What can I do about my migraines?

This article discusses what someone who suffers from migraines can do about their headaches.

If you are one of the roughly 30 million Americans who suffer from the intense, throbbing misery of migraines, you'd probably try anything to ease the pain. Here are some options to consider and discuss with your doctor:

Pain-relieving medications.

Over-the-counter aspirin, ibuprofen or acetaminophen, as well as formulations marketed specifically for migraines, may help relieve mild to moderate pain. Take at the first sign of a headache. Prescription drugs may be needed for more severe attacks. Preventive therapies may also be an option if you suffer from frequent attacks, if they last a long time or if pain-relievers aren't helping.

Biofeedback.

This alternative therapy uses electrical sensors on your body to detect and monitor physical responses related to stress, such as muscle tension. Having that information helps you learn to make subtle changes — such as relaxing those specific muscles — to relieve headaches. A form of this therapy called neurofeedback, or EEG biofeedback, focuses on helping people alter brain waves, which some research suggests may ease migraine pain. Other alternative treatments include acupuncture and massage therapy.

Avoid your triggers.

Whether it's a type of food or smell, a specific medication, or even disrupted sleep or missed meal – many factors can set off an attack. Do your best to steer clear of them and maintain a consistent routine.

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Obesity and diabetes may be helped by migraine medication

A migraine medication that blocks specific pain receptors may also treat obesity and diabetes.

By blocking a key pain receptor in mice models, a team of researchers has discovered a potential new method for treating obesity and diabetes. 

In a study published in the May 22, 2014, issue of Cell, Andrew Dillin, PhD, and researchers at the University of California, Berkeley found genetically modified mice that lacked a certain pain receptor called TRPV1 lived 14% longer than mice that had it. 

“In long-lived TRPV1 knockout mice, the nuclear exclusion of the transcriptional coactivator CRTC1 within pain sensory neurons originating from the spinal cord … decreases production of the neuropeptide CGRP from sensory endings innervating the pancreatic islets, subsequently promoting insulin secretion and metabolic health,” the authors wrote. “In contrast, CGRP homeostasis is disrupted with age in wild-type mice, resulting in metabolic decline.”  

Furthermore, the researchers found TRPV1-deficient mice had lower levels of the CGRP proteins that are responsible for blocking insulin release and increasing blood glucose levels, which ultimately affect the development of type 2 diabetes and obesity. As a result, treated mice were able to quickly remove sugar from their systems, regardless of exercise frequency or aging. 

“We think that blocking this pain receptor and pathway could be very, very useful — not only for relieving pain, but (also) for improving lifespan and metabolic health, and, in particular, for treating diabetes and obesity in humans,” Dillin said in a press release. 

The investigators noted an anti-migraine medication produces similar results, since it inhibits a CGRP protein that triggers TRPV1. In fact, older mice treated with the drug in the study had increased longevity compared to untreated older mice, and they were also metabolically similar to younger mice. 

Moving forward, Dillin said he plans to further examine the influence of TRPV1 and CGRP in both mice and humans. 

“Our findings suggest that pharmacological manipulation of TRPV1 and CGRP may improve metabolic health and longevity,” Dillin noted. “Alternatively, chronic ingestion of compounds that affect TRPV1 might help prevent metabolic decline with age and lead to increased longevity in humans.”

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FDA approves migraine prevention medication for adolescents

The FDA has approved Topamax for migraine prevention in adolescents aged 12 to 17 years old. This is the first approved medication for this purpose in this age group.

Today, the U.S. Food and Drug Administration approved Topamax (topiramate) for prevention (prophylaxis) of migraine headaches in adolescents ages 12 to 17. This is the first FDA approval of a drug for migraine prevention in this age group. The medication is taken on a daily basis to reduce the frequency of migraine headaches.

Topamax was first approved by the FDA in 1996 to prevent seizures. It was approved for migraine prevention in adults in 2004.

“Migraine headaches can impact school performance, social interactions, and family life,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “Adding dosing and safety information for the adolescent age group to the drug’s prescribing information will help to inform health care professionals and patients in making treatment choices.”

About 12 percent of the U.S. population experiences migraine headaches. Migraine headaches are characterized by episodes of throbbing and pulsating pain in the head, and may occur several times per month. Other common symptoms include increased sensitivity to light, noise, and odors, as well as nausea and vomiting. Many patients experience their first migraine attack before reaching adulthood, and migraine can be just as disabling in teens as it is in adults.

The safety and effectiveness of Topamax in preventing migraine headaches in adolescents ages 12 to 17 was established in a clinical trial that enrolled 103 participants. Those treated with Topamax experienced a decrease in the frequency of migraine of approximately 72 percent compared to 44 percent in participants that took an inactive drug (placebo). 

The most common adverse reactions with the approved dose of Topamax (100 milligrams) were paresthesia (a burning or prickling sensation felt in the hands, arms, legs, or feet), upper respiratory infection, anorexia (loss of appetite), and abdominal pain.

Topamax must be dispensed with a Medication Guide that describes important safety information about the drug. Topamax and all anti-epileptic drugs may increase the risk of suicidal thoughts and behavior, and patients should be advised of the need to be alert for the emergence of, or worsening of, the signs and symptoms of depression, or unusual changes in mood or behavior.

