Migraine Patients are Not Being Diagnosed, Treated Correctly

Migraine is going under-treated and misdiagnosed in the UK, according to Peter Goadsby, professor of Neurology at University College, London. "Only 8 per cent of the estimated 9 million people with migraine in the UK are prescribed medications that can reduce the severity of acute attacks, and still fewer are given preventive drugs that can reduce their frequency."

In the United States the situation is better but not by much. Only about 12 to 14 per cent of migraine patients are being treated and diagnosed correctly.

To compare, 1/3 of migraine population of Sweden is receiving proper treatment.

The reasons cited for this sad state of affairs were as follows:

• Stoical attitude among migraine patients (Seriously?)
• Lack of awareness among doctors
• Widespread perception that there are few good drugs for treating migraines

"There is a misconception that migraine means apoplectic and on the floor. There is a big problem with misdiagnosis. If you're a woman and you see your GP, you have only a 60 per cent chance of a correct diagnosis. If you're a man, it's just 50 per cent, as GPs have a concept that it's a women's disease,” Prof. Goadsby said.

So, use the rule of a thumb - if your head hurts, talk to you doctor about it. Migraine is an "invisible" disease, they can's see it, they can't even test for it. It's up to you to bring it up.


link: Migraine sufferers are missing out on medication, says leading neurologist
link: Migraine sufferers being failed in UK

Nerve Decompression Procedure For Treating Persistent Occipital Neuralgia Headaches

Migraine really is a brand-name that covers a whole lot of different severe and recurring headaches. This is why it is so important to get the right diagnosis and the right treatment.

Case in point - occipital neuralgia is not exactly a migraine even though it might feel like one. "It's usually straightforward to determine who may be a candidate for nerve decompression – all one has to do is touch the area and watch the patient's response."

Dr. Pamela Blake, (former) Director of Georgetown's Headache Clinic and Dr. Ducic, Chief of Peripheral Nerve Surgery, have developed a "nerve decompression" technique for such patients. Pretty simple from a surgical standpoint procedure opens up the space or widen the muscle that surrounds occipital nerve without actually operating on the nerve itself.

Dr. Blake, referenced on MyMigraineConnection.com, has since then moved to Texas, from the looks of it. She founded Headache Treatment Center of Northwest as part of Memorial Hermann Medical Group. The latest news reports suggest that she has introduced the "nerve decompression" procedure at the new clinic and is currently treating many a sufferer.

Here's a short video from the local TV station in Houston that tells us a story from one of her recent patients' point of view.




link: New Procedure Claims To Rid Headaches Forever

link: Revolutionary Migraine Treatment Only at Georgetown

technorati tags: migraine migraines headache headaches Dr. Ducic Dr. Pamela Blake occipital neuralgia nerve decompression CDH migraine treatment

War on Generic Drugs

At the end of 2008 (this year, if you're still keeping count), several prescription medicines for migraine patients should be available in a generic form. Among those are Imitrex, triptan used to abort acute migraines and Efexor, psychiatric drug prescribed as a migraine preventive.

It's a good news for our valets - generics cost less than one-third of the price-tag of the brand-name drugs.

There is, however, a caveat - recently, more and more patients, organizations and medical professionals are questioning the validity of The Generic Pharmaceutical Association's slogan: "Same Medicine. Same Results."

Cardiologists, endocrinologists, physicians who care for organ transplant recipients, all actively resist using certain genetic substitutes. In 2004, The American Association of Clinical Endocrinologists, the Endocrine Society and the American Thyroid Association issued a warning that patients with hypothyroidism could be harmed by switching to generics.

"A switch from a long-used brand-name drug to its generic equivalent can, on occasion, bring a shifting profile of side effects. In a number of cases documented in medical journals and recounted in interviews with physicians, a generic version of what is often called a "pioneer" drug simply doesn't appear to work as well for many patients."

