Migraine Treatments

MIGRAINE AND HEADACHE DIETS.


Posted By on Sep 10, 2021

Last updated on October 14th, 2021 at 03:00 pm

MIGRAINE AND HEADACHE DIETS.

@Neuralgroover

The best migraine diet is…

 

Well first, there are many well established migraine triggers. The beverages and foods that we consume play a role in headaches and migraines for many patients. In fact, about 10% of headache and migraine sufferers can attribute at least a small part of their headaches to food and diet triggers. Often the trigger is a specific type of food or beverage. For example, in some studies (seen here and here) migraineurs reported their most common food triggers as chocolate (19-22%), cheese (9-18%), citrus fruit (11%), and alcohol (29-35%).

 

Certain types of diets may help reduce the likelihood and severity of headaches and migraines. Let’s take a look at some of the diets out there that may help with headaches and migraines.




How Does the Keto Diet Impact Headaches and Migraines?

The keto diet is unique in the sense that your body consumes more fat and protein while lowering the intake of carbohydrates. The idea is that your body is forced to burn fats rather than carbohydrates. Studies have shown that the keto diet was able to significantly reduce migraine frequency and abortive medication intake. It is thought that the keto diet can be particularly helpful for migraine sufferers on a twofold front:

  1. Ketone bodies produced by the liver can provide the brain with more energy than glucose.
  2. Additionally, ketones are thought to be anti-inflammatory. Since inflammation is a central piece of migraines, the keto diet can potentially help by reducing inflammation.

 

For those who are starting out fresh on the keto diet, there may be an occasional headache since the body is learning to burn fat instead of sugar. To avoid these headaches early on in the keto diet, the following suggestions will help:

  • Drink plenty of water.
  • Eat low-carb, water-rich vegetables.
  • Eat foods that are rich in electrolytes.
  • Avoid exercise on the opening days of your keto diet.

 

Can a Low-Histamine Diet Help With Headaches and Migraines?

Histamine can be a headache or a migraine trigger for certain individuals, even if they do not have allergies. The body makes a digestive enzyme called DAO (diamine oxidase) that processes histamine. About 25% of people have an issue with DAO production in their bodies. One study found that about 87% of people with migraines also had issues with DAO deficiencies. It was found that people who participated in a low-histamine diet had improved in their overall experiences with their migraines while a handful of people in the study had no migraines or headaches at all.

 

What can you eat on the low-histamine diet? You can eat fresh meat (especially chicken) and freshly caught fish. Some non-citrus fruits are low in histamine levels and include things like apples, raspberries, blueberries, melons, bananas, and kiwi. Eggs are also low in histamine. Gluten-free grains, such as rice and quinoa are also low in histamine. Fresh vegetables other than tomatoes, avocados, spinach, and eggplant are also low in histamine levels. Lastly, if you cook with oils, olive oil is low in histamine levels.

 

Elimination Diet, Headaches, and Migraines

From a dietary perspective, an elimination diet is any type of diet where you eliminate foods and beverages that you suspect your body does not tolerate well. On the elimination diet for headaches, there are some things that you might want to avoid:

  1. Caffeine and alcohol: These are known to dehydrate the body and cause headaches.
  2. Chocolate and cocoa: These are known to cause headaches. However, you may eat white chocolate.
  3. MSG: This is a flavor enhancing substance known to trigger headaches and migraines. If you want to avoid MSG, you can eat whole foods that have been flavored with natural herbs and spices. On food labels, it is often hidden as other names including glutamate, natural flavor, and partially hydrogenated vegetable protein.
  4. Processed meats: Anything like jerky, cold cuts, and lunch meats should be avoided. You can however eat fresh meats that you prepare yourself. Nitrates and nitrites are the migraine trigger culprits in these types of foods. These are vasodilating agents found in many foods, especially preserved and processed meats such as lunch meats, sausage, smoked foods, pork, bacon, salami, pastrami, hot dogs, corned beef, ham, and bratwurst. So if you have a child that is getting a lot of headaches and migraines, and eats lunch meat for lunch, you may want to look into nitrate and nitrite-free lunch meat options.
  5. Dairy: You should avoid certain dairy foods like aged cheese, buttermilk, sour cream, and yogurt. However, you can eat things like cottage cheese, cream cheese, and American varieties of cheese.
  6. Nuts: Try substituting seeds for nuts.
  7. Fruits: Avoid citrus fruits altogether. You can eat things like apples, peaches, pears, etc.
  8. Some vegetables, like onions, pea pods, and sauerkraut should be avoided. You can eat most leafy green vegetables and water-rich vegetables.
  9. Condiments: You should avoid things like ketchup, mustard, vinegar-based condiments, etc.
  10. Baked goods: Be careful to make sure that anything you eat is gluten-free while you are on the elimination diet for headaches and migraines.
  11. Avoid any artificial sweeteners altogether, like NutraSweet.
  12. Avoid Fermented foods such as sauerkraut, soy products, and pickled foods because they contain tyramine which is a migraine trigger for many patients. Brewer’s yeast also contains a large amount of tyramine. A low tyramine diet can be very helpful for some patients with migraine.

 

Overall, your doctor may advise you to try the elimination diet for a trial period to see if the foods you are eating are contributing to your headaches and migraines. When attempting to figure out what foods to try eliminating, sometimes IgG food testing against food allergens can assist in determining specific foods which may be associated with high IgG levels in the blood (meaning your immune system is reacting against them).




Inflammatory Foods, Headaches, Migraine, and the Anti-Inflammatory Diet

Another way to fight off headaches and migraines is to avoid foods that are known to cause inflammation. For example, sugar and high fructose corn syrup are found in most processed foods and sweets. In some studies, these sweet substances were known to counteract the effects of omega-3 fatty acids, which can help reduce inflammation. Artificial trans fat, vegetable oils, and seed oils can also cause inflammation, leading to headaches and migraines. Refined carbohydrates, prepared meats, and other processed foods can also cause inflammation. In addition to causing headaches and migraines, foods that cause inflammation can cause a wide variety of other issues including high cholesterol, heart disease, obesity, and diabetes.

 

There are other variations of the anti-inflammatory diet which focus on omega fatty acids including the high omega 3/low omega 6 (H3/L6) and low omega 6 (L6) diets. The thinking is based on the fact that omega 3 is anti-inflammatory, whereas omega 6 is more inflammatory and can increase pain. Fast food is often loaded with omega 6 fatty acids, along with many other chemical additives which are often migraine triggers. So the goal is to eat foods with a higher ratio of omega 3 as compared with omega 6. In fact, a recent study showed that eating fish with healthy omega ratios can help prevent migraines.

