The findings are noteworthy because high-dose intravenous aspirin is not widely available for headache sufferers in the United States, the authors say. Aspirin also is nontoxic, non-addictive, non-sedating, has few side effects for adults, and is less expensive than drug regimens such as triptans that physicians typically prescribe to headache patients to combat severe pain.

The study was published in the September 21, 2010, issue of Neurology, the medical journal of the American Academy of Neurology.

“These results tell migraine sufferers, their doctors and insurance providers that high-dose intravenous aspirin is a beneficial way to treat difficult withdrawal headaches via a medicine that is not addictive or toxic,” said Peter Goadsby, MD, PhD, lead investigator of the study, professor and director of the UCSF Headache Center. “We hope to make this inexpensive therapy more available to patients seeking treatment for severe pain.”

Many headache and migraine sufferers can manage pain without hospital stays. However, for severe pain that is difficult to manage, medication overuse often is a complicating factor. To develop a successful treatment plan for these patients, physicians first turn to a hospital inpatient program where medication withdrawal can be overseen by a neurologist or pain specialist. High-dose intravenous aspirin can help patients manage headache pain while undergoing medication withdrawal, the study shows.

The American Academy of Neurology estimates that more than 30 million Americans suffer from migraine, a syndrome characterized by recurrent, often excruciating headaches. The National Headache Foundation estimates that migraine causes 157 million lost workdays each year due to pain and associated migraine symptoms, resulting in a $13 billion burden on American employers.

Further research is needed to understand how exactly the aspirin works to reduce headache pain, the UCSF team said, but the findings give neurologists a safe and effective treatment option for migraine sufferers that is less expensive than the alternative multi-drug alternative. At present, the cost for IV aspirin costs around $7 per dose depending on the drug provider. Triptans cost about $22 per pill.

For the study, researchers reviewed the charts of 168 patients ranging in age from 18 to 75 years – 51 were men and 117 were women. Nearly all subjects (159) were admitted to the hospital for severe headache complicated by medication overuse. Participants received doses of one gram of aspirin – the equivalent of three times the dose for typical pain relief – through an IV, and averaged five doses.

Nurses’ notes and the hourly diaries of 86 participants were used to measure the safety and effectiveness of the high-dose intravenous aspirin. Participants kept hourly diaries about their pain before, during and after treatment, rating their pain on a 10-point scale. Scores of 1-3 associate with a mild headache, 4-7 indicates a moderate headache, and 8-10 signifies a severe headache.

Approximately six percent of participants experienced side effects ranging from nausea and vomiting to pain from the IV insertion, but none were considered severe. Potential side effects of aspirin include heartburn, nausea, bleeding, worsening of asthma, rash and kidney impairment.

“It is important to acknowledge that a placebo was not used in this case because participants knew they were receiving aspirin therapy,” Goadsby said. “However, a number of previous placebo-controlled trials have shown intravenous aspirin to be effective for migraine.”

Keywords: Aspirin, Benzoic Acids, Carboxylic Acids, Drugs, Headache and Migraine, Hospital, Hydroxy Acids, Nausea, Nervous System Diseases, Neurologic Manifestations, Neurology, Organic Chemicals, Pain, Pharmaceuticals, Salicylic Acids, Therapy, Treatment, University of California — San Francisco. This article was prepared by Obesity, Fitness & Wellness Week editors from staff and other reports. Copyright 2010, Obesity, Fitness & Wellness Week via NewsRx.com.

“Genetic analysis ruled out pathological mutations in the known genes for familial hemiplegic migraine, but identified a homozygous 65-bp deletion (Delta65bp) in the C terminus of NBCe1, corresponding to the codon change S982NfsX4. Several heterozygous members of this family also presented glaucoma and migraine with or without aura. Despite the normal electrogenic activity in Xenopus oocytes, the Delta65bp mutant showed almost no transport activity due to a predominant cytosolic retention in mammalian cells. Furthermore, coexpression experiments uncovered a dominant negative effect of the mutant through hetero-oligomer formation with wild-type NBCe1. Among other pRTA pedigrees with different NBCe1 mutations, we identified four additional homozygous patients with migraine,” wrote M. Suzuki and colleagues, University of Tokyo, Department of Internal Medicine (see also Headache and Migraine).

The researchers concluded: “The immunohistological and functional analyses of these mutants demonstrate that the near total loss of NBCe1 activity in astrocytes can cause migraine potentially through dysregulation of synaptic pH.”

