Migraine and Migraine-Related News from the AAN: American Academy of Neurology Meeting

The AAN: American Academy of Neurology is currently holding their annual meeting. Although the meeting does not until tomorrow, May 2, here's news they have already released.

Preventive Drugs Reduce Severity of Menstrual Migraine
SEATTLE, April 29 -- Preventive eletriptan (Relpax) and sumatriptan (Imitrex) may reduce the severity and duration of menstrual migraine, researchers here said....
To read the entire article click HERE.

Stroke Risk Cut 65% in Patients Who Hit Major Risk Factor Targets
SEATTLE, April 29 -- Patients who meet guideline targets for "good" and "bad" cholesterol, triglycerides, and blood pressure can expect a 65% reduction in stroke risk, according to research presented here....
To read the entire article click HERE.

Glutamate Receptor Inhibitors May Help Migraine
SEATTLE, April 30 -- Inhibition of glutamate receptors may play a role in migraine treatment, researchers here said...
To read the entire article click HERE.

Epilepsy Drug Not Effective for Chronic Headache
SEATTLE, April 30 -- The epilepsy drug levetiracetam (Keppra) does not appear to be effective for prevention of chronic daily headache, researchers said here...
To read the entire article click HERE.

New Hope For Stroke Patients: Reversing Stroke Damage By Jumpstarting Growth Of Nerve Fibers

ScienceDaily (Aug. 25, 2008) — If a stroke patient doesn't get treatment within approximately the first three hours of symptoms, there's not much doctors can do to limit damage to the brain.

But now researchers report a technique that potentially could restore functions to patients weeks or even months after a stroke. The technique involves jumpstarting the growth of nerve fibers to compensate for brain cells destroyed by the stroke.

"In the best-case scenario, this would open up the window of time that people could recover and go back to normal functional status," said Gwendolyn Kartje, MD, Ph.D., a professor in the department of cell biology, neurobiology and anatomy and department of neurology at Loyola University Chicago Stritch School of Medicine in Maywood, Ill. and chief of neuroscience research at Edward Hines Jr. VA Hospital in Hines, Ill.

Kartje and colleagues described the experimental approach, called anti-nogo-A immunotherapy, in a recent review article in the journal Topics in Stroke Rehabilitation...
To read the entire article click HERE.

Migraine News: Exercise, Stroke and Heart Risk, Oxygen Therapy

Exercise plus relaxation may lessen migraine pain

NEW YORK (Reuters Health) - A combination of aerobic exercise and muscle relaxation may help ease migraine pain, a small study suggests.



Austrian researchers found that when 15* migraine sufferers added an exercise-and-relaxation routine to their usual care, the patients reported an improvement in migraine pain intensity over six weeks...

To read this entire article click HERE.



*Note: 15 participants IS a very small study.

Gene May Put Women With Migraine At Increased Risk Of Heart Disease And Stroke

Women who experience migraine with aura appear to be at an increased risk of heart disease and stroke if they have a certain gene, according to a study published in the July 30, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.



For the study, researchers followed 25,001 Caucasian women for the occurrence of cardiovascular disease, including heart attacks and ischemic stroke. About 18 percent of the women in the study had a history of migraine while 40 percent of those with active migraine reported migraine with aura...

To read this entire article click HERE.



Oxygen Therapy Might Ease Pain Of Migraine, Cluster Headaches



ScienceDaily (July 17, 2008) — Two types of oxygen therapy could offer some relief to adults who suffer from disabling migraine and cluster headaches, according to a new research review from Australia...

To read this entire article click HERE.

Abnormal Sleep Patterns in Women Linked to Stroke

NEW YORK (Reuters Health) - Sleep patterns in middle-aged women can increase their risk for stroke, researchers in the United States have found. The greatest increase in stroke risk -- 70 percent -- was noted among women who slept 9 hours or more per night, according to their report in the medical journal Stroke.

To read the entire article click HERE.

Cymbalta Approved For Fibromyalgia Treatment

Cymbalta (Duloxetine) has just been approved to treat Fibromyalgia. Until now, there was only one medication, Lyrica (Pregabalin), approved to treat this illness.

In addition to the side effects of Cymbalta, Medpage Today warns:

Duloxetine should not be taken by patients who are using or have recently used a monoamine oxidase inhibitor, patients taking thioridazine (Mellaril) or patients with uncontrolled glaucoma. Severe and sometimes fatal liver problems have been reported among patients taking duloxetine. Duloxetine may increase the risk of hemorrhage among patients taking NSAIDs, aspirin, or other blood thinners.

Cymbalta is also approved for Major Depressive Disorder, the pain caused by Diabetic Peripheral Neuropathy and Generalized Anxiety Disorder.

