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David Baxter

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Spinal Cord Stimulators Tested As Treatment For Patients With Migraine Headaches
September 29, 2006

Researchers at Rush University Medical Center are testing a new treatment for migraine headaches: occipital nerve stimulation, a surgical procedure in which an implanted neurostimulator delivers electrical impulses to nerves under the skin at the base of the head at the back of the neck.

This therapy may help migraine sufferers who do not respond to other available therapies, or who cannot tolerate the side effects of existing medications.

"The purpose of the randomized, double-blinded study is to evaluate the safety and efficacy of occipital nerve stimulation as a treatment for refractory migraine headache," says Dr. Sandeep Amin, Rush study investigator and anesthesiologist who surgically implants the device in the two-visit operation.

Rush is recruiting patients through the Diamond Headache Clinic and is the only site in Illinois in the trial.

The study, known as PRISM (Precision Implantable Stimulator for Migraine), uses Boston Scientific's Precision neurostimulator with approximately 150 patients at up to 15 sites in the U.S. The implantable pulse generator will deliver electrical impulses to the occipital nerves located just under the skin at the base of the skull at the back of the neck.

The Precision device is the smallest rechargeable neurostimulator on the market today and is already approved by the FDA for spinal cord stimulation to treat chronic pain.

There are more than 28 million migraine sufferers in the U.S., and up to 10 percent of these patients may not respond to existing treatments.

"Occipital nerve stimulation has the potential to provide relief to the large population of migraine sufferers who currently have no other medical treatments available to them that bring them relief," said Amin. "If effective, the implantable neurostimulator would provide a new treatment option to free these patients from their long-standing headache pain."

The smallest rechargeable neurostimulator available, the Precision device has been used in the treatment of more than 6,000 patients suffering from chronic pain, according to Boston Scientific.

The Precision neurostimulator is currently FDA approved for spinal cord to treat chronic pain by precisely delivering tiny electrical signals to the spinal cord that mask the perception of pain. Spinal cord stimulation is prescribed for patients with chronic pain in the limbs, trunk and back.

Migraine sufferers are monitored and complete a month-long pain diary as the first part of the study. Patients then undergo a two-part operation in which thin electrode leads are placed under the skin at the back of the neck.

A week later, the patient returns for the 45 minute procedure in which the neurostimulator is placed on one side in the lowest part of the back, and the leads are connected and the device activated. Patients then return to the neurologist for monitoring of their headaches.

During the first 3 months after the Precision neurostimulator is implanted, two different stimulation settings will be tried in different groups of patients. One group of patients is programmed to settings more likely to show a response, while the control group of patients is programmed to settings rather unlikely to be effective.

After the first three months, the control group of patients will have their devices programmed to the stimulation settings more likely to show a response.

Individuals interested in learning more about the trial can call 888 352-7874.
 
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People who experience migraine, me being one, welcome research in this area.

Treatment of choice is currently the medication class known as triptans, such as Imitrex, Zomig and Maxalt.

Triptans are effective in aborting the migraine but sometimes may become ineffective over time and their use is limited to a maximum number of doses per month. Physicians sometimes switch from one triptan to another to maintain efficacy if a person reports not getting relief from the current medication.

Over the counter pain relievers such as aspirin and Motrin {NSAID's} provide temporary relief at best, but usually result in the migraines becoming worse between doses...a phenomenon referred to a rebound headaches.
 

David Baxter

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is there a link between migraine headaches and depression?

The short answer is yes, it seems so - several studies have reported a correlation or increased risk of depression for migraine sufferers.
 

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several studies have reported a correlation or increased risk of depression for migraine sufferers

This is facinating! Would you point me toward more info on this topic or elaborate on the mechanism of action that would result in this connection?

It is my understanding the illness of depression is thought to be linked to seretonin activity, and the triptans used to treat migraine touch a component of seretonin as well, but a different purpose, ie to act as a vasoconstrictor.

A side effect of SSRI's is headache, and though I have not seen SSRI side effects ever refer to headache as migraine in the various monographs, I have long wondered if there is a relationship in all this.
 

