Category: Headaches

A Mayo Clinic case study finds Botox may offer new hope to patients suffering disabling low cerebrospinal fluid headaches. The successful treatment also offers new insight into Botox and headache treatment generally. The case study was presented March 13th, 2011 at the American Academy of Neurology meeting in Hawaii.

Low CSF pressure headaches are caused by an internal spinal fluid leak. The pain can range from slight to disabling. The headaches are most commonly triggered by a lumbar puncture. The pain is caused as fluid leaks out and the brain sags. For many patients, lying down has offered the only relief, because existing therapies weren't fully effective. Traditional treatment is a blood patch, which is just that: a patch of the patient's blood injected over the puncture hole.

The patient in the case study suffered low CSF pressure headaches for 25 years. For most of that time, she only felt better while lying down, curtailing her day-to-day activities. Five years ago, she sought help from Michael Cutrer, M.D., and Paul Mathew, M.D. The patient has received Botox for three years and the results have been consistently positive. After each treatment, improvement would last for three months before pain returned, requiring another dose. While not cured, the patient is now able to live a more normal life.

"We had been using Botox for several years for treatment of migraine and had been successful in many patients. And because we really didn't have anything else to offer her, we gave her the Botox," says Dr. Cutrer, a neurologist at Mayo Clinic in Rochester, Minn., and the report's co-author. "To everybody's surprise she made a remarkable improvement." The intensity of the patient's headaches dropped from 8 out of 10 on a visual pain scale to 3 out of 10.

Migraine rates in a comprehensive Norwegian health study have climbed by 1% in a decade — that may not sound like much, but in the Norwegian context, it means 45,000 more migraine sufferers — and if the trend were to hold for the European Union, that would be an additional 5 million more people plagued by migraines. Researchers at the Norwegian University of Science and Technology (NTNU) are baffled by the cause of this trend.

The findings, in which researchers compared data from a survey conducted in the mid-1990s to data collected in 2006-2008, shows that people aged 20-50 years are more prone to migraines now than in the mid 1990s.

The numbers are derived from the second and third phases of the Nord-Trøndelag Health Study, called HUNT 2 and 3 after their Norwegian acronyms, which represents one of the largest comprehensive health studies in the world. HUNT 2 involved the collection of a health history during 1995-1997 from 74,000 people, with the collection of blood samples from 65,000 people. The follow-up in 2006-2008, called HUNT 3, involved 48,289 people, many of whom were represented in the earlier study.

The findings showed that while 12 per cent of the population met the medical criteria for having migraine headaches in the HUNT 2 survey, 13 per cent of the HUNT 3 respondents 11 years later met the medical criteria for having migraines.

While that 1 per cent increase "may not sound dramatic, in the context of the population as a whole, that represents an increase of roughly 45 000 Norwegians," says Professor Knut Hagen, one of the NTNU researchers working with the data. "Those are real numbers and give some cause for concern. The increase has also occurred over a relatively short period of time."

The increase is most marked in the age group 20-50 years, but is also found in older age groups. Hagen does not have data for people younger than 20.

The most puzzling aspect of the finding is that it has no obvious scientific explanation, Hagen says. Diagnostic criteria were the same in the 1990s as they are today, and the level of self-reported migraine did not increase. The number of migraines caused by medicines has also not increased between the HUNT 2 and HUNT 3 databases, he said.

"This last finding is really good news because the use of pain relievers has risen sharply since these drugs have been available for sale in stores without a prescription," says Hagen.

A more likely explanation for the increase in migraines is a change in the external environment, Hagen says.

"From experience we know that visual impacts, such as flickering screens, can trigger migraines. Measurements of the neurophysiological activity in the brain with EEG shows that migraine patients are more susceptible to light stimulation. It is tempting to believe that the increase in migraines is due to the increase in these kinds of stimuli during the 11 years between the two HUNT surveys," Hagen says. "But this is speculation that we have no scientific evidence for."

But Hagen was clear that one possible candidate — radiation from mobile devices — was not a cause of the increase, based on the results of a previous NTNU study, which found no evidence that radiation from mobile phones contributed to an increase in headaches.

