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Migraine and Pregnancy

When you suffer from headaches, including migraine, your expectation should be that your headaches will improve when you get pregnant, especially after the first trimester. If your headaches do not improve, something is amiss and it certainly does not have to be serious. Common medical conditions that can develop during pregnancy are anemia, hypertension, hypothyroidism, and diabetes. Of these four conditions, diabetes tends to be protective of headaches, while the other three tend to make headaches worse or cause them. Anemia is the most common, usually from iron deficiency, and is often not recognized. Get it checked and make sure your hemoglobin (Hg) is around 13.5 and your ferritin level (iron reserve) is at least 80. Slow Fe® is a great over-the-counter iron preparation to take if your numbers are not as good as indicated. However, be sure to treat the constipation that may result from taking iron with docusate (Colace®). If your constipation is particularly bad, combine the docusate with Senna or take magnesium citrate instead. The magnesium citrate comes in 200-mg tablets and can be bought in health-food stores. Hypertension refers to elevated blood pressure and is readily picked up at prenatal care visits. It is a different story with hypothyroidism, which, like anemia, needs a blood test. The blood test is called TSH, which stands for thyroid stimulating hormone. Its level increases with the development of hypothyroidism. During pregnancy, the TSH should be 3 or less. Treatment is with thyroid hormone, which is available in tablet form. It can only be obtained by prescription. The prescription thyroid hormone will bring your TSH down and a good value is around 0.5.

The Puzzle of Face Pain

Although not as common as headache, face pain is quite frequent. In addition, it’s often associated with headache, including migraine. Trigeminal neuralgia is by far the best known face pain condition. However, it’s very rare and occurs mostly in the elderly. Its hallmark is severe stabbing pain in one side of the face. It’s important to know that stabbing pain in the face can also have other causes. These other causes are much more common than trigeminal neuralgia. The most frequent cause of stabbing face pain is, in fact, spasm of the jaw muscle. It can be treated very easily with heat applied to the muscle. However, for this very simple treatment to be effective, it has to be done daily. It’s even better if the heat is applied several times a day. Massage therapy or physical therapy can also be helpful. A medical treatment of this condition is with Botox®, injected into the muscle to relax it. An effective dental treatment can be with an appliance worn at night.

The face pain caused by jaw muscle spasm does not have to be stabbing. It can also be constant, with or without stabbing on top. This is very often the case when it affects both sides of the face. The treatment is the same as described above, with heat, massage, etc. Constant pain around the nose comes out of the sinuses. However, the culprit lies in a congested nose, generally from allergies. The congestion closes off the openings to the sinuses. As a result, the air in the sinuses is absorbed, creating a vacuum, and pressure in the face ensues. A nasal spray provides relief here. The nasal spray can contain saline or a decongestant, anti-allergy, or corticosteroid medication. If the face pain is just on one side of the nose, it tends to be severe. Also here, the cause is in the nose but due to an extra piece of bone, called spur. The spur comes off the septum that divides the nose in two. It becomes a problem when it sticks into a swell body on the side of the nose. The resulting pain can be excruciating: it’s like having a splinter in the nose! An ENT surgeon needs to be consulted here to obtain relief.

For more information about face pain, its diagnosis and treatment, send us an email through our website.

Effective Abortive Treatment: The Foundation of Long-Term Migraine Management

Migraine treatment is divided into abortive and preventive. Abortive treatment aims at the individual migraine headaches to curb their intensity and duration. Preventive treatment aims at the occurrence of migraine headaches over time to decrease their frequency. Abortive migraine treatment is not only always indicated but it is also very important that it is effective. It is always indicated because of the often disabling nature of migraine headaches. It can only be called effective, however, if it fully relieves migraine headaches within 2 hours. This can generally be accomplished with a class of medications referred to as triptans. The best known medication of this class of seven is sumatriptan (Imitrex®). However, the medication may have to be used as an injection, which can be self-administered. The sumatriptan injection is a great medication but under-prescribed by physicians and under-used by patients. It is currently available in doses of 3, 4, and 6 mg of which the lower dose strengths are generally well tolerated, without side effects. If necessary, preventive treatment is added to effective abortive treatment.

Unmitigated migraine headaches are bad for mental and physical health. There is no benefit suffering through them. In fact, repeatedly going through bad migraine headaches impacts the ability to cope with them. In addition, over time it tends to cause anxiety and depression. Equally important, bad migraine headaches cause more headaches to occur. They progressively lower your migraine threshold by making your head, neck, shoulder, and upper-back muscles tight. This kind of muscle tightness is invariably present in those who suffer from chronic migraine. These people have very frequent headaches, including migraine, often on a daily or almost daily basis. It’s the reason why botulinum toxin (Botox®) is effective in chronic migraine treatment. Obtaining effective migraine treatment, in and by itself, may decrease headache frequency over time. It also makes it more likely that added preventive treatment will, indeed, reduce headache frequency.

MedVadis Patients in the News

MedVadis Research has been working with Amgen since August 2013 on a clinical trial determining the efficacy and safety of the investigational medication, erenumab. Erenumab, also known as Aimovig®, is used for the prevention of migraine. Our site enrolled a total of 17 patients in the study and five of them are still continuing in the open-label extension. These patients come in every month to get their injection of erenumab, to get their vitals taken, and to undergo other appropriate medical procedures, such as blood draws every 6 months for safety.

We are happy to announce that on June 17th, 2018, erenumab was approved by the FDA under the brand name, Aimovig®. It is the first of four CGRP antibodies to become available, making it the first time in history that a medication specifically developed for the treatment of migraine has come to market. Aimovig® is given through an auto-injector device in a dose of either 70 mg or 140 mg, the latter consisting of two injections.

Of the five patients who continued in the open-label erenumab study, four were interviewed about the medication and said nothing but great things about their experience. Prior to being enrolled in the study, these subjects were suffering from migraine headaches on a daily basis to the point that they were unable to do their day-to-day tasks; even getting out of bed in the morning was a problem for them! Now they are doing much better and are able to live their lives with significantly fewer migraine headaches. Below please find the links to the interviews:

https://www.nytimes.com/2018/05/24/health/migraines-headaches-treatments.html

http://time.com/5282661/aimovig-migraine-treatment/

http://newyork.cbslocal.com/video/category/health-fitness/3866804-new-drug-promises-relief-from-chronic-migraine/

https://www.nbcnews.com/health/health-news/new-drug-uses-antibodies-stop-chronic-migraines-without-side-effects-n866696

The New York Times, TIME Health, CBS New York, and NBC News.

Antibodies as Treatment for Chronic Pain and Migraine

 By Egilius L.H. Spierings, M.D., Ph.D.

Antibodies help our body in an extremely targeted way to fight infections, such as with viruses or bacteria. They are formed by the immune system to specifically attack an invader, whatever it is. With vaccinations, the antibodies are formed to prevent specific viral or bacterial infections. Antibodies are also involved in allergies and allergic reactions as well as in so-called autoimmune diseases. What is new, however, is that they are now also being used as medications for non-infectious illnesses, in this particular case, chronic pain and migraine. Continue reading “Antibodies as Treatment for Chronic Pain and Migraine”