 

Fish with a healthy omega ratio include tuna (canned in water), wild salmon, swordfish, mackerel, herring, sea bass, anchovies, sardines, cod, and bluefish. Fish with a less healthy omega ratio include farm raised fish and fish canned in oil. Vegetables with a healthy omega ratio include green leafy vegetables, and those with a less healthy omega ratio include beats, carrotos, chard, and parsley. Nuts and seeds with a healthier omega ratio include walnuts, flax and chia seeds. Those with a less healthy omega ratio include almonds, pecans, cashews, and pistachios. Oils with a healthier omega ratio ratio include olive oil and canola oil, while those with a less healthy omega ratio include highly processed oils such as corn, soy, safflower, and peanut oil.

 

Gluten Free Diet (Celiac Sprue)

Celiac sprue is caused by inflammation in the digestive tract, caused by exposure to gluten. Gluten is a protein found in many grains, including barley, wheat, and rye. Thus it is a common ingredient in foods such as pizza, pasta, bread, and cereal. Patients often complain of abdominal bloating and pain, diarrhea, and headache when they eat these foods. Some patients can less commonly have additional neurological symptoms besides headaches, including unsteadiness/imbalance (ataxia), and peripheral neuropathy. Unexplained iron deficiency is common, and liver function tests are sometimes abnormal. 70% of patients with true gluten sensitivity and celiac sprue have been shown to have improved symptoms within 2 weeks of doing a gluten free diet. Many patients get loosely diagnosed or self diagnosed as “celiac disease” or “gluten sensitive”. However, the gold standard diagnosis is made by small bowel biopsy, along with supporting bloodwork. So if there are suspicious symptoms as discussed here, a gluten free diet for 2-4 weeks may be a good consideration to try.

 

Low Fat Diet

Low fat diets have been reported to decrease headache and migraines in some patients. One study looked at patients eating no more than 20 grams of fat per day. It reported significant differences in migraine frequency which went from 6 days to 1 day per month on average, along with significant decreases in migraine severity, duration, and medication intake.

 

Finding What Works Right For You

The various diets discussed above all have one principle in mind, eliminating certain foods from your diet that can cause headaches and migraines. Many of the foods that are mentioned in the diets above that are to be avoided contain Tyramine. This is the substance produced when the amino acid tyrosine breaks down and can cause headaches.

 

Not only will the right diet help you mitigate the frequency and severity of headaches and migraines, but a proper diet can also help avoid certain types of chronic health conditions. Good diet is only part of the formula that will help you reduce headaches and migraines in your daily life. Your physician will also counsel you on good diet and exercise practices to help you with your headache and migraines.

 

In summary, the answer to which diet is the best migraine diet is… there isn’t one. Finding dietary influences on migraine and headache will vary widely between patients and what their migraine may be susceptible to or what it responds to. However, if there are clues to when you get migraines in relation to any of the dietary factors discussed above when you eat meals, it may be worth trying that particular diet or dietary modification for at least 4 weeks. Any dietary changes should always be discussed and approved of with your regular medical doctor first though, to make sure it is safe to try depending on your particular medical history.

 

Regardless of dietary factors, keep in mind that having migraine means that you are wired in a way that migraines can be triggered easier as compared to someone without migraines. You may be able to identify triggers, but many times there may not be a trigger and migraines can just happen because that is the nature of the disorder, unfortunately. So you still want to ensure that you have a good migraine abortive option for when they do happen. Abortive treatments are taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack and associated symptoms. Some of these options include NSAIDs, ergots, triptans, neuromodulatory devices, the ditans (Reyvow (Lasmiditan)) and the gepants (Ubrelvy (Ubrogepant) and Nurtec ODT (orally dissolvable tablet) (Rimegepant)).

 

If the migraines are happening frequently enough, then a migraine preventive treatment should be considered. Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, CGRP monoclonal antibodies (mAbs) (Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), Vyepti (Eptinezumab)), neuromodulation devices, Botox, Nurtec ODT every other day (1st and only dually approved migraine abortive and preventive), herbal and natural supplements and vitamins, yoga and meditation, and acupuncture and acupressure.




IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 04:53 am

WHAT ARE THE CGRP MIGRAINE MEDICATIONS AND HOW ARE THEY USED?

@Neuralgroover

What is CGRP (Calcitonin Gene Related Peptide)?

During a migraine attack, the trigeminal nerves release a variety of inflammatory proteins. One of the main proteins is called CGRP (calcitonin gene related peptide). CGRP has been studied since the early 1980s when it was discovered. It was found throughout the trigeminovascular system and trigeminal cranial nerves which transmit pain in the head and face. Therefore, a role in migraine was suspected. The trigeminal nerves are central to causing migraine as explained here. The trigeminal nerves and their associated electrical circuitry throughout the brain, brainstem, and arteries in the brain is called the trigeminovascular system. This system is the basis and an “on switch” for migraine.

In the early 1990s it was shown that CGRP was released by the trigeminal nerves and levels increased during an acute migraine attack. In 2004, a CGRP antagonist (blocks the binding of CGRP to its receptor) was shown to abort (stop) an acute migraine attack, and decrease CGRP levels. Subsequent preventive migraine studies done since 2014 with a CGRP antibody to block the effects of CGRP continued to show reduction in migraine frequency and severity.

 

CGRP causes inflammation around the brain and cerebral arteries (“sterile inflammation”) in the dural membrane surrounding the brain, intensifies pain signals, enhances transmission of pain signals through the trigeminal nerves into the brainstem and into the brain, and causes dilation of the cerebral arteries through the dural membrane. Trigeminal nerve endings surround these arteries. The dilation of these arteries triggers these trigeminal nerve endings and this leads to further increasing pain signals. Think of the process like a painful meningitis, minus the infection.

 

The result of these steps is intense migraine pain (as you are unfortunately very familiar with). So, if we can block these steps of migraine pain, the attack should be aborted quickly, and not as severe. That’s the thinking here, and that’s where the CGRP medications (gepants and CGRP monoclonal antibodies) come into play, as discussed below.

 

CGRP MEDICATIONS USED TO ABORT MIGRAINE (TAKEN AS NEEDED)

Abortive migraine medications are medications taken at the onset of the migraine with a goal of lessening the duration and severity of the migraine attack. Historically, the options have included NSAIDs, ergots, triptans, and neuromodulatory devices.