Journal Reference:

1. M. Linde, L. J. Stovner, J.-A. Zwart, K. Hagen. Time trends in the prevalence of headache disorders. The Nord-Trondelag Health Studies (HUNT 2 and HUNT 3). Cephalalgia, 2010; 31 (5): 585 DOI: 10.1177/0333102410391488

Surgery to "deactivate" migraine headaches produces lasting good results, with nearly 90 percent of patients having at least partial relief at five years' follow-up, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

In about 30 percent of patients, migraine headaches were completely eliminated after surgery, according to the new study, led by Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio.

'Trigger Site' Surgery Reduces or Eliminates Migraine Headaches

Dr. Guyuron, a plastic surgeon, developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead-lift procedures. The techniques consist of "surgical deactivation" of "trigger sites" in the muscles or nerves that produce pain.

For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. This procedure may reduce headache attacks by relieving pressure on key nerve in the frontal area. Other approaches target other migraine trigger sites.

Before surgery, each patient was tested with botulinum toxin A (Botox) to confirm the correct trigger sites. For most patients, surgery targeted at least two trigger sites. The five-year results — including standard measures of migraine-related pain, disability, and quality of life — were evaluated in 69 patients.

Eighty-eight percent of these patients had a positive long-term response to surgery. Headaches were significantly decreased in 59 percent of patients, and completely eliminated in 29 percent. The remaining patients had no change in headache activity.

Migraine attacks were less frequent after surgery; average migraine frequency decreased from about eleven to four per month. When attacks occurred, they didn't last as long — average duration decreased from 34 to eight hours. Migraine surgery also led to significant improvements in quality of life, with few serious adverse effects.

Migraine is a very common problem that interferes with many aspects of daily life for millions of Americans. About one-third of patients are not helped by current treatments. The new surgical techniques have the potential to reduce or eliminate migraine attacks for many patients who do not respond to other treatments. A previous study found good results at one-year follow-up evaluation.

The new report shows that these good outcomes are maintained through five years' follow-up. The findings "provide strong evidence that surgical deactivation of one or more trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache, and the results are enduring," Dr. Guyuron and colleagues write. More research will be needed to refine the surgical techniques — as well as to clarify the reasons for the effectiveness of surgical deactivation of trigger sites in relieving migraine headaches.

Journal Reference:

1. Bahman Guyuron, Jennifer S. Kriegler, Janine Davis, Saeid B. Amini. Five Year Outcome of Surgical Treatment of Migraine Headaches. Plastic and Reconstructive Surgery, 2010; 1 DOI: 10.1097/PRS.0b013e3181fed456

Significant and repetitive headaches are associated with a greater prevalence of small lesions in the brain, which are detectable by MRI imaging. However, they do not increase the risk of cognitive decline. This reassuring conclusion, reached by researchers from Inserm and Université Pierre et Marie Curie, Paris, is based on a survey of a cohort of 780 individuals, over 65 years old.

The results of this study are published online in the British Medical Journal.

Recent work, in particular the CAMERA study, has used MRI to study the brains of migraine sufferers and has shown that a higher proportion of these patients exhibit lesions of the brain microvessels than the rest of the population.

Lesions of the brain microvessels

Lesions of the brain microvessels, visible on cerebral MRI images, can be of various kinds: white-matter hyperintensities and, more rarely, silent infarcts leading to loss of white-matter tissue.

They result from a deterioration of the small cerebral arteries that supply blood to the brain's white matter, the material which ensures, among other things, the passage of information between different parts of the brain.

These lesions are observed in almost all elderly people. However, their severity varies greatly from one individual to the next. Moreover, it has been shown that they are more severe among hypertension sufferers and diabetics.

A large quantity of hyperintensities leads to many cerebral complications: cognitive deterioration, increased risk of Alzheimer's disease, depression, movement disorders and increased risk of stroke.

