What is new is in Migraine?
My top 5 take away from:
2014 American Headache Society Scottsdale Headache Symposium
- Migraine facts: One billion people on this planet have migraine headaches. One out of every four households has someone who suffers from migraines. 10% of children have migraines. Between 1-3% of people who have migraines will develop chronic migraines. Less than 50% of people who have migraines seek medical treatment.
- Neuromodulation: Neuromodulation via either direct transcranial magnetic stimulation of the brain or stimulation peripherally, is the new wave of future treatment options for both migraine and cluster headaches. They are not yet ready for prime time but the future looks promising. Some of the most promising include the sphenopalatine ganglion stimulator for cluster headaches and the vagal nerve stimulator for both migraine and cluster headaches. Currently available for purchase is a transcutaneous supraorbital neurostimulator (cephaly). In the studies it was reported to have a responder rate of 38% with 1/3rd of responders having a 25% reduction in headaches and decrease in headache severity. The most common side effect was strong paresthesias.
- Nutraceuticals: More and more people are reaching for a more natural treatment options for migraines. However, just because it is natural does not mean it that is always safe. Butterbur (petasites hybridus) is a popular nutraceutical often given for migraine prevention. Butterbur in its natural plant form contains pyrrolizidine alkaloids, which are hepatotoxic if not processed correctly. Petoladex formulation of butterbur previously had the most trusted processing standards to which the butterbur was purified to contain less than the detectable limit of this hepatotoxic alkaloid. Because Petoladex safety has recently come to be questioned it has been taken off the market in Europe and is no longer recommended by the AHS.
- Food Sensitivities: The scientific community is slowly coming around to what my patients have been telling me for a while now. That is, that the foods that we are eating may be triggering our migraines. Some foods have long been associated with triggering migraines such as MSG or Red Wines. New triggers or food sensitivities can be found by testing for IgG sensitivities instead of relying on food diaries or IgE skin testing. Removal of those food sensitivities from the diet may make significant difference headaches frequency. (For more information on food/gluten sensitivities check out my recent post). Also discussed was that a specific diet i.e., a diet in high Omega 3 vs Omega 6 has been shown decrease the frequency of migraines. (For more information on this study of high omega 3 diet see my recent post).
- Obesity: Obesity is a strong risk factor for both having migraines and progressing into chronic migraines (>15 migraines a month). As your BMI increases so does the risk of having migraines, specifically, up to 2 times the risk of having migraines and 5.28 times the risk of developing chronic migraines. The reason why is probably multifactorial but one interesting theory is based on the fact that adipose tissue produces cytokines that are pro- inflammatory (IL-6 and TNF alpha). Studies currently are under way looking at the potential benefits weight loss might have on the treatment of migraines.
This information is for education only, it is not intended to replace the advice of your physician .