Acute Migraines More Apt to Turn Chronic With Poor Treatment

Study compared patients to see who made the jump to frequent headaches within year

By Robert Preidt

HealthDay Reporter

FRIDAY, June 28 (HealthDay News) -- People who receive inadequate treatment for acute migraine headaches are more likely to develop chronic migraines, according to a new study.

Researchers looked at data from more than 4,600 people with episodic migraines (14 or fewer migraine days per month) and found that 48 percent of them received poor or very poor treatment.

These patients were more likely to progress to having chronic migraines (15 or more migraine days a month) than those who received better treatment, according to the study, which was presented this week at the International Headache Congress meeting in Boston.

Within a year, about 8 percent of patients who received very poor treatment progressed to chronic migraine, compared with 4.4 percent of those who received poor treatment, 2.9 percent of those who received moderate treatment and 2.5 percent of those who received the best treatment.

Migraines are debilitating headaches involving intense pulsing or throbbing pain, and often nausea, vomiting and hypersensitivity to light and sound.

The study was conducted by a team from the Montefiore Medical Center and Albert Einstein College of Medicine, in New York City, and Vedanta Research, in Chapel Hill, N.C.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"These findings are exciting as they provide clinical targets for intervention. When we discover factors that increase the risk of progression, health care providers can focus their efforts in those areas to improve care and outcomes," study co-author Dawn Buse said in an International Headache Congress news release.

"In this case, we have found several factors in acute migraine treatment which may likely improve outcomes, including using medications that work quickly and maintain pain-free results, which allows and empowers people who live with migraines the freedom and confidence to make plans and fully engage in their lives," Buse said.

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Brain Differences Seen in People With Migraines

MRI study suggests changes occur in areas associated with pain

By Amy Norton

HealthDay Reporter

TUESDAY, March 26 (HealthDay News) -- People who suffer migraines may have certain structural differences in pain-related areas of the brain, a new study suggests.

Using MRI scans, researchers found that in specific brain regions related to pain processing, migraine sufferers showed a thinner and smaller cortex compared to headache-free adults. The cortex refers to the outer layer of the brain.

It's not clear what it all means. But the researchers suspect that certain aspects of brain development may make some people more vulnerable to developing migraines -- and that migraine attacks create further changes in the brain.

The surface area of the brain "increases dramatically" during fetal development, while the thickness of the cortex changes throughout life, explained senior researcher Dr. Massimo Filippi.

"We speculate that migraine patients might have a sort of cortical 'signature' -- abnormal cortical surface area -- which could make them more susceptible to pain and abnormal processing of painful stimuli," said Filippi, a professor of neurology at the University Vita-Salute's San Raffaele Scientific Institute in Milan.

Once migraines develop, they may alter the thickness of the brain's cortex, Filippi explained.

A neurologist who was not involved in the study said it "adds to the growing body of knowledge that patients with migraine have brains that not only function differently, but may actually look different structurally as well."

That's important because it helps "legitimize" migraine as a neurological disorder associated with "real structural changes in the brain," said Dr. Matthew Robbins, of the Albert Einstein College of Medicine and Montefiore Headache Center, in New York City.

Worldwide, an estimated 11 percent of people have had a migraine in the past year. Migraines typically cause intense, throbbing pain on one side of the head, along with sensitivity to light and sound, and sometimes nausea and vomiting.

About 30 percent of people with recurrent migraines also have sensory disturbances right before their head pain hits. Those disturbances, known as "aura," are usually visual -- like seeing flashes of light or blind spots.

No one knows precisely what causes migraines, but they do seem to involve abnormal brain activity and -- like the new study suggests -- abnormal brain structure.

The findings, published online March 26 in Radiology, come from MRI scans of 63 adults with migraines, and 18 migraine-free men and women.

Filippi's team found that the migraine brain was complicated. In some areas, the cortex was thicker, but in others -- including pain-processing areas -- the cortex was thinner, versus migraine-free adults.

And there were also differences among migraine sufferers. The exact location of the cortex abnormalities tended to differ between the half of patients who had aura and the half who did not.