Moreover, according to several studies, the presence of a large quantity of this type of brain lesion increases the risk of cognitive deterioration (reasoning, memory, etc.) and of Alzheimer's disease. This is why the research team coordinated by Christophe Tzourio, director of the Inserm-Université Pierre et Marie Curie Mixed Research Unit 708 "Neuroepidemiology," advanced the hypothesis that migraines could "damage" the brain.

To test this hypothesis, the researchers evaluated the impact of migraine on cognitive function. The team used the EVA study-group of individuals aged over 65 years, recruited from the general population in Nantes, and monitored them over a 10-year period. Cerebral MRI was performed on more than 800 of the participants and these individuals were also questioned about their headaches by a neurologist. "The advantage of this cohort is that it involves relatively elderly individuals. However, since migraine often begins before age 30, if it did indeed have a deleterious and cumulative effect on the brain, then we should observe cerebral damage and a higher level of cognitive decline among the migraine sufferers," explains Christophe Tzourio.

The cognitive tests performed, involved an evaluation of the volunteers orientation in time and space, their short-term memory and their capacity and speed to correctly carry out specific tasks.

The results show that 21% of people suffer or have suffered from severe headaches over the course of their lives. For more than 70% of these, this involves migraines, some of which are with aura (see box below). The MRI scans for those participants having severe headaches confirm that they are twice as likely to have a large quantity of microvascular brain lesions as subjects without headaches.

In contrast, the cognitive scores were identical for individuals with or without severe headaches and for those having or not having cerebral microvascular lesions.

Among participants having a migraine with aura (2% of the total sample), a specific increase in silent cerebral infarcts and certain lesions was observed, hence confirming previous studies, but without detectable cognitive harm.

"This is a very reassuring result for the many people who suffer from migraine. In spite of the increased presence of lesions of the brain microvessels, this disorder does not increase the risk of cognitive decline. Therefore, we have not observed negative consequences of migraine on the brain ," concludes Tobias Kurth, lead author of the study, who designed and carried out these analyses.

Migraine and brain lesions: a suspected link

Headaches (or cephalgias) are very common among the general population. This is particularly the case for migraine, a very painful, chronic and debilitating variety of headaches. It is estimated that around 12% of adults and 5 to 10% of children are afflicted, which represents 11 million migraine sufferers in France. There are two types of migraine, migraine without aura, by far the most frequent, and migraine with aura (15% of migraines). Migraine aura involves the appearance of, often visual, phenomena (zigzag lines of light, the impression of viewing the world through frosted glass, etc) in the minutes preceding the appearance of the headache.

The mechanisms of migraine and migraine aura are still largely unknown. However, it is suspected that a transitory contraction of the blood vessels could be responsible for a reduction of blood flow in the brain promoting the appearance of migraine aura. Much research elsewhere has shown that people suffering from migraine with aura have an increased risk of cerebral infarction (or strokes). Extremely fortunately, this risk remains low among migraine sufferers. However, the research confirms the existence of a link between migraine and blood vessels in the brain.

Journal Reference:

1. T. Kurth, S. Mohamed, P. Maillard, Y.-C. Zhu, H. Chabriat, B. Mazoyer, M.-G. Bousser, C. Dufouil, C. Tzourio. Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study. BMJ, 2011; 342 (jan18 2): c7357 DOI: 10.1136/bmj.c7357

Women with a history of migraine headache with aura (transient neurological symptoms, mostly visual impairments) are at increased risk of stroke. However, according to new research reported in Circulation: Journal of the American Heart Association, stroke events in women with migraine with aura are more likely to have mild or no disability compared to those without migraine.

In a new analysis of the Women's Health Study involving 27,852 women over 13.5 years, researchers found those who have migraine with aura and who experience an ischemic stroke were twice as likely to have no significant disability from stroke.

"The message from this study should be reassuring for migraineurs," said Tobias Kurth, M.D., Sc.D., the study's principal author and associate epidemiologist at Brigham and Women's Hospital in Boston, Mass.

"It is important for women who have migraine with aura to know that their risk of stroke is considerably low and there is high likelihood of a migraine-associated stroke being mild."

