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Headache-Adviser Newsletter, Issue #28 Headache and Migraine Updates
June 13, 2011

Headache Updates

When I started putting this newsletter together, I realized that the last one I sent out was around the Thanksgiving holidays..good grief! Where did the time go?

I have been busy since then attending conferences and one of them was the American Academy of Neurology yearly meeting in Hawaii. (Hey someone has to go right?). Unlike the American Headache Society meetings, this one was more about general neurology but there was one full day on headache.

As I attended the meetings with my collegues, unfortunately there was not too much new to report. It looks as if many providers are on the same page when it comes to headache treatments includine headache medications and alternative headache treaments.

I did pick up one or two new treatments that I brought back to our practice and one of them is....

Chronic Cluster Headache Treatment

One of the few new treatments that is gaining attention is the use of Botox for chronic cluster headache. What is chronic? Any cluster headache syndrome that has gone beyond 6 months of treatments, usually up to one year.

Most cluster patients have headaches for a few months then they may go away for several years. For the chronic patient, however they never go away.

A few small studies have shown that about 50 units of Botox may help these patients. Unlike Botox for migraine the amount used is much less, and the injections are placed solely in the area where the pain of the cluster headache lies. We have started doing this for a few select patients here at the Dent Headache Center, but I do not have any results yet as to whether or not it is helping.

In the studies I reviewed, including one poster presentation at the meeting in Hawaii, it appears that about 50% of the patients with chronic cluster headache did respond. These studies were very small, less than 50 patients so a larger study is needed. One of the problems with getting a larger study done, is that is is a very rare type of headache syndrome so there is not a large patient population.

Migraines Do Not Cause Cognitive Damage

In a study published earlier this year, researchers determined that chronic migraine does not cause cognitive damage. At issue was the fact that many migraineurs have tiny changes that are seen on MRI's of the brain. They can be tiny ruptures of vessels and in the elderly can lead to Alzheimer symtoms if severe and large in quantity.

"Given this association, researchers at Universit Pierre et Marie Curie in Paris monitored more than 800 adults over age 65 for 10 years to see if those with migraine were prone to cognitive degeneration over time. Study subjects were given MRIs and tests of cognitive ability, including short-term memory.In the end, the cognitive scores of those people with migraine were identical to those without it."

-National Headache Foundation

This is good news for all of you with chronic migraine. Although you might have temporary cognitive problems during a severe migraine, there is apparently no risk of developing cognitive problems as you age because of migraine. You do however, still have a slighly higher risk of stroke so it is important to get these migraines under control.

Red Ears and Migraine

Did you know that red ears in children may predict migraine? (Learn something new everyday right?)

In a study by the journal Cephalgia, a type of head pain that is accompanied by burning red ears (red ear syndrome) is a highly specific marker for migraine in children. In this study of 226 children, RES was seen in 23% of children with migraine and only 3.7% of chilren with other types of headache.

So if your child is complaining of "head hurts" and the ears are to your doctor about seeing a pediatric neurologist for migraines.

If you are in the area for our clinic, we have one pediatric neurologist on staff now, and are hiring another this year.

National Headache Foundation Magazine

I just received the premier issue of the new patient magazine from the National Headache Foundation. It is called "Headwise" and is filled with great articles to help you with your headaches. They even review the 5 different cell phone apps available to help you track your headaches.

There is also an excellent article on ways to manage your anxiety which is highly associated with migraine.

Addtional articles are on migraine food triggers and there is also a case study featuring Teri Roberts who is a spokes person for the NHF.

You can check it out at

That is it for now. Please take care of yourself and...

Here's To Headache Free Days

Take care..

Mary Kay Betz MS RPA-C
Physician Assistant

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