 

The gepants were the first new medicine class to emerge as new migraine abortive options (FINALLY!!!) since the triptans became available in 1992. There are currently 2 oral pill gepant abortive options available. They are Ubrelvy (Ubrogepant), and Nurtec ODT (orally dissolvable tablet) (Rimegepant). These 2 gepants are discussed and compared in much greater detail here. Zazegepant will be the 3rd abortive gepant, and will be the 1st nasal spray gepant option available. It is in ongoing clinical trials currently.

 

How does Nurtec ODT and Ubrelvy (gepants) work?

Gepants work as CGRP receptor antagonists, which means they directly block (antagonist) the CGRP receptor. This results in the medication “blocking” the CGRP inflammatory protein from sticking to the CGRP receptor to activate it, and thus prevents it from “turning on” the pathways of pain described above.

 

So, you get reversal of cerebral vasodilation, which decreases the firing off of the trigeminal nerves. Notably, the gepants do this in a way that does not cause vasconstriction, in contrast to the triptans. Thus, they are felt to be safe in those with cardiovascular or cerebrovascular disease (as opposed to the triptans).

 

By blocking the CGRP receptor, you also get reversal of the neurogenic inflammation going on through the brain and around the arteries, and you block the electrical transmission of migraine pain from traveling from the trigeminal nerves into the brainstem, and ultimately into the brain.

 

The other huge benefit of the triptans compared to all other abortive options is that they do not cause medication overuse headache (rebound headache)!

 

What are the side effects of Nurtec ODT and Ubrelvy?

The side effect profile of the gepants is minimal and similar to placebo. The most common side effects of gepants are very low risk of nausea for Nurtec ODT and low risk of nausea and mild sedation with the higher dose of Ubrelvy. Side effects are discussed in more detail here.

 

In addition, there is no interaction with using them and triptans, NSAIDs, or other acute meds in case they happen to be taken close together.

 

Compared to other abortive medications such as the triptans and NSAIDS, these medications are not associated with medication overuse headache (rebound headache), which is great! They also have no addiction potential.

 

Compared to the triptans and ergots, these medications are NOT contraindicated in patients with stable cardiovascular or peripheral vascular disease or risk factors because they do not cause vasoconstriction (narrowing) of the arteries, which is a HUGE benefit.

 

Triptans are also contraindicated in patients with visual snow, persistent migraine aura, and migrainous stroke (infarction). However, gepants are felt to be safe for these patients, as well as those with hemiplegic migraine and migraine with brainstem aura (previously called basilar migraine). There are many patients who have been stuck without safe options since they have been unable to use standard therapies such as triptans due to other medical problems such as heart disease. So, we finally have a safe alternative for them, which is a highlight of these medications.

 

Can Nurtec ODT and Ubrelvy be used in pregnancy and breastfeeding?

Safety of these medications in pregnancy or breastfeeding is unknown because they haven’t been studied, and therefore are not recommended.

 

Are there drug interactions with Nurtec ODT and Ubrelvy (gepants) and other medications?

The primary drug interactions to be aware of with these medications are when used with other medications that are metabolized by the liver enzyme system called CYP3A4. Many commonly used medications are metabolized by this system. Strong or moderate inhibitors of CYP3A4 (which slow down the metabolic drug breakdown) will cause an increase in gepant blood levels. Strong or moderate inducers of CYP3A4 (which increase the metabolic drug breakdown) will cause a decrease in gepant blood levels and possibly decreased effectiveness. These medications should be avoided in patients with severe liver disease or end stage kidney disease such as those on dialysis.

CGRP MEDICATIONS USED TO PREVENT MIGRAINE

Preventive migraine treatments are used to lessen the frequency and/or severity of migraine attacks. Preventive treatments include a variety of daily pill medications, neuromodulatory devices, herbal and natural supplements and vitamins, yoga and meditation, acupuncture and acupressure. All of the medications used for migraine prevention have always been “adopted” from other specialties. In other words, these were medicines made for other purposes (such as antidepressants, antiseizure, anti-blood pressure meds), but eventually some were also found to be useful for migraine prevention.

 

There has never been a medicine engineered and created purely and only for migraine prevention. However, that changed in 2018 when the migraine preventive landscape changed abruptly and significantly. The 1st medication class designed purely and only for migraine prevention become available, called the CGRP monoclonal antibodies (mAbs). There are currently 4 CGRP mAb treatment options. They are Aimovig (Erenumab), Emgality (Galcanezumab), Ajovy (Fremenazumab), and Vyepti (Eptinezumab).

 

These medications either target the CGRP receptor (Aimovig), or the CGRP protein (Emgality, Ajovy, Vyepti). The result of “blocking” the CGRP protein or CGRP receptor prevents the CGRP pathways of pain from “turning on”, as discussed above and here. Clinically, some patients tend to respond better to the CGRP receptor blockade, whereas others tend to do better with binding the CGRP protein itself. There is not really any data on this in terms of who may respond to which type of CGRP mAb target, but I’m sure it will be studied further eventually.

 

Aimovig, Emgality, and Ajovy are all once monthly self-injections (push button autoinjection), although Ajovy also has the option of quarterly injections (3 injections every 3 months). Vyepti is the only IV (intravenous form) and is done by 30-minute IV treatment every 3 months. These individual CGRP mAbs are discussed and compared in much greater detail here.

 

What are the side effects of the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti)?

Compared to most other medications used for migraine prevention historically, the side effects of the CGRP mAbs are very low. The most common side effects reported (at a very low rate) are mild upper respiratory infections and minor injection site reactions. Aimovig has a slightly increased risk of constipation and possible mild increase in high blood pressure for some patients. These have little to no drug interactions and do not affect the liver or kidneys. Data show no immunological (they do not suppress or alter the immune system because they do not have a target within the immune system), cardiovascular, or neurological safety concerns of significance.

 

Can the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used in pregnancy and breastfeeding?

There is no data to answer this question yet. However, CGRP is suspected to play a possible role in regulating uteroplacental blood flow, myometrial and uterine relaxation, and in maintaining normal gestational blood pressure. Since the mAbs have a long half-life and can last in the system for 5 months, it is recommended to stop it about 6 months prior to pregnancy planning. The CGRP mAbs are also not recommended to use during breast-feeding since we do not have enough safety data at this time.

 

Nurtec ODT and gepants for migraine prevention.