The reason for these results is unclear. But Kurth, who is also director of research at INSERM in Paris, France, speculated that mechanisms, perhaps involving smaller vessels — not the traditional mechanisms for stroke, lead to a smaller size stroke.

Compared to those without migraine history, women with migraine and aura were more likely to have a good to excellent functional outcome — defined as having no symptoms and no significant disability, researchers said.

Women participating in the study were divided into four groups: 22,723 who reported no migraine history; 5,129 who reported a migraine history; 3,612 who had active migraine; and of those who reported active migraine, 1,435 reported active migraine with aura.

Researchers evaluated functional ability after stroke at hospital discharge using the modified Rankin Scale, a seven-point scale that measures degree of impairment.

At the onset of the study, women completed a questionnaire about their headaches that allowed classification into the groups of migraine with and without aura, history of migraine or no history of migraine. Each following year, the women reported new medical conditions, including transient ischemic attack (TIA) or stroke, which were confirmed after medical record review.

During 13.5 years of follow-up, 398 TIAs and 345 ischemic strokes occurred.

Women in the study were primarily Caucasian, average age 55, healthy and working in the healthcare field.

There is currently little reason to believe that the association differs for women with other characteristics or men, Kurth said.

The first author is Pamela M. Rist, M.Sc., a doctoral student at the Harvard School of Public Health and research fellow at Brigham and Women's Hospital. Other co-authors are: Julie E. Buring, Sc.D.; Carlos S. Kase, M.D.; Markus Schurks, M.D., M.Sc. Author disclosures are on the manuscript.

The Women's Health Study is supported by grants from the National Heart, Lung, and Blood Institute and the National Cancer Institute. Grants from the Donald W. Reynolds, Leducq and Doris Duke Charitable foundations funded part of the study.

Journal Reference:

1. P. M. Rist, J. E. Buring, C. S. Kase, M. Schurks, T. Kurth. Migraine and Functional Outcome From Ischemic Cerebral Events in Women. Circulation, 2010; DOI: 10.1161/CIRCULATIONAHA.110.977306

The combination of preventive medication and behavioral changes offered significant relief for 77 percent of the individuals enrolled in a study aimed at combating frequent, disabling migraine headaches, according to new Ohio University research published this week in the British Medical Journal.

Though daily preventive medication and behavioral techniques individually have been shown to improve headache pain, the new research is the first controlled study to assess if the combination of the two types of interventions might bring more relief to people whose debilitating migraines can interfere with career, social and family life, said lead author Kenneth Holroyd, an Ohio University Distinguished Professor of psychology.

The new study, funded by the National Institutes of Health, collected data daily from 232 adult participants for 16 months — a longer duration than usual for evaluations of new therapies.

"Migraines are a long-term disorder," Holroyd said, "and we wanted to closely monitor participants every day for at least 16 months to find out if these treatments keep working over time."

Participants needed to experience at least three debilitating migraines per 30 days, even when using the best acute migraine medication (which is taken when a migraine first occurs), to qualify for the project. On average, participants recorded 5.5 migraines and 8.5 days with migraine per 30 days, despite using the acute migraine therapy best suited to their needs.

Participants who continued to experience severe migraines were assigned randomly to have one of four treatments added to their existing therapy: One group received the combination of preventive medication (beta blockers) and behavioral migraine management, one received only the medication, one received only the behavioral therapy, and one served as a control group. Seventy-nine percent of the study participants were women, and subjects had a mean age of 38.

The combined therapy group showed the greatest improvement in the number of migraines, days with migraine and in quality of life, the researchers report. In comparison, the other three groups experienced modest improvements, a finding that's been reported previously by studies of those individual techniques.

Patients learned behavioral migraine management skills at the four monthly clinic visits used for medication dose adjustment, and then worked on their own between sessions with a workbook and 10 audio lessons. The researchers addressed problems with medication adherence or behavioral management assignments during phone calls between visits.

The first two sessions involved basic migraine management skills, including identification of migraine triggers and early signs of a pending migraine attack. Study participants also learned progressive relaxation skills and muscle stretching exercises to prevent or stop migraines.

