Don't dismiss aspirin for those migraines

Aspirin may seem too old-fashioned to be effective against headaches as severe as migraines, but that doesn't appear to be the case.

In a review of previous studies, researchers at the Cochrane Library found that 1,000 milligrams of good old-fashioned salicylic acid works fairly well at easing migraine pain.

For 1 in 4 people, it takes away the pain completely in two hours. For 1 in 2 people, it reduces the pain to mild or better. In fact, the medicine cabinet staple works about as well as the prescription drug sumatriptan at controlling the headaches.

An anti-nausea drug, specifically metoclopramide, can ease that roiling feeling that often accompanies migraines, the researchers add.

Here's the review summary.

And here's information on sumatriptan (brand name Imitrex), metoclopramide (Reglan) and aspirin  (Bayer, Bufferin among others), all from RxList.

Plus, a good overview of migraines from MedicineNet and a summary of migraine treatment from the American Headache Society.

-- Tami Dennis

Photo illustration credit: Gary Friedman / Los Angeles Times

For cluster headaches, oxygen is good medicine, study finds

"Cluster headache is probably the most severe pain known to humans. Most female patients describe each attack as worse than childbirth."

You’d think that such an excruciating condition would require some mighty strong medicine. But a study coming out today in the Journal of the American Medical Assn. -- the source of the statement above -- concludes that cluster headaches can be treated by inhaling pure 100% oxygen.

Cluster headaches affect about 0.3% of the general population, according to the study. The National Institutes of Health says the debilitating headaches can strike daily for weeks at a time. Other sources say the bouts can last for months before patients go into remission.

Migraine drugs such as Imitrex (sumatriptan) are typically prescribed to stop the pain, but there are limits on daily usage. A small study of 15 patients has found that inhaling high-flow oxygen for 15 minutes was helpful. A trio of researchers from the National Hospital for Neurology and Neurosurgery in London decided to test the therapy more rigorously.

They found 76 patients who suffered cluster headaches and treated them for four attacks. They were asked to inhale either pure oxygen or normal air (which includes 21% oxygen) through a face mask for 15 minutes. Neither the patients nor the providers knew which odorless, colorless gas was being administered.

But there was a difference. When asked to rate their pain relief, 78% of patients said they felt fine within 15 minutes of breathing high-flow pure oxygen. By contrast, only 20% of patients had the same response after being treated with high-flow regular air. Oxygen continued to outperform air at 30 and 60 minutes after the onset of the attack, according to the study. The researchers didn’t report any serious adverse effects.

The study was funded in part by Linde Industrial Gases, a German supplier of industrial and medical gases. One of the study’s authors disclosed that he had served on a Linde advisory board about the use of oxygen to treat cluster headaches.

-- Karen Kaplan

Photo illustration: Excruciating headache? Oxygen may help. Credit: Gary Friedman / Los Angeles Times

Surgery may cure some cases of migraine

Surgery to remove so-called trigger points for migraines can lead to dramatic improvements in patients' health, researchers from University Hospitals in Cleveland reported today at a Seattle meeting of the American Society of Plastic Surgeons. Although surgery may seem like a drastic solution for what some people consider simple headaches, migraines are a major, debilitating problem for those who suffer them. They can produce severe pain and sensitivity to light and noise, sometimes restricting a patient to bed for a day or longer and dramatically interfering with their ability to function normally. Migraines can sometimes be prevented or mitigated with prophylactic drugs, and a relatively new family of drugs called triptans can reverse symptoms for many people. Surgery could be a last resort for those who can't find relief through other treatments.

Dr. Bahman Guyuron, chairman of plastic surgery at University Hospitals Case Medical Center, and his colleagues performed surgery on 79 migraine sufferers, who were then followed for at least five years. Ten of the patients required additional surgeries and were removed from the analysis. Sixty-one of the remaining 69 patients maintained their positive response to the procedure for the full five years. Twenty patients reported elimination of the migraines entirely, 41 reported a significant decrease in symptoms and frequency, and  eight experienced less than a 50% improvement.

