There is encouraging news for migraine sufferers—a new study shows a minimally invasive treatment lowers the subsequent use of pain medication in the vast majority of patients.
In the treatment, a numbing medication called lidocaine is administered nasally through a thin tube; its purpose is to block a bundle of nerves called sphenopalatine ganglion (SPG); these nerves are closely associated with migraines.
As sufferers well know, migraines cause intense throbbing or a pulsing sensation in one area of the head; they are often accompanied by an extreme sensitivity to light and sound. The attacks can cause severe pain for hours or even days.
Migraines can also cause nausea and vomiting. Dr. Mauricio Munoz, a Vero Beach internist who treats migraine patients, says that administering medication nasally (as was done in the study) can be an effective alternate route, so as not to worsen those digestive problems.
Dr. Kenneth Mandato, the study’s lead researcher and an interventional radiologist at Albany Medical Center, says the administration of lidocaine to the SPG acts as a “reset button” for the brain’s migraine circuitry. “When the initial numbing of the lidocaine wears off, the migraine trigger seems to no longer have the maximum effect that it once did,” Dr. Mandato says. “Some patients have reported immediate relief and are making fewer trips to the hospital for emergency headache medicine.”
The study involved 112 participants who were asked to score the severity of their symptoms on a scale of 1 to 10. Prior to the treatment, the average score was 8.25; the day after, it was halved to an average of 4.1. Thirty days after the treatment, the score was 5.25, still a significant decrease from baseline levels. The most compelling statistic is that 88 percent of patients said they were using less or no migraine medication for relief following the procedure. The researchers will continue to track the participants to assess their responses 6 months after treatment.
The height of the migraine is called the attack; in addition, migraines can go through other phases. A summary from the Mayo Clinic:
• Prodrome. One or two days before a migraine, there may be subtle changes that signify an oncoming migraine, including constipation, depression, food cravings, hyperactivity, irritability, neck stiffness, and uncontrollable yawning.
• Aura. These are nervous system symptoms which may occur before or during migraine headaches. Auras are usually visual disturbances, such as flashes of light, but can also be disturbances related to touch, movement, or speech. Most people experience migraine headaches without aura.
• Postdrome. This phase occurs after a migraine attack. It is common to feel drained and washed out, although some people report feeling mildly euphoric.
There is no cure for migraines, and traditionally they have been treated via pain-relieving medications such as aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol). Moderate or severe migraines are often treated with triptans, a drug that narrows blood vessels in the brain and relieves swelling; they also help with nausea and vomiting. Opioids – such as hydrocodone, oxycodone, and codeine – can be habit forming and are only used as a last resort.
Up to 90 percent of people with migraines have a family history of attacks. Most sufferers experience their first migraine during their teen years; if you’ve reached the age of 40 without having an attack, it’s unlikely that you ever will. Dr. Munoz says that 18 percent of women and 6 percent of men in the United States have had at least one migraine in the last year. Even with those relatively high numbers, he believes that it is an under-diagnosed condition, and is too often self-treated with over-the-counter medications. He cautions that long-term use of those medications may actually cause “rebound headaches,” also known as medication-overuse headaches.
Depending on individual circumstances, doctors will sometimes recommend preventive medications to reduce the severity and frequency of migraines. Researchers don’t know why, but certain high blood pressure drugs have been shown to help. Tricyclic antidepressants can provide relief by affecting chemicals in the brain; some anti-seizure medications (such as Depacon and Topamax) seem to reduce the frequency of migraine headaches. All of these drugs have potential side effects, some serious, so it’s important for patients to have an in-depth discussion with their doctor about risks and benefits.
Vero’s Dr. Munoz says that the aggressiveness of treatment approaches is determined by a number of factors, including the severity, frequency, and degree of disability the headaches cause. He also is careful to evaluate other conditions the patient may have. For instance, if the patient has high blood pressure, Dr. Munoz may prescribe a calcium channel blocker called verapamil; while it’s designed to treat the hypertension, it has also been shown to be effective in preventing migraines.
Botox, best known as a cosmetic drug to smooth frown lines and crow’s feet, can also be effective in preventing chronic migraines; it has been studied in adults who have attacks 15 or more days each month, with headaches lasting four hours or more. Its effectiveness and safety is not known in other circumstances. Injections are made in muscles of the forehead and neck; when it’s effective, the treatment usually needs to be repeated every 3 months or so.
Dr. Munoz spoke of butterbur, a shrub that typically grows in wet, marshy ground. Various parts of the shrub are used to make extracts for use as a dietary supplement. There is some evidence (but no real consensus) that this supplement, when taken consistently, can help reduce the frequency of migraines.
Other advice for migraine sufferers:
• Stay hydrated.
• Avoid food or smells you think have triggered attacks in the past.
• Avoid tobacco and reduce your alcohol and caffeine intake (this includes chocolate, unfortunately).
• Establish and maintain a consistent eating and sleeping schedule.
• Try to control your stress levels. Dr. Munoz recommends meditating and using relaxation techniques.
• Keep a healthy weight (obesity is thought to be a factor in migraines).
Dr. Munoz believes that it’s beneficial for migraine sufferers to engage in regular aerobic exercise, but cautions that exercise itself can bring on an attack; so it’s best to first talk to your doctor about what type and level of exercise is right for you.
That brings us back to the nasal lidocaine studied by Dr. Mandato and his team; he believes the treatment is safe enough for patients to have on multiple occasions if necessary and that it “offers a patient-centered therapy that has the potential to break the migraine cycle and quickly improve patients’ quality of life.”
Dr. Munoz practices as part of the Vero Internal Medicine Group. The practice is located at 1155 35th Lane, Suite 201, in Vero Beach; the phone number is 772-794-3364.
