Dr. Curtis McElroy

Tag: migraine

  • Breakthrough Medicines – Migraine Headache

    Breakthrough Medicines – Migraine Headache

    Migraine headaches are a neurological condition characterized by intense, throbbing pain, typically on one side of the head. They are often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines can last for hours or even days, and they can significantly affect a person’s quality of life.

    Common Symptoms of Migraines:

    1. Intense headache (usually one-sided but can occur on both sides)
    2. Nausea and vomiting
    3. Sensitivity to light (photophobia)
    4. Sensitivity to sound (phonophobia)
    5. Aura: About 25% of migraine sufferers experience an “aura” before or during the migraine, which can include visual disturbances like flashes of light, blind spots, or zigzag patterns.
    6. Fatigue and irritability before or after the headache.

    Migraine Phases:

    1. Prodrome: Occurs hours or even days before a migraine. Symptoms include mood changes, food cravings, and fatigue.
    2. Aura: Some individuals experience visual or sensory disturbances before the headache.
    3. Headache: The main phase, with severe pain, nausea, and sensitivity to light and sound.
    4. Postdrome: The “migraine hangover” where people feel exhausted, confused, or unwell even after the pain subsides.

    Types of Migraines:

    • Migraine with Aura: Visual or sensory disturbances precede the headache.
    • Migraine without Aura: The most common type, where no aura occurs.
    • Chronic Migraine: Occurs more than 15 days per month.Causes and Triggers:

     

    While the exact cause of migraines is not fully understood, they are believed to be related to abnormal brain activity affecting blood flow, neurotransmitter levels, and nerve signaling.

    Common triggers include:

    • Stress
    • Hormonal changes (e.g., during menstruation)
    • Certain foods (like chocolate, aged cheeses, and processed meats)
    • Alcohol (especially red wine)
    • Changes in sleep patterns
    • Environmental factors (bright lights, loud sounds, strong smells)
    • Weather changes

    Treatment:

    Migraines can be managed with medications, lifestyle adjustments, and preventive strategies:

    1. Pain relievers: Over-the-counter (OTC) medications like ibuprofen or prescription drugs.
    2. Triptans: These medications specifically target migraine-related brain activity.
    3. Preventive medications: For frequent migraines, doctors may prescribe drugs such as beta-blockers, antidepressants, or anti-seizure medications.
    4. Non-medication treatments: Biofeedback, relaxation therapy, acupuncture, and lifestyle changes (like maintaining regular sleep, eating, and exercise routines).

    Medication Advancements

    There have been several notable advancements in the treatment of migraines in recent years, particularly with the development of medications that target specific pathways involved in migraine pathophysiology. Here’s an overview of some of the most important developments:

    1. Calcitonin Gene-Related Peptide (CGRP) Inhibitors

    Calcitonin Gene-Related Peptide (CGRP) inhibitors are a class of medications primarily used to prevent migraines. They work by targeting and blocking the action of CGRP, a neuropeptide involved in the transmission of pain and the dilation of blood vessels in the brain, which are key processes in migraine attacks.

    Mechanism of Action:

    • CGRP is released during a migraine attack and is thought to contribute to the headache by promoting inflammation and dilation of blood vessels in the brain.
    • CGRP inhibitors are designed to block CGRP or its receptor. By doing this, they reduce the peptide’s ability to cause inflammation and vasodilation, which helps to prevent or reduce the severity of migraines.

    Types of CGRP Inhibitors:

    • Monoclonal Antibodies are designed to bind to CGRP itself or its receptor and are administered via injection. Examples include erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality).
    • Small Molecules are oral medications that block the CGRP receptor, such as rimegepant and ubrogepant.
    • IV Infusion, such as Eptinezumab (Vyepti), is administered via IV infusion every three months, this CGRP inhibitor is designed for rapid onset of action in preventing migraines.

    Overall, CGRP inhibitors offer a targeted approach to migraine prevention by addressing a key component of the migraine pathophysiology.