Suzuki and colleagues published their study in Proceedings of the National Academy of Sciences of the United States of America (Defective membrane expression of the Na(+)-HCO(3)(-) cotransporter NBCe1 is associated with familial migraine. Proceedings of the National Academy of Sciences of the United States of America, 2010;107(36):15963-8).

For additional information, contact M. Suzuki, University of Tokyo, Dept. of Internal Medicine, Bunkyo-ku, Japan.

Keywords: Country:Japan, Headache, Headache and Migraine, Migraine, Neurology. This article was prepared by Obesity, Fitness & Wellness Week editors from staff and other reports. Copyright 2010, Obesity, Fitness & Wellness Week via NewsRx.com.

http://clinics.migrainetrust.org/

Migraine is the most common neurological condition in the developed world.  It is more prevalent than diabetes, epilepsy and asthma combined – eight million people in the UK have migraine

Migraine is a condition of recurring headaches that may be linked with other symptoms, such as sensitivity to light and noise, nausea, vomiting, dizziness and eyesight changes.

Key facts and figures about migraine:

• Among adults of all ages, migraine is one of the top 20 causes of disability expressed as years of healthy life lost to disability (The World Health Report 2001, WHO)
• Severe migraine attacks are classified by the World Health Organisation as among the most disabling illnesses, comparable to dementia, quadriplegia and active psychosis  (Shapiro & Goadsby, Cephalalgia, September 2007)
• Migraine is the least publicly funded of all neurological illnesses relative to its economic impact (Shapiro & Goadsby, Cephalalgia, September 2007)
• In the UK, there are an estimated 190,000 migraine attacks every day (Steiner et al, Cephalalgia, 2003)
• An estimated 25 million days are lost from work or school because of migraine (Steiner et al, Cephalalgia, 2003)
• Just over a third (34.3%) of migraine sufferers face difficulties or discrimination at work because of their condition (The Migraine Trust, 2004)
• Over half (54%) of migraineurs experience one or more attacks per month, and 13% claim one or more attacks per week (Steiner et al, Cephalalgia, 2003)
• Women are more likely to have migraine attacks than men – 18% of women and 8% of men (Steiner et al, Cephalalgia, 2003)
• Children can get migraine attacks too.  Attacks can start at any age, but they usually start in children who are in their early to mid teens (Goadsby et al, New England Journal of Medicine, 2002)
• A survey of neurologists found that up to one-third of all patients consulted because of headache – more than for any other complaint (WHO, Factsheet 277, March 2004)
• Depression is three times more common in people with migraine or severe headaches than in healthy individuals (WHO, Factsheet 277, March 2004)
• Migraine remains undiagnosed and undertreated in at least 50% of patients, and less than 50% of migraine patients consult a physician (Pavone, Banfi, Vaiani & Panconesi, Cephalalgia, September 2007)

This fact sheet was produced by the Education Department at The Migraine Trust.  The information in this fact sheet has been read and checked for accuracy and relevance by headache professionals and people living with migraine.

SOURCE: http://www.migrainetrust.org/C2B/document_tree/ViewADocument.asp?ID=43&CatID=28

These facts are available as a factsheet here: http://www.migrainetrust.org/module_images/FactSheet8Facts.pdf

The exact reason why a migraine occurs is unknown. However, research suggests that attacks are linked to chemical changes in the body and that blood vessels and certain nerve cells in the head are involved.

These changes appear to be triggered in susceptible people by stress.

Other triggers reported are:

* Physical fatigue or lack of sleep
* Too much sleep
* Certain foods such as cheese and alcohol
* Extreme emotions
* Missed meals
* Hormonal factors, such as use of the contraceptive pill and periods

The Migraine Trust has produced a comprehensive factsheet on migraine triggers which can be downloaded here for free: http://www.migrainetrust.org/module_images/Factsheet3Triggers.pdf

Exercise is sometimes cited as a migraine trigger – the Migraine Trust have a free fact sheet on this too: http://www.migrainetrust.org/module_images/FactSheet10Exercise.pdf

The Migraine Action Association also runs a helpline on: 01932-352468.

There are two types of migraines:

Migraine without an aura (common migraine)

This consists of a severe, throbbing headache, usually located on one side, with abdominal symptoms including loss of appetite, nausea, vomiting, dislike of food, constipation or diarrhoea. This affects about nine out of 10 sufferers.

Sufferers may also experience sensitivity to smell, light and noise, which leads them to rest in a quiet, darkened room.