The third session either continued focus on basic skills or introduced cognitive-behavioral stress management (if stress was a notable migraine trigger), or introduced thermal biofeedback training (if stress was not a significant trigger). Thermal biofeedback offers information about a patient's hand temperature or blood flow, which can help control or prevent migraines, Holroyd explained.

The final session offered trouble-shooting for the behavioral skills, preparation of a written migraine management plan, and advice on relapse prevention and coping with other problems that might arise.

A small percentage of participants reported fatigue as a side effect of the preventive medication, and some participants reported lack of time to learn or practice the behavioral techniques. But used consistently and together, the two approaches were effective for prevention and management of migraines, Holroyd said.

Gary Cordingley, an associate professor of neurology at the Ohio University College of Osteopathic Medicine involved with the new study, noted that the findings could be useful to clinicians seeking an edge in treating patients with frequent, hard-to-control migraines.

"Relentless, individualized fine-tuning of the acute therapy improves outcomes," Cordingley said. "Supplemental treatment combining preventive medication and behavioral management raises that improvement to a still-higher level."

Some people progress from frequent migraines to chronic migraines, a condition in which headaches occur daily or nearly every day. These chronic migraines can be very debilitating and even more difficult to treat, Holroyd said.

"Frequent disabling migraines may be bad for the brain," he said. "Effectively controlling this disorder may have long-term benefits in addition to the immediate benefits of reducing pain and improving quality of life."

In future studies, Holroyd would like researchers to test specifically whether the behavioral migraine management program reduces the number of people who progress to chronic migraines, as well as whether such a management program modified for chronic migraines can improve outcomes for individuals with the disabling disorder.

Other collaborators on the study were Constance Cottrell and Jana Drew of Ohio University and Headache Treatment and Research of Westerville, Ohio; Frank O'Donnell of the Ohio University College of Osteopathic Medicine, Headache Treatment and Research and OrthoNeuro Inc., of Westerville, Ohio; and Bruce Carlson and Lina Himawan of the Ohio University Department of Psychology.

Journal Reference:

1. K. A. Holroyd, C. K. Cottrell, F. J. O'Donnell, G. E. Cordingley, J. B. Drew, B. W. Carlson, L. Himawan. Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial. BMJ, 2010; 341 (sep29 2): c4871 DOI: 10.1136/bmj.c4871

For many people suffering from migraine headaches, over-the-counter ibuprofen — Advil and Motrin are well-known brands — might be enough to relieve the pain.

A new Cochrane review finds that about half of those with migraine headaches will have pain relief within two hours after taking ibuprofen.

"We knew that many migraineurs rely on over-the-counter medication to treat attacks and surveys show that while some find them helpful, many are dissatisfied," said review co-author Sheena Derry of the Pain Research and Nuffield Department of Anaesthetics at the University of Oxford.

Migraine headache is intense throbbing pain on one side of the head, and an attack can last anywhere between four and 72 hours. Symptoms such as nausea, vomiting, aura and increased sensitivity to light and sound often accompany migraines.

The systematic review was published by The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

According to the Migraine Research Foundation, migraine ranks in the top 20 of the world's most disabling medical illnesses with more than 10 percent of the population, including children, suffering from the condition.

Migraine also causes less productivity at work and school. Less than 10 percent of sufferers are able to work or function normally during their migraine attacks, and American employers lose more than $13 billion each year as a result of 113 million lost work days, says the Migraine Research Foundation.

To relieve their headache pain, almost half (49 percent) of migraine sufferers use over-the-counter medication only, 20 percent use prescription medication and 29 percent use both, according to the Cochrane review.

Derry said she and her fellow reviewers conducted the Cochrane review to help provide a more definitive answer on whether ibuprofen is effective for migraine pain. They also wondered whether also taking an antiemetic to relieve nausea was better than taking an ibuprofen alone.