     

    2. Gepants

    Gepants are a class of oral medications used for the acute treatment of migraines. They work by targeting and blocking the CGRP receptor, which is crucial in the migraine process.

    Mechanism of Action:

    1. Gepants are selective antagonists of the CGRP receptor. They bind to this receptor and prevent CGRP from attaching to it.
    2. By blocking the CGRP receptor, gepants inhibit the effects of CGRP, which include the dilation of blood vessels and the promotion of inflammatory responses in the brain that are associated with migraine attacks.
    3. By interfering with the CGRP signaling pathway, gepants help alleviate the symptoms of migraines, such as headache pain, by counteracting the peptide’s role in migraine pathophysiology.

    Examples of gepants:

    • Ubrogepant (Ubrelvy): Approved for the acute treatment of migraines, this medication works by blocking the CGRP receptor, providing relief from migraine attacks.
    • Rimegepant (Nurtec ODT): Initially approved as an acute treatment, it has also been approved for preventive treatment, offering a flexible option for migraine management.

    Gepants offer an alternative to traditional triptans, especially for patients who cannot tolerate triptans or for whom triptans are contraindicated (e.g., those with cardiovascular disease.

    This type of treatment is distinct from other migraine treatments, such as triptans, which work by agonizing serotonin receptors to constrict blood vessels. Instead, gepants provide a different approach by focusing on the CGRP pathway.

     

    3. Ditans

    Ditans are a class of medications used for the acute treatment of migraines, and they work through a different mechanism compared to other migraine treatments like triptans or gepants.

    Mechanism of Action:

    1. Ditans act as selective agonists for the 5-HT_1F serotonin receptor. Unlike triptans, which agonize the 5-HT_1B and 5-HT_1D receptors to cause vasoconstriction, by specifically targeting the 5-HT_1F receptor.
    2. The activation of the 5-HT_1F receptor by ditans helps to modulate the release of neurotransmitters involved in the migraine process. This receptor agonism can help reduce the release of pro-inflammatory neuropeptides, including CGRP.
    3. By focusing on the 5-HT_1F receptor, they help to inhibit the activation of trigeminal neurons and reduce the associated neurogenic inflammation, which contributes to migraine pain.
    4. Unlike triptans, ditans do not cause significant vasoconstriction, making them a potentially safer option for individuals with cardiovascular concerns.

    As an example, Lasmiditan (Reyvow) is an oral ditan approved for the acute treatment of migraines, particularly for patients who may not tolerate triptans due to cardiovascular concerns. It provides effective pain relief without causing vasoconstriction.

    Overall, ditans provide an alternative mechanism for migraine relief, particularly for those who may not tolerate triptans or need a different approach to managing their symptoms.

     

    4. Combination Therapies

    Overview: Research is ongoing into combining newer migraine medications with traditional treatments (e.g., triptans, NSAIDs) to improve efficacy and patient outcomes. The goal is to create more personalized treatment plans that address the specific needs of migraine patients.

    Studies combining CGRP inhibitors with gepants, or gepants with triptans, have shown potential for enhanced efficacy with reduced side effects.

     

    These advancements represent significant progress in the management of migraines, offering new options for both acute treatment and prevention. They also provide hope for patients who have not found relief with older medications, as well as those who are at risk for medication overuse headaches or have contraindications to existing therapies

  • Migraines and Insomnia: Improving Your Sleep

    Migraines and Insomnia: Improving Your Sleep

    Getting a good night’s sleep can be tricky. Your brain’s working overtime all day long and getting it to rest down for the night is the last thing it wants to do. The problem with not getting enough sleep is that it has a negative effect on practically every aspect of your life. Lack of sleep doesn’t allow your brain to work to its maximum potential.

    You’ll find it harder to focus and concentrate and your memory will start to lag. It also affects your mood by making you react negatively and more spontaneously without thinking things through first. In addition, studies have shown that getting too little sleep leads to weight gain. To top it off, it triggers migraines, which can turn your day into one big, pounding mess.

