Even when you feel like you’ve tried everything, there’s almost certainly more out there. This is something I’ve been posting about and e-mailing people a lot lately. Without knowing everything they’ve tried, it’s hard to point someone in the right direction.
Top 10 Unexpected Migraine Treatments, a HealthTalk webcast scheduled for Wednesday, April 18 will get to right to the point. Guessts will be Brian D. Loftus, MD and John Claude Krusz, MD PhD.
In the meantime, here are some other resources:
A fairly comprehensive list of available preventive and abortive medications, including some of the newer ones, like Lyrica and Cymbalta. (These websites describe the drugs, but don’t talk specifically about headache. They are both prescribed off-label (read comments at this link) as Topamax was for a long time.)
The National Headache Foundation‘s podcasts: The Condition of Migraine, Symptoms and Triggers, Migraine Treatments, Latest Migraine News and Information. It’s good stuff, particularly the one on migraine treatments (not surprising, huh?).
The American Council for Headache Education has a collection of articles on treatment (the second heading on the page). They cover a wide range of topics, but some of the articles are old. If something catches your eye, I recommend doing some further research on the topic. I’m happy to answer questions when I can.
The World Headache Alliance also covers various treatments. Most topics are supported by recent research. Non-Pharmacological Therapies. The Treatments section covers a huge variety of topics. They include studies that contradict each other, which is good to get both sides. Check out the news section, too.
Sorry for such a link-heavy post!
Tests for gluten intolerance are really unreliable, so even if you get one and it comes back negative that doesn’t mean you don’t have a problem. And because we all know that medical issues are never simple, if you have problems with IBS symptoms, it may not even be the gluten that you have an issue with – I have IBS and can’t eat wheat due to the fructans (polymeric chains of fructose) it contains.
Sadly, I still get daily migraines, so for me going gluten-free is not the solution to that problem. But I recommend looking into a low-FODMAP diet for those with IBS issues, it’s made that aspect of my life a lot easier.
I would also say that gluten may be a factor in migraines, as gluten can cause so many different health issues. With so much gluten-free foods available today, this should not be too hard to try. I’ve also heard that eating too much tofu can result in frequent migraines, perhaps due to the estrogenic effects of tofu.
If you have tested negative for hypoglycemia on a 5- or 6-hour glucose tolerance test, you are not hypoglycemic.
There was an interesting study done some years ago in individuals who had symptoms similar to yours and who tested negative for hypoglycemia. They did have EEG changes triggered by high-glucose foods when they were symptomatic. So, although glucose is triggering something in you, it may not be hypoglycemia. It may simply be a headache trigger.
The word “hypoglycemia” means low blood sugar. If your blood sugar does not drop when you have these symptoms, you are not, by definition, hypoglycemic. Something else is going on.
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Good information, thanks!
Kerrie
My neurologist says its worth doing the blood test for gluten intolerance even if you don’t have IBS like symptoms because sometimes it manifests as migraine/headache alone without the GI symptoms being too severe.
Also, I wonder how many people actually know they are hypoglycemic? I know I am because if I eat sugar I have visual symptoms and dizziness a couple hours later… but in talking to my primary care doctors over the years none of them have been the least bit concerned about it, and this is the first time a neurologist has mentioned a connection to migraine. I’ve been glucose tolerance tested negative twice, so they blow me off about it. No one has suggested low glycemic diet or eating every couple of hours… so I say its worth a shot if you have frequent migraines. 2 weeks now and no migraine…. I’ve missed 6-8 migraines at this point from just eating low glycemic foods every 2-3 hours.
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Have your results on gluten intolerance come back? I’m so curious…
Kerrie
There is some comorbidity between gluten intolerance and migraine. If you have symptoms of irritable bowel syndrome, it is worthwhile getting tested for gluten intolerance (blood tests first, and a small bowel biopsy if those are positive). Unless this is your situation, there is no reason to avoid wheat. I have had the occasional patient who did benefit from the glycemic impact diet; unfortunately, there is no way of predicting which ones those will be. It’s a pretty healthy way to eay, though. Low blood sugar certainly can be a headache trigger, but not every person is hypoglycemic!
Now–as for off-label medications: side-effects that are listed in the package insert are based on pre-market testing, and thus, are related to the indicated or “on-label” condition. However, every pharmaceutical company keeps a database of post-marketing reports of side-effects which your doctor can request. The FDA also keeps such a database. So, side-effects that that are related to off-label useage are captured in this fashion. They are also reported in case reports that are published in medical journals. The information is there for those who take the time to look for it.
I cannot see how never using anything off label will force anyone to make medications for headache. Despite our large numbers, we are invisible to the pharmaceutical industry. They will invest billions of dollars in Alzheimer’s drugs and anti-psychotics. According to the World Health Organization, migraine is twice as prevalent as depression, and more than ten times as prevalent as bipolar disorder, schizophrenia, or Alzheimer’s and other dementias. I do understand that those mental health disorders take a huge toll on lives and are worthy of treatment. Are we less worthy?
