Migraine is known to be associated with depressive disorders and this recent study highlighted its impact on migraneurs with major depressive disorders, concludingt:  Migraine may have a negative impact on the improvement of partial SF-36 subscales, especially on functional recovery, after acute treatment among outpatients with MDD. Whether additional intervention besides antidepressant treatment for migraine is indicated may need further study.

For further details go to:  http://www.ntkinstitute.org/news/content.nsf/PaperFrameSet?OpenForm&pp=1&id=51C341692B2CC8088525762000542653&refid=3737&specid=999&newsid=852576140048867C8525798B0031556A&locref=ntkwatch&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=22250605

Following the past success of the training days on medical management of headaches it is being presented again on March 25th at the London Gateway hotel.

The presenter is a renowned headache specialist and author Dr Andrew Dowson. He works closely with chiropractors as the medical director of HCUK and  runs a number of NHS and private headache clinics in which he sees the full range of headache types.

The one day introduction is designed for any healthcare practitioner who works with headaches and wishes to understand more about the diagnosis and medical management of headaches. It is part of the compulsory training for all Headache Clinic chiropractors.

To download a flyer with more details and booking form please click here Chiropractor_Headache2012_Booking

Please Note that this seminar is open to other Musculoskeletal Practitioners including Osteopaths and Physiotherapists.

To download a flyer with booking form please click hereMusculoskeletal_Headache2012_Booking

The London Gateway Days hotel have a special room rate of £59.50 per room including breakfast for the training day when mentioning Headache Clinics.

A recent study highlights the unpredictable nature of medications for migraine. Some work well for some people others not at all. The article looks at new ideas on medication management.

Pharmacological Synergy: The Next Frontier on Therapeutic Advancement for Migraine.

Blumenfeld A, Gennings C, Cady R.

 Source

From The Headache Center of Southern CA-Headache Center, Encinitas, CA, USA (A. Blumenfeld); Virginia Commonwealth University-Department of Biostatistics, Richmond, VA, USA (C. Gennings); Headache Care Center-Medicine, Springfield, MO, USA (R. Cady).

 Abstract

The burden of migraine significantly impacts the individual sufferer, their families, the workplace, and society. The World Health Organization has identified migraine as an urgent public health priority and has initiated a global initiative to reduce the burden of migraine.

 Click here for full abstract

A recent report stemming from the The European Headache and Migraine Trust International Congress (EHMTIC) 2010 in Nice has confirmed what we here at Headache Clinics UK have been promoting since we began. Headaches are a multifactorial problem and as such require a multidisciplinary approach to treatment. Below is an abstract for the study published in Journal of Headache Pain and available on open access by springer link .

Abstract
Multidisciplinary approaches are gaining acceptance in headache treatment. However, there is a lack of scientific data about the efficacy of various strategies and their combinations offered by physiotherapists, physicians, psychologists and headache nurses. Therefore, an
international platform for more intense collaboration between these professions and between headache centers is needed. Our aims were to establish closer collaboration and an interchange of knowledge between headache care providers and different disciplines.

At HCUK we are firm believers in this approach but have some minor issues with the report and it’s (in our opinion) over focus on the hospital or medical setting for headache care. Multidisciplinary means exactly that and for the benefit of patients the horizons of the terms multidisciplinary team need widening.

For an open access copy of report click here

Whilst nobody would argue that migraine treatment has been helped immeasurably by medications such as triptans, there are people who cannot for various reasons take medications and others who just don’t want the side effects that many have. Below is a section from a review of non pharmacological options.
____________________________________________
‘Pharmaceutical interventions are obviously favored by the medical community even when, at least according to this review, riboflavin and butterbur demonstrate equal or superior effectiveness in A graded studies yet report infrequent adverse effects.

Butterbur: A 2006 systematic review reported on 2 randomized trials (RCT) of butterbur extract (Petasities hybridus) which totaled 293 patients. In these studies a 150 mg dose of butterbur was more effective than a 100 mg dose over a period of 3 to 4 months. Overall butterbur demonstrated a decreased frequency of migraine in over 50% of patients. The brand name of the form of butterbur used in this study was Petadolex (2). In an open label study of 109 children and adolescents the authors found 77% of all patients reported at least a 63% reduction in the frequency of migraine (3). Although no significant adverse effects have been reported in the studies mentioned above, concerns relating to hepatotoxicity have been reported in the literature. A recent study utilizing Petadolex found it to be “free of signals for drug induced liver injury” (3). Several authors have suggested butterbur may be a valuable tool in the prevention of migraine (4-7).

Riboflavin: A RCT compared a combination of riboflavin (400 mg), magnesium (300 mg) and feverfew (100 mg) to 25 mg of riboflavin. Both groups achieved statistically significant improvements over baseline. The authors noted both groups exceeded the normal placebo response reported in other migraine prevention studies. This study suggests a small dose of riboflavin may be an effective prophylaxis for migraine (14). Another RCT using 400 mg daily reported statistically significant improvements in headache frequency and headache days after 3 months. The number needed to treat in this study was 2.3 (15). Unfortunately 2 studies of riboflavin in children did not demonstrate improvement (16;17).

Magnesium: A 2008 RCT examined the prophylactic effect of 600 mg of magnesium citrate daily for 3 months compared to a placebo. Statistically significant improvements in frequency and severity were found in the treatment group. Additionally cortical blood flow increased significantly in the treatment group (18). A second RCT also found a statistically significant decrease in migraine frequency after 3 months using 360/mg per day (19). Not all RCTs have shown magnesium to be of effective. A 1996 RCT found no benefit when using magnesium (20). Soft stools and diarrhea were a common mild adverse event occurring in 18.6% (19) to 47.7% (20) in the magnesium groups.