"We knew that there were a number of published trials using ibuprofen for acute treatment of attacks," she said. "Individual trials, however, can be misleading for a number of reasons, and generally it is recognized that using systematic review and meta-analysis is likely to provide a more accurate estimate of the effects of any intervention."

The reviewers evaluated nine studies with 4,373 adult participants who had a diagnosis of migraine headache. The average age of the participants was 30 to 40 years and all had a history of migraine for at least 12 months before entering the studies.

In total, 414 people with migraines underwent treatment with 200 milligrams of ibuprofen, 1,615 received a dose of 400 milligrams, 208 received a 600-milligram dose and 1,127 received a placebo.

Twenty-six percent of patients taking the 400-milligram dose were pain free within two hours, compared with 20 percent who took the smaller dose and 11 percent who received a placebo. In the same period, 57 percent who took 400 milligrams of ibuprofen had their pain reduced from moderate or severe to "no worse than mild," compared with 25 percent taking a placebo.

"For those who experience these outcomes, ibuprofen is a useful, inexpensive and readily available treatment," Derry said. "Those who don't experience good outcomes will need to look at alternative treatments."

Roger Chou, M.D., associate professor of medicine at Oregon Health & Science University and the director of clinical guidelines development at the American Pain Society, said that it is common to use OTC medications such as ibuprofen to treat migraines.

"Migraine sufferers really vary in what they do, in part because the severity and frequency varies so much," said Chou. "People with relatively mild migraines probably do use over-the-counter medications and so do people who find that they work."

He added, "Those with more severe migraines, or who don't get relief with over-the-counter medications, or who have very frequent migraines, often end up in the doctor's office and are given various prescriptions."

Derry and her colleagues also found that the nausea and other symptoms that usually accompany migraines decreased within two hours and fewer participants used rescue medications with ibuprofen compared with placebo. Only mild side effects occurred with the ibuprofen.

The reviewers found little information comparing ibuprofen with other medications and no information comparing the effectiveness of ibuprofen combined with an antiemetic.

Two of the four reviewers disclosed previous consulting work with various pharmaceutical companies.

Journal Reference:

1. Roy Rabbie, Sheena Derry, R Andrew Moore, Henry J McQuay. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews, 2010 (10): CD008039 DOI: 10.1002/14651858.CD008039.pub2

An international study led by scientists at Université de Montréal and University of Oxford, has identified a gene associated with common migraines. Their findings show that a mutation in the KCNK18 gene inhibits the function of a protein called TRESK. TRESK normally plays a key role in nerve cell communication.

Published in Nature Medicine, this study may have implications for people who suffer from recurrent headaches, which include more than six million Canadians.

Previously, genes for migraine have been found only in a rare form involving headaches combined with limb weakness limited to one side of the body. "We focused on the more common types of migraine, without this muscle weakness, in our study, and looked at genes controlling brain excitability," says lead author Ron Lafrenière, Associate Director of the Centre of Excellence in Neuromics of the Université de Montréal (CENUM).

The researchers compared the DNA from migraine sufferers to that of non-sufferers. "We found a mutation in the KCNK18 gene that interrupts TRESK function in one large family suffering from migraine with aura," say Lafrenière. "When we tested everyone in the family, all those who suffered from migraine also had the mutation."

Aura migraines are those that are preceded or accompanied by sensory warning symptoms or signs (auras), such as flashes of light, blind spots or tingling in an arm or leg. The ensuing headache can be associated with sensitivity to lights, sounds, and smells, as well as nausea and occasional vomiting.

Mutation results in incomplete TRESK protein

The mutation causes production of an incomplete form of TRESK which disrupt the normal functioning of this protein. The end result is an alteration in the electrical activity (excitability) of cells. "We now have direct evidence that migraine is a nerve excitability problem and have highlighted a key causal pathway in migraine' says the joint lead author, Dr Zameel Cader from the MRC Functional Genomics Unit at Oxford.

TRESK present in migraine-relevant areas

Cell culture and in vitro experiments revealed that TRESK is present in certain neurons of the brain. "We showed that TRESK is in specific neuronal structures (trigeminal ganglia and dorsal root ganglia) that have been linked to migraine and pain pathways," says Lafreniere.

