The Net Guide: Migraine and Headache

MDNG Primary Care, August 2010, Volume 12, Issue 8

//The Educated Patient

My Migraine Connection

Read personal stories from migraine sufferers, articles on the latest research, and tips from Health Central’s migraine section. Visitors can use the Ask the Clinician tool, featured in the community section, where questions can be submitted and each week health experts respond. Past questions answered have included “Are severe headaches worsened by coughing, sneezing, bending?” and “How does a migraine cause stuttering or slurring of words?” Additionally, there is a community forum, where visitors can connect to others, a migraine glossary, where they can research commonly used and associated terms, and a number of videos that outline symptoms, treatments, and more. Videos include “Find out the Key Cause of Migraine Pain” and “Nerve Stimulation Leads to Migraine Relief.”

Migraine Headache

This extensive 10-page section on Migraine will leave visitors pretty knowledgeable on all the basics including causes and triggers, preventative steps, and treatment options. Under the “What are some variants of migraine headaches?” header, patients can read about vertebrobasilar migraines, hemiplegic migraines, or retinal and ocular migraines in detail. In the “What should migraine sufferers do portion?” the writers advise patients to create regular sleeping and waking schedules, exercise regularly, limit caffeine, and other lifestyle changes for optimal health. A slideshow on headaches and migraine triggers is also available for viewing and lists a number of possibilities including the boss as a possible culprit, warm weather, and strong scents.

Migraine Foundation

Featuring podcasts, blogs, articles on headache information, patient stories, and more, the National Headache Foundation’s website offers a number of resources for patients with migraine and headache. In the “Programs” section, visitors can read about local events taking place, read poetry, and view artwork submitted by migraine sufferers. In the “Education” section, visitors can access quizzes, multimedia tools, checklists, and instructional health modules. The site also features information for health professionals in the form of CME activities, links to clinical trials, tools, and information about fellowships, research grants, and more.

//Online CME

Migraine: Relieving the Pain



Expires:October 26, 2010


This program “reviews migraine epidemiology and comorbidities,” provides an understanding of migraine, pathophysiology, and diagnostic criteria, and discusses “new treatment options.”

Migraine: It’s Not Just a Headache



Expires:May 18, 2011


This activity is designed to help physicians “recognize the various classes of migraine and its impact on quality of life,” “explain the different phases of a migraine headache,” and “describe available treatment strategies for the management of migraine.”

Comorbid Migraine Does Not Affect Efficacy of Milnacipran in Management of Patients with Fibromyalgia (APS 2010)



Expires:June 30, 2011


This activity helps physicians to “demonstrate management strategies to provide adequate pain relief for a spectrum of patients with chronic pain,” “compare existing and novel pharmacologic agents and technologies under investigation for pain management,” and “select appropriate therapies for patients that will provide effective analgesia while minimizing risk.”


Migraine Is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders

Journal:Journal of Orofacial Pain (Summer 2010)

Authors:Franco A, Goncalves D, Castanharo S, et al.

Purpose:The study is designed to “assess the prevalence of primary headaches (HA) in adults with temporomandibular disorders (TMD) who were assessed in a specialty orofacial pain clinic, as well as in controls without TMD.”

Results:The study included “158 individuals with TMD seen at a university-based specialty clinic, as well as 68 controls.” The results demonstrated that “among individuals with TMD, migraine was the most prevalent HA (55.3%), followed by tension-type headache (30.2%),” and 14.5% had no headache. The researchers concluded that “TMD was associated with increased primary HA prevalence rates” and migraine was the most common primary HA diagnosis” for those with TMD.

Association between Body Mass Index and Migraine

Journal:European Neurology (July 22, 2010)

Authors:Téllez-Zenteno J, Pahwa D, Hernandez-Ronquillo L, et al.

Purpose:To “explore the prevalence of overweight and obesity in patients with migraine.”

Results:The researchers studied “1,371 patients with migraine and 612 controls.” Age and gender were matched for both groups. The results demonstrated that “overweight and obesity in migraine patients versus controls” was “statistically significant;” however, no “association was found between the disability and severity of migraine and BMI.”

Plasma and Saliva Levels of Nerve Growth Factor and Neuropeptides in Chronic Migraine Patients

Journal: Oral Diseases (July 23, 2010)

Authors:Jang M, Park J, Kho H, et al.

Purpose:The study was designed to “investigate the level and interrelationship of nerve growth factor (NGF) and sensory neuropeptides [substance P (SP), calcitonin gene-related peptide (CGRP)]” in the “plasma and saliva of chronic migraine patients.” Researchers also sought to “analyze the association between pain intensity and their concentration.”

Results:The “plasma and resting whole saliva were collected from 33 chronic migraine patients and 36 control subjects.” The results demonstrated that “chronic migraine patients showed higher NGF and neuropeptide levels in both plasma and saliva.” Also of note, “plasma NGF, and plasma and saliva levels of SP and CGRP were highly associated with pain intensity.” The researchers concluded that the “increased production of NGF and sensory neuropeptides may play an important role in the maintenance of pain in chronic migraine and analysis.”

