Genetic Differences Distinguish Episodic Versus Chronic Migraine and May Open New Avenues of Pain Relief

PainRelief.com Interview with:
Aliya Yakubova MD
OpenLab “Gene and Cell Technologies”
Institute of Fundamental Medicine, Kazan Federal University
Kazan, Russia

Dr. Yakubova

PainRelief.com:  What is the background for this study?

Response: Migraine is a common debilitating primary headache disorder with strong socio-economic effects. According to some estimates, migraine is the most costly neurological disease: for example, in the European Union, it costs more than 27 billion euros a year.

In this regard, chronic type of migraine (with more than 15 attacks per month for more than three months) is of special interest. Because of high prevalence and the burden of attacks, it is of great importance to improve diagnostic tools for patient stratification and choosing appropriate treatment strategies of migraine. For this purpose we investigated contribution of transient receptor potential vanilloid type 1 (TRPV1) receptors to migraine chronification. It is known that these receptors are directly involved in the disease pathogenesis being associated with the release of the key migraine pain mediator, the calcitonin gene – related peptide (CGRP). Moreover, recent studies have suggested that the non-synonymous TRPV1 single-nucleotide polymorphism (SNP) 1911A> G (rs8065080), resulting to the substitution of amino acids isoleucine to valine in the protein structure of receptor (Ile585Val), influences functional activity of these receptors in neuropathic pain syndromes. All this together was the starting point of our research in collaboration with colleagues from the University of Eastern Finland.

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Study Evaluates Inhaled Cannabis for Pain Relief from Headache and Migraine

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Assistant ProfessorWashington State University
Department of Psychology
Pullman, WA, 99164-4820

PainRelief.com:  What is the background for this study?

Response: Many people report using cannabis for headache and migraine and claim that it is effective in reducing their symptoms. However, to date there has only been one clinical trial examining the effectiveness of a cannabinoid drug called Nabilone (synthetic THC that is orally administered) on headache. The results of that trial indicated that Nabilone was more effective than ibuprofen in reducing pain and increasing quality of life. There have also been a couple of preclinical (animal) studies suggesting that cannabinoids like THC may be beneficial in the treatment of migraine. But there are surprisingly few studies examining the effectiveness of cannabis, particularly whole plant cannabis rather than synthetic cannabinoids on headache and migraine.

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Opioids Frequently Prescribed For Headache Pain Relief

PainRelief.com Interview with:
Richard B. Lipton, M.D.
Professor, The Saul R. Korey Department of Neurology
Professor, Department of Psychiatry and Behavioral Sciences
Professor, Department of Epidemiology & Population Health
Edwin S. Lowe Chair in Neurology
Vice Chair The Saul R. Korey Department of Neurology
Director, Montefiore Headache Center
Albert Einstein College of Medicine

PainRelief.com:  What is the background for this study

Response: Almost everyone with migraine takes acute treatments at the time of attacks to relieve pain and restore function.  Acute treatments include over-the-counter medications. prescription drugs and devices.  The most widely used prescription drugs for migraine are triptans (such as sumatriptan and rizatriptan) and NSAIDs (such as ibuprofen and naproxen). 

Richard B. Lipton, M.D. Professor, The Saul R. Korey Department of Neurology Professor, Department of Psychiatry and Behavioral Sciences Professor, Department of Epidemiology & Population Health Edwin S. Lowe Chair in Neurology Vice Chair The Saul R. Korey Department of Neurology Director, Montefiore Headache Center Albert Einstein College of Medicine
Dr. Lipton

Opioids are not recommended in treatment guidelines as acute treatments for migraine.  Longitudinal studies show that in people with migraine treatment with opioids is associated with dose dependent acceleration of headache frequency and the development of chronic migraine in people with episodic migraine.  The purpose of this study was to determine the relative frequency of opioid use and the characteristics of those who use opioids to treat migraine. The hope is to use this information to develop programs which will encourage guideline compliant treatment.

