Current Treatment Methods
     

"Taylor's Autumn Beach Gallop" 
  
               

Michael John Coleman 2006

A looming storm front can disrupt the free spirit of a day at the beach for a Migraineur. Better understanding of triggers such as barometric pressure changes induced by changing weather can help a suffer, or their parent, take appropriate preemptive abortive or other medication. Stopping a severe Migraine before it becomes severe, offers the best way to enjoy planned events, such as a fun of a playful autumn afternoon at the beach.
             
              

Many breakthroughs regarding the biological and genetic causes of Migraine have been made in recent years. And while certain of the exact biological mechanisms are still being studied, breakthroughs in treatment offer hope and relief for millions of people who suffer from the pain of Migraine.

MAGNUM has noted that in the past, Migraine tended to be managed in a way that either prescribed drugs that helped prevent attacks OR prescribed drugs that treated pain during an attack, but not both. However, the best approach to Migraine management is what MAGNUM calls a MULTIFACTORAL approach, which involves addressing all four aspects of Migraine health care: preventive treatment, trigger management, abortive treatment, and general pain management.

 


(I) Preventive or Prophylactic

First, preventive, or prophylactic, medications are prescribed to prevent or reduce the number of attacks in patients who experience frequent Migraines, typically two or more per month. In general, these medications act over time to prevent blood-vessel swelling; however, they do not treat the Migraine-associated symptoms and are non-selective. Many sufferers using preventive treatments will still have to take attack-aborting medications to relieve pain and other symptoms.

Beta-blockers are the most commonly prescribed prophylactic treatment for Migraine and are considered to be an effective preventive treatment. Medication includes propranolol. Click here for more detailed information.

Antidepressants are believed to have a possible effect on serotonin or possible analgesic effects. Click here for more detailed information.

Calcium channel blockers are also used to decrease the frequency of Migraine attacks. It is thought that calcium channel blockers play a role in vessel constriction. Click here for more detailed information.

Methysergide is thought to block the inflammatory and vessel-constricting effects of serotonin. Because of potential side-effects, methysergide is generally used only on select patients. This medication also requires a four to six week drug hiatus every six months. Click here for more detailed information.

Divalproex Sodium (Depakote®) is probably the most promising of the preventive regiments currently available for Migraine. This drug was originally developed for Epilepsy; a disease often referred to as a sister disorder to Migraine, prescribed in much smaller doses when used to treat Migraine thus lessening the mild side effects.

Non-drug Alternatives to Preventative Treatment of Migraines

Gut Brain Therapy  MAGNUM looks into the exciting work that ForeverWell is doing in Migraine research & the gut brain. An intriguing possibility is beginning to develop. The growing evidence supporting our long term belief that Migraine is a brain disorder coupled with the work showing a second brain in the gut might cause some to look at proper neuropeptide/neurotransmitter production by the digestive system as a root cause of the factors leading to Migraine.

One company doing just that has recently published an outcome based study in which they focus primarily on healing and improving digestive dysfunction that they believe on some level is occurring in most Migraine sufferers. Synergistically, they provide nutritional support to the liver and kidney believing that these organs are critical in balancing internal function.

This natural Migraine prevention approach has shown very positive results in their initial study. Interestingly, some of the comments from study participants included that while on the nutritional supplements they found that the Migraines they did get were less severe and a lower dose of various pain treatments seemed to be more effective.

80% of the 40 study participants reported good to dramatic benefit from this approach. 20% had no benefit. In 60% of the cases the participants quality of life rating was in the 80 to 100 range indicating a virtually Migraine free condition. To learn more about Gut Brain Therapy and to read the entire study visit, www.foreverwell.com.

Michael Gershon, MD of Columbia University is the recognized father of the growing field of neurogastroenterology and author of The Second Brain. His book is fascinating and may explain why ForeverWell is getting great results with Migraine by focusing on the digestive system. For a FREE, chapter by chapter description of the book click here.

For more information:

  • Take a look at Michael Gershon, MDs book The Second Brain and how it supports and points to the possibilities that healing the gut could help the brain.

  • Review Gary Zaloga, MDs book Nutrition in Critical Care and how small chain peptides may provide an explanation of ForeverWells preliminary success.

