New insight, treatments for migraine headaches: brain wave differences in females now seen as a risk factor. And an Alzheimer's drug leads the list of new treatments.
"We know that migraine is much more common in women than in men, but we haven't understood the mechanisms that cause this gender difference," says neurologist Andrew Charles, MD, professor and director of the Headache Research and Treatment Program in the Department of Neurology at UCLA School of Medicine. "Our study ... showed there may be a fundamental brain mechanism involved."
Brain mechanism studied. Dr. Charles, Dr. K.C. Brennan, and colleagues at UCLA studied migraine in male and female mice by inducing a phenomenon called cortical spreading depression (CSD), which is considered a fundamental mechanism for migraine. With CSD, waves of brain activity pass over the cerebral cortex, or the part of the brain called the "gray matter," eventually leading to activation of headache. The researchers found that female mice required much less stimulation than male mice to activate the particular brain waves associated with migraine.
"Males required as much as two to three times the amount of stimulation to evoke the same response as females," says Dr. Charles.
It is well known that migraines occur more commonly around the time of the menstrual period in women. However, the researchers found that female mice had increased brain excitability compared with males regardless of the time of their hormonal cycle, indicating that there is more to the gender difference than simply cycling levels of hormones.
In a separate study, Dr. Charles and colleagues evaluated memantine (Namenda), a drug approved to treat Alzheimer's disease, to see if it would help migraine sufferers. Memantine appears to block the wave of brain activity associated with migraine. A study of almost 60 patients with migraine who took memantine as a preventive therapy showed promising results, and the UCLA Headache Program has now treated nearly 200 patients with this therapy.
"What we found was that even some patients who had tried and failed most other first-line medications for migraine had significant improvement with memantine," Dr. Charles says.
Further larger studies are planned, he adds. Because memantine was well-tolerated in the study, it may be a good alternative for older patients.
Prevention, treatment options. In the meantime, what is the best migraine drug therapy for people in their 60s and older? Merle Diamond, MD, associate director at the Diamond Headache Clinic in Chicago, says that migraine medications usually belong in one of two categories--treatment or prevention (see breakout box at left).
Some drugs are not appropriate for older patients, Dr. Diamond says. Ergot or triptan medications (dihydroergotamine and zolmitriptan, for example) cause blood vessels to constrict, which can aggravate heart disease. In patients with heart disease or risk factors such as smoking, she prescribes a prescription-strength nonsteroidal anti-inflammatory drug or narcotics. She does prescribe triptans in patients older than age 60 who are healthy and do not have heart disease risk factors.
"You have to look at each patient individually," she says.
The National Institutes of Health is now recruiting for more than 50 clinical trials for people with migraines. To find out more, go to: www.clinicaltrials.gov or call 800352-9424. For more information on the National Headache Foundation, go to www.headaches.org, or call 888-643-5552.
Talk to your doctor about therapies to prevent or treat migraines, as follows:
Antidepressants such as amitriptyline (Elavil)
Beta-blockers, such as propanolol (Inderal)
Calcium channel blockers, like verapamil (Calan)
Anticonvulsants, like divalproex (Depakote)
Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen and acetaminophen
Ergotamine/ergot combinations (Ergomar)
Triptans such as sumatriptan (Imitrex)
Narcotics such as codeine
Anti-nausea drugs like promethazine (Phenergan)
WHAT YOU CAN DO
* Avoid missing meals, consuming too much alcohol (especially red wine), excess caffeine, or meats preserved with nitrates.
* Do not sleep either too much (more than 8 hours a night) or too little (less than six hours).
* Prevent stress by finding activities that relax you and avoiding those that upset you.
* Be aware of environmental factors, such as weather or time zone changes, glaring lights, or strong odors.
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|Date:||Jan 1, 2008|
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