Migraine and Fibromyalgia are often comorbid. Other illnesses comorbid with Migraine include but are not limited to Thyroid Disease, Temporomandibular Disorders, Depression, Anxiety, Epilepsy, Hypertension, and Stroke.

Who is GINA? And What Does She Have To Do With Migraine Disease?

GINA is not a "who" but a "what". GINA is the Genetic Information Nondiscrimination Act of 2008. GINA was signed into law by President George W. Bush on May 21, 2008.

On April 24, 2008, the Senate passed this bill 95 - 0. It was sent back to the House of Representatives on May 1, 2008 and passed 414 - 16 - 1. Congressman Ron Paul (R-TX) was the only person to vote against this bill.

GINA makes it illegal for insurance companies and employers to discriminate against you because of your genetic makeup. A press release issued by Coalition for Genetic Fairness explains that this legislation protects against this discrimination by:

• Prohibiting group health insurance plans and issuers offering coverage on the group or individual market from basing eligibility determinations or adjusting premiums or contributions on the basis of an individual's genetic information. Insurance companies cannot request, require or purchase the results of genetic tests, and they are prohibited from disclosing personal genetic information.
• Prohibiting issuers of Medigap policies from adjusting pricing or conditioning eligibility on the basis of genetic information. They cannot request, require or purchase the results of genetic tests, or disclose genetic information.
• Prohibiting employers from firing, refusing to hire, or otherwise discriminating with respect to compensation, terms, conditions or privileges of employment. Employers may not request, require or purchase genetic information, and they are also prohibited from disclosing personal genetic information. Similar provisions apply to employment agencies and labor organizations.

Congresswomen Louise Slaughter (D-NY), who first authored and introduced genetic nondiscrimination legislation thirteen years ago, issued this press release explaining the historical precedents for GINA:

• In the 1970s, many African-Americans were denied jobs, educational opportunities, and insurance based on their carrier status for sickle cell anemia, despite the fact that a carrier lacked the two copies of a mutation necessary to get sick.
• In 1998, Lawrence Livermore Laboratories in Berkeley was found to have been performing tests for syphilis, pregnancy, and sickle cell on employees without their knowledge or consent for years.
• In 2000, the Burlington Northern Santa Fe Railroad performed genetic tests on employees without their knowledge or consent.

So, what does all this have to do with Migraine Disease?
Migraine is a hereditary condition. It is a genetic neurologically-based disease. The MAGNUM article, Migraines: Myth Vs. Reality explains:

Migraine is a genetically-based disease. We first learned this in the mid-90's, as it was specifically stated in correspondence with M.A.G.N.U.M. by Dr. Stephen J. Peroutka, M.D., Ph.D., President & CEO of Spectra Biomedical, Inc., a group of research physicians dedicated to understanding the genetic basis of Migraine and other illnesses, the "data are unequivocal: Migraine is a genetically-based illness. Individuals with a single parent having Migraine have approximately a 50% chance of having Migraine. This susceptibility is neither psychological nor induced by environmental causes."

Although Griffith University's Genomics Research Centre (GRC) in Australia is not the only one doing genetic research for Migraine disease, it is the home of the world's largest collection of DNA samples from migraine patients. The GRC has discovered different genetic regions on chromosomes 1, 19 and X where Migraine genes are found. Through genetic research, they have identified a link between hormones and Migraine and a link between Migraine genes and stroke saying:

There's a mutation in this gene that makes people more likely to suffer stroke and also increases the risk of migraine. We believe this to be a link between migraine and stroke.

It is possible for genetic testing to play a huge role in finding a cure for Migraine and other diseases and conditions. GINA will allow those of us with a genetic disease or condition to participate in testing without the fear that our insurance companies and employers find out. Those who may be predisposed to a specific genetic condition now have the opportunity to be proactive by monitoring their health and possibly preventing a genetic disease or condition.

For more information on genetic discrimination, you can read the 25-page report in pdf format: Faces of Genetic Discrimination: How Genetic Discrimination Affects Real People. (I did say it was 25-pages and in pdf format, right?)

The Pitfalls of Over-The-Counter Pain Medications for Migraine and Other Types of Pain

Next time you grab that bottle of over-the-counter (OTC) pain medicine for your Migraine, neck, headache, back, knee or other pain make sure you know the facts. Acetaminophen, aspirin, ibuprofen, ketoprofen and naproxen CAN hurt you. Two articles published this past week discuss the overuse of OTCs. The June 2008 issue of Consumer Reports features the article, Beware of overusing over-the-counter pain relievers and U.S. Pharmacist features the May 20, 2008 article, Common Adverse Events and Interactions with OTC Pain Medications.

