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Welcome to my website blog. My intentions are to share the wealth of orofacial pain knowledge I have obtained over the years through study and experience. Please feel free to leave quesitons and comments. Victoria Wexley, DDS
Cluster headaches, which arguably cause the worst pain of any headache, are not likely to be cured by trigger point injections, according to a group of Spanish doctors. They treated 12 patients with trigger point injections and some of the patients reported some relief, but they all needed medications as well. This is a small study without placebo control, which means that no conclusions can be made about usefulness of this treatment. We do have better evidence that occipital nerve blocks can be helpful in aborting cluster headaches. This is a procedure similar to trigger point injections, and involves injection into an area of the occipital nerve on the side of the headaches. It is a simple and safe procedure and it should be tried in most patients, particularly those who in addition to pain around the eye have pain or tenderness in the back of the head or upper neck.
Red wine to relieve migraine? Red wine is a well-known trigger of migraine headaches (although French tend to disagree). A recent study published in journal Pain found that resveratrol, the active ingredient in red wine which is responsible for its health benefits, has pain relieving properties when given to rats. There have been no reports in the literature or from my own patients that resveratrol causes headaches and judging from this study, it may in fact help.
Mindfulness meditation has been shown to produce numerous benefits in older adults with chronic low back pain. These benefits included less pain, improved attention, better sleep, enhanced well-being, and improved quality of life. One patient reported: “I felt like a new person”. The subjects attended a weekly 90-minute class and practiced for 45 minutes every day for 8 weeks. The study was conducted at the University of Pittsburgh by Natalia Morone and her colleagues, who speculated that this approach might help with other chronic conditions. And we can speculate that if the elderly, who are often regarded to have a less adaptable nervous system, responded so well, then younger patients may do even better.
Magnesium is effective in preventing migraine headaches according to a new study published in the last issue of journal Magnesium Research. The researchers found that patients treated with magnesium, compared to those treated with placebo, had fewer migraine attacks and the attacks were milder. In addition, magnesium treated patients had improved blood flow in their brains, while those on placebo did not. This is just another confirmation of previous findings of the efficacy of magnesium in the treatment of migraine headaches. Since magnesium is very inexpensive and extremely safe, every patient with migraine headache should be given a trial of magnesium supplementation.
Progressive muscle relaxation is an integral part of biofeedback training, but can be used by itself for the treatment of migraine and tension-type headaches. A group of researchers at the Ohio State University published an article in the journal Pain which reports the effect of progressive muscle relaxation on experimental pain in healthy volunteers. A single 25-minute tape-recorded session of progressive muscle relaxation resulted in a higher pain tolerance and reduced stress from pain. It can be safely assumed that regular practice sessions will result in even better results and all pain patients, including those with headaches should be encouraged to learn this simple technique.
Chronic migraine is very disabling and is poorly treated according to a study by Dr. Marcelo Bigal and his colleagues published in the current issue of journal Neurology. The study looked at 520 patients with chronic migraine (those who had more than 15 days with headaches a month) and 9,424 with episodic. More than half of the patients with chronic migraines missed at least five days of household work, compared 24% of patients with episodic migraine. The majority of chronic migraine sufferers (88%) had previously soguht care, but most of them did not receive specific acute or preventive medications. Only 33% of these patients were on preventive medications at the time of the study. Millions of Americans who suffer from migraines do not receive appropriate treatment, but those with chronic migraines are particularly under-treated and suffer needlessly. Chronic migraine is a common conditions.
Vitamin D deficiency has become a very popular topic in lay and professional literature, and deservedly so. Vitamin D is important not only for bone health, but for normal functioning of many organs. Its deficiency appears to be much more common than it was previously suspected. Dr. Steve Wheeler has found vitamin D deficiency in 42% of 55 patients with chronic migraine headaches. He presented these findings at the recent meeting of the American Headache Society. We do not have evidence that taking vitamin D will help relieve headaches, however if a deficiency is present correcting it can certainly improve overall health of the patient. One possible cause of what appears to be increasing incidence of vitamin D deficiency is widespread use of prescription and over-the-counter antacids. Reducing stomach acidity helps relieve heartburn and other symptoms of reflux, but it may also interfere with absorption of vitamins and minerals.
Patients who faced delays in the treatment of their chronic pain were found to have worsening of their condition, according to a recent review published in the journal Pain. The review of 24 trials showed that patients had a significant deterioration of their health-related quality of life and psychological well being. This was true for patients who waited for six or more months to receive treatment. Studies looking at shorter wait times were less conclusive. The authors conclude that waiting for treatment of chronic pain for six months or longer is medically unacceptable. While our medical system is often to blame for such delays, many patients delay their treatment for a variety of other reasons as well. It is important for friends and relatives to urge someone who suffers from chronic pain (including headaches) to seek medical attention from a qualified specialist.
Scientists in Trieste, Italy suggested a new approach to the treatment of migraine headaches. They hypothesized that combining two different approaches would yield better outcomes than either one alone. A neurotransmitter CGRP antagonists appear to be effective in the treatment of an acute migraine. Merck has a product in late stages of development that works through this mechanism and hopefully will be the first of a new class of migraine drugs. Based on laboratory research the Italian group suggests that combining a CGRP antagonist with a blocker of nerve growth factor may result in a more effective treatment. This fits with a new trend in treatment of many conditions - combining drugs that work in different ways, rather than trying to always use a single medication.
Treatment of migraines leaves a lot to be desired and in part not because we do not have effective treatment, but because of a communication barrier. Doctors appear not to want to hear what migraine patients have to say about their headaches, according to a remarkable study by a top headache researcher Richard Lipton and his colleagues. Patients and doctors agreed to be videotaped during a visit and 60 such interactions were analyzed. The analysis showed that doctors did not ask about the disability of headaches and tended to ask closed-end short questions. Very often the information they did obtain was incorrect. 55% of doctor-patient pairs were misaligned regarding frequency of attacks; 51% on the degree of impairment. Of the 20 (33%) patients who were preventive medication candidates, 80% did not receive it and 50% of their visits lacked discussion of prevention. The authors recommended that doctors assess impairment using open-ended questions in combination with what is called the ask-tell-ask technique.
For many years migraines have been thought to occur more often in left-handed people, but a new study from Germany disputes this theory. A recent study published in journal Cephalalgia looked at 100 people with migraines and 100 controls and also reviewed five similar studies and found no difference in the incidence of migraines in left-handed and right-handed people. This has been the observation at our headache clinic as well.
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