If you are switching from a brand-name medication to a generic form of the same, do pay attention to those "little" details. And here's hoping that the generic Imitrex will work just as well as the real deal. Lets wait and see, only 6 or 7 months left till the GIMITREX lift-off.

In the mean time, think healthy thoughts, my gentle readers.

Link: Copycat drugs aren't always created equal

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technorati tags: generic prescription hypothyroidism migraine migraines Imitrex Efexor migraine treatment
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Migraine Arts or Martial Headaches?

A Dojo in Berakas, Brunei recently introduced a new form of martial arts - Physiotherapy. As funny as it sounds, "this new form of training fuses physiotherapy with Chinese traditional stretching techniques, suitable for people who are suffering from diabetes, migraine, and high-blood pressure and is also a good form of exercise for those suffering from mild stroke", according to Lim, the instructor for these classes. "It is more of a treatment than an exercise," he also added.

Tai chi and similar eastern martial practices are often recommended as supplementary medical rehabilitation techniques; this is the first time, however, anyone referred to the martial arts as "treatment".



link: New courses by Busiido

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What is up with Arizona?

Mary Beth Faller of "The Arizona Republic" publication has posted two articles on migraine in a row. Both mention Dr. Carol Foster, a neurologist and migraine specialist working in Phoenix. Dr. Foster has had the migraines since the age of 12 so rest assured, she does "get" them.

Neither article is exactly groundbreaking but they do deserve a read-through.

Here are the interesting parts:

Behavioral training by Dr Foster:

• She requires her patients to "commit to new behaviors to reduce their adrenaline and increase their serotonin. She calls it "brain-cell fitness."
• "Patients are to avoid certain foods or drinks that can stimulate adrenaline in the brain, such as alcohol, caffeine, chocolate, nuts, aged cheeses, some kinds of milk, certain fruits, artificial sweeteners, cured meats and most food additives."
• "Patients must incorporate calm time into their day. "With migraine, the brain is excited by visuals, so you need to have non-visual relaxation," Foster says."
• "Repetitive rhythms also boost serotonin, so she advises patients to walk or otherwise exercise", even if a little bit.

All of the above sound like a good advise. A bit restrictive but what you gonna do. However, there must be more to the whole "Behavioral Training" business. Diet, exercise and relaxation can get one only so far.


Valley Neurological Headache and Research Center - which looks like a likely place for Dr. Foster to work (neither article states it specifically) - is testing therapies for treating migraines that include:

• "Capsaicin nasal spray. Capsaicin is the ingredient in cayenne pepper that gives it its hot and spicy taste. It relieves pain by destroying a chemical that carries pain messages to the brain." ed. - an old and beaten to death idea; they can test it till the cows come home but the fact is that capsaicin sprays like "Sinus Buster" cannot completely abort a full-blown migraine.
• "Alzheimer's drug. Eisai is used to treat Alzheimer's disease, but new research suggests it may act on pain receptors in the brain as well." ed. - Eisai is the name of the company that makes those drugs, not a name of a specific medication.
• "Heart surgery. Some people with intractable migraine pain have a hole between the right and left atrial chambers of the heart. Surgery to close the hole has decreased headaches in these patients. Several companies are studying less invasive ways to repair the hole." ed. - they must be talking about patent foramen ovale (PFO).
• "Neurostimulation devices. Also for people who find no relief from medications, neurostimulation devices are implanted under the skin and disrupt nerves' pain signals. Several types of devices are being tested."

Hopefully, with the "helpful" comments of yours truly, both articles would be a touch more informative. I did find the concept of balancing of serotonin and adrenalin fascinating - might not be a new take on the migraine but a rarely discussed one for sure. This alone makes the articles worth reading. Also, the part about non-visual relaxation is a good thing to keep in mind next time you want to unwind.

