level of pain relief that is made possible by one dose of morphine.

According to Traditional Chinese Medicine (TCM) theory, acupuncture point ST36 is located along a channel of other points starting in the head and terminating in the feet. ST36 is on the Stomach channel, which is also referred to as the Foot-Yangming Meridian. This acupuncture channel originates at another acupuncture point, LI20, runs to the inner canthus of the eye to an acupuncture point called UB1 and then descends to the gums and joins with yet another acupuncture point called DU26. The Foot-Yangming channel then circles around the mouth, meets with acupuncture point CV24 and then follows the angle of the jaw. Other details of Chinese medicine theory demonstrate that the various branches of the Foot-Yangming Stomach channel connect to the head, mouth, gums and jaw and therefore are consistent with the research demonstrating that acupuncture point ST36 relieves jaw pain.

The mounting evidence from both primary and secondary research demonstrates that acupuncture has significant effective actions in controlling pain. Acupuncture is a covered benefit in many health insurance plans, is used by the US military for the treatment of pain and PTSD and is supported by a deluge of research from prestigious universities. That, combined with publication of supportive research published in important medical journals, suggests that acupuncture is now entering a more mainstream branch of medicine.

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Social Stigma of Migraine Headaches Similar to Social Stigma of Epilepsy

A study shows that the social stigma of those who suffer from migraine headaches is similar, if not worse, to the social stigma of those who suffer from epilepsy.

A groundbreaking study lead by William B. Young, MD, a neurologist at Thomas Jefferson University Hospital's Headache Center, shows that patients with migraine (a combination of severe headache, nausea, light sensitivity, and other factors) suffer social stigma from their disease similar to the stigma experienced by patients with epilepsy.

The study, to be released on January 16, 2013 in the online journal PLOS ONE, is one of the first to study the social cost of this frequently debilitating and misunderstood illness. The study was co-authored by Joanna Kempner, PhD, Assistant Professor of Sociology at Rutgers University in New Brunswick, NJ.

Social stigma occurs when society disapproves of a person because they are different in some way -- either externally, as with a birthmark, or in an unseen way, as with migraine. Stigma can hurt people's personal relationships, their work prospects, and their state of mind.

"When people treat my patients as if they are to blame because they have a severe, debilitating disease, they are contributing to the problem and making life harder for them," commented Dr. Young.

The authors conclude that the high level of stigma for chronic migraine sufferers is due to the impact of migraine on the study subjects' work lives: Chronic migraine has a bigger impact on the work of migraine patients than epilepsy has on the work of epilepsy patients. Stigma is worse because the chronic headache patients are more disabled. If you take out disability, the stigma of chronic migraine and epilepsy are about the same and the stigma of episodic migraine is less.

"I don't think people realize that it is not unusual for people with migraine to have severe headaches every day -- to be so disabled that they are unable to work," said Dr. Young. "This is what causes the stigma -- the fact that people with severe migraine may not be able to work."

Investigators surveyed 123 episodic migraine patients1, 123 chronic migraine patients, and 62 epilepsy patients using a 24-item stigma scale for chronic illness. They used epilepsy for comparison, a disease well-known for the stigma associated with it. Patients were recruited between October 2009 and July 2011 from the Jefferson Headache Center and the Jefferson Comprehensive Epilepsy Center in Philadelphia, PA.

The study showed that patients with chronic migraine had higher scores (54.0+/- 20.2) on the stigma scale than either episodic migraine (41.7 +/-14.8) or epilepsy patients (44.6 +/-16.3) (p<0.001). Adjusted scores put migraine and epilepsy scores roughly equal, with (49.3 vs. 46.5; 95% confidence interval for both). Adjusted scores for episodic migraine were lower (43.7; 95% confidence interval).

Study subjects with chronic migraine reported a greater inability to work than patients with epilepsy. Many required bed rest during the day for hours at a time, many times per month.

The study and treatment of migraine suffers from stigma itself; it is often considered a minor health problem -- "just a headache." Yet in Dr. Young's clinic alone, 25 percent of migraine patients cannot hold a job due to the disease. Many more suffer severe headaches nearly every day. Severe depression and even suicidal thoughts are common among patients with chronic migraine.

Episodic migraine was defined as 14 headaches per month or fewer. Chronic migraine is greater than 14 headaches per month, with eight of these meeting the criteria for migraine.

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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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