    In addition, it’s a well-known fact that migraines and the quality of your sleep are part and parcel of the same package, a little like the chicken and the egg. They hit 50% of the time between 4 – 9 am and are more common among those who suffer from sleep disorders, such as insomnia.

    Insomnia is defined as having trouble falling asleep or staying asleep for more than 5-6 hours. It’s one of the main reasons behind migraines because it disrupts your natural sleep rhythms, and a result, you’re stuck with throbbing, pounding, sometimes debilitating, headaches.

    Insomnia is also a trigger for mood swings, depression, and anxiety, which all can be contributing factors to migraine headaches. Moreover, it decreases daily functioning and impairs your quality of life.

    Read on to find out how you to get your circadian rhythm back in order and keep it that way to enjoy migraine-free, healthier, happier days.

    Try to go to bed at the same time each day, and get 7-8 hours of sleep per night. This allows you to get a regularly scheduled sleep schedule. The scientific reason behind it is that we go through four main stages of sleep; the deepest and most beneficial are the third and fourth stages, which are at their most powerful just right before we wake up.

    These stages are crucial for the production of dopamine and serotonin; the “feel good” hormones produced by your brain, and anytime their levels decrease, sleep problems arise as well as other disorders.

    1. Eliminate factors that sabotage your sleep.

    • Exercising late in the day
    • Eating protein at night

    • Going to bed hungry can keep you awake because the hormone that’s responsible for your hunger pangs makes your brain alert to get your digestive system ready for food. If that’s the case, eating a small snack will suffice to end your hunger pangs without making you feel too full.

    • Hidden sources of caffeine, like medications or drinks, can prevent you from getting enough sleep. If you take them close to bedtime, they can interfere with your sleep cycle.

    • Too much sleep can also trigger migraines. Sleeping in on the weekends and taking long naps will wreak havoc on your night’s sleep.

    2. Increase your quality of sleep naturally without medication.

    • Put your phone on silent an hour before your bedtime. This will help put distractions at a minimum.

    • Dim the lights in your bedroom and turn off the TV. Bright lights alert your brain and make it think it’s daylight, instead of getting it to wind down and get into sleep mode.

    • Lower the temperature on your thermostat. It’s been proven that the best temperature for optimal sleep should be around 60 to 68 degrees Fahrenheit. Just make sure you keep your hands and feet warm, even if it’s with just a sheet because these areas are the most problematic for those suffering from migraines and insomnia. Also, make sure your pajamas are made from natural material, like cotton or silk, or flannel in the winter – and doesn’t stick to your body as you sleep.

    3. Hydrate adequately throughout the day. Studies show that dehydration increases the risk of migraines, and is an unavoidable trigger. A mere 1.4% of fluid loss can result in headaches and difficulty concentrating.

    4. Make it a point to exercise regularly, preferably in the morning, which can help improve your mental abilities and increase your focus. It also boosts the level of endorphins in your system, “feel good” chemical messages in the brain known to decrease stress levels as well as reduce the effects of painful headaches. Getting a good workout also, helps get your sleep cycle back in order so you can wake up and go to sleep at regular times, and increase the amount of quality sleep during the night.

     

  • How To Get Relief From Migraine

    How to get relief from migraine can be an important question, especially if you are the one suffering the headache.

For many years it was thought that migraines were a woman's disease.  Women were diagnosed with migraines when they were pregnant or they had become very stressed but it was believed that men rarely experienced a migraine.  Today, we know that to be untrue and that men are also prone to experiencing migraine headaches, although not at the rate that women do.  In an online survey conducted by the National Headache Foundation researchers found that men diagnosed with headache of some kind, were most often diagnosed with migraine headaches.

Those who suffered through migraines will report that they are debilitating and often life altering.  Despite this fact, men often take a more silent approach and are not willing to discuss their condition with healthcare providers.  Almost one third of all men who suffer from headaches, according to the online survey, have never reported them to their primary care physician.  They believed that it was a sign of weakness and not important enough to require the care of a doctor.