  • Visit the ForeverWell website, www.foreverwell.com and read the details and explanation of their work and approach to treating Migraine.

Contact Information:
Tom Staverosky, President
ForeverWell
PO Box 14653
Reading, PA 19612
www.foreverwell.com

1-800-619-5969
610-374-5258


Petasites Hybridus (Butterbur root) is a new non-drug preventive treatment available in the United States. It is available under the name of Petadolex™ from the well respected German firm of Weber & Weber. In recent double blind studies it was shown 77% effective as a Migraine prophylaxis. Dose is one 50mg capsule twice a day.


Feverfew Leaf is a good non-drug preventitive treatment you may want to explore. Its main uses are for migraines and arthritis. Studies at the London Migraine Clinic have increased interest in this herb. This herb continues to undergo extensive scientific investigation of the parthenolide content, and how it normalizes the funtion of platelets in the blood system by inhibiting platelet aggregation, reducing serotonin release from platelets and blocking the formation of pro-inflamatory mediators. Seventy percent of the patients in these studies report fewer attacks of migraines and less painful attacks. Researchers believe that Feverfew prevents the spasms of blood vessels in the head that trigger migraines. This herb also relieves the inflammation associated with arthritis. Other benefits include: relief from nausea and vomiting; improvement of digestion; more restful sleep; and, relief of dizziness, brain, and nerve pressure.


Vitamin B2 supplements is another preventative non-drug treatment you may want to consider taking. A study in Belgium found that people who took 400 milligrams of vitamin B2 daily had about one-third fewer migraines than did those taking a placebo. The study, published in the February issue of the journal Neurology, included 55 patients in Belgium and Luxembourg who normally had two to eight migraine attacks each month.


Magnesium as an alternative preventive treatment has mixed support in the medical community. The most current position on this alternative over the counter preventive approach is best summarized by the Migraine and headache expert Ninan T. Mathew, M.D., which he noted the following at the 1998 AASH (American Association for the Study of Headache) Scottsdale Symposium-"Even though magnesium deficiency in the brain is implicated in the pathophysiology of Migraine, there is still no proof that magnesium replacement is of any benefit in Migraine prophylaxis. The only double-blind placebo controlled study in patients with Migraine without aura (69 patients) reported negative results, even though a previous small study in menstrual Migraine reported magnesium to be effective. Mauskop et al emphasized the importance of serum ionized magnesium measurements in determining the magnesium state in Migraine patients and have used intravenous magnesium in patients found to have low ionized magnesium level. These observations have not been confirmed yet."

Perhaps oral magnesium supplementation should be a part of treatment for migraine as a preventive. Taking a 100% of the USDA recommended DV (daily value) would be safe and prudent. That would be 400mg of magnesium (from magnesium oxide or magnesium sulphate) a day.

A Canadian approach suggested that physicians advise migraine patients to consume at least 6 mg magnesium per day for each kilogram of body weight. An even higher intake of 10 mg/day per Kg of body weight may be desirable provided that it does not trigger a laxative effect. Breaking the dosage into three or four parts taken at different times of day helps prevent laxative effect. Magnesium hydroxide is NOT recommended because of poor bioavailability and because they know of no instance of it having any beneficial use other than as a laxative. Other Magnesium compounds appear to be better, including Magnesium oxide, Magnesium sulphate, and Magnesium citrate. Natural magnesium in water (magnesium carbonate dissolved in CO2-rich water) is 30% more bio-available than Magnesium in food or pill, and offers much greater cardio-protection. If pills are used, they suggest chelated, Krebs cycle, with several Magnesium compounds; this gives greater bio- availability, and doesn't upset the stomach.

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(II) Trigger Management

Second, trigger management is important in preventing Migraine attacks. Triggering factors can cause Migraine, and if recognized and/or avoided, may impede an impending attack. Triggers vary from person to person.

Examples of what ARE triggers include changes in weather or air-pressure, bright sunlight, glare, fluorescent lights, chemical fumes, menstrual cycles, and certain foods such as processed meats, red wine, beer, dried fish, broad beans, fermented cheeses, aspartame, and MSG.