For patients with frontal migraines, Guyuron removes the corrugator supercilii (frowning) muscle group in the forehead, which is thought to compress nerves and produce inflammation. For temple migraines, he removes a small branch of the trigeminal nerve. For headaches that are located behind the eye and triggered by weather changes, he works on the nose septum and surrounding structures. Guyuron said he had performed more than 1,000 procedures on more than 450 patients total.

-- Thomas H. Maugh II

Prone to headaches? Drink coffee. No wait, don't.

As medical writers, we are used to penning an article one week that says oat bran prevents colon cancer and the next week that it does nothing of the kind. Such, too often, is the pendulum-swing way of studies. Not that it isn't frustrating for us as well as for readers, especially since we're prone to alter our habits -- at least for a femtosecond or two -- based on studies we cover (to say nothing of becoming convinced we've got every disease we write about).

And sometimes there are reports in which a foodstuff or habit prevents and causes something in the same study. Here's one. A study in the Journal of Headache Pain surveyed 50,483 Norwegians about their caffeine consumption and headache frequency. The scientists found that those who consumed higher amounts of caffeine reported a greater number of occasional headaches than those who consumed lower amounts of caffeine. But ("for no obvious reason," the scientists said) those who consumed less caffeine suffered more chronic headaches (headaches for 14 or more days every month).

Finally, because the study was a survey of people simply living their lives, it can't even be concluded that caffeine was the issue in the headaches. It could have been some other factor: The habit of consuming caffeine may track with other habits that people do or don't have. And foods that contain caffeine can contain other items that may also make one's head pound.

It's enough to give you a headache.

Actually, this isn't the first time scientists have reported a confusing relationship between caffeine and headaches.

Read more about that here, for example.

Here's how caffeine might help, according to the above website: "Caffeine has a range of effects on the body, one of which is the narrowing of blood vessels, which then restricts blood flow. Since blood vessels are thought to expand at the onset of headaches, it is thought that caffeine's vasoconstrictive property eases the pain of headaches and migraines. Caffeine is also believed to increase the effectiveness of many pain relievers, and is therefore added to various headache medications. It would then be logical to suggest that less pain reliever would be required to obtain the intended benefits of the medication."

And how it makes things worse: "Caffeine can, however, also cause some unpleasant feelings such as restlessness, headaches, dizziness, shaking and insomnia. In addition, caffeine stimulates the heart and raises metabolic rate. It is at higher doses that the unpleasant effects of caffeine are more likely to occur."

Withdrawal from caffeine can also cause headaches.

It's a morass.

--Rosie Mestel

Look years younger! Get rid of your headaches! (True, or too good to be true?)

Looking for another reason why you “need” a forehead lift? The surgery eliminates or reduces pain for migraine sufferers, Case Western Reserve researchers reported.

In a double-blind study published in the August issue of Plastic and Reconstructive Surgery, patients with frequent moderate to severe migraine headaches with pain radiating from a single region were treated surgically -- with excellent results.

Botox injections to the forehead, neck or shoulders have already been shown to help some people who suffer from migraines, possibly by relaxing key muscles. But the pain eventually comes back. In this new study, doctors were seeking a more permanent solution via plastic surgery.

The doctors first injected patients with Botox to determine the location of the trigger site for each person's migraine: the forehead, temple or back of the head.

Those who reported a decrease in migraine symptoms upon Botox injections were then selected for surgery to deactivate the trigger site in a procedure similar to that of a traditional forehead lift.

In the study, 76 patients in total were assigned randomly to undergo either a sham surgery (serving as the control group) or an actual operation. Unaware of which surgery they had received, patients recorded the frequency, intensity and duration of their headaches for the next 12 months.

