By

Placebo Effect: In the Brain, Not the Mind

Many of us learned in high school biology that the placebo effect is when you think that a treatment is effective even though the treatment or medication is an inactive form of treatment. You think you will feel better, so you believe that you are better.

High school biology was wrong. Studies using sophisticated brain scanning equipment have shown that when participants believed a medication would ease pain, the brain releases endorphins and opioids, the brain’s natural painkillers.

PET scans turned up differences in brain activity. Those who reported pain relief after taking the placebo showed increased activity in parts of the brain associated with modulating pain. A radioactive tracer also revealed that binding occurred at receptors for naturally occurring pain-fighting endorphins.

“If somebody believes something will work,” says Zubieta, “that positive expectation by itself, through different connections in the brain, activates mechanisms that suppress pain. We saw a linear relationship between how people reported pain and how their brains released opioids.

People Need Both Drugs and Faith to Get Rid of Pain is an excellent article explaining current and past placebo research and understandings.

By

Botox Doesn’t Relieve Migraines & Tension-Type Headaches?

A review of all available data on treating migraines and tension-type headaches with Botox indicates it is no better than a placebo, according to a US News & World Report article. The findings are included in guidelines for using Botox published in today’s issue of the journal Neurology.

Botox Works on Muscle Disorders But Not Migraines

[B]otulinum toxin has become an effective treatment for numerous movement disorders associated with excessive muscle contraction.

The new guidelines approve its use for treating cervical dystonia, a condition of involuntary head tilt or neck movement; involuntary facial contractions, involuntary eye closure, focal limb dystonias (such as writer’s cramp), essential tremor and some spastic bladder disorders. The drug is injected directly into affected muscles.

[non-contiguous paragraphs]

The finding that botulinum toxin probably does not help relieve migraine or chronic tension headaches surprised the researchers.

“Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” pain guidelines author Dr. Markus Naumann, head of the Department of Neurology at Augsburg Hospital in Germany, said in a prepared statement. “It is no better than placebo injections for these types of headache.”

I haven’t even found the abstract yet. I’ll let you know as soon as I learn more about this surprising report. If you know anything about it, please leave a comment below.

By

Migraine’s Visual Aura & Hallucinations on the New York Times Migraine Blog

The deep explorations of visual aura and hallucinations in the two latest entries on the New York Times migraine blog provide education far beyond what most migraineurs encounter; including one who writes about headache disorders and migraines nearly every day (me!). Check out the following posts to expand your knowledge.

Patterns
Acclaimed writer and neurologist and migraineur Oliver Sacks explains the neurophysiology of visual auras and describes the patterns, or “geometric hallucinations,” some see during an aura. His intricate depiction is a fascinating eye-opener for those without aura and excellent information for those with it.

Lifting, Lights and Little People
Siri Hustvedt, author and migraineur, wrote of the hallucinations she has had with migraine episodes.

It is comforting to think that visual perception is a matter of taking in what’s out there, that a clear line exists between “seeing things” and the everyday experience of looking. In fact, this is not how normal vision works. Our minds are not passive containers of external reality or experience. Evidence suggests that what we see is a combination of sensory information coming in from the outside, which has been dynamically translated or decoded in our brains through both our expectations of what it is we are looking at and our human ability to create coherent images. We don’t just digest the world; we make it.

You can hear more from New York Times migraine bloggers Siri Hustvedt and Paula Kamen on NPR’s Talk of the Nation. Headache specialist and founder of the Michigan Headache and Neurological Institute Joel Saper weighed in and responded to callers’ questions. Congratulations to Migraine Blog, Migraine Chick and Somebody Heal Me for being mentioned on NPR’s website.

By

Nominate Your Headache Care Provider for The National Headache Foundation’s Healthcare Provider of the Year Award

There’s still time to nominate your favorite headache care provider for the National Headache Foundation‘s Healthcare Provider of the Year Award. Submissions are due March 14.