Acupuncture for Migraine Pain Relief

PainRelief.com Interview with:

Prof. Wei Wang
Department of Neurology,
Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology,
Wuhan, Hubei, P.R. China

acupuncture

PainRelief.com:  What is the background for this study?

Response: The burden of migraine is substantial, resulting in considerable economic and social losses. The latest Global Burden of Disease Study showed that 1.25 billion people had migraine in 2017. A significant number of patients are still not responding well to drug therapy, or cannot tolerate the adverse effects of drugs, or have contraindications, which can lead to low medication compliance, headache chronification and acute medication overuse. Prophylactic drugs should be recommended for migraineurs who have at least four headache days per month, but only 13% of patients reported current use of preventive drugs. Besides, ineffectiveness of and/or contraindications to migraine medication affect 10-15% of people with migraine. Hence, a need exists to investigate non-drug interventions.

Previous studies suggest that acupuncture works particularly well on a range of pain disorders. However, clinical evidence for the benefit of manual acupuncture for migraine prophylaxis remains scarce. Appropriate placebo control settings and successful blinding are two critical elements in addressing this challenge. Sham acupuncture involving penetrating needles should be avoided in clinical trials. Previous acupuncture research has often used penetrating sham acupuncture, involving needling non-acupuncture points, needling irrelevant acupuncture points, or superficial needling. However, whether the needle is inserted into an acupuncture point or a non-acupuncture point, it could produce a physiological effect. Comparisons between true acupuncture and sham acupuncture might also be biased by unsuccessful blinding. To ensure an inert placebo control and successful blinding, we recruited acupuncture-naive patients, using non-penetrating sham acupuncture at heterosegmental non-acupuncture points as the control, and designed the same procedures to perform the same rituals as much as possible in the manual and sham acupuncture groups.

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Migraine: Aspirin Evaluated for Pain Relief and Prevention

PainRelief.com Interview with:

Charles Hennekens, MD, DrPH

Prof. Hennekens

Sir Richard Doll Professor
Senior Academic Advisor to the Dean
Charles E. Schmidt College of Medicine
Florida Atlantic University

PainRelief.com:  What is the background for this study?

Response: Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine as well as prevention of recurrent attacks there are prescription drugs of proven benefit. For those without health insurance or high co-pays, however, they may be neither available nor affordable and, for all patients, they may be either poorly tolerated or contraindicated. 

Short and Long-Term Effects of Cannabis For Headache and Migraine Pain Relief

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Assistant Professor
Washington State University
Department of Psychology
Pullman, WA, 99164-4820

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Use of cannabis for headache and migraine is relatively common yet there have been few studies examining the effectiveness of medical cannabis for these purposes.

PainRelief.com: What should readers take away from your report?

Response: We analyzed data from nearly 20,000 cannabis use sessions tracked using the medical cannabis app Strainprint. The results show that headache and migraine severity ratings were reduced by nearly 50% from before to immediately after cannabis use. The results further revealed that men report larger reductions in headache severity following cannabis use than do women and that use of cannabis concentrates was associated with larger reductions in headache severity ratings than use of more traditional cannabis flower.

We also demonstrate that dose of cannabis used to manage these conditions increases across time and that efficacy of cannabis in reducing headache decreases across time. This indicates that there is some evidence of tolerance to the acute effects of cannabis on ameliorating headache across time. More encouragingly we found that baseline ratings of headache and migraine remained stable across time/cannabis use sessions which indicates that cannabis is not associated with the medication overuse headaches (i.e., increases in baseline headache and migraine severity across time as a function of the use of medications to treat these conditions) that more conventional treatments tend to produce.

Chronic Back Pain and Headache Often Occur in Same Patient

PainRelief.com Interview with:

Arani Vivekanantham, MBChB, MPhil
University of Warwick
University Hospitals Coventry and Warwickshire NHS Trust
Coventry, UK
Centre for Epidemiology Versus Arthritis
University of Manchester, Manchester, UK

ni Vivekanantham, MBChB, MPhil
 University of Warwick
 University Hospitals Coventry and Warwickshire NHS Trust
 Coventry, UK
 Centre for Epidemiology Versus Arthritis
 University of Manchester, Manchester, UK

PainRelief.com:  What is the background for this study?