The CGRP mAbs have been a major step forward for migraine prevention. However, up to this point, we still have not had an oral pill that has been engineered and created purely and only for migraine prevention (not “adopted” from a different medicine class as mentioned above).

 

That was until now, with development of the gepants (discussed above). On 5/27/21, Nurtec ODT (Rimegepant) made history as the first and only FDA approved medication for BOTH abortive and preventive migraine treatment simultaneously, and the only option with this flexibility and is discussed in greater detail here!

 

The perspective behind this is that migraine is a fluid and variable disease, fluctuating between periods of episodic migraine (1-14 headache days per month), and other periods of chronic migraine (15 or more headache days per month). So, having a medicine that can function as both types of treatment, depending on what type of phase the migraine is in (episodic or chronic) opens up an entirely new flexible treatment paradigm and approach which we have never had up to this point.

 

So essentially, taking Nurtec ODT every other day could be used as an ongoing daily preventive strategy (the long half-life of 11 hours allows for this spread-out dosing) when the migraine is in a high frequency to chronic migraine phase. If it evolves back into a lower frequency episodic migraine pattern, it can then just be used abortively only when needed for a migraine attack.

 

This new flexible dosing option of Nurtec ODT could also be used as a “mini-prophylaxis” within the month. For example, if patients know they are approaching a predictable migraine trigger, such as menstrual migraine, barometric trigger from an airplane trip, upcoming stressful event such as an exam, etc., the medication could possibly be taken daily or every other day starting a few days before the anticipated trigger, and stopping it a day or so after the trigger is no longer present. Unlike other migraine preventive pill treatments which take 4-6 weeks to start working and 2-3 months to see full effect, the gepants work fast and this would allow this potential treatment option to begin working immediately. In fact, studies show that migraine frequency dropped by 30% within the first week alone of preventive use.

 

Atogepant is the 2nd gepant that will be used as a daily preventive pill only and is pending FDA approval, but is anticipated soon.

 

Can the preventive CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used with the CGRP abortive gepant medications (Nurtec ODT, Ubrelvy)?

Can I use Aimovig with Nurtec ODT? Can I use Aimovig with Ubrelvy? Can I use Emgality with Nurtec ODT? Can I use Emgality with Ubrelvy? Can I use Ajovy with Nurtec ODT? Can I use Ajovy with Ubrelvy? Can I use Vyepti with Nurtec ODT? Can I use Vyepti with Ubrelvy? These are very common questions. Unfortunately, there aren’t many studies so far to clarify this, although I’m sure these questions will be studied and clarified in the near future. The gepants and the CGRP mAbs have much different structures, molecule sizes, and metabolism.

 

So theoretically, it would make sense that using an abortive CGRP medication (gepant) on top of a CGRP preventive medication (CGRP mAb) would give synergistic (working together) benefit. Using a CGRP preventive medication targeting the CGRP protein (Emgality, Ajovy, Vyepti) and a CGRP abortive medication targeting the CGRP receptor (Nurtec ODT, Ubrelvy) seems like a very sensible idea. Similarly, using a CGRP preventive medication targeting the CGRP receptor (Aimovig) combined with a CGRP abortive medication also targeting the CGRP receptor (Nurtec ODT, Ubrelvy) would make a lot of sense too. In fact, there are some limited studies which provide evidence that these medications used together do work better and are safe.

 

There was a publication of data from only a 2-patient cohort showing that the use of these acute and preventive CGRP migraine therapies together can be successful and safe. These two patients had been using Rimegepant (Nurtec ODT) in a long-term safety study and they had added Erenumab (Aimovig) once monthly injection as a preventive treatment. After Aimovig was added, patient 1 had 100% relief for 7 of 7 acute migraine attacks treated with Nurtec. Patient 2 had 100% relief for 9 of 9 acute migraine attacks treated with Nurtec. So, the combination of using Nurtec abortively in addition to using Aimovig preventively appeared to provide an even more effective acute migraine response. Larger studies to confirm the suspicion that they likely work together synergistically will be helpful.

 

There was a larger safety study publication which evaluated the acute treatment of migraine with Rimegepant while using a CGRP monoclonal antibody for the prevention of migraine. The CGRP mAbs used were Erenumab (Aimovig) (7 patients), Fremanezumab (Ajovy) (4 patients), and Galcanezumab (Emgality) (2 patients). The study determined that Rimegepant used as an acute migraine treatment in combination with CGRP mAbs for migraine prevention was well tolerated with no safety issues identified. The researchers concluded that the probability between these 2 classes (gepants and CGRP mAbs) was low, especially because they have entirely different pathways of drug metabolism. The gepants are metabolized in the liver, while the CGRP mAbs are metabolized and cleared in the reticuloendothelial system. They also concluded that existing evidence supports the safety of combined use, although further larger research was warranted.

 

Can the CGRP mAbs (Aimovig, Emgality, Ajovy, Vyepti) be used with Botox (Onabotulinumtoxin A) for chronic migraine?

The answer is yes. Insurance companies often present various hurdles to using preferred treatment options (the bane of my existence). One common issue for patients with chronic migraine who are receiving Botox injections is that most insurance companies will now make the patient choose between Botox or the CGRP mAb. There is of course no good scientific basis for this, other than the company doesn’t want to pay for both.

 

Actually, there is evidence that using Botox with the CGRP mAbs works better together than with either individually. An abstract presented at the American Headache Society Annual Scientific meeting in June 2020 showed that in patients with chronic migraine and a baseline frequency of 25.7 days per month, the frequency dropped to 14.8 days with Botox, and 9.1 days with Botox plus a CGRP mAb.

 

Can I still use my CGRP mAb (Aimovig, Ajovy, Emgality, Vyepti) with the Covid-19 vaccine?

This hasn’t been a reported issue thus far. There is no current evidence for an interaction between the Covid-19 vaccine and CGRP mAbs, the same as any other vaccine. This has also been stated by the American Migraine Foundation. Patients receiving CGRP mAbs were not excluded from the Covid-19 vaccine trials. There is no evidence at this time that these treatments cannot be used along with receiving Covid-19 vaccination, nor do they need to be delayed or timed any differently in relation to receiving Covid-19 vaccination.

 

Most physicians feel that there should theoretically be no interaction or contraindication to receiving either of these treatments in relation to Covid-19 vaccination because they are entirely different proteins with different mechanisms of action. The Covid-19 vaccine stimulates the immune system to form antibodies against the virus, should you encounter it. The CGRP mAbs do not have any significant influence on the immune system (they do not cause immunosuppression, etc.).