According to the researchers, those structural differences might help explain why the two forms of migraine manifest differently.

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Having Both Migraines, Depression May Mean Smaller Brain

But it's unclear what the finding might mean for patients

By Maureen Salamon

HealthDay Reporter

WEDNESDAY, May 22 (HealthDay News) -- Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely -- a smaller brain.

Already aware that people with migraines face double the risk of depression, scientists wanted to determine if having both conditions together affected total brain volume. The difference in size -- about 2 percent -- isn't alarming, study authors said, but needs further research to determine if the disparity causes any meaningful health effects.

"There are several potential explanations why those with both conditions have smaller brain volume," said study author Larus Gudmundsson, a research associate at the Uniformed Services University of the Health Sciences in Bethesda, Md. "There could be some genetic factor driving the whole thing. It could be related to pain mechanisms [in the brain]. It's also possible there are social and economic reasons."

The study is published in the May 22 online issue of the journal Neurology.

More than 36 million Americans -- about 12 percent of the population -- are estimated to suffer from migraine headaches, which can be debilitating, according to the U.S. National Library of Medicine. Meanwhile, major depression affects 15 million people, and Gudmundsson estimated that perhaps 3 percent to 4 percent of Americans suffer from both conditions.

Gudmundsson and his colleagues analyzed data from Iceland on about 4,300 older adults at two time points. At an average age of 51, participants were assessed for migraine headache incidence and about 25 years later were asked about their lifetime history of major depressive disorder. A full-brain MRI scan was taken at that later point to measure brain volume, when participants were between 66 and 96 years old.

Compared to those with no history of migraines or depression, those with both conditions had brain volumes about 2 percent smaller. There was no difference in the total brain volume when comparing people with only one of the conditions to those with neither condition.

Although the study found a connection between brain size and the combination of migraines and depression, it did not show a cause-and-effect relationship, as one expert noted.

"We certainly know that migraine sufferers tend to have smaller brains than non-migraine sufferers. But I'm not sure this study confirms that, apart from a neurodegenerative process, the two diseases act to do anything to increase the rate of [brain shrinkage] with aging," said Dr. Dara Jamieson, an associate professor of clinical neurology and director of the headache center at New York-Presbyterian/Weill Cornell Medical Center, in New York City.

"The people they were imaging [with MRI] were quite old -- 66 to 96 -- and you can expect brain atrophy in that group," added Jamieson, who was not involved with the study. "Maybe there's something to be said for these disorders accelerating brain atrophy ... but to take away that because of migraine and depression that your brain is smaller is unnecessarily glum."

Study author Gudmundsson, who's also a guest researcher at the U.S. National Institute on Aging, pointed out that those with migraines and depression may not suffer brain shrinkage since it's possible that their brains are smaller from birth.

"The clinical impact needs to be determined," he added. "We have to keep in mind that several studies have looked at migraine and cognition [thinking ability] and have not found a difference in cognition. That is reassuring."

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Nerve-Stimulating Device Might Ease Migraines

By Alan Mozes

HealthDay Reporter

WEDNESDAY, Feb. 6 (HealthDay News) -- Migraine sufferers in search of a non-medicinal alternative for relief may be encouraged by new Belgian research that suggests that 20 minutes a day of nerve stimulation might cut back on the frequency of attacks.

The finding stems from a small study involving 67 migraine patients. All participants were outfitted with a wearable device called a "supraorbital transcutaneous stimulator," or STS, which was placed on the forehead and designed to deliver electrical stimulation to the patient's supraorbital nerve.

Use of the stimulator device was found to be "effective and safe as a preventive therapy for migraine," according to the study.

Study lead author Dr. Jean Schoenen, of the headache research unit in the department of neurology & GIGA-neurosciences at Liege University, and colleagues described the team's findings in the Feb. 6 online issue of Neurology.

Study participants were aged 18 to 65 and were being treated for migraines at one of five headache clinics in Belgium. All routinely experienced a minimum of two -- and an average of four -- migraine attacks per month. Although some had previously tried standard drug-based treatments, none had been taking any type of preventive chronic anti-migraine treatment in the three months leading up to the study launch.

