Most Migraines Successfully Treated
By Michael Lasalandra
Beth Israel Deaconess Medical Center CorrespondentRose Ducharme has suffered from severe migraine headaches for more than 20 years.“I’d get two or three a week and they were debilitating to the point where I couldn’t function to my full capacity on a daily basis,” says the 47-year-old corporate recruiter from Lexington.“People who haven’t suffered them think they are just headaches,” she says. “They don’t know about the intensity of the pain, the nausea, the duration. You are miserable.”Like Ducharme, most migraine sufferers are women -- three out of four. Nobody knows what causes migraines, but hormonal changes clearly play a role. Over half of women with migraine report having them right before, during, or towards the end of their period. Others may get them for the first time when taking birth control pills. Although most sufferers start getting migraine attacks before age 35, some women start getting them when they enter menopause.Migraines can be felt on either side of the head or both sides. The pain is mostly in the front around the temples or behind one eye or ear. They can last for hours or for days.Treating migraines is a tricky business, but most cases can be treated successfully, says nationally known headache and pain specialist Dr. Zahid Bajwa, Director, Education and Clinical Pain Research, at Beth Israel Deaconess Medical Center in Boston and Assistant Professor of Anesthesia and Neurology at Harvard Medical School.“The vast majority of patients can be treated successfully with currently available therapies,” he says. “That’s the important message. Some cases can be very challenging and frustrating, requiring a multidisciplinary approach to reduce the frequency, intensity and duration of migraine attacks.”Treatments for acute migraine attacks have improved significantly. They include including migraine-specific medications called triptans, which work to normalize dilating blood vessels. Like most other acute migraine therapies, triptans also work the best if taken at the onset of a migraine attack.Some patients combine triptans with general painkillers such as non-steroidal anti-inflammatories (NSAIDS) and anti-nausea medications, Dr. Bajwa notes.If migraine attacks are very frequent, patients may take preventive medications including anti-seizure medications, anti-depressants or certain blood pressure medications to help prevent them from starting in the first place, according to Dr. Bajwa.Some patients turn to alternative therapies such as acupuncture, herbal remedies, nutritional supplements or special diets. Stress management, meditation, relaxation and biofeedback also can be very helpful, as stress and sleep disorders can exacerbate migraines.Botox injections can be helpful for certain patients who are not responding to other medical therapies. Trigger point injections and a variety of nerve blocks using local anesthetics, with or without steroids, may also help some patients, Dr. Bajwa says.Ducharme says she tried just about everything over the years without much success.“I tried all the drugs, triphans, anti-depressants, preventatives you take at night,” she says.Then about two years ago she saw Dr. Bajwa being interviewed on TV about a study he was running that sought to test out injections of Botox -- botulinum toxin type A -- to treat migraines. She enrolled in the study and has been on a regimen of botox injections, alternating with trigger point injections and nerve blocks with Marcaine, a local anesthetic, and Depo Medrol, a long-acting steroid, ever since.“I get a shot every three months,” she says. “I’m down from three migraines a week to about one a month. I’d say I’m about 75 percent better. They’re definitely less frequent, less severe and don’t last as long.”Botox, a popular treatment for wrinkles, works by preventing release of a neurotransmitter called acetylcholine into the area where muscles meet nerves, causing temporary weakness. Doctors aren’t quite sure how it works to help prevent migraines and stress that it doesn’t work for everybody. Botox is not approved by the FDA for the treatment of migraine or any other type of headache.One study in which Dr. Bajwa participated showed Botox reduced migraine attacks in people with the most frequent and most severe headaches.In that study, reported in 2005, patients received between 10 and 25 Botox injections every 90 days for a total of three treatments. Before the study, the patients averaged 14 migraine attacks a month. After the Botox treatments, they reported an average of six migraines -- a 55 percent drop.“What we have found is that for some patients, Botox is dramatically beneficial where many other treatments fail,” Dr. Bajwa says. “But it is clearly not first line therapy. It’s actually a treatment of last resort.”Dr. Bajwa is working with Rami Burstein, an internationally known researcher and scientist and associate professor of anesthesiology at BIDMC, to try and find out why Botox works for some patients but not for others.
