Category Archives: Migraine

Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

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PainRelief.com Interview with:
Allison Lee, MD, MS  [she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

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

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.

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Migraine: Genetic Factors May Differ Between Men and Women

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PainRelief.com Interview with:
Matthew S. Panizzon, Ph.D.
Associate Professor
Department of Psychiatry
Center for Behavior Genetics of Aging
University of California San Diego

Dr. Panizzon

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

Response: Migraine is a severe neurological disease that affects over 12% of the population.  Women are also much more likely to suffer from migraine then men.  Despite how common it is, the factors that contribute to migraine are poorly understood.

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Large Study of Painful Cluster Headaches Has Revealing Findings

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PainRelief.com Interview with:
Mark J. Burish, MD, PhD.
Assistant Professor
Vivian L. Smith Department of Neurosurgery
Director, Will Erwin Headache Research Center
McGovern Medical School at UTHealth Houston

Dr. Mark Burish – Neurosurgery
Photo by Dwight C. Andrews/The University of Texas Medical School at Houston Office of Communications

PainRelief.com:  What is the background for this study?  Would you describe cluster headaches?

Response: Cluster headache is a disease associated with excruciating attacks of one-sided pain around the eye – patients regularly say it is more painful than childbirth, kidney stones, or gunshot wounds.  The attacks last between 15 minutes and 3 hours and can occur up to 8 times per day.  During an attack, patients will often have changes around the eye (such as a watery or bloodshot or droopy eye) changes in the nose (like congestion and a runny nose), and a restless feeling like they can’t sit still.  It is called “cluster” headache because, for most patient, the headaches occur every day for several weeks then go away for the rest of the year, only to come back the following year.  This is called “episodic” cluster headache, though there is another version called “chronic” cluster headache in which the headaches occur at least 9 months a year.

Cluster headache is found in about 1 in 1000 patients.  Because it is uncommon, there have not been a lot of large international studies investigating basic questions like the age that these headaches start and the differences from patient to patient.  There is a great need to understand more about this disorder at every level.  So two researchers from the University of West Georgia (Larry Schor and Stuart Pearson) performed a large epidemiology study on cluster headache because very few have been done.  They created an online questionnaire and advertised it internationally.  They ended up obtaining the largest study in terms of participants and the most international study ever performed (at least to our knowledge).  They then asked for help analyzing it from several physicians (including myself) and statisticians.  I felt very fortunate that they reached out to me and I really enjoyed working on this project because I think it gives us a lot of insights into cluster headache.

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Case Report Describes Pain Relief from Chronic Migraines with LIFE Diet

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PainRelief.com Interview with:
David M. Dunaief, M.D.
Principal Investigator
MedicalCompassMD.com

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

Response: As an internist focusing on dietary intervention, I have been caring for patients with chronic diseases for the past 12 years. Many of my patients have had rapid, marked improvements when they adhere to my LIFE (Low Inflammatory Foods Everyday) diet. The diet, as well as objective evidence that it reduces systemic inflammation (lowers serum C-reactive protein levels), has been described in the peer-reviewed publications:

https://journals.sagepub.com/doi/full/10.1177/1559827619894954 

and https://journals.sagepub.com/doi/full/10.1177/1559827620962458.

In addition to improving migraines, the diet has improved symptoms and blood chemistries in patients with high blood pressure, high cholesterol, diabetes, cancer, auto-immune diseases, inflammatory bowel disease, and others. In this case report, we describe a patient who suffered from debilitating migraines for 12.5 years, and who had minimal benefit from avoiding dietary triggers or medications. Within 3 months of adopting the LIFE diet, he was migraine free and remained that way for 7.5 years.

