The Headache Center

Medication Overuse Headaches Migraines, the most frequent cause of headaches can be changed from sporadic to chronic daily because of medication overuse. The revised criteria for these types of headaches is dated around 2006. What are the diagnostic criteria? A. Headache present greater than or equal to 15 days a month B. Regular overuse for more than three months of one or more acute-syntomatic treatment drugs such as: 1. ergotamine, triptans, opioids, butalbital containin...g compounds (fiorinal, fiorecet analgesic medications) for more than 10 days a month on a regular basis for more than three months. 2. Simple analgesics, or any combination or ergotamine, triptans, analgesic opioids for more than or equal to 15 days a month on a regular basis for more than 3 months without overuse of any single drug of group (1). C. Headache has developed or markedly worsened during medication overuse. Patients without proper education about acute treatments of attacks or lack of preventives are at great risks of overusing acute care medications and this may lead to overuse or rebound syndromes. The same may be true of patients with migraines averaging 6 oz. of regular coffee or more per day, so called, caffiene rebound headaches or overuse of compounds with caffeine contents (Excederin migraine tabs). The best treatment for these conditions is prevention. Once the overuse is installed and treatment is pursued,there are many strategies, most of them for individualized needs and are offered at The Headache Center. See more

Visual Disturbances and Migraine Visual auras in patients with migraines are episodic and associated with the headache attack. In some patients, visual symptoms are more frequent and sometimes long lasting (migraine aura status) or complex (visual snow syndrome). The latter is more rare in clinical practice. The word migraine aura derives from the greek word for "breeze", it involves all the symptoms before the beginning of head pain. Typical aura consists of visual and senso...ry and/or speech language symptoms gradual with the duration of each symptom lasting no longer than one hour with total reversibility. Sometimes a migraine aura is not followed by the headache. Migraine auras develop gradually over more than 5 minutes and last between 5 to 60 minutes, but can also have a longer duration. Migraines aura status is a rare condition, all patients have a history of a migraine with aura with a mean duration of 4 weeks. The treatment for this unusual condition has been anti seizure medications and nutritional supplements such as magnesium. Visual snow or "TV snow" consists of uncontrollable vision of tiny dots in the entire visual field, flickering typically between black and white. Symptoms are continuous and present when eyes are opened and closed. This condition is associated with additional visual symptoms and in most cases is not restricted to migraines. Visual symptoms are frequent in migraine patients, but often represent a minor problem when composed with the severity of head pain, nausea and disability. For visual symptoms that are neither aura nor visual snow, one can try different treatment options. Early referral to the Headache Center is the next step. See more

Why do women have more migraines? Migraine is an episodic headache primary disorder that affects one in nine adults worldwide. The most frequent subtype is a migraine without aura of which the main reported symptoms are headache, nausea, vomiting, photophobia and phonophobia. Research data suggests that women have more frequent, longer lasting and more severe headaches than men. Migraines initially increase with age and peak between 30-39 years old, followed by a gradual decl...ine over subsequent years in both sexes. Triggering factors and attack duration are modulated by sex hormones. In particular, estrogen increases migraine aura in women and estrogen deficiency is associated with migraines without aura. With respect to associated conditions, women appear to have many other conditions, particularly psychological, whereas men are more likely to have somatic complaints. Treatment strategies do not differentiate between sexes because research and clinical trails do no adjust for sex. It has been suggested that migraines might be an autosomal dominant condition in woman and autosomal recessive in men. This genetic variance supports predisposition; but endogenous and exogenous triggers in women, especially fluctuating in hormone concentrations, particularly estrogen, are considered to account for more women affected during the reproductive years. Our Headache Center considers all these variables in its personalized approach to every patient. Call today to make an appointment. See more

Migraine Prevention: The new anti CGRP antibodies Migraines are the third most prevalent and the seventh most disabling medical illness in the world. Acute attacks are better controlled now in comparison with prevention control. Chronic migraines (more than 15 headaches/day/month) affects now 2% of the population. Recent advances in our understanding of migraine has revealed several potential targets for prevention and acute attack treatment. Calcitonin Gene Related Peptide, ...(CGRP) is the most promising of these molecules. CGRP is found throughout the trigeminal vascular system and in central regions related to migraine origin. Concentrations of CGRP increases in the jugular venous blood coming from the brain during a migraine attack. Intravenous infusion of CGRP can trigger a migraine attack. Small molecules antagonists of CGRP were effective in reducing acute attack of migraines/headaches but were liver toxic. So in the last five years, monoclonal antibodies against CGRP, monospecific that is made by identical immune cells that are clones of a unique parent cell, they only bind to the same epitope (part of CGRP) that is recognized by the antibody. Since they do not penetrate the blood brain barrier (BBB) it is suggested that a peripheral set of action will happen. We currently known that during a migraine attack this BBB might be more transiently permeable. These Antibodies will be administered intravenously and the preferred group of patients targeted are the chronic migraine patients. There are several clinical trials on course and soon will be available for clinical use. Our Headache Center provides more updated information about this new therapy. -MB, MD See more

Not All Headaches are Migraines Effective Treatment Begins with Correct Medical Diagnosis. There are 36 million Americans suffering from headaches, but only 5 million are actually diagnosed and treated. Migraines are the most frequent headache, occurring in 12% of woman and 6% of men. Primary headaches include migraines and tension headaches and secondary headaches are due to serious intracranial disease. Other types of headaches are face pain and cranial Neuralgias, primar...y or secondary. Because there are more than 50 types of headaches, successful treatment must start with a correct diagnosis, most effectively by an experienced Headache Medicine Specialist. A detailed history and complete neurological exam are important in the comprehensive care of headaches. The reason for this is that migraines misdiagnosis, or abuse of certain over-the-counter and/or prescribed medicines- painkillers and acute treatment medicines like Triptans, Ergotamines and Butalbital compounds can change a migraine from episodic to chronic, which is a headache occurring more than 15 days per month. This makes treatment more difficult and increases patient discomfort and disability. If you are experiencing debilitating or frequent headaches, you should be encouraged to seek expert help. For years the treatment of headaches was quite limited, but remarkable progress has been made in recent years. We have more effective medicines to treat acute attacks, as well as better preventatives. Intense research, basic and clinical, is ongoing, and new methods of treatment are becoming available each year. By Dr. Max Benzaquen, M.D. County Living Magazine, Fall 2016 See more