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VoLUME 11, ISSUE 6  
NOVember 2006

 
November 14th Meeting of East Bay Headache Support Group:  
 
“Talk It Over Night” -- Discussion with Dr. Michael Stein, Headache Specialist

Bring your questions!  Michael Stein, MD, medical advisor and co-founder of the East Bay Headache Support Group, will lead us in a group discussion at the November 14th meeting.  Now’s your chance to ask questions of a headache specialist without paying a dime.

Dr. Stein has a private neurology practice in Walnut Creek, and specializes in aiding headache patients to gain control over their symptoms.  He is also director of the Neurological Institute of the East Bay which conducts studies of drugs for headache treatment and prevention.

Family and friends are welcome.  Join us in the Hanson Room downstairs at John Muir Medical Center-Walnut Creek Campus, 7:30 to 9:00 p.m., Tuesday, November 14.   Call Carol at 925-229-5550 for more information.

Next Meeting: Robin Polokoff, PhD:  The Effects of Nutrition on Headaches.  Unknown date in 2007 to be announced.

Editorial by Leslie Davis, co-founder and Headlines newsletter editor

Part of our November 14th meeting will be devoted to discussing how the support group should continue into 2007 (our 12th year).  Since 1996 we’ve held more than 90 meetings on a wide variety of topics, with an equally wide range of attendance—as many as 120 and as few as 5.

But people seem to be less interested in support groups, probably preferring to get their information off the Internet in the privacy of their own homes.  In fact, many support groups across the nation have disbanded.

Are you getting useful information and support from the East Bay Headache Support Group’s meetings and newsletters?  Or, is it time for us to downsize, that is, hold only 2, 3 or 4 meetings per year, or even hang it up?

It is very frustrating for the Planning Committee to find speakers and advertise and then have only a few people show up for the meetings.  I realize that some who receive our newsletter do not live close enough to Walnut Creek to attend meetings, but many do.

So, please plan on attending the November 14th meeting for a discussion of these issues.  And if you can’t make it, send us your thoughts—either an e-mail to Leslie Davis at davisgold@gmail.com or regular mail to Donna Johnson, 402 Kit Fox Court, Walnut Creek, CA 94598.

This editorial replaces our annual insert in each November newsletter.  So that we can support you better, please answer the following questions and return to either Leslie or Donna at addresses above.

Mailing List:  Do you want to continue receiving newsletters?  Do we have your correct address?  If you’d like to receive newsletters via e-mail instead, please provide your e-mail address.

Volunteers:  Would you like to join the Planning Committee to help find speakers and fold/label/stamp newsletters?  We’re also in need of a webmaster.

Speakers:  Please suggest speakers and/or topics you’d like to hear at future meetings.

Donations Accepted:  The East Bay Headache Support Group is a nonprofit 501(c)(3) organization and all of our speakers and volunteers donate their time and expertise.  Pharmaceutical companies have contributed monies to the group in the past, but we cannot depend on them any longer.  Please consider making a donation of any amount to help pay printing, postage and Web site expenses.  Make out your check to East Bay Headache Support Group and mail to Donna Johnson, 402 Kit Fox Court, Walnut Creek, CA 94598.  Also specify if you’d like a receipt.

Thank you for your interest and support.

Leslie Davis

New Analysis Shows Patients Who Treat Their Migraine Pain Early With Trexima™ Have Higher Sustained Pain-Free Rates
21 September 2006

Migraine sufferers frequently cite lack of recurrence of migraine symptoms as one of the most desired attributes of an acute migraine treatment.  Now, a new analysis of four studies showed that patients who treated their migraines with Trexima while pain was mild and within one hour of the start of pain were nearly twice as likely to be pain free at 2 hours, and remain pain free through 24 hours, than those who waited until the pain was more severe.  These findings were presented today at the 16th Migraine Trust International Symposium in London.

“Patients are often hesitant to treat their migraine early as they are concerned that the medicine will wear off and their symptoms will return.  These results are exciting because they may help dispel this myth,” said Jan Lewis Brandes, M.D., director of the Nashville Neurosciences Institute and lead study investigator. “These findings show that by treating a migraine early with a product like Trexima patients are more likely to still be pain free 24-hours later than if they wait to treat in the later stages of a migraine.”