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Chronic Migraine: TOP-PRO Study Compares Propranolol and Topiramate for Pain Relief

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PainRelief.com Interview with:

Dr. Debashish Chowdhury
MBBS; DTCD; MD (Medicine); DM (Neurology); FIAN
Commonwealth Fellow in Stroke Medicine (Edinburg, UK)
Director – Professor and HOD
Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research,
New Delhi, India

Dr. Chowdhury

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

Response: Chronic migraine is a highly disabling headache disorder affecting about 2% of the global population. Oral preventive treatment options for chronic migraine are limited. Only topiramate has good evidence of efficacy. Although propranolol has class I evidence of efficacy for the prevention of episodic migraine, it has not been tested for chronic migraine with a robust clinical trial. Hence, we conducted an RCT, called the TOP-PRO study assessing the efficacy and tolerability of propranolol against topiramate for the prevention of chronic migraine using a non-inferiority design.

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Migraine Pain Linked to Stress Varies by Individual

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PainRelief.com Interview with:

Serena L. Orr, MD, MSc, FRCPC, FAHS
Assistant Professor
Depts of Pediatrics, Clinical Neurosciences and Community Health Sciences 
Cumming School of Medicine, University of Calgary
Director, Pediatric Headache Program
Alberta Children’s Hospital

Dr. Orr

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

Response: Stress has long been felt to be one of the most common trigger factors for migraine. However, there is very little data on the relationship between stress and pain severity in individuals with migraine on a day-to-day basis, and this relationship is even more poorly understood among individuals with more frequent attacks, such as those with chronic migraine (who have at least 15 days/month of headache, 8 or more of which meet criteria for migraine attacks).

This was a study that looked at daily electronic headache diary data for 136 adults with chronic migraine, using data from the N1-Headache application. In this study, we aimed to understand the relationship between perceived stress and pain severity in individuals with chronic migraine. Individuals completed 90 days of daily diary entries where they reported on their headache characteristics, and their perceived stress levels, measured on a scale of 0-10.

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Green Light Therapy Can Augment Traditional Pain Relief Methods

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PainRelief.com Interview with:
Mohab Ibrahim, MD., Ph.D
Associate Professor, Departments of Anesthesiology, Neurosurgery, and Pharmacology.
Director, Chronic pain clinic. 
Director, Chronic pain fellowship. 
Medical Director, Comprehensive Pain and Addiction Center
Banner-University Medical Center
University of Arizona

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

Response: This study is the continuation of the green light story we first published in 2017. Our first paper in 2017 investigated the effect of green light on pain behavior in animals. This idea was inspired by my brother who suffers from headaches and finds relief in green spaces. My brother’s experience with green spaces inspired me to look initially into green light therapy for pain in rodents which resulted in our first publication in 2017.  Because green light therapy decreased pain behavior in animals coupled with the safety profile of green light (we use low-intensity green light), we obtained approval from the University of Arizona to conduct human trials. This has resulted in two clinical trial papers that were recently published.

We have shown that green light exposure decreased the severity of pain in patients with fibromyalgia and also decreased the intensity and frequency of migraine headaches in migraine patients. At this point, we wanted to explore the mechanism(s) of action and explain how green light works. We had some preliminary data from our initial publications pointing towards the endogenous opioid system. Therefore, we decided to explore the endogenous opioid system in more detail in the HIV-induced neuropathy model in rodents. Our findings indicate that green light reversed hypersensitivity in a model of HIV-related neuropathy in rodents by stimulating the endogenous opioid system. Green light exposure significantly increased the CSF levels of β-endorphin and proenkephalin, but not dynorphin. The µ- and δ-opioid receptors appeared to be key actors in green light-induced antinociception. 

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

Response: Chronic pain is a complicated medical condition with several dimensions. Chronic pain may affect sleep quality, life quality, and may result in depression.

The management of chronic pain requires a deep appreciation of the factors involved and necessitates the evaluation of a pain specialist and the collaboration of several medical specialists.

Non-pharmacological methods can be used to complement current pharmacological and procedural interventions to control pain.

Color and light therapy are still in their infancy and we still need to learn more about them. More research and more funding are needed to better understand the biological

Green light therapy can augment current traditional methods to control pain.

