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Interesting article - Gains in migraine treatment

Hi All,

Looks like MAV is becoming increasingly recognised.

Best … Scott

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For Sharon Gruszka, the room was spinning. For Bernard Kryszak, the pain was constant.

For both of them, migraine treatment was the answer.

Studies suggest more than 20 million people in the United States get migraines. Most migraine sufferers know when they are having one: There’s throbbing pain on one or both sides of the head and sensitivity to light, sound and smell. Often an aura of flashing lights or visual snow warns them when the headache is coming. Someone with a migraine can be out of commission for a few hours or a few days.

Shanon Gruszka, 36, of Downers Grove, hugs her teammate Melissa Granart, 37, of Woodridge, before they begin their softball game Thursday in Central Park at the Oak Brook Park District. Gruszka recently overcame migraines, which were preventing her from being able to play in her softball league.

“I didn’t think of that because I don’t get headaches,” said Gruszka, 36.

Once or twice a year, for no apparent reason, she felt like the room was spinning. The dizzy spells took up to six hours out of her day.

“It was weird,” said Gruszka, a commercial insurance reviewer from Downers Grove. “When they got more frequent, I went to the ear doctor. They did tests and said there was nothing wrong.”

The episodes disappeared during the three years she was either pregnant or nursing her two daughters. But in January, they came back with a vengeance. Twice in one week, she felt so dizzy, she needed a co-worker to drive her home so she could go straight to bed. Her daughters, now 1 1/2 and 3 years old, asked why Mommy wasn’t feeding them or playing with them. Her husband was worried.

A referral to a different audiology doctor and tests by a neurologist solved the mystery. She had vestibular migraine, also known as migraine-associated vertigo.

A quarter of U.S. migraine sufferers experience balance disorders as a side effect, according to the Vestibular Disorders Association, a trade organization of inner-ear doctors. Sometimes migraine patients feel dizzy one day and get a headache a few days later or not at all, said Dr. Ronna Fisher, audiologist and founder of the Hearing Health Center in Naperville, where Gruszka was diagnosed.

Fisher explained that the nerves that control balance - the inner ear and the brain receptors for sight and touch - are close together.

“A problem with one system can cause a problem in the system next door,” she said.

Some of her patients have lived with dizziness for 25 years and quickly responded to migraine treatment, Fisher said. Now Gruszka takes a prescription migraine medication when she gets dizzy, which doesn’t get rid of her condition entirely but keeps it from descending into full-blown vertigo. She also has taken preventive measures like getting different birth control pills and cutting caffeine out of her diet. No more Starbucks chai latte on the way to work.

And no more “Where’s Mommy?” questions.

“I couldn’t take care of my kids, and I’m very athletic - I do triathlons, I play softball - and I couldn’t do any of that when I had an episode,” she said. “Now … I’m able to go back to my normal routine.”

Kryszak’s normal routine was interrupted every time he took his headache medicine.

Since suffering a stroke five years ago, Kryszak, a 46-year-old Plainfield resident, has woken up with the same excruciating headache. The pain was constant. The prescription migraine medication he tried reduced some of the pain but made him so tired that he slept for four to five hours after taking it.

He didn’t want to live like that. So he sought help from a pain specialist, Dr. Ahmed Elborno of the Midwest Academy of Pain and Spine in Naperville.

Elborno happened to be studying a new migraine treatment for people who didn’t respond to dietary changes or drugs: peripheral nerve stimulation, an implant that works like a remote-control defibrillator in the brain.

Just under his skin, a wire runs from each of Kryszak’s temples to a battery pack, about the size of a pop can lid, on the back of his shoulder. Electrodes at the end of the wire use electrical impulses to zap the pain. Kryszak keeps the stimulator at a low level, then presses the “up” button on the remote when his headaches get stronger.

“Depending on how I adjust the remote, it’s pretty instantaneous,” he said.

He recharges the battery about every three weeks.

Elborno has been using stimulation technology on patients with leg and back pain for nearly seven years. Their stories are similar to Gruszka’s and Kryszak’s - they had tried multiple doctors, and multiple medications, with little relief.

His migraine patients are part of an ongoing nationwide study. So far, side effects include skin infections at the insertion point. Elborno treated Kryszak for that complication by temporarily removing the device and prescribing antibiotics.

The one-time cost of stimulation treatment is about the same as a year’s worth of prescription medications, Elborno said.

“You want patients off the narcotic because if they’re on the narcotic for life, they’re nonfunctional,” he said. “Just with the push of a button, your pain is gone and you’re on with your life.”

Get rid of migraine

Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking and other factors can trigger migraine - and migraine can trigger vertigo and imbalance. Typically, migraine treatment includes:

Diet changes such as eliminating or reducing foods known to trigger migraine attacks, such as chocolate, nuts, cheese and red wine.

Lifestyle changes such as establishing a daily routine with regular sleep patterns and regular meals, trying to control stress and exercising regularly to relieve tension.

Prescription drugs to relieve pain at the onset of the migraine.

Medications designed for other purposes - including birth control, antidepressants and beta blockers - that also tend to prevent migraines. Even Botox anti-wrinkle injections have improved migraines for some people, though studies of patients using the injections to treat headaches have shown mixed results.

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