 

Rarely, the immune system of some patients can form neutralizing antibodies against the CGRP mAbs, and this can weaken the effectiveness of these treatments in their ability to decrease migraine frequency and severity. However, this rarity really has nothing to do with the mechanism and how the Covid-19 vaccine works. So, it is not felt that the Covid-19 vaccine will lessen the effectiveness of these treatments, nor will these treatments lessen the effectiveness of the Covid-19 vaccine.

 

Notably, there have been just a few isolated reports of dermal fillers used in dermatology causing some facial swelling in association with Covid-19 vaccination, but not with Botox or the CGRP mAbs. These reports were with the Moderna Covid vaccine and resolved with steroids and/or antihistamines. The topic of Covid-19 headache and Covid-19 vaccination is discussed further here.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 06:47 am

WHAT IS TMS (TRANSCRANIAL MAGNETIC STIMULATION), AND CAN IT TREAT MIGRAINES?

@Neuralgroover

TMS, or transcranial magnetic stimulation, is an alternative therapy for pain (including migraine headache) and some mental illnesses. It involves transmitting a magnetic pulse onto the scalp, which induces currents within the brain. This electric field activates neurons in areas of the brain that are underactive; as of now, TMS can reach depths of about 1.5 to 3 cm below the skull surface. There are many different types of TMS, but they all can target specific areas of the brain, depending on where the magnetic pulse is administered. First developed in 1985, TMS was originally, and continues to be, used for clinical trials. It is used to measure motor conduction times and assess neural excitability.

 

What are the types of TMS?

The two main categories of TMS are sTMS and rTMS. sTMS refers to single-pulse TMS. This means that only a single magnetic pulse is transmitted. With rTMS, or repeated-pulse TMS, a train of pulses is administered. Sometimes a pair of single pulses is administered, and this can be referred to as paired-pulse TMS or ppTMS.

 

Another common type of TMS is theta burst stimulation, or TBS. During theta burst stimulation, the magnetic pulse is delivered at a specific frequency that mimics brain waves. This type of TMS is sometimes preferred because it promotes neuroplasticity. It is also often referred to as Express TMS because administration takes only about 3 minutes, whereas typical 10-Hz rTMS methods can take over 30 minutes.

 

Typically, TMS is done in a clinical office and administered by a professional. This is necessary for most types of TMS, including rTMS and theta burst. There are private clinics like TMS & Brain Health that administer TMS in a safe and comfortable environment. However, personal sTMS devices are now available. These mobile neuromodulatory devices can be self-administered at home.

 

What does TMS treat?

TMS has been used in clinical settings to monitor brain activity for over 30 years and is an FDA-cleared treatment for many types of mental illnesses as well as pain management. It is most often used as an alternative therapy for Major Depressive Disorder and bipolar depression that is resistant to standard forms of treatment. Patients with depression who have tried various medications like SSRI’s are often eligible to have TMS therapy covered by health insurance. It is still recommended to resume psychotherapy or other social therapies during and after TMS treatment. TMS can also be effective in treating anxiety, PTSD, OCD, and smoking cessation for some patients.

 

There is also evidence that TMS can effectively treat migraines. sTMS has been shown to be an effective treatment for acute migraines with aura when administered at the onset of aura. It is also an FDA-cleared treatment for migraine without aura, recommended to be administered at the onset of a migraine attack. rTMS also shows promise as a preventative treatment for chronic migraine. Repeated administration of rTMS resulted in a decline in migraine frequency, duration, and intensity.

 

The first device which was FDA cleared for migraine treatment was an sTMS device, discussed further here. It was initially FDA cleared for the acute treatment of episodic migraine with aura in adults in December 2013. It then received FDA clearance for both acute and preventive treatment of migraine in adults in 2017. This clearance was then expanded to the acute and preventive treatment of migraine in children 12 years of age and older in February 2019. Prior models included the Spring TMS and sTMS mini. The newest model, SAVI, is currently the only FDA cleared device for both the acute and preventive treatment of migraine in adults and children 12 years of age or older. Since the device is used acutely and preventively, the FDA approved it for a maximum of 17 pulses per day.

 

The user holds the device against the back of the head, and presses a button to release a very short magnetic pulse at the onset of aura or a migraine attack with or without aura. The magnetic pulse delivers a fluctuating magnetic field which induces a mild electric current through the skull and onto the surface of the occipital cortex (visual cortex) of the back part of the brain. This modifies the electrical excitability and hyperactivity of the cortical neurons to block or prevent the onset of a migraine from evolving to a full-blown migraine. The device stops cortical spreading depression, which is suspected to be the basis of migraine aura in the occipital cortex. It is also suspected to interfere with thalamocortical pain pathways that are normally activated during a migraine.

 

The most common side effects were mild and brief light-headedness/dizziness, tingling over the back of the head where treatment is performed, brief tinnitus (ringing in ears), nausea, and muscle spasm. You should not use this device if you have a cardiac pacemaker, vagus stimulator (VNS) or other implanted neurostimulator, implanted cardioverter defibrillator (ICD) or any implanted medical device that stimulates the body or uses any signal from the body. It is also suggested that patients with implants affected by a magnetic field should not use this device. Examples of such implants include aneurysm clips or coils, cochlear implants, cerebral spinal fluid shunts, bullets or pellets lodged in the head or upper body, metal plates, screws, staples or sutures in skull, neck, shoulders, arms or hands, and facial tattoos with metallic ink. Dental implants, fillings or other dental appliances are okay to use the device.

 

Acute migraine treatment consists of 3 sequential pulses (early) at the onset of a migraine (aura or pain). Then wait 15 minutes. If needed, treat with an additional 3 pulses. Then wait another 15 minutes. If needed, treat with an additional 3 pulses. Studies reported that 39% of patients were pain free at 2 hours.

 

Migraine prevention treatment consists of 4 pulses twice daily. This is performed by giving 2 consecutive pulses, waiting 15 minutes, and then repeating 2 consecutive pulses. Studies reported that 46% of patients had a greater than 50% reduction in monthly headache days and averaged approximately 3 less migraine days per month.

 

The use of non-medication options for migraine such as TMS can help to avoid common side effects of standard abortive pills such as NSAIDs and triptans, and can help to avoid rebound headache (medication overuse headache).

 

What are the side effects of TMS?

TMS is FDA-cleared and it is a very safe treatment option for pain and mental illness. In general, the most commonly reported side effect is light headedness or dizziness directly after treatment that fades quickly. Most patients describe the actual TMS administration to be mildly uncomfortable, and report feeling a tapping sensation on the scalp. Additionally, TMS cannot be administered if you have any kind of metal implants or a high risk of seizure.