Trexima, the proposed brand name for a single tablet containing sumatriptan 85 mg as the succinate salt, formulated with RT Technology(TM), and naproxen sodium 500mg, is currently under review by the United States Food and Drug Administration (FDA) for the acute treatment of migraines in adults.

Migraine pain is believed to be induced not only by the widening of blood vessels, or vasodilation, but also by inflammation, leading to increased nociception (perception of pain) and sensitization of nerves.  This complex sequence of events occurs long before patients feel pain and take their medication.

About the Studies

Data were derived from identical, randomized, multi-center, double-blind, placebo controlled studies.  This analysis evaluated sustained pain-free responses, defined as pain free at 2 hours and maintained through 24 hours, in these studies.

Two studies evaluated the clinical benefits of treating migraine early (while pain was mild and within one hour of the start of pain) with sumatriptan/naproxen sodium or placebo.  These findings showed:

1)  Significantly more patients who  treated with sumatriptan/naproxen sodium achieved a sustained pain-free response (45% and 40%) compared to patients who received placebo (12% and 14%).

Two studies evaluated the benefits of treating migraine late (when pain is moderate to severe) with sumatriptan/naproxen sodium; 85 mg of sumatriptan, formulated with RT Technology; 500 mg of naproxen sodium; or placebo.

2)  Significantly more patients who treated with sumatriptan/naproxen sodium achieved a sustained pain-free response (23% and 25%) compared to patients who treated with sumatriptan alone (14% and 16%), naproxen sodium alone (10% and 10%), or placebo (7% and 8%).

Sumatriptan/naproxen sodium was well-tolerated in all four studies.  The most common adverse events were dizziness, somnolence, nausea, tingling, dry mouth, dyspepsia, and chest discomfort.

 

Found on the Medical News Today Web site at http://www.medicalnewstoday.com/medicalnews.php?newsid=52360

Patients with Migraine Headaches Tested With Spinal Cord Stimulators

29 September 2006

Researchers at Rush University Medical Center are testing a new treatment for migraine headaches: occipital nerve stimulation, a surgical procedure in which an implanted neurostimulator delivers electrical impulses to nerves under the skin at the base of the head at the back of the neck.

This therapy may help migraine sufferers who do not respond to other available therapies, or who cannot tolerate the side effects of existing medications.  

“The purpose of the randomized, double-blinded study is to evaluate the safety and efficacy of occipital nerve stimulation as a treatment for refractory migraine headache,” says Dr. Sandeep Amin, Rush study investigator and anesthesiologist who surgically implants the device in the two-visit operation.

The study, known as PRISM (Precision Implantable Stimulator for Migraine), uses Boston Scientific’s Precision neurostimulator with approximately 150 patients at up to 15 sites in the U.S. 

The Precision device, the smallest rechargeable neurostimulator available, is currently FDA approved for spinal cord to treat chronic pain by precisely delivering tiny electrical signals to the spinal cord that mask the perception of pain.  Spinal cord stimulation is prescribed for patients with chronic pain in the limbs, trunk and back.

Excerpted from a news release on the Medical News Today Web site at http://www.medicalnewstoday.com/medicalnews.php?newsid=52908

Sinus, Allergy and Headache By David R. Marks, MD,  Alan Rapoport, MD

Many people who suffer from headaches mistakenly believe that their pain is due to “sinus headaches” or to allergies.  Although these conditions can occasionally cause headache, they are not the underlying cause of headaches in the vast majority of headache sufferers.  Most people who think they have chronic sinus headache actually have chronic tension-type headache.  Before beginning a course of treatment for headache, a physician should consider reversible causes such as allergies and sinusitis.  However, self-diagnosed sufferers who seek over-the-counter, mail order or alternative cures for allergies and sinuses are not likely to achieve satisfactory pain control.

Sinuses and Headaches

Sinuses are air pockets within the bones of the forehead, face and nose which are lined with mucus membranes.  The sinuses open into the nasal passages, providing a mechanism for draining the mucus fluid produced by the sinus mucus membranes.  If this drainage is blocked, fluid builds up, causing pain and pressure in the blocked sinus cavity.  In this situation, the patient may complain of head pain that is often localized to the region of the head or face corresponding to the location of the underlying blocked sinus cavity.

