New Device Approved For Migraine

FDAA headband delivering electrical nerve stimulation can prevent onset of migraine headaches and can be marketed for that purpose in the U.S., the FDA said Tuesday.

Called Cefaly, the Belgian-made device is the first to win FDA approval for migraine prevention and is also the first transcutaneous electrical nerve stimulation (TENS) system OK’d for any type of pain prevention, as opposed to acute treatment, the agency said.

The device is battery-powered and worn around the head, with the actual TENS stimulator centered on the forehead just above the eyes. It delivers a small, steady current to trigeminal nerve branches. Patients will be instructed to use the device once daily for a maximum of 20 minutes. It is approved for adults only.

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Migraine May Change Structure of Brain

headache-disordersMigraine was linked to structural brain changes, particularly in the presence of aura, a meta-analysis showed.

White matter brain lesions appeared 68% more often in migraineurs with aura than in those without migraine; a trend for 34% elevated risk of white matter in migraine patients without aura didn’t reach significance, Messoud Ashina, MD, PhD, of the Danish Headache Center at Glostrup Hospital in Copenhagen, and colleagues found.

Clinically-silent infarct-like abnormalities and brain volume changes also correlated with migraine, they reported online in Neurology.

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Migraine: A Brain Disorder

headache-disordersPositron emission tomography of patients experiencing the premonitory phase of migraine, prior to the headache setting in, shows activation in several areas of the brain, indicating that migraine is a brain disorder and not a response to pain stimuli.

The results are significant in terms of understanding the neurobiology of migraine and could have future implications for drug treatment, said study author Peter James Goadsby, MD, PhD, professor, neurology, and director, Headache Program, University of California at San Francisco, and president, International Headache Society.

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Pathogenesis of Migraine – Role of Neuromodulators

The pathogenesis of migraine is still, today, a hotly debated issue. Recent biochemical studies report the occurrence in migraine of metabolic abnormalities in the synthesis of neurotransmitters and neuromodulators. These include a metabolic shift directing tyrosine metabolism toward the decarboxylation pathway, therein resulting in an unphysiological production of noradrenaline and dopamine along with increased synthesis of traces amines such as tyramine, octopamine, and synephrine. This biochemical alteration is possibly favored by impaired mitochondrial function and high levels of glutamate in the central nervous system (CNS) of migraine patients.

The unbalanced levels of the neurotransmitters (dopamine and noradrenaline) and neuromodulators (eg, tyramine, octopamine, and synephrine) in the synaptic dopaminergic and noradrenergic clefts of the pain matrix pathways may activate, downstream, the trigeminal system that releases calcitonin gene-related peptide. This induces the formation of an inflammatory soup, the sensitization of first trigeminal neuron, and the migraine attack. In view of this, we propose that migraine attacks derive from a top-down dysfunctional process that initiates in the frontal lobe in a hyperexcitable and hypoenergetic brain, thereafter progressing downstream resulting in abnormally activated nuclei of the pain matrix. [Read more…]

Botulinum Toxin A for Chronic Migraine?

In a meta-analysis, benefits were modest. Botulinum toxin A is approved for prophylactic treatment of chronic migraine (≥15 headaches per month). The recommended regimen — 31 injections at specified sites in head and neck muscles — may be repeated at 12-week intervals. In a meta-analysis, researchers examined the effectiveness of botulinum toxin A prophylaxis for headaches. [Read more…]