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Headache NewsBlog By Headache Specialist Alexander Mauskop

Alexander Mauskop, director of the New York Headache Center, regularly posts his thoughts on current headache news on the aptly named Headache NewsBlog. He dispels myths and examines closely media coverage of headache news. Here’s a taste of Mauskop’s blog, but look over Headache NewsBlog to get the full flavor.

Current News

Medications

Botox

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Pain Receptors in the Bone, Skull & Scalp Pain, and Botox

Headache specialist Christina Peterson‘s comments on the news that a patient’s skin sensitivity may help predict Botox’s effectiveness for migraine explains the exciting research behind the story. Dr. Peterson attended the lecture on the topic at the International Headache Society’s annual conference. She wrote:

This was far and away the coolest lecture, although it was also given at the American Headache Society Meeting. Dr. Rami Burstein, who is a basic science researcher at Harvard, has done some ground-breaking research.

It has been conventional wisdom that there are no pain receptors within bone; the only pain receptors are on the periosteum–the lining on the bone. Dr. Burstein took it into his head to wonder if this were actually true of the skull, and set out to trace the pain pathways in rats. He showed amazing slides of fluorescent lime green nerve fibers shooting right through holes in the bone of the skull (so, yes, your skull can hurt), and terminating at the hair follicle.

So–when people say they have headaches that feel as if their hair hurts, it can be literally true. These nerve fibers were most dense at the sutures in the skull, where the bony plates of the skull come together. And now we know why craniosacral therapy works!

Dr. Burstein has also determined that there are three major types of headache pain:

  • Explosive pain (like you feel as if your brain is too big and will explode out of your head)
  • Implosive pain (as if your head will cave in the pressure is so great)
  • Orbital/eye pain (your eye hurts, or it hurts behind your eye, or it hurts to move your eye)

Unfortunately, you are permitted to have more than one of these in a given headache. He has found that it is the implosive type of pain that is most likely to respond to Botox. [all emphasis mine]

Dr. Peterson’s latest e-mail newsletter, which arrived in my inbox today, explains more about the research. If you aren’t subscribed to the newsletter, you’re missing out on an excellent, up-to-date resource. Take a look at previous newsletters and sign up for future issues.

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Migraine Treatment News

Here’s the roundup of migraine treatments. Other news posts I’m working on are about presentations at the International Headache Society’s conference (including cluster headache news), depression and chronic pain.

Migraine Patients Who Take Triptans Report Greater Satisfaction Than Patients Taking Barbiturates or Opioids
Survey: Migraine Patients Taking Potentially Addictive Barbiturate or Opioid
Medications Not Approved By FDA as Migraine Treatments

The survey found that patients taking triptans are significantly more likely than those taking barbiturates or opioids to report that their medication works well at relieving migraine symptoms, with sixty percent of triptan patients reporting that it describes their medication “extremely” or “very” well to say it relieves their migraines symptoms completely compared with 42 percent of patients taking barbiturates and opioids.

Patients taking opioids and barbiturates for their migraines also reported a lower quality of life than patients taking triptans, according to the survey. Patients taking these drugs were twice as likely as patients on triptans to say that migraines “always” limited their ability to exercise or play sports (35% vs. 14%), engage in sexual activity (33% vs. 17%), drive a car (28% vs. 14%), spend time with family and friends (28% vs. 8%) or simply get out of the house (33% vs. 15%).

Though many patients are prescribed barbiturates and opioids for their migraines, the majority indicated that they prefer their migraine medication to be FDA approved for the disease, not addictive and have few side effects. Seven out of ten patients (72%) surveyed said it’s “extremely” or “very” important that their prescription medications not be addictive, and eight out of ten patients (79%) said it’s “extremely”
or “very” important that their prescription medication have only minor side effects. Sixty-five percent said it’s important that their migraine medication be approved by the FDA to treat the disease.

Frova for Menstrual Migraine
Endo’s Menstrual Migraine Treatment Better Than Placebo in Study

Endo Pharmaceuticals said that its Frova 2.5mg tablets reduced the frequency and severity of difficult-to-treat menstrual migraine in women when used as a six-day preventative regimen.

Predicting Botox ‘s Effectiveness
Cutaneous Allodynia Predicts Response to Botulinum Toxin Type A in Migraine Patients

Botulinum toxin type A has been reported to be effective in preventing migraine attacks in some patients but not in others.

[R]esearchers found that patients with cutaneous allodynia had experienced significant reductions (P <.01) in migraine frequency and number of headache days in response to botulinum toxin type A, whereas patients without cutaneous allodynia had no such improvement in symptoms.

[I]nvestigators concluded that cutaneous allodynia could be used to predict which migraine patients are likely to respond to prophylactic therapy with botulinum toxin.

DHE Relieves Skin Sensitivity (Allodynia)
Migraine With Skin Sensitivity Eased By Older Drug

Dihydroergotamine or DHE, an established drug for migraine, works well even when the attack is accompanied by super-sensitivity to touch or heat and cold, according to researchers.

Many migraine sufferers get relief from the newer drugs known as triptans, but these are less effective when people also have heightened skin sensitivity. This condition, called cutaneous allodynia, makes even a light touch to the face or neck feel painful.

“Unlike triptans, DHE works in the presence of allodynia, any time in the migraine attack,” lead investigator Dr. Stephen D. Silberstein told Reuters Health.

Migraine Preventives
Migraines: Symptoms Disappear With The Right Prevention

According to Greek researchers, migraine sufferers can eliminate symptoms altogether if they take higher doses of anti-migraine medicine for a longer period of time than is now customary. Another team of researchers has found that certain psychopharmaceuticals could serve as a new therapy option for persistent chronic headaches.