Still, the question remains - is there a migraine epidemic in Arizona that we don't know about?


link: Early treatment, lifestyle changes can alleviate migraine suffering
link: More drugmakers reaching for headache solutions

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technorati tags: Carol Foster migraine treatment migraine prevention migraine research migraine migraines

Migraine in 2008 - will it cost you your job?

FMLA, Family and Medical Leave Act has been around since 1993 and, despite it's shortcommings and general vagueness, has been working well and benefited millions of working people. 2008 is the year when this law is going to have a major overhaul.

From the information available, it seems the businesses and business owners will have a major win over the employees. Here's a couple of proposed changes :

• A more specific definition of “serious health condition.”
• Limiting FMLA coverage to serious health conditions that require more than 10 days off work
• Allowing greater communication between employers and doctors

Dry, lawyer talk. Lets see if we can translate it into human language. Try to think of your migraine attacks and how you are going to explain taking a leave to take care of them to your boss.

• Can you prove that your migraine is a serious, debilitating decease? Or to think of it, is there any test you know of that you can take that will definitely show that you do indeed have a migraine?
• Can you justify staying at home for 10 days at a stretch for just one migraine attack? Some might last that long but for majority of people, especially the ones who have access to abortive medication, the time of an episode is much shorter.
• Do you really want to prove to the company you work at that you still have a migraine every six month with no fail?
• Are you really OK with the fact that now your employer can talk to your doctor directly, circumventing doctor-patience confidentiality?

Another good question would be - what would happen to so-called 'intermittent leave'. Migraine patients are the largest group who use that provision of FLMA. After the changes are implemented, the revisions proposed by the Labor Department would leave companies the option of disciplining workers who fail to adhere to policies requiring advanced notice of an absence. You might need to start scheduling your migraines to comply.

The U.S. Department of Labor has gathered over 15,000 comments on the proposed changes. Most of them came from employers, businesses and business groups. As such, it's not hard to imagine who would benefit most from the new law.

Democratic Congress is half-heartedly trying to sink the changes to the FMLA.

Hillary Clinton's opinion the the issue:

"Our economy is sliding into recession and the strain on working families- from stagnant wages, rising energy costs, looming foreclosures and skyrocketing tuition- is growing. Yet, the Bush Administration has acted once again to tilt the balance of power towards corporations instead of heard working Americans."

Senator Kennedy chimes in:

"When so many families are struggling, this is the worst possible time to roll back the protections of the Family and Medical Leave Act."

It is yet to be seen if Democrats will allot enough time from their busy schedule to address what to an untrained eye looks like a largest setback for a working-class Americans in the recent history.

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Race and Migraine Treatment Study

The difference in progress of treatment of Migraine headaches between black and white patients was recently highlighted in a study published in the "Journal of the National Medical Association" by B.D. Heckman and colleagues from Ohio University's Department of Psychology.

"African Americans were more likely to be diagnosed with depression than whites and were more likely to prematurely terminate their headache treatment appointments regardless of their socioeconomic status (SES). White patients with SES values above the median reported the lowest rate of premature treatment termination. Higher SES enables whites (but not African Americans) to attend all headache treatment appointments."

In other words, African-American migraine patients are more likely to stop the migraine treatment whether they can realistically afford it or not. It could be speculated that the perceived cost of medical care would appear prohibitive or the abandonment rate could be linked with depression. In either case, the researchers insist that "Interventions that enable African-American headache patients to complete their prescribed headache treatments are urgently needed."

link: Study results from Ohio University, Department of Psychology in the area of headache and migraine therapy published

related article: Black Women Have More Migraines, Less Treatment

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Black Women Have More Migraines, Less Treatment

"According to a recent study, African Americans tend to report higher levels of headache pain but are less likely to get treatment," NPR reports. Audio broadcast with Pam Oliver, a member of the Black Women's Health Imperative, available here:

click here to listen.

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Migraine cure - hot poker up the...

Dr. Elliot Shevel is a maxillo-facial and oral surgeon. That is to say he's a dentist with some extra training. Despite that, he is a medical director of The Headache Clinic and a chairman of the South African Headache Society to boot.

