A recent study in Headache Journal has been highlighted by the American Headache Society. The abstract describes the use of opiods for migraine as ‘pennywise and pound foolish’.

For the abstract and more information please go to study

A recent study was published which looked at data surrounding the use of selective serotonin-reuptake inhibitor (SSRI) or a selective serotonin/norepinephrine reuptake inhibitor (SNRI) with a triptan. This is in the light of a number of warnings initially by the FDA in 2006 on the risk of combining triptans with SSRIs.

The following links will help anyone interested in this area review some of the studies on a subject that has differing opinions amongst relevant healthcare professionals.

2012 Concomitant use of triptan, and SSRI or SNRI after the US Food and Drug Administration alert on serotonin syndrome.

Click here for details

Click here for details

click here for details

The training session on March 25th on medical management of headaches was a huge success with attendees hearing HCUK Medical Director and headache expert, Dr Andrew Dowson explain the pathophysiology of headaches, how the medical model works, looking at diagnosis and treatment approaches – old and new. The attendees consisted of new Headache Clinics UK chiropractors undergoing part of their initial training and others who simply had an interest. Feedback was highly positive.

If you have an interest in attending a future seminar please contact us.

Often migraneurs struggle to take medications orally or keep them down with vomiting.  Migraine induced gastroparesis can also slow down absorption and efficacy of medication. This new approach shows great promise for migraineurs. Click here for more information

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

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.