February 2005 Headache News
Note: This section highlights recent studies that have been published in the professional literature that could point to some promising discoveries. However, initial clinical observations that are based on uncontrolled studies or ones that include small numbers of research patients, need further investigation before the research can be considered foolproof. Should these additional investigations become available, we will report them to you.
One of the frequent reasons for people going to an emergency room is because of a headache. Researchers wondered whether headaches themselves (primary headaches) send people to the ER or other diseases that have headaches as a symptom (secondary headaches) do. In a study reported in the February 2005 issue of Revista de Neurología, a team sampled the emergency services in the Clinica Los Comuneros in Bucaramanga, Colombia. They found that nearly 10 percent of those coming to the ER did so because of a headache. However, of that group 75 percent had secondary headaches as a result of fever, cancer, head trauma, psychological reasons, or other diseases. Only 25 percent of those with headache sought emergency services for their headache symptoms only.
Magnesium salts appear to help children with chronic tension-type headaches, according to a recent study of a small group in Italy. Researchers treated children who had episodic and chronic tension-type headache with magnesium pidolate 2.25g for two months. Four patients with chronic tension-type headache and five who had this occasionally took the medicine over a two-month period. The results, published in the February 2005 issue of Neurological Science, showed that those in the chronic group had an 87.5 percent reduction in symptoms and the entire group reduced their headaches by 50 percent. They also took fewer analgesics such as aspirin. The symptoms of 76 percent of those who had episodes of headache were reduced. The researchers found the results encouraging and hope to do further, controlled research.
People with migraine are more likely to have a patent foramen ovale (PFO)—which is an opening or hole between the two small chambers in the heart-than those who do not have migraine. Conversely, patients with stroke and PFO are more likely to have migraine, especially the form of migraine called migraine with aura. This association led a group of researchers to look back at records of 162 patients who underwent closure of the PFO to prevent recurrent stroke or warning of stroke. They published their results in the February 2005 issue of the Journal of American College of Cardiology. Of the patients studied, 35 percent had migraine regularly; more than half of these had aura. After the surgery, over half of these patients no longer had migraine. Of the remaining group, 14 percent reported a significant reduction and 80 percent had fewer migraines. The researchers concluded that closure of PFO reduces the frequency of migraine attacks.
Another study reported in February 2005 issue of the Journal of American College of Cardiology covered a similar topic. This study looked at patients who either had PFO and a stroke or an atrial septal defect (ASD), which is also an opening between the two upper chambers of the heart. It causes blood to go from one upper chamber to another in addition to going the normal way from the upper to the lower chamber. Generally, a large ASD causes significant blood to go into the right upper (atrium) and the right lower (ventricle) heart chambers leading to enlargement of these chambers. About 42 percent of these patients suffer from migraine. Again, the researchers looked at whether closing the shunt would result in fewer migraines. The study looked at 89 patients after treatment. Of them, migraine disappeared completely in 75 percent of the group after three months. Of the remaining group, 40 percent had significant improvement.
Australian football differs greatly from the American version and is more like rugby. Clearly there are many injuries in the sport, but researchers wanted to know how often the Australian footballers had migraine. The results from a survey sent to football players and to a group of people in the community who were the same age and sex appeared in the February 2005 issue of the Journal of Sports Medicine. A full 80 percent of the 160 players responding indicated that they had headache, with 49 percent reporting headaches during games. Another 60 percent indicated they suffered from headaches during training. While the number of headaches among the athletes throughout the year did not differ from those in the community sample, the footballers had more headaches during the playing season. Also, 22 percent of the headaches met the International Headache Society definition for migraine, and 34 percent of headaches met the relaxed definition for “footballer’s migraine.” The study found, then, that Australian football players had a significantly increased risk of migraine, which has implications for how headache should be managed in this population.
When most drugs-including those for migraine—are tested, the results they deliver are compared to those of a placebo. Placebos are substances or preparations that do not contain active medicine. They are used as controls in an experiment or test to determine the effectiveness of a drug. In a study reported in the February 2005 issue of Cephalalgia, the research team asked whether using placebos in acute migraine treatment studies was both ethically and scientifically appropriate. To undertake the study, the researchers looked at controlled trials of the use of triptans-a class of seven migraine-specific drugs-over a 12-year period. In each case, the triptan was tested against a placebo in the treatment of acute migraine. Traditional placebo trials seek to show that the tested drug is better than placebo. On the other hand, “active control equivalence trials” are those in which, instead of placebo, another active drug (for example, aspirin) would be used in comparison to the drug that is being tested. In active control equivalence trials, a new drug is being compared to the “best available treatment” instead of placebo. The group concluded that use of placebo remains necessary to get an accurate picture of a drug’s benefits and dangers. In fact, the researchers found that, in the long run, avoiding placebo use may be more harmful to patients than using it early in a drug’s development to gain an accurate picture of the drug’s effects.
When patients who have severe epilepsy don’t respond to drugs, they can be treated with vagus nerve stimulation. This treatment involves the implantation of a generator that stimulates the vagus nerve-one of 12 pairs of nerves in the brain-to reduce seizure activity. Since anticonvulsant drugs and antidepressants have been shown to be effective in migraine treatment, researchers wondered if vagus nerve stimulation would be also. In a study reported in the February 2005 issue of Cephalalgia, the team implanted a generator in four men and two women with disabling migraine who were not responding to other treatments. They found that the treatment produced dramatic improvement and enabled the patients to return to work. Two patients with chronic cluster headaches also showed significant improvement. One patient developed nausea, but the others tolerated the treatment well.
Researchers know that riboflavin or vitamin B2 can be effective in preventing migraine. A drug called coenzyme Q10 (or CoQ10) is known to have a similar effect on mitochondrial encephalomyopathies, which are diseases caused by defective action of the cells and which affect the nervous system and/or skeletal muscle. To test whether CoQ10 would also help prevent migraine, the team gave the drug to a carefully selected panel of 43 patients in a double-blind, randomized test. The study, which was reported in the February 22, 2005 issue of Neurology, found that CoQ10 was superior to a placebo in terms of reducing the number of migraine attacks, the number of days with headache, and the days when patients suffered from nausea. Fifty percent of the patients responded to the drug, while only 14 percent of those on the placebo got relief. The researchers also found that CoQ10 had few side effects.