He and Harvard Medical School's neurology professor, Dr. E. H. Spierings conducted some unspecified studies and arrived to the conclusion that cauterising branches of the external carotid artery just might fix whatever ails us. If you haven't been following, it's migraines.

"The sample group (42 women and 13 men) reported an average factor of 2,5 times ... improvement in quality of life over the 12-month period which followed the ... surgery." It's is not clear how the researches measure "quality of life", however. According to some definitions, the "quality of life" is "the amount of money and access to goods and services that a person has". It might also include "freedom, happiness, art, environmental health, and innovation".

That sounds pretty good in exchange for a "simple" procedure that is performed in a "day clinic". I'll take two, please.


link: Simple surgery takes the pain out of migraine

Manage your migraines as you manage the rest of your life - with Prozac

In case kitten pictures didn't do the trick, here's a little article to help wash out the bad taste left over from CNN's postings earlier on.

Doctor Jerry Swanson speaks of "migraine management" in some lengths on the pages of chicagotribune.com ; kudos to good doctor for mentioning alternative treatments such as Botox injections rather matter-of-factly. Lets hope our physicians would get that open-minded in a hurry.

He also mentions antidepressants, anti-seizure medications and cardiovascular drugs as preventives. If your current doctor is reluctant to let you have a go at some of these, link her up, let her read what the experts are saying.

Overall a competent write-up, if limited. I would have preferred Dr. Swanson go into more details on the preventives besides mentioning some general categories. Don't make us post another kitten picture, doctor, to cover up the lack of information. No matter how much damage it will cause to the inter-webs, we are not afraid to do it.


link: With migraines, think management, not cure

New drag has a criptic name, old formula

MAP Pharmaceuticals got a go ahead from FDA on "the first late-stage clinical trial of its migraine treatment, MAP0004".

Granted, naming a migraine drag as one would an assault rifle might resonate with some people. Still, knowing what it is probably even better, seeing how wide an audience it's targeted at.

MAP0004 is an inhaled formula of Dihydroergotamine Mesylate, or Ergoline, or D.H.E; depending on what you know. For decades it's been used to threat migraines as injections under the name of DHE-45® and as inhalation under the name of Migranal®.

It is not yet clear how MAP0004 is different or why it would be more beneficial than existing solutions. It is known that it will be delivered by Tempo(TM) Inhaler, which does sound like a nice bundle of good ideas on paper - breath synchronized, plume controlled, easy to use, etc.

Lets wait and see. DHE does have a structure similar to LSD and such - for all we know, if inhaled, it might be good.


link: Pharma gets FDA nod on migraine study protocol

FDA approves of butch names, not so sure of new drugs

Good news! Trexima is now known as Treximet.

I can literally feel your joy and am barely containing the excitement myself.

For the two of you who know what the heck I am talking about, my hat goes to your erudition. For the rest of us here's the scoop:

Biotechnology company Pozen in cooperation with GlaxoSmithKline PLC have developed a new drug that's supposed to be the next big breakthrough in treating migraines. They submitted it to FDA way back in 2005 and it was on ice since then. Apparently, there are some questions about the drug's genotoxicity. In simple terms, FDA has asked Pozen to prove that the new medicine won't cause cancer or make you grow wings, tails or gills.

Just this Tuesday, Pozen made a statement that "a short-term study of human volunteers shows that the drug, ... , did not cause any harmful mutations in white blood cells when given to patients over the course of one week." One week is really short-term, seems to me. The markets think differently, however - Pozen's shares went up 10% overnight. Is this an indication that Treximet might finally be heading for our pharmacies? We'll see. All FDA did approve was a name change. Treximet does sound more mediciny, I suppose; more masculine, that's for sure.

At any rate, we'll be keeping the story in our sights. If anything comes up, you'll be able to read it right here.


link: Pozen shares rise on migraine drug test