Between 2009 and 2011, the patients were randomly divided into two groups. Both were given identical self-adhesive stimulation electrode pads to place on their forehead for 20 minutes daily over a three-month period. However, one group's electrode was a sham device that exerted an ineffectively weak electrical pulse, while the second group wore a working supraorbital transcutaneous stimulator.

Participants kept migraine diaries, which revealed that although migraine severity did not decrease much, by the third month of the study, those using the working devices saw the frequency of their attacks drop from about seven per month to fewer than five.

Sham device users experienced no such drop-off.

In addition, 38 percent of the working device users saw their attacks drop off by half or more, compared with 12 percent for those using fake stimulators.

Monthly use of anti-migraine drugs to cope with migraine attacks when they occurred dropped by nearly 37 percent among supraorbital transcutaneous stimulator users, with no drop among the sham group.

Schoenen and her associates said that the exact mechanism by which electrical stimulation seems to help migraine sufferers remains unclear, though they suggested it might have something to do with the neurological prompting of a "sedative effect."

Perhaps most important was the finding that none of the stimulator users experienced any side effects.

The researchers point to a previously conducted analysis of studies focusing on the impact of taking a 100-milligram dosage of topiramate -- a standard migraine drug. That analysis showed that the drug was considerably more effective than the nerve stimulator devices in its ability to reduce the frequency of monthly attacks.

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Migraine Triggers May Not Always Trigger Migraines

Jan. 23, 2013 -- Worrying about what may trigger a migraine attack adds to the discomfort of many people with migraines. But according to a new study from Denmark, much of that worry may be unfounded.

The researchers studied the effect of light and exercise -- both commonly believed by patients to trigger migraine with aura -- and demonstrated that neither caused attacks in most of the people enrolled in the study.

“There are a lot of things about headache and migraine that are accepted as true but that remain untested,” neurologist Peter Goadsby, MD, Dsc, says of triggers. “The results of this study may surprise some patients.”

Goadsby, director of the University of California, San Francisco Headache Center, co-authored an editorial that accompanied the Danish study. In his clinical practice, he sees many patients whose quality of life suffers as a result of both their migraines and their efforts to avoid triggers that they believe will lead to attacks. In addition to light and exercise, other proposed triggers include stress, emotions, and certain foods.

But there’s little evidence that any of these things really do trigger attacks, says Goadsby. He hopes that, in addition to the current study, there will be much more research on triggers.

“There are tens of millions of people with migraine,” says Goadsby, “and all they have to go on are tales handed down about what triggers them.”

To investigate the impact of light and exercise, researchers at the University of Copenhagen recruited 27 people who had migraine with aura, a condition in which headaches are preceded most often by other symptoms, such as blind spots and light flashes. Nausea, excessive yawning, and numbness are among the other possible aura symptoms. About 1 in 5 people with migraines has migraine with aura.

The study participants -- 17 women and 10 men whose average age was 40 -- all said that light or exercise, or a combination of the two, triggered their attacks. To test their claims, the researchers exposed each of the participants to their triggers.

In 30- to 40-minute sessions, one of three different types of stimulation was used to mimic the light that patients said triggered their migraines. The exercise portion of the study was also intense. Participants went running or pedaled on a stationary bicycle until they reached 80% of their maximum heart rate. Afterward, the researchers monitored the participants for three hours for symptoms.

Overall, only three of the 27 participants had an attack of migraine with aura: one after exercise alone and two following a combination of light and exercise. Another three participants had a migraine without aura. None of the participants had an attack after being exposed to light alone.

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Some Migraines Linked to Heart Attack, Blood Clots

Jan. 15, 2013 -- Women who have migraine with aura may have a higher risk of heart attacks, and they may face a higher risk of dangerous blood clots if they use certain hormonal contraceptives.

Those are the findings from two newly published studies to be presented in March at the 65th annual meeting of the American Academy of Neurology in San Diego.

Migraine with aura refers to migraine headaches that are preceded by visual or other sensory symptoms such as flashing lights, blind spots, smell distortion, numbness, or tingling of the hands and face.

About 1 in 4 people with migraines have this type of migraine.