I took an oath. I am not going to not treat my patients with medications I know will be effective in a vain effort to force a pharmaceutical company to follow a path they are not inclined to follow.
And, really, should we be discussing forcing the pharmaceutical industry to do drug research? Or should we be discussing why our government has not been funding more of this? I have some ethical issues with placing the entire burden of drug development on the pharmaceutical industry.
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You’re dashing my hopes of a last-ditch effort to break this current spell! I do have some IBS symptoms, so it makes sense for me to be tested for gluten intolerance. I know it’s a small chance, but I’m desperate.
Thanks for the information on post-marketing testing. I didn’t know it was available be request.
I’m with you about off-label drugs not keeping drug companies from developing headache-specific drugs. I wish we could shed the invisibility cloak as easily as Harry Potter can.
Kerrie
I have had problems with Topomax and Lyrica….and the Lyrica, quite honestly, screwed me up big time. I have such a hard time convincing doctors that the majority of my headaches are not migraines (though I feel one throbbing right now….I know, I should get off the computer).
The bad thing about using meds off label is that any side effects aren’t documented or (as in my case) told that they are all in my head (no pun intended). Plus it doesn’t force the drug companies to actually make meds *for* headaches (an important thing I learned from the book “All in my Head”)
I know they are a Godsend to some people though–wouldn’t it be great if there were a way to tell which headaches/people would respond to certain drugs?
I’ve missed reading your blog, always so helpful and informative!
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Thanks for the kinds words. I know things have been tough lately for you too.
I’m confused by your second paragraph. To be FDA-approved for their original intent, all drugs are put through rigorous trials and companies are required to disclose side effects. That’s not foolproof, but it’s useful information. Also, do you mean that using drugs off-label keeps companies from developing headache-specific drugs?
Having some indicator of what will work would certainly make finding helpful drugs less cumbersome. A blood test would be nice!
Take care of yourself.
Kerrie
I recently went to a migraine specialist, and he recommended reduce or eliminating wheat and going for a low carb diet, and eating every 2-3 hours to maintain even blood glucose. So I started a pretty strict diet change 12 days ago… and I’ve been migraine free for 10 days, which considering I usually get 2-3 a week, is a long time. Could be a fluke, but the longer this goes without one, the more I’m thinking its the diet.
I see alot of articles on eliminating trigger foods, but I don’t see alot on switching from 2-3 meals a day to 5-6 meals a day and selecting low glycemic index foods. It seems to make sense to me that any perturbation could trigger migraine …so blood glucose must be important. I’m wondering if anyone else has tried this. It takes planning (and cooking!) but right now I’m supermotivated.
Also the doc wants to try Topamax.. we’ll see how that works.
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Although a possible wheat connection to migraine is something I’ve always scoffed at, I started eliminating wheat on Friday. I’ve gotten to the point that I’m willing to try it. I hope it turns out to be an answer for you.
I’ve read some about blood glucose and migraine too. I’ve never tested positive for hypoglycemia, but it, again, seems like it’s worth a try. This isn’t a problem for me when I’m following any sort of special diet. It’s hard to get full eating so many vegetables and low-fat proteins that I wind up grazing all day long.
Keep us posted on how the diet goes. I’m really curious to see how you do on it.
Kerrie
James – are you saying that these vitamins as a once off were your cure? do you really belive that? Id love to belive it too – im that desperate but its just a vitamin – which will pass from your body through digestion in about 10 hours at most. 17 years later i dont see how it could still work!
How much did you take? are we talking a whole bottle of each or a couple of pills?
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I’m tempted to try them too. Even if it’s not a one-off thing, but a possible abortive that can be used repeatedly.
Please talk to your doctor first. Even vitamins are potentially harmful (especially if you take an entire bottle!) and may interact with other medications you are taking. That’s what I plan to do when I see my new headache specialist in May.
Kerrie
Pantothenic Acid (Vitamin B Family)
Vitamin C
I took these in equal quantities at the onset of a migraine headache. As soon as the pills hit my stomach, the pounding was gone immediatly! I ran into this very old man with an herbal book. He looked up Migraine Headaches and that is what it said to do. I don’t remember the quantity of each, but I remember they were equal amounts. I’ve never had another Migraine Headache since 1990! I only took those pills once. I lived with migraine headaches since I was three years old and I thank God that I got rid of them!
James
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I’m so glad this helped you! It’s hard to believe that a one-off dose of these two vitamins had such a dramatic effect, but it sure sounds like that was your experience.
I just read that B5 helps produce vitamin D. My vitamin D levels are really, really low, so I’m really curious about researching this. Thanks for the tip.
Kerrie