Down Dog it, Migraine Warrior!

We need all the angles we can come up with to fight against migraines, especially when they are frequent and hard to treat. In a study from researchers in India called Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial, subjects with migraine and 4-13 headache days per month were randomized […]

We’re all a little sick.

One of my mentors in neurology at Yale was making a point to me as we were struggling to figure out how to help an intractable headache patient in clinic one day. Literally nothing helped this person. No standard treatment made any difference. All her tests were normal and she appeared totally normal, yet had […]

Who needs a migraine after surgery?

For those with migraine, the presence of many potential triggers can be a daily minefield.  There are avoidable triggers (certain foods, drinks, activities or habits) and there are unavoidable triggers (menstrual cycle, weather or external stress.)  It’s pretty obvious that something like surgery could be a migraine trigger.  Really any physiologic disruption can trip the […]

The migraine / anxiety connection.

A recent article in the journal Headache called  Untangling the Association Between Migraine, Pain, and Anxiety: Examining Migraine and Generalized Anxiety Disorders in a Canadian Population Based Study, looked at the association between generalized anxiety and migraine headaches. The DSM V definition of Generalized Anxiety Disorder (GAD) is paraphrased as follows: Anxiety or worry over […]

Narcotic the loser in an acute migraine trial.

A clinical trial called Hydromorphone Versus Prochlorperazine + Diphenhydramine for Acute Migraine compared 2 treatment strategies for patients with severe migraine headaches, being treated in an Emergency Department setting.  The subjects were randomized to the narcotic hydromorphone (Dilaudid) 1 mg vs. prochlorperazine (Compazine) 10 mg and diphenhydramine (Benadryl) 25 mg all given intravenously.  The trial was stopped […]

Menopause means fewer migraines? Not so fast..

Migraine headaches, which are more common in women than men, are often hormonally influenced.  Menstrual migraine – migraines that occur regularly during menstruation – is a common phenomenon.  It’s probably the rapid fall in estrogen levels that triggers the migraine. It’s commonly thought, and often observed, that migraine frequency reduces after menopause -when estrogen levels […]

Migraines can be triggered by: Lack of stress!

When I see a patient with migraine we talk about trigger-avoidance before talking about medications.  There are many potential triggers for migraine headaches, some of which, like certain foods, drinks, or activities, can be avoided.  The list is different for each person.  Then there are potential triggers that cannot be avoided, including low barometric pressure, […]

The arsenal for a migraine attack

There are headaches and there are headaches.  Almost all of us get them from time to time.  Rarely does it mean something is wrong inside the cranium.  My mentors always told me beware of headaches that are “First, Worst, or Cursed.”  Meaning if a person has lived their life without a single headache and then […]

A MAGNET-icent new way to treat migraine with aura.

I can pretty much count on seeing at least a couple of migraine patients per day in my office practice.  It affects some 15% of the population (more common in women) and is under-diagnosed.  Any recurrent headache that keeps your attention, that is worse with activity, or that makes you feel sick is probably a […]

Melatonin for migraine prevention?

When I see patients with migraine, we review the three pillars of treatment: Identification and avoidance of triggers. Quick use of the abortive medication of choice (triptan, ibuprofen, etc.) Daily preventive medication if frequency and severity of episodes warrants. I find the best medications to lower the frequency of migraine headaches are tricyclic antidepressants (nortriptyline […]