David Baxter

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ACHE Articles
In other words, more people have both migraine and depression than could be ... The fact of the association suggests that depression and migraine might be ...
http://www.achenet.org/articles/bresla1.php

Triptans, migraine and depression
BACKGROUND: Epidemiologic studies have provided consistent evidence regarding an association between migraine and depression. In Puerto Rico, however, ...
http://www.biopsychiatry.com/migtripdep.htm

Headaches and depression
Migraine is a highly prevalent episodic headache disorder. When migraine and depression occur together, therapeutic opportunities, as well as limitations, ...
http://www.biopsychiatry.com/headache.htm

The Role of Stress in Migraine and Depression by Victor Vidal
The Role of Stress in Migraine Headache, Serotonin Dysfunction, and the Initiation of Depression by Victor O. Vidal, BS. MA. H(ASCP) - - author of the book: ...
http://www.outcrybookreview.com/Serotonin.htm

Alternative Mental Health
Guidebook for Preventing Migraine Headaches, Depression, Insomnia, ... Migraine, depression, and insomnia have similar mechanisms and pathways, ...
http://www.alternativementalhealth.com/articles/migraine.htm

Comorbidity of migraine and depression: Investigating potential ...
Background: An association between migraine and major depression has been ... Results: Major depression at baseline predicted the first-onset migraine ...
http://www.neurology.org/cgi/content/abstract/60/8/1308

The Migraine Solution
Migraine, depression, and insomnia have similar mechanisms and pathways, ... It appears that people who suffer from migraine, depression, insomnia, ...
http://www.allocca.com/migraine.htm

[PDF] Migraine and Depression: is there a linkFile Format: PDF/Adobe Acrobat Migraine had been linked to depression, anxiety and some other mental health ... between migraine and depression. We started two years ago to explore this ...
http://www.migrainetrust.org/module_images/migraineanddepression.pdf

THE COMORBIDITY OF DEPRESSION AND MIGRAINE
Before we question the extent to which migraine and depression are comorbid, ... So, on the surface, although both migraine and depression seem to function ...
http://sulcus.berkeley.edu/mcb/165_001/papers/manuscripts/_809.html

CJP - November 2005 -Comorbidity of Major Depression and Migraine— A Canadian Population-Based Study ... In the current study, we investigate the migraine–depression comorbidity ...
http://www.cpa-apc.org/publications/archives/cjp/2005/november/molgat-OR-nov.asp

Ask Dr Ivan
Given that both migraine and depression are serotonin based, I am interested in any studies, especially those available on the Net, of patients that have ...
http://www.priory.com/ivan3.htm

[PDF] Migraine and Depression
File Format: PDF/Adobe Acrobat
The risk of developing depression in migraine sufferers is three times higher ... migraine and depression. In one study we found 25% of depressed people to ...
http://www.migrainetrust.org/module_images/Depression.pdf

Pathways of Pain and Possibility: The Dysfunction of Migraine Headache
Increased understanding of the neurological ties of migraine and depression could aid in the development of more comprehensive knowledge of migraine ...
http://serendip.brynmawr.edu/bb/neuro/neuro03/web1/dmcmanus.html

Migraine and depression: biological aspects
There is a considerable overlap in migraine and depression incidence, and both conditions may be associated with low levels of 5-hydroxytryptamine(5-HT). ...
http://cat.inist.fr/?aModele=afficheN&cpsidt=4799288

Tyramine conjugation deficit in migraine, tension-type headache ...
Tyramine conjugation deficit in migraine, tension-type headache, and depression. KR MERIKANGAS, DE STEVENS, JR MERIKANGAS, CBS KATZ, V GLOVER, T COOPER, ...
http://cat.inist.fr/?aModele=afficheN&cpsidt=2912379

[PPT] Depression and Migraine Co-Morbidity...
File Format: Microsoft Powerpoint
Here we investigate possible co-segregation of depression and migraine ... That susceptibility genes for migraine and depression may be genetically linked. ...
http://www.tcd.ie/Psychiatry/Neuropsychiatry/Zainab poster.ppt

[PDF] Migraine and Depression: A Day in the Office
File Format: PDF/Adobe Acrobat
clinical ability to effectively manage their migraine and depression patients. ... migraine. Understand the neurotransmitter science of depression and ...
http://www.cumc.columbia.edu/dept/cme/Neuro-71-I/Seattle.pdf

ScienceDaily: Research Measures Migraine's Impact On "Typical ...
However, research shows that while migraine and depression are linked, they have independent causes and both cause a reduced quality of life. ...
http://www.sciencedaily.com/releases/2000/09/000921073320.htm

...more
 

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