Acute infection of the sinuses, otherwise known as acute sinusitis, is one example of a true sinus headache.  Although acute sinusitis is the result of a bacterial infection within the sinus cavity, it often follows a viral infection such as the common cold.  In this scenario, the virus causes nasal congestion which interrupts normal sinus drainage, resulting in a blocked sinus space in which bacteria can grow and flourish. In addition, the initial viral infection disables the tiny hairs which line the mucus membranes of the nose and sinuses and which normally help propel sinus secretions forward toward their drainage site.  As a result, sinus secretions lie stagnant in a blocked sinus cavity and are extremely susceptible to infection by bacteria.

Acute sinusitis often produces dramatic, painful symptoms and must be treated quickly.  In addition to pain, it is often accompanied by fever, a redness of the skin over the sinus, and yellow-green discharge from the nostrils and the back of the throat.  Treatment consists of antibiotic therapy and measures to help improve sinus drainage, such as decongestants and nasal steroid inhalants, which help to decrease the swelling of the mucus membranes.  Successful treatment of the infection should result in a resolution of the headache pain.

Chronic sinusitis is a result of a low-grade inflammation in any one of the sinuses.  The pain of chronic sinusitis is less severe than that of acute sinusitis and is more of an aching sensation over the sinus.  Chronic sinusitis is often accompanied by post-nasal drip and thickened nasal secretions.  It can be difficult to diagnose and can often only be detected by a “CAT” scan of the sinuses.

Many people feel that their headaches are caused by sinus problems because the pain of migraine and tension-type headaches can occur in the same location of the head and face as the pain of a sinus infection.  In addition, headaches such as migraines and cluster headaches are commonly triggered by changes in weather and can be accompanied by symptoms such as a runny nose and watery eyes.  These overlapping symptoms can cause confusion and lead to the mistaken belief that a person’s headaches are due to a sinus condition.

Allergies and Headaches

In general, allergies do not cause headaches.  However, allergies can cause nasal congestion which can lead to blockage of the sinuses as described above.  It is important to note that in this situation, it is not the allergy itself that causes the headache, but the infection that can arise as a result of the inflamed nasal passage.  Proper treatment of allergies can prevent headaches by interrupting the chain reaction of events that can result in attacks of acute sinusitis.

Certain foods (such as caffeine, chocolate, aged cheeses, alcohol, peanuts, MSG, and hot dogs) can trigger migraine headaches for some people, but the mechanism involved is not actually an allergy.  Although many people think that a “bad reaction” to a food is the same as an allergy, it is not.  Some of us simply have differences in our body chemistry so that irritating substances are released when we digest certain foods, such as apples or tomatoes.  An allergy develops when the immune system wrongly identifies some substance as dangerous and launches a counterattack in the form of hives, swelling, wheezing, sneezing, or other signs of hypersensitivity.  Food-induced headaches may indeed be a “bad reaction,” but that does not mean that the person is allergic to the offending food.

Related Causes

Abnormalities of the sinus cavities such as polyps, growths, and tumors are rare causes of headache.  They are unlikely to cause headache unless they inhibit mucus drainage from the sinus into the nose.  They are usually discovered because the patient begins to experience repeated episodes of acute sinus infections.  Any other condition which can cause a blocked sinus, such as a severely deviated septum and an abnormally located sinus drainage duct, can also result in sinusitis.  However, if these anatomical conditions do not cause recurrent episodes of acute sinusitis, then their surgical correction is not likely to result in significant headache relief.  Other more common conditions, such as migraine or tension-type headache, should be considered.

David R. Marks, MD, MPA.  Medical Director, The New England Center For Headache.  Stamford, CT
Alan M. Rapoport, MD. Co-founder and Director, The New England Center For Headache. Stamford, CT
From Headache, the Newsletter of the American Council for Headache Education (ACHE), Spring 1997, vol. 8, no. 1
Found on ACHE’s Web site: www.achenet.org

The intention of the East Bay Headache Support Group is to provide information and resources.  It does not provide medical advice, which should be obtained directly from a physician.

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