Lifewatch: Migraine treatment

Reported by Claire Hosmann - bio|email
Posted by Debra Worley - email

(WECT) - 35 million Americans suffer from migraines and chronic headaches.  The pain can be so intense it immobilizes people, bringing their world to a standstill.

Migraine sufferers can have headaches that last three months, and those headaches can come with a runny nose, nausea, and sensitivity to light and sound.

Medication is usually the only way to help, but now doctors are replacing meds with a machine that could shock the pain away.

"It comes very quickly," said migraine sufferer Kassie Adams.  'One minute you're OK, the next minute, you have a pounding headache."

"Imagine having a level five or six pain that doesn't go away," said migraine sufferer Maria McIntyre.

"The headaches were so debilitating that it was like, you could remove my head if you want to at this point - just get them to stop," said migraine sufferer Judy Caletti.

When medication doesn't help chronic headaches, some doctors turn to an implantable nerve stimulator.  The rechargeable battery powered electrode is about the size of a match stick and is implanted near the occipital nerve in the back of the head.

"Occipital nerve stimulation works by activating nerves at the back of the head that then feed into the brain and change the way the brain behaves, in terms of responses to head pain signals," said neurologist Dr. Peter Goadsby.

The stimulator can be turned on and off with a remote control.

"When you turn the stimulators off, as we did deliberately for this study, the headache comes back," said Dr. Goadsby.

After six months, five out of six patients reported less pain, some up to 95% less.

For many who suffer from migraines, the idea of getting rid of the pain without the side effects of medicine is a relief.

The nerve stimulator is also being used in pain management of osteo-arthritis.  The device is recharged using a special headband worn by the patient.

For more information, please contact:
Lauren Hammit
UCSF Public Affairs
(415) 476-0557

BACKGROUND: Hemicrania continua is a rare, treatable headache, that is not caused by any outside conditions. To be diagnosed, one must suffer from a headache for more than three months and experience headaches marked by continuous pain on one side of the face which varies in severity. More women than men suffer from hemicrania continua, and the cause is unknown. Symptoms include runny nose, tearing, eye redness, eye discomfort, sweating, and swollen and drooping eyelids. Migraine-like symptoms include nausea, vomiting and sensitivity to light and sound. There are two types of hemicrania continua -- continuous and remitting. Continuous is marked by daily headaches. Remitting takes place when the headaches last for months at a time and are followed by a short pain-free period of either weeks or months until the headache reoccurs.

TREATMENTS: For hemicrania continua and other types of chronic headaches, the most commonly recommended treatment is medication. Antidepressants are the most common medication prescribed for all chronic headaches except hemicrania continua. These drugs also help alleviate the daily stressors that often come with the chronic headaches. Tricyclic antidepressents such as nortriptyline (Pamelor) and protriptyline (Vivactil) are the most effective against headaches, according to the Mayo Clinic. Beta blockers are drugs commonly used to treat high blood pressure, but  they also serve as medication to treat chronic migraines. Doctors often prescribe beta blockers to be used with antidepressants for better results. These medications include atenolol (Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Inderal). Chronic daily headaches may also be treated with anti-seizure medications such as divalproex (Depakote), gabapentin (Neurontin) or topiramate (Topamax). When the migraine is very severe, or if one is going through withdrawal from other pain relievers, prescription nonsteroidal anti-inflammatory drugs may be used. These include naproxen (Aleve, Anaprox), ketoprofen and mefenamic acid (Ponstel).

The most common drug used to treat hemicrania continua is an anti-inflammatory called indometacin. This provides quick relief from most symptoms, but may cause stomach problems for some patients. Doctors also may recommend less-effective drugs such as ibuprofen, celecoxib or naproxen for temporary symptom relief.

OCCIPITAL NERVE STIMULATION: An alternative to drugs, occipital nerve stimulation is a new treatment for hemicrania continua. The method involves implanting a suboccipital bion device into the head which emits nerve stimulation. The use of a miniature nerve stimulator decreases pain for patients by 80 to 95 percent, according to a study conducted University of California, San Francisco. Previous trials have reported the nerve stimulation method is a safe and an effective long-term pain treatment.

OTHER METHODS: The transcranial magnetic stimulator (TMS) is another recently developed, non-drug treatment for chronic headaches. The device stimulates function in the targeted brain areas with a highly focused, pulsed magnetic field. It is currently being used to treat patients with migraine and depression. Researchers at Ohio State University report that this device may actually treat headaches rather than simply temporarily reduce the symptoms.

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