Examples of what ARE NOT triggers include lifestyle, stress, anxiety, worry, emotion, excitement, depressions, and caffeine. Unlike many articles mistakenly state, caffeine, which constricts blood vessels, is not a trigger, and, in fact, may help relieve mild Migraine pain caused by vasodilatation.

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(III) Attack-Aborting

Third, attack-aborting medications are used to relieve the severity and/or duration of Migraine and associated symptoms. In general, most attack-aborting medication should be taken as early as possible in an attack. Many Migraineurs learn to recognize their prodrome, others can use their aura as early warning systems to implement their abortive treatment of choice for an early intervention approach, many times avoiding a severe painful prolonged attacked.

Certain cerebral vasoconstrictor abortive agents are designed specifically for Migraine. They may be administered by subcutaneous, oral, rectal, or intramuscular means. These medications include ergotamine tartrate, dihydroergotamine (Migranal®, DHE45®), sumatriptan (Imitrex®), naratriptan (Amerge®), rizatriptan (Maxalt®), zolmitripan (Zomig®), Electriptan (Relpax®), frovatriptan (FROVA®) and isometheptene mucate (Midrin®). Maxalt® and Zomig® both come in a melting tablet version you can take with out water, which is very convenient for early intervention for a oncoming severe attack when you may not be able to make it to a restroom. Such as air travel or perhaps a class or meeting. Even more refined 'triptans' are under development as well. Click here for more detailed information.

An excellent non-vasoconstrictive abortive agent is butorphanol tartrate (Stadol NS) offered in patient administered injection and now a nasal spray. In an ER (Emergency Room) environment narcotic injections, usually taken with promenthazine (Phenergan) or hydroxyzine (Vistril) for nausea, can offer a non-cerebral vasoconstrictive option if all the above fail or are not appropriate (such as heart disease of other limiting medical condition). Click here for more detailed information.

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(IV) General Pain Management

Fourth and last, general pain management may include the prescription of narcotic analgesics which act on the central nervous system and alter the patient's perception of pain. These drugs generally relieve pain. However, because they are narcotic, they may be addictive, and such usage should be done in an appropriate manner to return a reasonable quality of life for the intractable Migraine sufferer. These medications include Fiorinal® with codeine, codeine, Percodan®, Demerol®, Tylox®, or methadone to name a few of the most well known. Click here for more detailed information and a complete list.

In addition, there are some strong non-narcotic analgesics that are very effective too, such as Midrin® or Fiorinal®. Click here for more information and a more detailed list.

NSAIDs (non-steroidal anti-inflammatory drugs) act by inhibiting blood vessel inflammation. NSAIDs are not specific, do not treat associated Migraine symptoms, and can cause gastrointestinal disturbances. These medications include naproxen, ibuprofen and ketorolac. You will notice that some of these over the counter NSAIDs have been repackaged to target our disease demographic such as Advil Migraine, although these NSAIDs may look like a new Migraine OTC, but they are not, but are rather an effective OTC treatment for use with mild to mild-to-moderate Migraines for some Migraineurs. But we might suggest if do you find sufficient relief with these OTC drugs, please still advise your attending physician or Migraine specialists of the addition to these treatments to whatever you are currently prescribed. Always keep your doctor advised any self-modifications to the regime the two of you have decided to use to manage your Migraines. Click here for more information.

Simple analgesics, available over-the-counter (OTC), are generally used for mild pain. They relieve pain by acting on peripheral pain receptors. (Some analgesics also have anti-inflammatory effects). Though readily available, they are generally not strong enough to relieve Migraine pain and overuse may cause rebound headaches. These medications include acetaminophen and aspirin, and include the newly released medication Excedrin® Migraine, which is the same exact medication as Extra Strength Excedrin, but with a new package and new name. But we might suggest if do you find sufficient relief with these OTC drugs, please still advise your attending physician or Migraine specialists of the addition to these treatments to whatever you are currently prescribed. Always keep your doctor advised any self-modifications to the regime the two of you have decided to use to manage your Migraines. MAGNUM is working to alleviate any misuse of and misperceptions about Excedrin Migraine & other OTC analgesic products remarketed for Migraine. Click here for more detailed information.

©MAGNUM, Inc. 2003 - 2006

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Artwork Michael John Coleman, Janet McKenzie, or Cara Weston. All other artists noted by 1976-2012