 

Occasionally, Virtual Headache Specialist will allow guest bloggers to write or contribute to an article on a migraine related topic. The bulk of this article was written by Ben Spielberg, M.S. with edits and contributions (especially the sTMS migraine treatment discussion) by myself. Ben Spielberg is the Founder and CEO of TMS & Brain Science, a brain health center dedicated to cutting-edge solutions for treatment-resistant depression and many other mental health needs. With his team of passionate mental health specialists, Ben has been a leader in bringing TMS, neurofeedback, and ketamine therapy to Southern California.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on October 1st, 2021 at 02:07 pm

SUMMER HEADACHES AND SUMMER MIGRAINES.

@Neuralgroover

The likelihood of a headache increases during the summer months. According to a recent study which surveyed ER visits for headaches, every 9°F rise in temperature increased a person’s short-term risk of a headache by about 7.5% before their emergency room visit. Heat, dehydration, weather changes and barometric pressure changes are the primary drivers of headaches during the summer months, but some lifestyle factors, such as the foods we eat during the summer, can also increase the risk of headaches.




Heat, Headaches, and the Weather

During the summer months, heat can be a contributor to both headaches and migraines. In certain areas of the country where barometric pressures can change suddenly during a storm, people frequently report headaches. This is a common and classic migraine trigger. Sometimes a headache may be caused by heat exhaustion, which has the following associated symptoms:

  • Dizziness
  • Muscle cramps or tightness
  • Numbness in the face and neck
  • Fainting
  • Nausea or vomiting
  • Cold, clammy, pale skin
  • Fast and weak pulse
  • Weakness or tiredness
  • Drenching sweat
  • Extreme thirst

For a summer headache that is not related to heat exhaustion, your symptoms may only include a throbbing or dull achy sensation in your head, fatigue, sensitivity to light, and dehydration. If you do have heat exhaustion, it is best to seek medical help because heat exhaustion can lead to heat stroke.

 

Relief for Heat and Weather-Related Headaches

For people prone to headaches and migraines triggered by heat, there are some ways to mitigate them. It might be wise to limit outdoor times on hotter days. Sunglasses, a hat, and sunscreen can also help. If you need to exercise, try to stay indoors in an air-conditioned environment. Sports drinks that contain electrolytes and plenty of water will also help you stay hydrated. If you already are suffering from a heat-related headache, certain essential oils, cold compresses, iced herbal teas (without caffeine), and NSAIDs can help reduce the intensity of the headache.

 

Exercise and Summer Headaches

Heat and exercise are often a combination of conditions for a headache, but if you choose to exercise, there are certain things that you can do to avoid getting a headache. Generally speaking, it is understood that when a person exercises, the blood vessels within their skull dilate. If you participate in strenuous activities, like rowing, running, weight lifting, or team sports (like baseball, softball, or volleyball), these can contribute to a headache.

Avoiding activities like these in high heat is advisable. However, another way to avoid headaches related to exercise is to develop a set of warm up exercises, which can help prevent headaches. Some good warmup exercises include stretches, followed by some light jogging and walking.




The Importance of Staying hydrated To Prevent Headaches

As a rule of thumb, people have generally learned that you should drink at least eight 8-ounce glasses of water each day. That is about two liters. However, during hot summer days when you are active, you might need to increase that to about 2-½ liters. When you are dehydrated, the brain can shrink and this causes the brain to pull away from the skull, causing a headache. When you relieve your dehydration, the brain returns to a normal state, relieving the headache.

 

Pollution, Allergens, and Summer Headaches

During the summer months, there are also other factors, like pollution and allergens, that can lead to headaches. Various air pollutants tend to increase during the summer months due to more people traveling and there being vehicles on the road. Lead, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matters all increase during the summer months and can cause headaches. Headaches that are related to pollution are often intense, sometimes leading to the point of being disabling, because they are often migraine. Pollution irritates the lungs, eyes, and triggers what is sometimes a very intense headache.

Allergy headaches have unique symptoms. Sometimes a person may experience pain localized over the sinus area and some other facial pain. More intense headaches can be throbbing and one-sided and sometimes are accompanied by nausea, and these are more likely to represent migraine.

Foods and Headaches During the Summer

More people typically barbecue and picnic during the summer months. Certain “summer foods” can trigger headaches. For example, hot dogs can potentially trigger headaches because of nitrites. Nitrites are generally present in some foods in very small quantities, but sensitivity will vary depending upon the person to this chemical. Processed meats like salami and bacon also can contain varying levels of nitrites. In this situation, it is best to substitute processed meats for something like a salad. Even the condiments that you put on your food can trigger headaches. Instead of pickles, you might want to consider swapping them for fresh vegetables on your burger. Avoid aged cheeses and try fresh herbs instead of soy-based condiments. More detailed discussion of migraine triggers can be found here.

 

Sunburn and Headaches

Generally, when we get sunburn, we think nothing of it and it goes away within a few days. However, sunburn can be more severe in certain types of situations. When swimming, sunburn is often more intense if you don’t use sunscreen. Sunburn can happen relatively quickly, within just 10 to 15 minutes of sun exposure. Some of the symptoms that you can get with severe sunburn include:

  • Tenderness and blistering of the skin
  • Pain and tingling sensations in the burned area
  • Headaches, fevers and chills
  • Nausea, dizziness, and dehydration.

The type of headache that accompanies a severe sunburn can sometimes feel like exhaustion and will often cover the entire head. To relieve a sunburn headache, cool/cold treatments can often help alleviate the intensity, including cold compresses, a cold shower, and drinking water.

 

Taking Care of Headaches During the Summer

Headaches are more frequent during the late spring and summer months. By drinking plenty of water, staying hydrated, regulating our exposure to sunshine, paying attention to food triggers, and not overexerting ourselves, we can reduce the potential for frequent and intense headaches. However, even with taking these precautions, headaches and migraines will still periodically happen. Thus, it is important to have a good abortive headache treatment such as the gepants (Ubrelvy, Nurtec ODT), Ditans (Reyvow)triptans, or regular over the counter (OTC) pain medicines such as acetaminophen, aspirin, ibuprofen, or naproxen if they work for you and if you can use them safely. If the headache frequency is high enough (generally more than 4 per month), a preventive headache or migraine treatment should be considered until your high frequency headache cycle subsides.




IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 06:46 am

ACUPUNCTURE, ACUPRESSURE, PRESSURE POINTS AND DAITH PIERCING FOR MIGRAINE, HEADACHE, AND PAIN.

@Neuralgroover

Acupuncture is an alternative medical therapy that involves thin needles being inserted into the body. Acupressure is a therapy, often used in conjunction with acupuncture, where the practitioner applies pressure to certain points of the body. These two therapies are used for a wide variety of different therapeutic purposes, but can be specifically used to address headaches and migraines with the advice of a headache specialist.

 

Acupuncture for Headaches, Migraines, and Pain

Acupuncture is a technique that is derived from ancient Eastern/Chinese medicine. It consists of inserting thin solid needles into specific acupuncture points in order to maintain the flow and balance of Qi (pronounced “chee”) in the body. Qi is another term for life force or life energy. Balancing Qi is felt to activate the body’s natural healing abilities, and achieve homeostasis (natural state of balance in physiological and organ systems and functions). It is believed that acupuncture achieves homeostasis when Qi is able to flow smoothly and unobstructed through a system of channels called meridians. This normal flow of Qi and restoring homeostasis is felt to aid in the treatment of a variety of ailments. Acupuncture affects the limbic and para-limbic networks in the brain, stimulates the nervous system, and improves communication between nerves and influences neurotransmitter actions.

Acupuncture can be specifically beneficial for headaches, migraines, and pain. In fact, the World Health Organization has endorsed acupuncture for headaches, migraines, and pain since 1979. Some research has been done to investigate the efficacy of acupuncture for headaches and migraines, and in that research, it was found that those who participated in acupuncture for headaches and migraines reported a 50% reduction in frequency of their symptoms.

Sometimes, traditional medicine is not successful in easing headache and migraine pain in sufferers and they are eager to explore other methods of treatment, like acupuncture. This therapy was developed in ancient China. According to the practice, there are fourteen points along the body called meridians. If the energy at these points in the body is disturbed, various types of pain or illness can happen. Acupuncture works by piercing these areas of the body with a thin needle.

 

How Does Acupuncture Work For Headaches, Migraines, and Pain?

It is not well understood how acupuncture specifically eases headaches and migraine pain, but it is believed that the pathways of the brain that are responsible for turning pain off are activated. Generally speaking, acupuncture is very straightforward and simple. The acupuncturist will place needles at certain points in the patient’s back and neck, the areas that are believed to be responsible for slowing pain transmission. Sometimes, a head massage will also be given while the needles are placed. An acupuncture session generally takes about an hour and the patient will have a weekly session over a duration of two weeks.

 

What Does the Medical Community Say About Acupuncture For Headaches, Migraines, and Pain?

Over the years, various medical professionals have said mixed things about acupuncture. However, a recent study by the NIH supports acupuncture as a very viable treatment for headaches, migraines, and pain. The study concludes that:

  • Acupuncture should be a first-line option for the treatment of headache and migraines.
  • It is at least as effective as preventative medications that are often prescribed for headaches and migraines.
  • In comparison to some of the medications that are on the market, acupuncture potentially has longer lasting effects, is safe, affordable, and can potentially reduce drug intake with side effects.

 

There was another publication which analyzed 15 systematic reviews of the effectiveness and safety of acupuncture in migraine treatment. This analysis concluded that acupuncture is more effective and safer than medication or sham (placebo) acupuncture in headache severity and frequency in various headache types including migraine and tension type headache.

 

Acupuncture can be safe and effective and you should consult with your healthcare practitioner on its employment and potential benefits. It should be considered as a complement and adjunct treatment to standard migraine treatments.

 

Acupressure for Headaches, Migraines, and Pain

Acupressure is very similar to acupuncture; however, acupressure does not involve needles. For some people who suffer from headaches and migraines, pressure can be applied to specific points on the body to relieve pain. An acupressure practitioner will use their fingers, palms, and elbows, as well as specialized devices to apply pressure to certain points on the body.

Acupressure may help alleviate some of the symptoms associated with migraines and headaches; however, more research is needed. A recent 2017 study by the National Institute of Health indicated that acupressure, at the very least, had the potential to reduce nausea associated with chronic migraines.

 

The Pressure Points For Headaches, Migraines, and Pain

Since acupressure and acupuncture are very similar and are often used in conjunction, the points where needles and pressure are applied (the meridians) are often the same. Here are some of the points along the body where the practitioner will apply the needle or pressure.

Ear Pressure Points

Ear pressure points, in addition to helping with migraine and headache pain, have the potential to help relieve chronic pain. Some of the points used along the ear include:

  • Ear Gate: This is the point where your ear connects with your temple.
  • Ear Apex: This is the very top of your ear.
  • Daith: The daith is near your cartilage above the opening to your ear canal.

Very little research has been done about these pressure points, but some people have reported that stimulation of the daith may lead to a reduction in headache severity and frequency. The daith piercing is done on the innermost cartilage fold near the entry of the ear canal. From a first-hand perspective, I see an extensive amount of patients in our headache center who have gotten one or two daith piercings. From my personal observations, the vast majority report no benefit at all. I have seen a few that said it did help, although they usually report this benefit wears off after a few months when I see them back in the office. I have also seen some patients whose headaches got worse and/or developed ear and nerve pain from the piercing. This certainly doesn’t mean that there is no benefit to it, but it needs to be studied more objectively. It may require a precision piercing in exactly the right pressure point spot for it to help, but this is not clear. Pain patients in clinical trials have a notoriously high placebo responder rate as well. This could also be a factor of why some tend to improve briefly and then the effect wears off.

 

Hand and Foot Pressure Points

Various pressure points on the hands and feet can also potentially reduce headaches and migraines. There is a point between your thumb and index finger where, if pressure is applied, can potentially alleviate headache pain. On your feet, points between your first and second toe and fourth and fifth toe, if pressure is applied, can reduce anxiety, reduce migraines, and decrease pain in the jaw and face.

Upper Body Pressure Points

The upper body also has several different pressure points. For example, a point between your eyebrows can potentially reduce stress. Acupuncture and acupressure applied to the points where your nose reaches your eyebrows can reduce headache and migraine frequency. The point where your neck reaches the base of your skull has the potential to reduce migraines and fatigue. Lastly, your shoulder well has the potential to release pain, headaches, and a stiff neck.

 

Are Acupuncture and Acupressure Viable Treatments for Headaches, Migraines, and Pain?