70-90% of people with migraine experience this type (Source: Migraine Trust Factsheet, http://www.migrainetrust.org/module_images/Factsheet1WhatisMigraine.pdf)

Migraine without aura has sometimes been called:

Common Migraine
Hemicrania Simplex

Migraine with aura (classical migraine)

The headache is preceded by visual disturbances such as flashing lights, zig zag lines and blind spots, or tingling limbs.

The average length of a migraine attack is 22 hours and sufferers generally feel washed out for another one to two days afterwards.

The average number of attacks per sufferer is 13 per year.

Some of this information is taken from BBC News Website (Health) which was last Updated: Friday, 3 September 1999.

10-30% of people with migraine experience this type (Source: Migraine Trust Factsheet, http://www.migrainetrust.org/module_images/Factsheet1WhatisMigraine.pdf)

Migraine with aura has sometimes been called:

Classic or Classical Migraine
Focal Migraine
Ophthalmic Migraine
Hemiparasthetic Migraine
Aphasic Migraine
Migraine Accompagnee
Complicated Migraine

Other types of migraine

There are other types of migraine described elsewhere on this site, including Retinal Migraine, Abdominal Migraine, Menstrual Migraine, Status Migrainosus, Basilar-type Migraine (formerly called Basilar Artery Migraine), Familiar Hemiplegic Migraine (FHM), and Sporadic Hemiplegic Migraine.

A migraine can be a very, very frightening experience because many of your senses are affected.  You can’t function as normal – your sight, speech, sense of smell and touch may all change.

How migraines feel for me

Sometimes my symptoms don’t immediately alert me that I have a migraine as they could be attributed to other things.  I may feel very cold, or more commonly, feel really hungry and actually be able to eat a huge amount of food and still feel starving.  Or I may feel sick at the thought of eating and want to throw up when I smell certain things like fried food or coffee.  This stage is a bit like having extreme morning sickness.

I’m often short tempered too in the early stages, and find myself snapping at people for no reason.  A bit like having PMT!

The first definite sign that I have a migraine usually relates to my sight, before I even have a headache.  I’ll start to see blobs or find it hard to read words (sometimes without visual disturbance).  Sometimes, it looks a bit like an out of tune TV.  It creeps up from one corner of my eye and slowly creeps across both eyes.  It can take seconds or minutes to develop, and this stage (often what people call the aura) lasts for between 10 minutes and 2 hours.  I’ve had one very extreme case where it lasted for several days at which point we decided to call out the doctor and I learned about Zomig!  Migraines that last for several days or weeks are known as Status Migrainosus (intractable migraine).

For a good few of my migraines I’ve had some other scary symptoms.  My face and the left side of my body has gone completely numb.  I’ve heard this description of symptoms before from people who’ve had a stroke and I did think the first time it happened I was having a stroke.  My speech becomes slurred and I don’t make a lot of sense, I’m told.  My coordination is badly affected – I struggle to pick up objects – part because I can’t see properly but part because my aim seems to be all wrong – and I definitely can’t read.  Trying to read, with any little part of my sight that is left, actually makes me feel sick.

When it eventually does clear, the visual disturbances go quite suddenly – over the course of about a minute.  My sight then returns to normal.  Any other symptoms, like numbness, tingling, paralysis etc also feel less noticeable about this time.  But my lack of coordination usually stays with me a while.  I also find it difficult to concentrate or think straight and I’ve discovered that driving is a definite no-no.

The best thing for the first visual stage, for me, is to go to sleep in a very dark room.  Sunglasses help if you need to get up.  I find it clears quicker if I sleep, perhaps because I’m more relaxed.

Usually after the visual disturbance, I get the headache.  The headache isn’t like an ordinary headache.  It feels like your brain is going to explode.  There’s a real feeling of pressure and I don’t like anything touching my head – I have to have a really soft pillow if I’m lying down.   The headache lasts for around 2-3 hours.

There’s also a nausea stage – sometimes this starts at the beginning of the headache stage, and sometimes a lot later on.  This ranges from feeling mildly sick, to actual vomiting.  Light seems to make me more prone to being sick (for example, if I try and use the PC after I’ve had a migraine).  Strong smells, loud noises etc also seem to make me more nauseous.  The nausea stage for me lasts at least a couple of hours – and often carries on right through the evening.

A typical migraine will put me out of action for a whole day.  Sometimes I can feel the affects of the migraine for 2 or 3 days afterwards.  I have used Zomig to take away my migraines – you dissolve Zomig on your tongue and it clears the aura very quickly.  But I find that after using Zomig, the symptoms that follow the aura are usually more extreme, and I also feel more confused and disoriented after using the Zomig, so in the past year, I’ve just gone for sleeping in a dark room when they come on, reserving Zomig for the extreme migraines where I feel numbness and partial paralysis.