If you live in an area with trees or forests, you can enjoy free green light therapy while walking and exercising. It’s a win-win situation.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: We and other labs have shown that different colors of light have biological effects. It’s important that we start looking at new indications for light therapy as well as mechanisms of action. Light therapy is relatively a new field and there may be some or a lot of skepticism in the scientific community about its benefits. It may be time to start thinking about organizing regional/national annual meetings focused on the medical benefits of light therapy. This type of meeting will foster collaborations among physicians and scientists and attract more attention and interest in this field.

Finally, looking at the financial burden secondary to the price and cost of medications and the side effects associated with some of these interventions, light therapy may offer a safer complementary tool that is more affordable and has fewer side effects than a significant number of medications. While light therapy may not replace traditional medications, it may decrease the amount of medications needed.

PainRelief.com: Is there anything else you would like to add?

Response: Even though green light therapy is easy to do and relatively safe, I advise anyone who wishes to try it to consult their physicians first. Some medical conditions may not be suitable for extended visual light exposure. Always check with your doctor before you start any new therapy. Also, please do not stop ANY medication you are on without consulting with your physician first. Some medications should not be stopped abruptly.

Finally, as a disclosure, I have a patent for the green light therapy, and it is currently being commercialized.

Citation:

Laurent F. Martin, Aubin Moutal, Kevin Cheng, Stephanie M. Washington, Hugo Calligaro, Vasudha Goel, Tracy Kranz, Tally M. Largent-Milnes, Rajesh Khanna, Amol Patwardhan, Mohab M. Ibrahim,

Green light antinociceptive and reversal of thermal and mechanical hypersensitivity effects rely on endogenous opioid system stimulation,

The Journal of Pain, 2021,

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Infused VYEPTI Provided Pain Relief When Initiated During a Migraine Attack

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PainRelief.com Interview with:
Roger Cady, MD
VP Neurology
Lundbeck Pharmaceutical
La Jolla Research Center
San Diego, CA 92121

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

Response: The RELIEF study evaluated how preventive migraine candidates may benefit from a VYEPTI infusion during an active migraine attack when administered within 1 to 6 hours of a moderate to severe migraine attack. VYEPTI is the first and only intravenous (IV) infusion approved for the preventive treatment of migraine in adults.

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Migraine: Galcanezumab (Emgality®) for Pain Relief in Patients with Previous Preventive Medication Failures

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PainRelief.com Interview with:
Dulanji K. Kuruppu, MD
Medical Advisor, Migraine & Headache Disorders
US Medical Affairs
Eli Lilly and Company
LTC-South, Indianapolis IN 46221 U.S.A.

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

Response: Galcanezumab is a monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) and is approved for the preventive treatment of migraine and for the treatment of episodic cluster headache in adults. The CONQUER study assessed the efficacy and safety of galcanezumab in 462 adults with episodic or chronic migraine who previously did not benefit from 2 to 4 standard-of-care migraine preventive medication categories. This study consisted of a 3-month double-blind, placebo-controlled period (months 1-3) followed by an open-label period (months 4-6). The primary endpoint, which was the mean change from baseline in the number of monthly migraine headache days for galcanezumab vs placebo over months 1-3, was met. In this post-hoc analysis, we assessed onset of effect of galcanezumab in the CONQUER population.

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Aimovig® plus OnabotulinumtoxinA (onabot) For Migraine Pain Relief

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PainRelief.com Interview with:
Fred Cohen, MD
Department of Medicine, 
Montefiore Medical Center and the Albert Einstein College of Medicine
Bronx, New York

Dr. Fred Cohen

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

Response: OnabotulinumtoxinA (onabot) and calcitonin gene-related peptide monoclonal antibodies (CGRP-targeted mAbs) are two medications used to treat chronic migraine. While both have been shown to significantly reduce monthly headache days, they are some patients that require further treatment after receiving one of these therapies. Prior to this study, there was limited data on the efficacy and safety of concomitant treatment with onabot and a CGRP-targeted mAb. 

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