The above report can be found at Prevention of Migraine

The World Health Organisation have produced the Atlas of Headache Disorders 2011. It is extremely interesting reading and the following is taken from its preface.

Headache disorders are among the most common disorders of the nervous system, causing substantial ill-health and disability
in populations throughout the world. Despite this, they are underestimated in scope and scale, and there is little recognition
of their public-health impact. It is not known how, or how effectively, health-care and other resources are utilized to mitigate
their effects.
WHO has a number of important initiatives in the field of clinical neuroscience designed to promote international collaboration,
enhance research capacity and, above all, develop programmes to benefit communities worldwide affected by neurological
disorders. Among them is Project Atlas, a series of publications now including the Atlas of Headache Disorders, the result of a
collaborative study by WHO and the nongovernmental organization,Lifting The Burden: the Global Campaign against Headache.
The Global Campaign involves multiple nongovernmental organizations, academic institutions and individuals worldwide,
with objectives not only of better professional, public and political awareness of the global burden of headache but also
of solutions to it. It might appear that production of an Atlas would be difficult in relation to headache disorders, but this publication, carefully and expertly designed and covering, as it does, very important causes of population ill-health and disability, is highly appropriate and timely. Its introduction provides a clear description of its purpose, definitions and descriptions of the principal headache disorders and an account of barriers to care that must be overcome if these are to be managed effectively. The results, gathered from respondents from more than half the world’s countries, are set out in themes: epidemiology, the impact of headache disorders on society, health-care utilization, diagnosis, assessment and treatment, professional training and the
importance of national professional organizations are all given full consideration.

For copy of the full report

Headache Clinics UK supports Migraine Action, one of the UK’s foremost charities aimed at helping people who suffer from migraines and headache. This year, Migraine Awareness Week will start on September 4th to promote awareness of the problems caused by migraine to individuals and to the economy of the country.

For more details Migraine Action Awareness Week.

For many migraineurs the weather is thought to be a trigger, but recent research seems to cast a cloud of doubt over this as the following paper from cephalalgia reports.

Migraine and weather: A prospective diary-based analysis

Karin Zebenholzer1,
Ernest Rudel2,
Sophie Frantal1,
Werner Brannath1,
Karin Schmidt3,
Çiçek Wöber-Bingöl1 and
Christian Wöber1

+ Author Affiliations

1Medical University of Vienna, Austria.
2Central Institute of Meteorology and Geodynamics, Austria.
3Donauspital Vienna, Austria.

Christian Wöber, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria Email: christian.woeber@meduniwien.ac.at

Abstract

Aims: Weather is mentioned as a trigger factor by migraine patients most frequently. We examined the impact of meteorological factors and the impact of their day-to-day change on the risk of occurrence and persistence of headache and migraine and the correlation of subjective weather perception with objective weather data.

Methods: We performed a prospective, diary-based cohort study in 238 patients suffering from migraine with or without aura. Patients had to live within 25 km of the Vienna meteorological station and were required to keep a diary for 90 days. We analysed 11 meteorological parameters and 17 synoptic weather situations. For evaluating the hazard of occurrence and persistence of migraine and headache, we performed a univariate and a stepwise multivariate Cox regression analysis. We calculated correlations between subjective weather perception and meteorological data.

Results: In the uni- and multivariate analysis, a ridge of high pressure increased the risk of headache occurrence, lower mean daily wind speed increased the risk of migraine occurrence and a day-to-day change of daily sunshine duration increased the risk of migraine occurrence. A day-to-day change of the daily minimum temperature decreased the risk of migraine persistence. After correction for multiple testing, none of these findings remained statistically significant. Subjective weather perceptions did not correlate with the occurrence or persistence of migraine or headache. Subjective perception of cold and too-cold weather and of too-warm weather correlated with daily minimum, mean and maximum temperature.

Conclusion: The influence of weather factors on migraine and headache is small and questionable.

For a full text copy click here

A recent study highlights the existance of neck pain with migraine and makes interesting reading for those who have not considered seeing a Headache Clinics UK chiropractor for their migraines.

The prevalence of neck pain in migraine.

Calhoun AH, Ford S, Millen C, Finkel AG, Truong Y, Nie Y.
SourceCarolina Headache Institute, Chapel Hill, NC 27516, USA.

Abstract
OBJECTIVE: To determine the prevalence of neck pain at the time of migraine treatment relative to the prevalence of nausea, a defining associated symptom of migraine.

METHODS: This is a prospective, observational cross-sectional study of 113 migraineurs, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache medicine specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all migraines were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. For each attack, subjects recorded the presence or absence of nausea as well as the intensity of headache and neck pain (graded as none, mild, moderate, or severe).

RESULTS: Subjects recorded 2411 headache days, 786 of which were migraines. The majority of migraines were treated in the moderate pain stage. Regardless of the intensity of headache pain at time of treatment, neck pain was a more frequent accompaniment of migraine than was nausea (P< .0001). Prevalence of neck pain correlated with chronicity of headache as attacks moved from episodic to chronic daily headache.

CONCLUSIONS: In this representative cross-section of migraineurs, neck pain was more commonly associated with migraine than was nausea, a defining characteristic of the disorder. Awareness of neck pain as a common associated feature of migraine may improve diagnostic accuracy and have a beneficial impact on time to treatment.

PMID:20100298[PubMed - in process]

Headache Clinics UK training day

The latest HCUK training day for our existing and potential chiropractors took place at the Belfry on July 10th and was a complete success, selling out and gaining high marks for the day and the presenter, Dr Andrew Dowson.

Dr Dowson is a well known Headache Specialist and author of many papers and books on headaches. Dr Dowson regularly lectures around the world on the subject of headaches and is the Clinical Director of Headache Clinics UK.