The Consumer Reports article contained the results of an online survey regarding how people use OTCs. The Consumer Reports National Research Center surveyed 47,283 subscribers in 2007. They found that 14,658 (31%) of the survey participants did not always follow instructions on the label. The also found that:

• 5 percent used OTC pain relievers daily for two weeks or more without a health expert's approval, ignoring label directions.

• 4 percent routinely took excessive doses without consulting a health professional.

• 4 percent experienced serious side effects, including ulcers and kidney, liver, and heart problems, that a health professional said could be traced to use of OTC drugs.

The three main excuses reasons survey participants used to explain why they were overusing OTCs were 1) They were in severe pain, 2) They didn't experience any side effects, or 3) They weighed more or they were taller than average.

Published research indicates OTC overuse is more prevalent nationally than among Consumer Reports subscribers. A 2005 study, published in The Journal of Rheumatology, claims:

...36 million Americans are using OTC pain medications daily, with roughly 23 million using NSAID. Further, one-fourth of users exceeded the recommended dose of OTC medication, and the belief that OTC are safer than prescription doses was common. More disturbing is that about half of the interviewees either were unaware of the potential toxicity of these agents or were unconcerned. These findings strongly underscore the need for educational interventions directed to the general public as well as physicians.

There are dangers of OTC analgesics that many people are not aware of. Most healthcare providers believe that using analgesics for Migraine pain, regardless of whether they are prescribed by your healthcare provider or purchased OTC, more than 2 or 3 DAYS a WEEK or consecutively can cause Medication Overuse Headache (MOH) also known as Rebound Headaches. The article, Medication Overuse Headache - When the Remedy Backfires explains:

Medication-overuse headache is an interaction between a medication used excessively and a susceptible patient...
... What is crucial is that treatment (resulting in MOH) occurs both frequently and regularly, i.e., on several days each week...
...the headache associated with medication overuse often has a peculiar pattern shifting, even within the same day, from having migraine-like characteristics to having those of tension-type headache (i.e., a new type of headache).
The diagnosis of medication-overuse headache is clinically extremely important because patients rarely respond to preventative medications whilst overusing acute medications.

Acetaminophen is not recommended for those with liver disease, kidney disease or those who consume 3 or more alcoholic drinks per day. The FDA warns that exceeding the recommended dosage or overdosing on acetaminophen can lead to liver damage.

NSAIDs, include aspirin, ibuprofen, ketoprofen and naproxen. With the exception of aspirin, NSAIDs can increase stroke and heart attack risk. (Aspirin combined with another NSAID carries the same risk.) They can also be harmful to the liver, kidneys and stomach. NSAIDs can cause ulcers, bleeding, perforation and other gastrointestional effects. The FDA says:

The risk for bleeding is low for those who take these products intermittently. For those who take the products on a daily or regular basis, the risk is increased, particularly for those over 65 years of age or those who take corticosteriods (such as prednisone). Those who use hormone therapy (estrogens and progestins) for post-menopausal symptoms or birth control do not have an increased risk for bleeding.

In addition, consumers should ask health care providers about NSAID use if they have kidney disease or are taking diuretics (fluid pills).

The U.S. Pharmacist article, geared towards pharmacists rather than the public, discusses the dangers of these medications in more detail:

OTC pain medications should be used at the lowest effective dose for the shortest duration possible to minimize the potential risk for an adverse event. Patients taking acetaminophen should not exceed the recommended maximum daily dose, while patients taking NSAIDs should not exceed the recommended single or daily dose.

The article also discusses the pharmacist's duty to play a critical role in educating patients of the dangers of OTCs and how to use them safely. To decrease accidental overdoses, pharmacists should encourage people to read labels and learn the ingredients in the product. To prevent using a combination of products containing the same ingredient, pharmacists should provide educational material on generic names. And to prevent dangerous or fatal results, pharmacists should caution people on the misuse and overuse of OTCs.

WOW! What a novel idea; pharmacists educating patients about their medications regardless of whether it's available OTC or requires a prescription! Sarcasm aside, this would be great but there's no way our pharmacists can do this alone. The Consumer Reports article tells us:

Debra Latimore, 52, of Whiting, Ind., told us she's been taking Advil for osteoarthritis pain daily since 2006 without telling her internist. "I forget to list it on doctor forms because it's over-the-counter," she says. "It's not something I think of as a drug."

