In-Focus: Headache and Migraine

 

Vitamin D Deficiency Tied to Headache

Decreased vitamin D levels appear to be linked with chronic tension-type headache (CTTH), according to results from a new study. In a case-control study, investigators evaluated 100 adult patients with CTTH and 100 matched healthy controls and found that serum 25(OH) D levels were significantly lower in CTTH patients than in the controls. Additionally, the prevalence of vitamin D deficiency (defined as less than 20 ng/mL) was greater in patients with CTTH (71 percent vs. 25 percent). CTTH patients also had a significantly high prevalence of musculoskeletal pain, muscle weakness, muscle tenderness score, and bone tenderness score in comparison to controls. The authors noted a strong positive correlation between serum vitamin D levels and total muscle tenderness score and total bone tenderness score. They concluded that intervention studies are required to find out if supplementation of vitamin D is effective in patients with CTTH.

—Headache. 2017, May 3

Ibuprofen and Lorazepam Found Effective in Acute Migraine

The combination of ibuprofen and lorazepam is effective in alleviating symptoms of acute migraine, new findings suggest. Researchers examined 90 patients with an average of two to six attacks per month and an initial diagnosis of migraine based on the International Headache Society (IHS) criteria. The first group was administered 200mg Ibuprofen capsules, the second group 400mg Ibuprofen capsules and the third group a combination of 200mg Ibuprofen capsules and 1mg Lorazepam tablets. All three treatment regimens reduced the severity of headache significantly in patients. However, the combination therapy produced the lowest mean severity of headache, according to the investigators.

— Electron Physician. 2017, Mar 25;9(3): 3912-3917

Hypothalamus Discovered to Play a Role in the Pathophysiology of Chronic Migraine

The hypothalamus plays a crucial role in the pathophysiology of migraine chronification and acute pain stage of migraineurs, according to new research. To identify pathophysiologic mechanisms of migraine chronification, researchers evaluated 18 migraineurs (EMs), 17 chronic migraineurs (CMs), and 19 healthy controls (HCs) who underwent painful ammonia stimulation of the left nostril in a 3T MRI scanner. Using brainstem-optimized protocol for high-resolution echo-planar imaging, they detected a significantly stronger activation of the anterior right hypothalamus in CMs compared to HCs. To exclude the headache as a prime mediator of the hypothalamic activations, they compared all migraineurs with headaches (EMs and CMs) to all migraineurs without headaches (EMs and CMs) and to HCs in a second analysis and found the more posterior region of the hypothalamus to be more activated bilaterally during headaches. “While the more posterior part of the hypothalamus seems to be important for the acute pain stage, the more anterior part seems to play an important role in attack generation and migraine chronification,” the authors wrote.

—Neurology. 2017, Apr 26

FDA Releases Non-Invasive VNS Therapy for Pain Associated with Episodic Cluster Headache

The FDA has released the use of gammaCore, a non-invasive vagus nerve stimulator for the acute treatment of pain associated with episodic cluster headache in adult patients. The device transmits a mild electrical stimulation to the vagus nerve through the skin, resulting in a reduction of pain.

The decision was based on subgroup analyses from two trials in the ACT (Non–Invasive Vagus Nerve Stimulation for the ACute Treatment of Cluster Headache) clinical trial program evaluating the safety and efficacy of gammaCore for the acute treatment of episodic cluster headache.

For more insight on how the gammaCore device may fit in the current spectrum of neuromodulation treatments, see the article here.

 

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About Practical Neurology

Launched in January 2002, Practical Neurology strives to enhance quality of care and improve the daily operation of neurology practices. Each month, our experts explain the real-world significance of recent advances in neurologic science and offer step-by-step advice on how to overcome the clinical and business challenges neurologists face. Our straightforward, how-to articles give neurologists tools they can put into practice right away.

 
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