Thankfully, with today's advances in technology and research, there is migraine relief that can be offered to both men and women.  The first step in finding relief of these debilitating headaches is to determine your individual triggers.  By figuring out your triggers you can also help to prevent the majority of headaches you may experience.

Recognize that most common triggers are food, stress, environmental changes, weather changes and amount of sleep.  By keeping a simple journal and writing down things that happened just before you have a headache, including any foods, and exposure to environmental toxins, increased stress or lack of sleep, most individuals are able to pinpoint the factors which most commonly trigger a migraine for them.  Many individuals also find that there will be more than one trigger.

If you have been unable to prevent a migraine by staying away from all triggers the next goal in migraine relief is to alleviate the pain after it has begun and before it gets worse.  The goals are to relieve the pain quickly, prevent any nausea or vomiting and provide the most cost effective and sustained relief possible.  

Many people are able to find relief using over-the-counter medications while others require prescription strength pain relief.  Some of the over-the-counter pain relief medicines include ibuprofen, aspirin, acetaminophen and caffeine.

However, it is also important to use caution when using over-the-counter medications because they can sometimes contribute to the development of a headache or worsening of the symptoms.  Overuse of some over-the-counter medications can also cause a rebound headache.  If you are taking any over-the-counter medication more than three times a week see your primary care physician about another means of both preventing and treating migraine headaches.

When you feel a migraine headache coming on it's important to act immediately.  The faster you act to prevent the migraine from progressing the more effective the pain relief will be.  Never try to "tough it out" when you have a migraine headache because not only will it make the pain worse but you may end up stuck somewhere unable to get home because of pain and nausea.

Pay attention to the responses your body is giving you to the medications and other alternatives treatment protocols you may be trying to find relief for your migraine.  You can often tell immediately if something is, or is not, working.  If there is a medication of treatment you are taking that is making you feel worse then stop immediately.

People who suffer from migraines report that they feel better when they're able to shut down, stop what you're doing and find a quiet place to rest.  When you are home, your own bedroom is often the best place, but if you're away from home anyplace you feel comfortable and safe can work.  Cool the room off, darken room for your eyes and turn off anything that is making noise.  Migraines make it feel as if you are in "sensory overload".  This means that any noises, lights, and smell can all cause more pain. Getting into a cool, dark and quiet environment you will minimize the number of things that will irritate your senses and increase the pain.

You can also cool your body down by using an ice pack on the back of the neck and at the base of the skull.  Some people also find relief by using a cold wet washcloth over there for head and covering their eyes.  Migraines are actually different than normal headaches because the blood vessels will dilate, or get bigger, during a migraine rather than constrict, or get smaller, like they do during a normal headaches.  Icing a regular headache will make it worse but will help a migraine by counteracting the effect on the blood vessels.

Many people also find relief from their migraines by attempting to get some sleep.  Lying as quietly as possible, relaxing your body and quieting your mind you may be able to fall asleep.  Sleep seems to act like a reset button and will help to change the amount of pain you're experiencing from the migraine.

Speak with your primary care physician or neurologist about the type of medication relief that you would like to try.  There is symptomatic relief where medications are used to treat the headache pain or symptoms of migraine, such as nausea, and there are abortive therapies which are medications used to stop the made migraine completely.

With the improved medical care, technology and research that has gone into how to find relief for an individual's migraine pain most sufferers are able to accomplish good pain relief within a matter of an hour or two.  Sometimes abortive medicine are effective for individuals who are able to recognize the signs an aura of a migraine before it even began while others find great relief from over-the-counter medications or physiological changes they can make based on the manipulation of their environment.  The best migraine pain relief comes from knowing your body, understanding what works for you and keeping a log of your triggers so that you can avoid them at all costs.

RESOURCES

Migraine Research Foundation

    2024년 최고 무료 토토사이트 순위
    

DailyMed Current Medication INformation: Equate
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=71117
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