“In treating migraines, optimizing the effect of already available agents is at least as important a task as developing new substances.”

I’m a little wary of this article, but wanted you to know about it. Take it with a grain of salt.

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Botox

Botox helps a portion of people with headache, but news stories don’t generally address how and why it works and how effective it really is. Some sources to help you figure out if Botox might be a good option for you include:

My story isn’t too encouraging, but it’s at least one perspective to consider. I’ve had three different rounds of injections. The first was done using the same injection sites as a plastic surgeon uses for wrinkles; it didn’t help at all.

The other two rounds were using the International Headache Society‘s protocol for injection sites. I thought the first set of these injections might have helped, but minimally. The second time wasn’t effective at all. I called it quits after that.

Getting the injections wasn’t painful for me, although a lot of people do have pain. The day following the injections, though, I had some of the worst headaches of my life.

Have any of you tried Botox to treat your headaches? What were your experiences with it?

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More News Than You Want to Read

I’ve attempted to gather the news I’ve missed, but articles are surely missing. If you know of something, please post a comment with a link to it if you have it.

Under each heading the articles are vaguely ordered by relevance.

Research
Acupuncture May Ease Impact of Headaches
Adding acupuncture to standard medical treatment may improve the quality of life for people who suffer from frequent headaches, according to a new study.

Botox May Ease Facial Pain: Benefits Lasted for 60 Days in Small Study
A shot of Botox may ease a type of facial pain called trigeminal neuralgia, doctors report.

Pain Affects Black Women More Intensely
The far-reaching effects of chronic pain may be worse for black women than they are for white women.
(via Kevin, MD)

Websites Bolster Chronically Ill
Using interactive websites can help people with long-term conditions that include depression, heart disease and HIV/Aids, a study has found.
(via Medical Humanities)

Drugs
Eli Lilly Expands Cymbalta Liver Warning: FDA
Eli Lilly and Co. has expanded its warning about possible liver-related problems with its depression drug, Cymbalta, and cautioned doctors against its use in chronic liver disease patients, U.S. health regulators said on Monday.

EU Body Gives Old Pain Drugs Clean Bill of Health
Europe’s drug watchdog said on Monday it had no new safety concerns over older pain medicines like ibuprofen and naproxen, following an extensive review of side effect issues.

Another Way to Cut Drug Costs: Split Pills
Smart shoppers can’t resist a two-for-one sale. But should you purchase prescription drugs the same way you buy pizza or canned corn? For years, people who take daily medications have saved money by asking their doctors to prescribe pills with double the dose they need, which they then cut in half with a knife.
(via Kaiser Network)

Pain Meds Scarce in Black Neighborhoods: Study Finds Medicines Understocked
Pharmacies in black neighborhoods are much less likely to carry sufficient supplies of popular opioid painkillers than those in white neighborhoods, a new study has found, leading researchers to conclude that minorities are routinely undertreated for chronic pain.
(via Kevin, MD)

PhRMA Lawsuit Challenges D.C. Rx Drug Price Control Law
The Pharmaceutical Research and Manufacturers of America filed suit against the Washington, D.C., government last week alleging that a new price-control law on prescription drugs will cut supplies, hinder development and cause a “limitless parade of lawsuits.”

Drug Panels ‘Have Financial Links’
Doctors around the world are being advised to prescribe specific drugs by experts with close financial links to the pharmaceutical industry, it has been claimed.
(via Kevin, MD)

Healthcare Costs
Is Complementary Medicine Cost Effective? BMJ
The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.
(via Kevin, MD)

Treated for Illness, Then Lost in Labyrinth of Bills
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.
(via Kevin, MD)

Dying to Pay, New Bankruptcy Laws Hurt Seriously Ill
New bankruptcy rules that went into effect on Monday, don’t just affect those who’ve run up their credit cards due to poor spending habits.

They also affect people who have little choice about their cash flow, people who’d give anything ‘not’ to be in the situation they’re in.
(via Kevin, MD)

Insurance
Workers May Be in For Health Plan Sticker Shock
USA Today on Friday examined the shift toward higher employee contributions to health care costs as employers try to curb their health care spending. According to USA Today, employers are utilizing various methods, including coinsurance, restrictions on prescriptions, high-deductible plans and wellness incentives.
(via Kaiser Network; quote from USA Today Examines Rising Health Insurance Premiums, Out-of-Pocket Costs for Employees)

Wall Street Journal Examines UnitedHealth Group’s Move to Consumer-Driven Insurance Plans
The Wall Street Journal on Monday examined Minnesota-based UnitedHealth Group’s move to “so-called consumer-driven health care” in the face of “steadily eroding business” as a traditional health insurer. Consumer-driven plans are based on the idea that people will consider health care spending more carefully if they have to pay a larger proportion of the cost themselves.

High Deductible, High Risk: ‘Consumer-Directed’ Plans a Health Gamble
Elizabeth Fowler can be called an educated health care consumer: An expert on health care policy, she used to be the chief health and entitlements counsel for the Senate Finance Committee. But she was pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan — a type of insurance designed to protect consumers from catastrophic medical costs while prompting them to shop wisely for routine care.
(via Kaiser Network)

Policy
Canadians Still Waiting: 18-week Delay for Medical Care Reduced by a Day
Large increases in health-related spending have only marginally reduced the waiting times for medical services in this country from record-high levels in 2004, a new report says.
(via Kevin, MD)