//Clinical Trials

Pilot Study to Compare Frovatriptan vs. Topiramate for Prevention of Migraine

Study Type:Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor:Roger Cady, MD

Purpose:This study will “compare the effectiveness of daily treatment vs. treatment during the pre-headache phase for prevention of migraine.”

Treximet in Acute Migraine Headache: Assessing Cognitive Function

Study Type:Interventional

Age/Gender Requirements: 18-65 years (male/female)

Sponsor:Neurological Research Center

Purpose:The study is designed to “determine the type and intensity of cognitive dysfunction associated with migraine headache” and to evaluate the extent that “Treximet may relieve the cognitive dysfunction in a safe and effective manner.”

Trial of Comprehensive Migraine Intervention

Study Type: Interventional

Age/Gender Requirements: 21-70 years (male/female)

Sponsor:Montefiore Medical Center

Purpose:The goal of the study is to “determine whether a migraine protocol designed for use in an emergency room can be used to deliver the headache care that many migraine patients never receive.”


Maxalt MLT (Rizatriptan)

Clinical Trials

A Study to Evaluate the Efficacy and Tolerability of Rizatriptan for Treatment of Acute Migraine in Children and Adolescents

Study Type:Interventional

Age/Gender Requirements:6-17 years (male/female)


Purpose:The study is designed to “provide efficacy data for Rizatriptan in children and adolescents.”


Formulation and Evaluation of Rizatriptan Benzoate Mouth Disintegrating Tablets

Journal:Indian Journal of Pharmaceutical Sciences (January 2010)

Authors:Keny R, Desouza C, Lourenco C

Purpose:The investigation was designed to develop and evaluate mouth disintegrating tablets of rizatriptan benzoate.

Results:The team developed the disintegrating tablets using “superdisintegrants crospovidone, carboxymethylcellulose calcium, Indion 414 and Indion 234” through the “direct compression method.” The tablets were evaluated for “thickness, uniformity of weight, content uniformity, hardness, friability, wetting time, in vitro and in vivo disintegration time, mouth feel, in vitro drug release and assay by high performance liquid chromatography.” The researchers found that the “formulation containing combination of crospovidone and Indion 234” produced the best results. Also, “apart from fulfilling all official and other specifications, the tablets exhibited higher rate of release.”

From the HCPLive Network:

Mind Your Heart: Migraines Linked to Heart Disease

February is American Heart Month, and many patients and health care providers are pondering ways to improve cardiovascular health and prevent heart disease. A study published in the February 10, 2010 online issue of the Journal of Neurology may give patients suffering from migraines greater incentive to get heart healthy

Study Shows Aspirin Effective for Migraine Pain

Aspirin is an alternative to ibuprofen or acetaminophen for the temporary self-treatment of migraine, according to a new review by researchers at the University of Oxford.

In more than half of patients who took it, a single 1000-mg dose of aspirin was proven effective as a temporary treatment for acute pain associated with migraine headaches in adults, according to the results of a cumulative study published in the current online issue of the Cochrane Database of Systematic Reviews.

SUMAVEL DosePro Migraine Treatment Injection System Going on Sale in US

Having received FDA approval last July, Zogenix out of San Diego, California is bringing to market its SUMAVEL DosePro sumatriptan delivery system for the treatment of oncoming migraines and cluster headaches. The needle-free device delivers the drug subcutaneously, bringing both speed and efficacy when oral pills are a poor option.

Abnormal Brain Activity in Migraineurs

"There has been increasing evidence that the processing and perception of sensory stimuli is abnormal even outside of attacks," said Dr. Till Sprenger, regarding the results of study he and a team of researchers from CSF Headache Group and Technische Universität München. “Now our findings underline that abnormal brain activity in migraineurs is not restricted to attacks—that there is an extensive alteration of functional connectivity in multiple networks reflecting the migraineurs phenotype, emphasizing that migraine is a disorder of the brain."

Sedentary Activity Linked to Back Pain and Headache in Teenagers

Although the amount of time teenagers spend in front of the TV, as well as on the computer or playing video games, has long been associated with physical complaints, an international team of researchers has now definitively linked TV viewing, computer use, and computer gaming (screen time) to back pain and recurrent headaches.

Chronic Migraine Associated with REM Sleep Deprivation

Sleep deprivation can lead to changes in the levels of key proteins associated with the pathology of migraine, according to new research reported at the American Headache Society’s 52nd Annual Scientific Meeting in Los Angeles.

Drinking and Smoking Linked to Migraines in Teens

Alcohol consumption and smoking are associated with migraine and tension-type headaches (TTH) in adolescents, according to a study published in Headache, the journal of the American Headache Society.