Topamax increases the risk of the development of cleft lip and/or cleft palate (oral clefts) in infants born to women who take the drug during pregnancy. The benefits and risks of Topamax should be carefully weighed before using it in women of childbearing age.  If the decision is made to use the medication by a woman of childbearing age, effective birth control should be used.

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Study: Thinking migraine drugs will help will boost the positive effects

According to a study, simply thinking a drug will help the effects of migraine headaches make the drug more effective and boosts the positive effects of the drug.

A new study of migraine sufferers is the latest to demonstrate the remarkable power of the placebo effect, finding that what a doctor tells you when prescribing medicine can influence your body’s response to it. The study, published Wednesday in the journal Science Translational Medicine, compared the effects of the common migraine drug Maxalt (rizatriptan) to an inactive placebo (sugar pill) in 66 sufferers of chronic migraine headaches, a condition whose symptoms include throbbing headaches, nausea, vomiting and sensitivity to light and sound.

The researchers from Harvard Medical School and Beth Israel Deaconess Medical Center (BIDMC) in Boston found that study participants reported relief from the placebos even when they knew they were taking them.

Interestingly, the researchers also found a ‘reverse-placebo’ effect, whereby patients who believed they were getting the placebo found that the real drug did not work as well as it should have.

The so-called ‘placebo effect‘ is a powerful, effective medical treatment and has been found to help treat or reduce the symptoms of a wide variety of conditions such as irritable bowel syndrome (IBS), depression, anxiety, ADHD, restless leg syndrome and others.

However, the current study is the first to quantify how much pain relief is attributed to a drug’s pharmacological effect, and how much to a placebo effect, and demonstrates that a positive message and a powerful medication are both important for effective clinical care.

The study uncovered three key findings: 1) the benefits of Maxalt increased when patients were told they were receiving an effective drug for the treatment of acute migraine; 2) when the identities of Maxalt tablets and placebo pills were switched, patients reported similar reductions in pain from placebo pills labeled as Maxalt as from Maxalt tablets labeled as placebo; and 3) study participants reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all.

“One of the many implications of our findings is that when doctors set patients’ expectations high, Maxalt [or, potentially, other migraine drugs] becomes more effective,” said Rami Burstein, PhD, the study’s senior author and Director of Pain Research in the Department of Anesthesia, Critical Care and Pain Medicine at BIDMC.

“Increased effectiveness means shorter migraine attacks and shorter migraine attacks mean that less medication is needed,” he said.

“This study untangled and reassembled the clinical effects of placebo and medication in a unique manner,” said the study’s other senior author, Ted Kaptchuk, Director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at BIDMC and Harvard Medical School.

“Very few, if any, experiments have compared the effectiveness of medication under different degrees of information in a naturally recurring disease. Our discovery showing that subjects’ reports of pain were nearly identical when they were told that an active drug was a placebo as when they were told that a placebo was an active drug demonstrates that the placebo effect is an unacknowledged partner for powerful medications,” Kaptchuk said.

The researchers studied over 450 attacks in the 66 participants. After an initial “no treatment” episode in which patients documented their headache pain and accompanying symptoms 30 minutes after headache onset, and again two hours later (2.5 hours after onset), the participants were provided with six envelopes containing pills to be taken for each of their next six migraine attacks.

Of the six treatments, two were made with positive expectations (envelopes labeled “Maxalt”), two were made with negative expectations (envelopes labeled “placebo”), and two were made with neutral expectations (envelopes labeled “Maxalt or placebo”). In each of the three situations – positive, negative or neutral – one of the two envelopes contained a Maxalt tablet while the other contained a placebo, no matter what the label actually indicated. The patients then documented their pain experiences in the same manner as they had initially in the no-treatment session.

The results consistently showed that giving the pills accompanied by positive information incrementally boosted the efficacy of both the active migraine medication and the inert placebo.

“When patients received Maxalt labeled as placebo, they were being treated by the medication – but without any positive expectation,” Burstein said.

“This was an attempt to isolate the pharmaceutical effect of Maxalt from any placebo effect.”

Conversely, the inert placebo labeled as Maxalt was an attempt to isolate the impact of the placebo effect from pharmaceutical effect.

“Even though Maxalt was superior to the placebo in terms of alleviating pain, we found that under each of the three messages, the placebo effect accounted for at least 50 percent of the subjects’ overall pain relief. When, for example, Maxalt was labeled ‘Maxalt,’ the subjects’ reports of pain relief more than doubled compared to when Maxalt was labeled ‘placebo.’ This tells us that the effectiveness of a good pharmaceutical may be doubled by enhancing the placebo effect,” said Kaptchuk.

The researchers were surprised to find that even when subjects were given a clearly labeled placebo, they reported pain relief when compared with no treatment.

“Contrary to conventional wisdom that patients respond to a placebo because they think they’re getting an active drug, our findings reinforce the idea that open label placebo treatment may have a therapeutic benefit,” wrote the study’s authors.

The researchers said the study’s findings suggest that placebos may someday provide a therapeutic boost to drug treatments, although further research is needed to explore how this is best applied in clinical care settings.

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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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