The National Headache Foundation Healthcare Provider of the Year Award recognizes an outstanding healthcare provider. The award is open to physicians, physician assistants, nurse practitioners and nurses serving patients with headaches and practicing in the United States or U.S. territories. Patients, friends and co-workers may nominate healthcare providers. A selection committee compiled by the National Headache Foundation will judge nominations based on the following criteria:

NOMINATION CRITERIA

Scope of Care
Nominee must be a physician, physician assistant, nurse practitioner or and nurse who cares for or serves patients with headaches.

Quality of Care
The nominee must demonstrate a high level of clinical expertise and a commitment to improving healthcare delivery to headache sufferers.

Dedication
The nominee must have demonstrated extraordinary dedication to patients with headaches during the year and throughout his or her career.

The Healthcare Provider of the Year Selection Committee will review all nominations. Current members of the National Headache Foundation board of directors and staff are not eligible to participate as nominees in the Healthcare Provider of the Year program.

The nomination form (with applicable attachments) must be postmarked or received at the National Headache Foundation office no later than March 14, 2008.

Nominations can be submitted via email to nhf1970@headaches.org. Completed nomination forms can also be mailed to:

National Headache Foundation – Healthcare Provider of the Year
820 N. Orleans, Suite 217
Chicago, IL 60610-3132

For additional information, please call (888) NHF-5552 or email info@headaches.org.

Nomination Form (Word file)
Nomination Form (PDF)

By

Cluster Headache Drug Verapamil May Cause Heart Problems

People who take verapamil for cluster headaches may be at greater risk of irregular heartbeats than those who don’t, according to a study published in the August issue of the journal Neurology. Researchers recommend that those who take the drug should have frequent EKGs to watch for possible heart problems.

The study of 108 people with cluster headache specifically looked at high doses of verapamil. 21% showed an irregular heartbeat while taking high dose verapamil. 37% of participants had slower than normal heart rates while on the drug. Most cases were not considered serious.

The study abstract and the press release from the American Academy of Neurology (below) provide details.

Drug for Cluster Headaches May Cause Heart Problems

ST. PAUL, Minn. – A drug increasingly used to prevent cluster headaches can cause heart problems, according to a study published in the August 14, 2007, issue of Neurology®, the medical journal of the American Academy of Neurology. Those taking the drug verapamil for cluster headaches should be closely monitored with frequent electrocardiograms (EKGs) for potential development of irregular heartbeats.

Cluster headache is a rare, severe form of headache that is more common in men. The attacks usually occur in cyclical patterns, with frequent attacks over weeks or months generally followed by a period of remission when the headaches stop.

“The benefit of taking verapamil to alleviate the devastating pain of cluster headaches has to be balanced against the risk of causing a heart abnormality that could progress into a more serious problem,” said study author Peter Goadsby, MD, PhD, DSc, of the National Hospital for Neurology and Neurosurgery in Queen Square, London, UK, and the University of California, San Francisco and a member of the American Academy of Neurology.

The study involved 108 people with an average age of 44. The participants started taking verapamil and then had an EKG and an increase in the dosage of the drug every two weeks until the headaches were stopped or they started having side effects.

A total of 21 patients, or 19 percent, had problems with the electrical activity of the heart, or irregular heartbeats, while taking the drug. Most of the cases were not considered serious; however, one person required a permanent pacemaker due to the problem. A total of 37 percent of the participants had slower than normal heart rates while on the drug, but the condition was severe enough to warrant stopping the use of the drug in only four cases.

Goadsby noted that 217 people taking the drug were initially supposed to take part in the study, but 42 percent of them did not have the EKGs done to monitor their heart activity. “Many of them said either they or their local services were reluctant to undertake such frequent tests, or they were not aware of the need for the heart monitoring,” he said. “Since this drug is relatively new for use in cluster headaches, it’s possible that some health care providers are not aware of the problems that can come with its use.”

emphasis added