How are our pharmacists supposed to educate people about OTCs if they don't know who the consumers are? Latimore didn't tell her doctor she was taking an OTC medicine every day, so how is her pharmacist supposed to know about the bottle of ibuprofen she (probably) bought at Wally World? The majority of responsibility must lie with us patients. We have to be the ones to seek out our pharmacist's guidance and we have to be the ones to initiate discussions with them. It's our responsibility to be informed patients and learn all we can so that we use OTCs properly and according to their labels. Way better than my advice though, is Schoolhouse Rocky's great words to live by:

As your body grows bigger,
Your mind must flower,
It's great to learn,
'Cuz knowledge is power!

May is Stroke Awareness Month - Do You Know the Warning Signs?

Did you know Migraine increases your Stroke risk? Information regarding the Migraine - Stroke connection can be found in MAGNUM's article Migraines: Myth Vs. Reality:

According to the New England Journal of Medicine, "migraine can sometimes lead to ischemic stroke and stroke can sometimes be aggravated by or associated with the development of migraine." Twenty-seven percent of all strokes suffered by persons under the age of 45 are caused by Migraine. Stroke is the third leading cause of death in this country. In addition, twenty-five percent of all incidents of cerebral infarction were associated with Migraines, according to the Mayo clinic. Most recently the British Medical Journal reported that after evaluating 14 major Migraine & stroke studies in the U.S. and Canada that Migraineurs are 2.2 times greater risk for stroke than the non-migraine population. That risk goes up to a staggering 8 times more stroke risk for women Migraineurs on the pill!

Can you recognize ALL five correct Stroke symptoms? Can you identify an incorrect Stroke symptom? Do you know when you need to call 9-1-1 when someone appears to be having a Stroke? If you answered "no", you're not alone.

Results of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey that was used in 13 states and the District of Columbia (DC) to examine public awareness of Stroke warning symptoms and the importance of seeking emergency care were examined in this week's issue of the CDC's Morbidity and Mortality Weekly Report article Awareness of Stroke Warning Symptoms --- 13 States and the District of Columbia, 2005. Out of 71,994 participants only 16.4% of respondents could recognize all five correct symptoms, identify an incorrect symptom and recognize the need to call 9-1-1.

May is Stroke Awareness Month. The National Institute of Neurological Disorders and Stroke (NINDS) developed the Know Stroke, Know the Signs. Act in Time campaign to educate the public about recognizing Stroke symptoms. If you don't know these five symptoms, take the time to learn them. If you already know them, teach them to someone else. At the very least, print them and attach them to your refrigerator so that your family can learn them.

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

These five symptoms can also be found HERE.

The NINDS says you may not realize you're having a stroke and you may not be able to call 9-1-1 on your own. The people around you may not know you're having a Stroke and just think you're confused. Don't waste precious time. Arriving at the hospital within 60 minutes after experiencing symptoms can greatly reduce Stroke damage. If you or someone you know is having a Stroke call 9-1-1 IMMEDIATELY.

Migraine at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago

Here's a synopsis of Migraine research that was presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago April 12–19, 2008.

Migraine frequency linked with women's risk of cardiovascular disease
CHICAGO – New research shows women who have weekly migraine are significantly more likely to have a stroke than those with fewer migraines or no migraine at all, but those with lower migraine frequency may face increased risk of heart attacks. The research was presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12–19, 2008...
To read the entire article click HERE.

Children with migraine at increased risk of sleep disturbances
CHICAGO – Children with migraine are more likely to have sleep disorders, such as sleep apnea and lack of sleep, than children without migraine, according to research on the effects of headaches on children’s sleep patterns was presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12–19, 2008...
To read the entire article click HERE.

Overuse of codeine, oxycodone and barbiturates increases risk of chronic migraine
CHICAGO – People who overuse barbiturates and opioids, such as codeine, butalbital, and oxycodone, to treat migraine are at an increased risk of developing chronic migraine, according to research that was presented at the American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12–19, 2008. People with chronic migraine have headaches on 15 or more days a month...
To read the entire article click HERE.

New Hope for Migraine Sufferers: Optinose Nasal Delivery of Sumatriptan Proves as Effective as Invasive Subcutantaneous Injection
WASHINGTON--(BUSINESS WIRE)--At the American Academy of Neurology Annual Meeting, Optinose, the Norwegian drug delivery specialists, today presented Phase I data that could lead to faster, effective and less invasive relief for migraine sufferers. The recently completed trial first demonstrated that Sumatriptan powder delivered intranasally using OptiNose’s 2nd generation device has a rapid onset of action and is as effective as subcutaneously administered Sumatriptan in preventing GTN Challenge Induced EEG changes in migraine sufferers...
To read the entire article click HERE.

For more information about the American Academy of Neurology, visit www.aan.com.