Migraine (Pain) Management – Audio Digest Jan 2008

Hi All,

Here’s a really informative talk given by James U. Adelman, MD. He is at the Headache Wellness Centre in Greensboro, North Carolina. He discusses many therapies at length:


There are some accompanying notes here:

mvertigo.org/articles/migrai … digest.pdf

Best … Scott

Thanks for posting this. I found it to be very informative, especially the preventative medication portion.

Yes, thanks, I also found the preventative section most informative. Julie

Thanks for the info and I too was very interested in the preventative stuff. I’ve just started a new med Dothep, a tricyclic antidepressant to add to my existing meds, sandomigran (Pizotifen), antihistamine & klonopin. Interesting to hear that tricyclic antidepressants can cause weight issues, I’m already having to deal with that issue with the Pizotifen and have gained 10 kilos and counting. My neuro told me to “keep my mouth shut” lol, will try to do so! :?
regards Judy

Yes, it’s a great talk about drug options from a guy who really knows his stuff!

In summary:

Only about one-half of patients with migraine are correctly diagnosed; of those diagnosed incorrectly, 42% are diagnosed as having sinus-type headache and 32% as having tension-type headache; a survey showed that 94% of patients who sought treatment in physicians’ offices had migraine (migraine is a type of headache that gets severe enough for patients to seek treatment); although tension-type headache is most common in the population.

[size=150]Beta-blockers[/size]: all effective; propranolol most commonly used, but [size=140]speaker prefers atenolol[/size] (inexpensive; can be given once daily, typically at night; fewer side effects). In studies, 45% to 60% of patients reported 50% reduction in headaches.

[size=150]Calcium channel blockers[/size]: good for cluster headaches, [size=140]not good for migraine[/size] ; use doses higher than those for treatment of hypertension; may be effective if aura prominent feature; in studies, verapamil and amlodipine took up to 3 months to achieve effect.

[size=150]Tricyclic antidepressants[/size]: low doses effective (for amitriptyline, doxepin, and imipramine, 50 mg/day); with amitriptyline and doxepin, end point is sleep without daytime sedation; side effects with amitriptyline and doxepin include weight gain; with nortriptyline and imipramine, all side effects less; when using nortriptyline, prescribe by generic name, which costs about $17/month (brand name [Pamelor] costs $575/month!); desipramine and protriptyline nonsedating and not associated with weight gain (protriptyline currently available only by brand name [Vivactil])

[size=150]Other antidepressants[/size]: SSRIs and bupropion not effective in migraine; [size=140]venlafaxine (Effexor) effective[/size] ; in study, patients with anxiety benefitted from duloxetine; monoamine oxidase inhibitors effective, but have numerous side effects. Surprisingly, Cipramil (citalopram) did work for me although perhaps the SSRIs are more effective for vestibular migraine.

[size=150]Neural stabilizers[/size]: previously called anticonvulsants; divalproex (Depakote) and topiramate FDA-approved; both have significant side effects, including weight gain, hairloss, and fetal neural tube defects; in study, only 36% of patients responded to gabapentin.

[size=150]Alternative treatments[/size]: riboflavin—in small study, 59% of patients responded; magnesium—should be effective; known that patients with migraine have low levels of magnesium in brain; shown that intravenous magnesium stops headache; feverfew—effectiveness not clear; coenzyme Q10—effective in some studies; butterbur—in study, efficacy "71%, but efficacy of placebo 59%; botulinum toxin type A (Botox)—no clinical profile; anecdotally, some large trial now under way.

Best … Scott 8)