In the first study, having migraine with aura, but not regular migraines, was a risk factor for heart attacks among middle-aged and older women.

The analysis included data on close to 28,000 women enrolled in the ongoing Women’s Health Study.

During 15 years of follow-up, about 1,400 women who had migraine with aura were identified, and there were 1,030 heart attacks, strokes, or deaths from cardiovascular causes.

After having high blood pressure, having migraine with aura was found to be the second strongest contributor to heart attack and stroke risk, according to researcher Tobias Kurth, MD, of Brigham and Women’s Hospital in Boston and the French National Institute of Health.

Migraine with aura was found in the study to be a bigger risk factor for these cardiovascular conditions than having a family history of early heart disease or having diabetes or being obese or a smoker.

“We have known that migraine with aura is associated with cardiovascular risk,” neurologist and migraine specialist Noah Rosen, MD, says. “What is striking about this study is that it shows just how big this risk is.”

Rosen directs the Headache Center at the Cushing Neuroscience Institute, of the North Shore-LIJ Health System in Manhasset, N.Y.

In the second study, women with migraines who used combined hormonal contraceptives had a higher risk for dangerous deep vein blood clots, and the risk was highest in women with migraine with aura. Combined hormonal contraceptives contain both estrogen and progestin.

While there was a suggestion that newer-generation combined hormonal contraceptives might carry a greater risk for blood clots, researcher Shivang Joshi, MD, of Boston’s Brigham and Women’s Faulkner Hospital, says the difference among users of newer- and older-generation hormonal contraceptives was not that great.

Joshi and colleagues examined the impact of migraine type and combined hormonal contraception type on blood clot risk using data from a health insurance registry that included women enrolled between 2001 and 2012.

The researchers identified around 145,000 women who used combined hormonal contraceptives, including 2,691 who had migraines with aura and 3,437 who had migraines without aura.

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Epilepsy, Migraines May Have Family Ties

Jan. 8, 2013 -- People with epilepsy have a higher risk for migraines, and now new research offers evidence of a genetic link between the two conditions.

The study confirmed that having a strong family history of epilepsy is a strong risk factor for migraine headaches.

When researchers studied about 500 families that included two or more members with epilepsy, they found that people with the largest number of close relatives with seizures also had the highest migraine risk.

Those with three or more close relatives with seizure disorder had more than double the risk for migraine with aura -- headaches with additional symptoms such as nausea or sensitivity to sound or light.

By following families, the researchers were able to show that the link between epilepsy and migraine was due to shared biology and not some other cause, says researcher Melodie R. Winawer, MD. She is an assistant professor of neurology at Columbia University in New York City.

“There are many reasons two diseases occur together, but it has not really been clear until now that these two diseases are genetically linked,” she says.

Winawer and colleagues at Columbia University analyzed data from an ongoing genetic study of epilepsy families in the U.S., Canada, Argentina, Australia, and New Zealand.

The study represents the largest collection of families with multiple members with epilepsy ever assembled, and a main goal is to determine how genes contribute to epilepsy risk.

Winawer explains that there are many kinds of epilepsy, and many people with the condition do not have family members who are afflicted.

Some people begin to have seizures after experiencing a blow to the head, for example.

But she says that studying families at strong genetic risk for seizure disorders could lead to a better understanding of epilepsy, and risk for migraine.

The analysis, which appears in the journal Epilepsia, included 730 epilepsy patients in the study from 501 families.

Neurologist Nathan B. Fountain, MD, says the study makes a good case that shared genes help explain the higher incidence of migraines in people with epilepsy.

Fountain directs the epilepsy program at the University of Virginia School of Medicine, and he serves on the advisory board of the Epilepsy Foundation.

He says the genetic link could also explain why anti-seizure drugs like Depakote, gabapentin, and Topamax help prevent migraines or lessen their severity in some, but not all people with migraines.

He adds that the search for common genes that link epilepsy and migraines could lead to better strategies to treat or even prevent both disorders.

“Family-based population studies like this one represent a whole new way of doing research,” he says. “There is no telling what we can learn from them in the future.”

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