Beth Israel Deaconess Medical Center CorrespondentRose Ducharme has suffered from severe migraine headaches for more than 20 years.“I’d get two or three a week and they were debilitating to the point where I couldn’t function to my full capacity on a daily basis,” says the 47-year-old corporate recruiter from Lexington.“People who haven’t suffered them think they are just headaches,” she says. “They don’t know about the intensity of the pain, the nausea, the duration. You are miserable.”Like Ducharme, most migraine sufferers are women -- three out of four. Nobody knows what causes migraines, but hormonal changes clearly play a role. Over half of women with migraine report having them right before, during, or towards the end of their period. Others may get them for the first time when taking birth control pills. Although most sufferers start getting migraine attacks before age 35, some women start getting them when they enter menopause.Migraines can be felt on either side of the head or both sides. The pain is mostly in the front around the temples or behind one eye or ear. They can last for hours or for days.Treating migraines is a tricky business, but most cases can be treated successfully, says nationally known headache and pain specialist Dr. Zahid Bajwa, Director, Education and Clinical Pain Research, at Beth Israel Deaconess Medical Center in Boston and Assistant Professor of Anesthesia and Neurology at Harvard Medical School.“The vast majority of patients can be treated successfully with currently available therapies,” he says. “That’s the important message. Some cases can be very challenging and frustrating, requiring a multidisciplinary approach to reduce the frequency, intensity and duration of migraine attacks.”Treatments for acute migraine attacks have improved significantly. They include including migraine-specific medications called triptans, which work to normalize dilating blood vessels. Like most other acute migraine therapies, triptans also work the best if taken at the onset of a migraine attack.Some patients combine triptans with general painkillers such as non-steroidal anti-inflammatories (NSAIDS) and anti-nausea medications, Dr. Bajwa notes.If migraine attacks are very frequent, patients may take preventive medications including anti-seizure medications, anti-depressants or certain blood pressure medications to help prevent them from starting in the first place, according to Dr. Bajwa.Some patients turn to alternative therapies such as acupuncture, herbal remedies, nutritional supplements or special diets. Stress management, meditation, relaxation and biofeedback also can be very helpful, as stress and sleep disorders can exacerbate migraines.Botox injections can be helpful for certain patients who are not responding to other medical therapies. Trigger point injections and a variety of nerve blocks using local anesthetics, with or without steroids, may also help some patients, Dr. Bajwa says.Ducharme says she tried just about everything over the years without much success.“I tried all the drugs, triphans, anti-depressants, preventatives you take at night,” she says.Then about two years ago she saw Dr. Bajwa being interviewed on TV about a study he was running that sought to test out injections of Botox -- botulinum toxin type A -- to treat migraines. She enrolled in the study and has been on a regimen of botox injections, alternating with trigger point injections and nerve blocks with Marcaine, a local anesthetic, and Depo Medrol, a long-acting steroid, ever since.“I get a shot every three months,” she says. “I’m down from three migraines a week to about one a month. I’d say I’m about 75 percent better. They’re definitely less frequent, less severe and don’t last as long.”Botox, a popular treatment for wrinkles, works by preventing release of a neurotransmitter called acetylcholine into the area where muscles meet nerves, causing temporary weakness. Doctors aren’t quite sure how it works to help prevent migraines and stress that it doesn’t work for everybody. Botox is not approved by the FDA for the treatment of migraine or any other type of headache.One study in which Dr. Bajwa participated showed Botox reduced migraine attacks in people with the most frequent and most severe headaches.In that study, reported in 2005, patients received between 10 and 25 Botox injections every 90 days for a total of three treatments. Before the study, the patients averaged 14 migraine attacks a month. After the Botox treatments, they reported an average of six migraines -- a 55 percent drop.“What we have found is that for some patients, Botox is dramatically beneficial where many other treatments fail,” Dr. Bajwa says. “But it is clearly not first line therapy. It’s actually a treatment of last resort.”Dr. Bajwa is working with Rami Burstein, an internationally known researcher and scientist and associate professor of anesthesiology at BIDMC, to try and find out why Botox works for some patients but not for others.