The research for headaches and migraine relief is always ongoing. The World Health Organization has endorsed acupuncture since 1979 and acupressure is very closely related and used in conjunction with acupuncture. Generally speaking, acupressure and acupuncture is at least as effective as preventative medications and therapies for headaches and migraines and may potentially have longer lasting beneficial effects without the side effects of medication. As with any therapy, acupuncture and acupressure should be explored as a possible treatment after consultation with your primary care physician or headache specialist.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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Last updated on September 17th, 2021 at 06:46 am

YOGA AND MEDITATION FOR HEADACHE, MIGRAINE, AND PAIN.

@Neuralgroover

Yoga and meditation can help with fitness and mindfulness, but there are additional benefits. These activities can help you with migraines, headaches, and other types of pain. Yoga has the ability to help you:

  • Alleviate stress, which is a common source of headaches, migraines, and pain.
  • Sleep better, as sleep deprivation can cause or worsen headaches and migraines.
  • Support better posture, as poor posture is an agitator of migraines and headaches.
  • Reduce muscle tightness, as tension in your back, shoulders, and neck can be a contributor to migraines and headaches. Keep in mind that there is often an interconnection between neck and shoulder musculature and headaches. 70% of patients with migraine get neck pain and stiffness associated with their migraine attacks. Conversely, if there is significant tightness and spasm in these muscles, they can irritate the nerves in the back of the head (occipital nerves), and this can also contribute to headaches and migraines. So targeting these muscles to get them to relax can be very helpful.

 

There was a study published which looked at adding on yoga therapy in combination with standard migraine medical treatments. The study results concluded that yoga as an add-on therapy in migraine was superior to medical treatment alone. Therefore, it was suggested to integrate yoga as a cost-effective and safe intervention into the management of migraine. Other prospective randomized open label trials, systematic reviews, and meta-analyses have shown yoga to decrease headache frequency, headache pain intensity, and headache duration in both migraine and tension type headaches.

 

Tips for Starting Yoga To Improve Headaches, Migraines, and Pain

If you are thinking about starting yoga to improve your headaches, migraines, or pain, there are a few tips to keep in mind:

  • Always speak with your doctor before beginning to see if it is a good fit for you.
  • Consider a beginner’s class if you are new to yoga.
  • Check with the instructor to tell them about your headaches, migraines, or pain. They can recommend good poses or even modify certain poses so that they do not contribute to agitating your headaches or migraines.
  • Avoiding certain types of poses, like inversion, can reduce the likelihood of causing a headache.

 

 

Yoga Poses That Your Instructor Might Recommend To Reduce Headaches, Migraines, and Pain

There are a few poses that many yoga instructors might recommend if you suffer from headaches, migraines, or pain. These include:

  • Child’s pose: This pose can reduce tension in your upper body.
  • Cat and cow pose: This pose increases circulation, as well as reduces tension in your shoulders and back.
  • Seated forward fold: This pose opens up your shoulders and stretches out your back, a great way to relieve the tension in these areas of your body that causes headaches.
  • Legs up the wall: This pose helps blood flow towards your brain, which can help alleviate an existing headache.
  • Savasana: This pose uses the ground below your body to provide throughout and can increase oxygen to your brain, alleviating an existing headache or migraine.

Not only are the poses that go along with migraines beneficial, but some of the other techniques that go along with yoga, like breathing can help with headaches and migraines. Alternate nostril breathing is a common way to calm the mind and relieve stress. Yoga also helps tames the anxiety center of the brain, which is another way to relieve stress.

 

Meditation for Headaches, Migraines, and Pain

Meditation reduces stress and can possibly impact the severity of headaches and migraines. A recent study by the NIH was conducted that found several interesting results when meditation was used for headache and migraine sufferers:

  • The frequency and intensity of headaches and migraines could potentially decrease as a result of meditation.
  • People who practiced meditation had a decreased use of non-opioid medications over time.

The benefits of meditation for headaches and migraines include:

  • The ability to potentially lower stress levels, a key driver of headaches and migraines.
  • An improved pain tolerance with the onset of headaches and migraines.
  • A reduction in the frequency and intensity of headache, migraines, and other types of pain.
  • A better quality of life.

 

Meditation and migraine were studied in 92 patients and results were published. Over 30 days, the frequency of migraines decreased significantly. Medication usage was also significantly lower in the meditation group.

 

Different Types of Meditation Techniques To Try For Headaches, Migraines, and Pain

There are several different types of meditation techniques that you can try that can potentially help with stress reduction. These different techniques can also take your thoughts off of your headache, migraine, or pain.

Mindfulness Meditation

This type of meditation has its origins in Buddhism and is one of the most popular meditation techniques to try. When practicing mindfulness meditation, you will focus on your thoughts, as well as sensations, thoughts, and feelings.

Visualization Meditation

This type of meditation involves visualizing positive scenes and images and focusing on them. Another type of thing to focus on with visualization meditation is thoughts and scenes of where your headache, migraine, or pain has subsided.

Progressive Relaxation

This type of meditation is common to help you relax before you sleep and involves reducing tension in the body and promoting an overall sense of relaxation. This technique also involves “scanning” your body to isolate areas of pain and tension. When focusing on the head, shoulders, and neck, this technique can be particularly effective in reducing the intensity of headaches and migraines.

Movement Meditation

This technique involves changing your surroundings. You can take a walk, practice gardening, or even exercise while being aware of sensations and feelings within your body. Movement meditation can help reduce stress, which may in turn, alleviate the onset of headaches, migraines, and other types of pain.

 

 

Additional Benefits of Meditation

Meditation indirectly reduces the onset and severity of headaches, migraines, and other types of pain. However, there are several additional health benefits, over time, that come along with meditation practices:

  • Meditation has the power to reduce blood pressure, which can be a driver of headaches and other chronic diseases, like diabetes. High blood pressure is also the leading cause of stroke.
  • Anxiety is a condition that can be potentially alleviated by meditation.
  • Meditation can also increase feelings of self-worth, which can help overcome depression.
  • Sleep can be aided by meditation and improved sleep can also help reduce the onset of headaches, migraines, and pain.

 

 

Reducing Tension, Stress, and Anxiety

Overall, meditation and yoga are an array of techniques that you can use to reduce stress, tension, and anxiety in your body. These are things that can contribute to headaches. Yoga may help increase blood flow in the body, which can also help reduce headaches, migraines, and pain.

Overall, it is best to consult your doctor when considering treatments for headaches, as yoga is an advanced technique that you should work with an instructor on.

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

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