Response: Around one in five people have persistent low back pain and one in thirty have chronic headaches. People with low back pain are usually managed by musculoskeletal services whilst those with headaches are typically treated by primary care doctors and neurologists. There may be particular challenges in treating people with both disorders because of the risk of medication overuse headache in people taking regular pain killers for back pain.

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Migraine: Pain Relief from BotoxA May Last At Least 6 Months After Injections Stopped

PainRelief.com Interview with:
Jason Ching MD
Department of Neurology
George Washington University School of Medicine
Washington, DC

headache migraine

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: The clinical course of chronic migraine patients who respond positively to serial botulinum toxin A (BotoxA) injection therapy and eventually discontinue treatment has not been well-studied. Optimizing the duration of treatment would be beneficial from both a cost and safety perspective.

In our study, we found that over 80% of our chronic migraine patients who achieved our stipulated stopping rule experienced no clinical worsening or associated need to resume prophylactic therapy for at least 6 months following discontinuation of BotoxA.

A greater number of BotoxA treatments required to achieve the stopping rule and the presence of baseline chronic daily headaches for over 6 months duration were factors correlated with clinical deterioration.

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Migraine Linked to Poor Sleep and Sleep Apnea

PainRelief.com Interview with:

Dawn C. Buse PhD
 Clinical Professor of Neurology
 Albert Einstein College of Medicine
 New York City

Dawn C. Buse PhD
Clinical Professor of Neurology
Albert Einstein College of Medicine
New York City

PainRelief.com:  What is the background for this study?

Response: Sleep is essential in the regulation of a wide range of homeostatic functions.  Dysregulation of sleep process may be triggers for migraine attacks and increase the risk of migraine disease chronification.  Migraine is comorbid with a range of medical, neurologic, and psychiatric comorbidities that may exacerbate the disease, complicate treatment, and reduce health-related quality of life.  These comorbidities include sleep disorders such as sleep apnea, insomnia, circadian rhythm (i.e., sleep-wake) disorders, and sleep movement disorders.

The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study that used a series of web-based surveys over 15 months to assess migraine symptoms, burden and patterns of healthcare utilization among people in the US population.  Validated questionnaires were used to assess many comorbidities.  Migraine can be classified based on the number of headache days per month into episodic migraine (<15 headache days/month) and chronic migraine (≥15 headache days/month).

In this cross-sectional analysis of data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, we assessed sleep apnea and poor sleep quality in a US population based sample of 12,810 people with migraine.  Respondents were stratified by episodic (11,699) and chronic (1,111) migraine and by body mass index (BMI).

Headache an Immense Public Health Problem, for Rich and Poor Countries

PainRelief.com Interview with:

Lars Jacob Stovner MD PhD Professor of Neurology Department of Neuromedicine and Movement Science NTNU, Norwegian University of Science and Technology Head of the Norwegian Advisory Unit on Headaches, St. Olavs Hospital Trondheim, Norway

Prof. Stovner

Lars Jacob Stovner MD PhD
Professor of Neurology
Department of Neuromedicine and Movement Science
NTNU, Norwegian University of Science and Technology
Head of the Norwegian Advisory Unit on Headaches,
St. Olavs Hospital Trondheim, Norway

PainRelief.com: What is the background for this study? What are the main findings? 

Response: The study focuses on prevalence and burden of migraine and tension-type headache in the Global Burden of Disease project from 2016.

Previous analyses has shown that migraine is the second most disabling disorder in terms of years lived with disability. This particular analysis shows that more than 1 billion people suffered from migraine in 2016 and 1.9 billion from tension-type headache, and it gives estimates each country and different world regions.

Headache is particularly burdensome in young and middle-aged women, but the impact is also quite marked also in men, children and elderly.

There is considerable variation between countries, but the burden is relatively stable over time (from 1990), and there is no obvious relation to the socioeconomic level of the country.  Continue reading