The researchers found that 28 of 49 patients (57.1%) in the actual surgery group reported complete elimination of migraine headaches at the end of a year, compared to just 1 of 26 patients (3.8%) who had undergone sham surgery.

Forty-one of 49 patients (83.7%) in the actual surgery group had significant improvement in migraine frequency, intensity and duration, compared to 15 of 26 patients (57.7%) in the control group.

“This is an outpatient operation. Each trigger site takes about 45 minutes or so,” said study coauthor Dr. Bahman Guyuron, a plastic surgeon at University Hospitals Case Medical Center in Cleveland. “Patients go home right away after surgery and are back to work in about a week.”

And, Guyuron added, “We’re not introducing the surgery for cosmetic reasons. But this is more of a reason to have the surgery if a patient is [already] thinking about cosmetic surgery.”

Some of the study’s methods and findings have raised some eyebrows among other physicians, however.

Dr. Sheena Aurora, neurologist and director of the Swedish Headache Center in Seattle, said she wondered whether the observed effects might have been caused at least in part by the Botox -- and not the surgery alone.

“It seems a bit too good to be true," said Dr. William Young, an associate professor of neurology at Thomas Jefferson University and director of the inpatient program at the Jefferson Headache Center. "For migraines, these results are unheard-of from any treatment, anywhere.”

Young wonders whether the patients truly remained in the dark about whether they'd received real or sham surgery: If they didn't, the results could have been confounded by the so-called placebo effect -- in other words, people who knew they'd had the procedure may have been more inclined to believe that they had improved. “Somehow, patients can know whether they got the real treatment or not," Young said.

Another issue is whether these results would be generalizable to migraine patients at large, said Young's colleague Dr. Michael Marmura, an assistant professor of neurology at Thomas Jefferson University. In this study, “only patients with an excellent response to small doses to Botox injections were included,” Marmura said. “Basically … these are not typical patients.”

“I think they did a meticulous job of patient selection,” said Dr. Richard Lipton, a professor and vice-chair of neurology at Albert Einstein College of Medicine and director of the Montefiore Headache Center.  “But because the patients were so carefully selected, the results don’t apply to everyone. They only apply to a subgroup of migraine sufferers with identified triggers and a demonstrated response to Botox."

“There’s a lot of natural skepticism for things that are new,” Lipton added. “I think it’s really exciting and would love to see it replicated.”

-- Shara Yurkiewicz

Migraine sufferers, lace up your sneakers

Migraine sufferers often avoid exercise because they believe the exertion will trigger symptoms. But a recent study shows that regular exercise — even at a vigorous level — may offer some relief for those with the condition.

The study, conducted in Sweden, included 26 people who took part in a 40-minute indoor cycling exercise program three times a week for 12 weeks. Each session began with a 15-minute warm-up in the light to moderate range, segued into a 20-minute exercise bout that increased the intensity into a more challenging range, and ended with a five-minute cool-down.

Participants kept a diary of their migraine attacks, noting the days, the intensity of the pain, and how much medication was taken. They also filled out a questionnaire regarding quality of life. Researchers measured VO2Max, or the maximum amount of oxygen a person can use during intense exercise — a good measure of fitness.

By the end of the study, VO2Max increased considerably and study participants found their symptoms did not get worse during the study. They also had fewer migraines, less intense pain, and used less migraine medication during the last month.No one reported side effects, although one person did have a migraine attack immediately after exercising. Scores in the quality of life questionnaire also improved notably at the end of the study.

Dr. Emma Varkey, co-author of the study, said via a release: "While the optimal amount of exercise for patients with migraine remains unknown, our evaluated program can now be tested further and compared to pharmacological and non-pharmacological treatments to see if exercise can prevent migraine." The study apears in this month’s issue of Headache: The Journal of Head and Face Pain.