"This is a highly significant finding because activation of trigeminal ganglion neurons is central to migraine development and increased activation of these neurons could very plausibly increase the risk for developing a migraine attack," explains senior author Guy Rouleau, a Université de Montréal professor and Director of the Sainte-Justine University Hospital Research Center. "While TRESK mutations are present only in a small number of migraine sufferers, because we believe that TRESK helps control the excitability of nerve cells, our results suggest that increasing TRESK activity pharmacologically may help reduce the frequency or severity of migraine episodes, irrespective of their origin."

About migraines

Migraines are debilitating chronic headaches that can cause pain for hours or days. They can begin in the early teen years and may be triggered by many things, including stress, odors, certain foods, alcohol, etc.

This study was funded by Genome Canada, Génome Québec, Emerillon Therapeutics, the Wellcome Trust, Pfizer, the Medical Research Council (UK) and the Natural Sciences and Engineering Research Council of Canada.

Journal Reference:

1. Ronald G Lafrenière, M Zameel Cader, Jean-François Poulin, Isabelle Andres-Enguix, Maryse Simoneau, Namrata Gupta, Karine Boisvert, François Lafrenière, Shannon McLaughlan, Marie-Pierre Dubé, Martin M Marcinkiewicz, Sreeram Ramagopalan, Olaf Ansorge, Bernard Brais, Jorge Sequeiros, Jose Maria Pereira-Monteiro, Lyn R Griffiths, Stephen J Tucker, George Ebers & Guy A Rouleau. A dominant-negative mutation in the TRESK potassium channel is linked to familial migraine with aura. Nature Medicine, 2010; DOI: 10.1038/nm.2216

A new study shows that aspirin, given intravenously (IV), may be a safe and effective option for people hospitalized for severe headache or migraine, undergoing medication withdrawal.

The research will be published in the Sept. 21, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology.

"Intravenous aspirin is not readily available in the United States and only on a 'named patient' basis in the United Kingdom, while it is more generally used in other parts of Europe," said study author Peter J. Goadsby, MD, PhD, with the Department of Neurology, University of California, San Francisco and a member of the American Academy of Neurology. "Our results show it could be a cost-effective, safe and easy to use treatment for people hospitalized for headache or migraine." A "named patient" program is only available to people who have tried all other alternative treatments and do not qualify for a clinical trial.

For the study, researchers reviewed the medical records of 168 people between the ages of 18 and 75, hospitalized for headache and given aspirin through an IV. Of those, 117 were women. All but three people had chronic daily headache, a condition defined as having a headache 15 days or more per month for three months. Most had a diagnosis of migraine.

Participants received doses of one gram of aspirin, with an average of five doses. Overall, about six percent of people experienced side effects, none of which were considered severe. Side effects included nausea, pain from IV insertion and vomiting.

Before, during and after treatment, 86 participants wrote hourly in diaries about their pain. Pain was rated on a 10-point scale, with scores of 1-3 for mild headache, 4-7 for moderate headache, and 8-10 for severe headache. Participants' comments, along with nurses' notes, were also used to rate the effectiveness of IV aspirin.

The study found that more than 25 percent of the time, people experienced a 3-point or greater reduction in pain scores, downgrading the headache from severe to moderate, moderate to mild or from mild to no headache. About 40 percent of the time, participants reported a moderate effect.

"It's important to note that participants knew they were getting treatment and a placebo was not used, although placebo-controlled trials have shown intravenous aspirin is effective in acute migraine," said Goadsby. "Our findings warrant more research into the use of IV aspirin for severe headache or migraine."

Potential side effects of aspirin include heartburn, nausea, vomiting, bleeding, worsening of asthma, kidney impairment and rash.

Journal Reference:

1. M.W. Weatherall, A.J. Telzerow, E. Cittadini, H. Kaube, and P.J. Goadsby. Intravenous aspirin (lysine acetylsalicylate) in the inpatient management of headache. Neurology, 2010; 75: 1098-1103 [link]