If you experience symptoms like these, it is recommended that you keep a migraine diary.  An example is provided by the Migraine Trust and can be downloaded here:

http://www.migrainetrust.org/module_images/FactSheet5aMigraineDiaries.pdf

Stages of a migraine

The stages of a migraine that I’ve described above fit into four stages that are used clinically.

Premonitory Stage of the Migraine

This describes certain physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and a stiff neck. These feelings can last from 1 to 24 hours.

Aura Stage of the migraine

This may last from 5 to 60 minutes. Symptoms may include visual disturbances such as flashing lights or sensory symptoms such as pins and needles.

Main Attack Stage

This consists of head pain and associated features which can typically last anything between 4 and 72 hours. The head pain is typically described as throbbing and one sided.

Resolution and Recovery Stage or Postdrome Stage

Most migraines fade slowly although some can be resolved suddenly by vomiting, for example.

These four stages are described on the Migraine Trust Factsheet, ‘What is Migraine’ which can be downloaded for free here: http://www.migrainetrust.org/module_images/Factsheet1WhatisMigraine.pdf

Typical migraine symptoms include:

• persistent throbbing or pounding pain in the head
• feeling of pressure in the head
• sensitivity to light
• sensitivity to sound
• sensitivity to movement
• nausea
• vomiting
• diarrhoea
• feelings of exhaustion.

Aura

Some migraine headaches can cause other neurological (to do with the brain) symptoms – called aura.

These are usually visual disturbances that start before or accompany the headache, including flashing lights, black spots, zig-zag patterns or distorted vision.

You might also get a stiff neck, have tingling or stiff limbs, or have difficulty speaking.

For many, the symptoms are so severe that they are forced to lie down in a quiet dark room and wait until the migraine stops.

Abortive migraine treatment

This is sometimes referred to as acute treatment or pain-relieving treatment. The goal of abortive migraine treatment is to prevent a migraine attack or to stop it once it starts.

The medication perscribed can stop a headache during its prodrome stage or once it has begun and may be taken as needed.

Some abortive migraine treatments are administered as a self-injection into the thigh.  Others can be taken as a wafer that melts on the tongue.

These forms of medication are especially useful for people who vomit during a migraine, and they work quickly.

Abortive treatment medications include the triptans, which specifically target serotonin.

They are all very similar in their action and chemical structure.

The triptans are used only to treat headache pain and do not relieve pain from back problems, arthritis, menstruation, or other conditions.

• Sumatriptan (Imitrex)
• Zolmitriptan (Zomig)
• Eletriptan (Relpax)
• Naratriptan (Amerge, Naramig)
• Rizatriptan (Maxalt)
• Frovatriptan (Frova)
• Almotriptan (Axert)

The following drugs are also specific and affect serotonin, but they affect other brain chemicals.

Occasionally, one of these drugs works when a triptan does not.

• Ergotamine tartrate (Cafergot)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Acetaminophen-isometheptene-dichloralphenazone (Midrin)
• Ergotamine tartrate (Cafergot)
• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
• Acetaminophen-isometheptene-dichloralphenazone (Midrin)

The following drugs are mainly used for nausea, but they sometimes have an abortive or preventive effect on headaches:

• Prochlorperazine (Compazine)
• Promethazine (Phenergan)

The next drugs are weak members of the narcotic class. They are not specific for migraine, but they can help relieve almost any kind of pain. Since they are habit forming, they are less desirable than the specific headache drugs listed above. These drugs should be used primarily as a “backup” for the occasions when a specific drug does not work.

• Butalbital compound (Fioricet, Fiorinal)
• Acetaminophen and codeine (Tylenol With Codeine)

Preventive migraine treatment

This type of treatment is considered if a migraineur has more than 1 migraine per week. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:

• Medications used to treat high blood pressure – Beta-blockers (propranolol [Inderal]), calcium channel blockers (verapamil [Covera])
• Antidepressants – Amitriptyline (Elavil), nortriptyline (Pamelor)
• Antiseizure medications – Gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax)
• Some antihistamines and anti-allergy drugs, including diphenhydramine (Benadryl) and cyproheptadine (Periactin)

Source

Some of the information on this page was taken from WebMD Medical Reference from eMedicineHealth, reviewed by Jonathan L Gelfand, MD on January 23, 2008 © 2007 WebMD, Inc. All rights reserved.