-- Jeannine Stein

Photo credit: Gary Friedman / Los Angeles Times

Does pollution cause migraines?*

High temperatures and low air pressure trigger migraines, according to a large study published online today in the journal Neurology. But researchers did not find a clear association between headaches and air pollution.

Triggers increase the probability of having a migraine attack. A variety are well-known: red wine, chocolate, soft cheese and the beginning of the menstrual cycle.

Weather -- especially changes in air pressure -- is frequently cited as a headache trigger but it had not previously been shown in such a large, well-designed study.

The researchers, from Boston's Beth Israel Deaconess Medical Center and the Harvard School of Public Health, were curious about pollution because fine particulate pollutants cause or complicate other health problems, including heart attacks, stroke, congestive heart failure and asthma.

The study included 7,054 headache patients of both genders and varying ages and ethnic groups who were seen at the medical center's emergency room between May 2000 and December 2007. Researchers looked at temperature levels, barometric pressure, humidity, fine particulate matter and other pollutants during the three days before each patient was seen in the ER and for a control day, in which the patient did not report a headache.

A rise in temperature was strongly associated with headaches: An increase of 5 degrees Celsius (9 degrees F, as a reader has so kindly pointed out below) increased the risk of migraine by 7.4%. Low air pressure, which often precedes storms, played a smaller role.

"This study provides pretty rigorous scientific proof that changes in temperature are migraine triggers, and that's something that's not been known before," said Dr. Richard Lipton of the Montefiore Headache Center in New York City.

Knowing what can trigger an attack gives migraine sufferers a measure of control, said Lipton, who was not associated with the study. One of his patients, for example, moved from New York City to Arizona because air pressure in the Southwest is less changeable.

Triggers often work in concert. So migraine sufferers could, for example, be especially careful to avoid red wine and chocolate on hotter days or when a storm is forecast.

Lipton was less convinced by the study's finding on ambient air pollution, which, he said, was harder than temperature to measure over a large region. But he also said that a similar study that found a correlation between particulate matter and asthma also used a central monitoring site.

The migraine study did find a borderline association between headaches and levels of nitrogen dioxide, found in smog and car exhaust. Given the role of fine particulate matter in cardiovascular disease, the researchers called for additional study on its relation to migraines.

-- Mary Engel

Photo credit: Janet Morgan Mol / Novartis Pharmaceuticals

D.M.G.Y.H.? (or, Do Mnemonics Give You Headaches?)

They do me. Maybe it's the memory of an unsuccessful U.K. 1970s road safety campaign that used the word "SPLINK." The I in SPLINK stood for "If traffic is coming..." The N was for "When there is no traffic near..." And the K? "Keep looking and listening for traffic." Kids, not surprisingly, did not pick it up very easily.

Hey, did I mention headaches? As it happens, the National Headache Foundation has just released its own mnemonic in honor of the 15th Annual National Headache Awareness Week, which kicks off June 1. Its aim is to hammer home coping tools --or, as the foundation puts it, to "get a Head S.T.A.R.T. on your headaches."  (Me, I'd sooner W.A.I.T. on my headaches.)

According to a release from the foundation, the S.T.A.R.T stands for:

Seek diagnosis — Obtaining the correct diagnosis for your headache is the first step toward effective treatment.
Triggers — Identify and track your triggers (e.g., foods, stress, hormonal and weather changes)         
by keeping a headache diary and share this information with your healthcare provider.
Advocate — Be an advocate. Be informed. Be a participant in your headache care.
Resources — Utilize the National Headache Foundation as a resource. Visit www.headaches.org
for the latest information about headache causes and treatments, or call (888) NHF-5552.
Treatment — Successful treatment may include medications and lifestyle changes. Work with your healthcare provider to find the right plan for you.

It's not fabulous, but it's better than SPLINK -- and at least anyone trying to recall it won't risk getting flattened by a truck.

You can find more about the events planned for National Headache Awareness Week at the foundation's website.

--Rosie Mestel

Illustration: Stephen Sedam