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David Baxter

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Woman?s Brain Wired for More Migraines
By Jennifer Warner

Women May Have a Faster Migraine Trigger in Their Heads Than Men

Aug. 8, 2007 -- Women may get more migraines than men because their brains are quicker to release the trigger that begins the migraine cycle.

Women are three times as likely as men to suffer from migraine headaches, and a new study suggests the reason may be that their brains are faster to activate the cascading waves of activity thought to cause migraine pain as well as other migraine symptoms.

Researchers say migraines were once thought to be caused by constriction and dilation of blood vessels. But advances in brain imaging technology now suggest that migraines may start as a result of brain excitability.

People with migraines show dramatic waves of brain activity that spread across the surface of the brain -- known as cortical spreading depression (CSD). This depression is thought to trigger not only the severe pain associated with migraines but also the visual symptoms, dizziness, and difficulty concentrating often associated with migraines.

New Target for Treatment?
In a study published in the Annals of Neurology, researchers found that compared with male mice, female mice had a much lower threshold for releasing the CSD trigger.

"The results were very clear," says researcher Andrew Charles, MD, director of the Headache Research and Treatment Program in the UCLA department of neurology, in a news release. "The strength of the stimulus required to trigger CSD in males was up to two or three times higher than that required to trigger the response in females."

Researchers say many factors may reduce the CSD threshold in both sexes, such as genes, hormones, and environmental triggers like stress, diet, and changes in sleep patterns.

"Our results suggest that the female brain has an intrinsic excitability that predisposes them to migraine that may not be simply linked to a specific phase of the menstrual cycle," says Charles.

Researchers say if these results are confirmed in future studies this triggering mechanism may be a new target for migraine treatment.

SOURCES: Brennan, K. Annals of Neurology, June 2007; vol 61: pp 603-606. News release, University of California, Los Angeles, Health Sciences.
 

ladylore

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How fun.:rolleyes: I have had migraines since I was a kid. But I do have a question if anyone can answer it. Since I started taking anti-depressents the migrains are fewer but if not caught in time much more severe (I am talking about physically getting sick). I take amotryptoline 25ml. Is this usual?

Ladylore
 

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Amitriptyline is a tricyclic antidepressant that has also been prescribed off-label as a Migraine and headache preventive for many years. It was, in fact, among the first medications recognized as a potential preventive.

You can read prescribing information for amitriptyline HERE although there is no mention of treating migraine because this document is a copy of a product monograph. Treatment of migraine with TCA's is off label, which is perfectly acceptable, as long as the off label use is supported by medical evidence or the prescribing physician's best clinical judgement.

What is especially important to know when taking this medication is the potential for drug/drug interaction with many prescription as well as over the counter preparations.

If you are taking anything else in addition to the amitriptyline, use one of the online interaction checkers or speak to your doctor or pharmacist.
 

HA

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Hi Ladylore,

I get migraines as well but only rarely and not to the level of requiring emergency room intervention. Like you, if I don't catch it with extra strength Ibuprofen or other pain killer then I get physically sick and completely out of commision for the day. I carry these with me at all times.

You could ask any pharmacist and they would be able to answer your question about the relationship with the antidepressant.

Another thing to consider is Menstrual Migraine and Menstrually-Related Migraine (MRM)

http://www.wdxcyber.com/ngen03.htm

http://www.guideline.gov/summary/summary.aspx?doc_id=6587

Cheers
 

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don't catch it with extra strength Ibuprofen or other pain killer

My understanding about treating migraine with analgesics such as ibuprophen, acetomenophen (Tylenol) and or aspirin, there is a risk of developing rebound headaches, whereby a migraine is triggered by the absence of the analgesic.

If the headaches are true migraine, a more effective treatment might be one of the triptans, which are specific to migraine and actually abort the event from ocurring.

Since triptans (Imitrex/sumatriptan, Maxalt/rizatriptan, Zomig.) were introduced in 1992, some doctors have been reluctant to prescribe them because of concerns about cardiovascular safety.

"While serious cardiovascular events have been reported after the use of triptans, their occurrence appears to be extremely low -- on the order of less than one in 1 million."?

Such figures put triptans in a better safety position than over-the-counter non-steroidal anti-inflammatory medications (NSAID's) such as ibuprofen, acetaminophen, and aspirin. The risk of death from those medications is as little as one in 1,200, while prescription NSAID's contribute to approximately 16,500 deaths per year.?

References:
? Dodick, David, Lipton, Richard B., Martin, Vincent, Papademetriou, Vasilios, Rosamond, Wayne, MaassenVanDenBrink, Antoinette, Loutfi, Hassan, Welch, K. Michael, Goadsby, Peter J., Hahn, Steven, Hutchinson, Susan, Matchar, David, Silberstein, Stephen, Smith, Timothy R., Purdy, R. Allan & Saiers, Jane (2004). Consensus Statement: Cardiovascular Safety Profile of Triptans (5-HT1B/1D Agonists) in the Acute Treatment of Migraine. Headache: The Journal of Head and Face Pain 44 (5), 414-425. doi: 10.1111/j.1526-4610.2004.04078.x
? Mundell, E.J.; HealthDay Reporter. "Migraine Sufferers Not Getting Best Drugs." Forbes.com. May 5, 2004.
? U.S. Newswire Press Release. "Triptans Safer Than Many Common Drugs; Underused Treatment Most Effective Migraine Medication." May 5, 2004.
 

David Baxter

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The other concern about triptans is that you have to be careful taking them if you're also taking anti-depressants, especially the SSRIs.
 

HA

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I don't know about the rebound headaches, Steve, as it has not happened to me. Here is an article about a quick test to diagnose migraines.

3-Question Test Identifies Migraine
Researchers Say Test Will Help Find Those Suffering Needlessly

WebMD Medical NewsAug. 18, 2003 -- By asking three simple questions, you may be able figure out if you have a migraine -- an often-missed diagnosis.

If you answer yes to at least two of these three questions, you could have a migraine, according to a new study.

  1. Has a headache limited your activities for a day or more in the last three months?
  2. Are you nauseated or sick to your stomach when you have a headache?
  3. Does light bother you when you have a headache?
The study, appearing in the recent issue of Neurology, calls the test ID Migraine.

Migraines Often Misdiagnosed

Researchers say this test is a major breakthrough because as many as half of migraine sufferers go undiagnosed -- leaving many people frustrated from lack of answers for their pain.

"Because patients with migraine often present [themselves] in the primary care setting, the hope is that ID Migraine will help primary care doctors identify migraine quickly and easily," Richard Lipton, MD, vice chairman of neurology at the Albert Einstein College of Medicine in New York, says in a news release.

"ID Migraine is very easy to use for both patients and doctors, and we hope it will prompt patients to talk to their primary care doctor to get diagnosed and to receive treatments that will relieve their pain and improve their ability to function."

Easy as 1, 2, 3

Researchers tried out the migraine screener on more than 400 patients making routine primary care visits to their doctor. Each patient completed a nine-question survey. Patients in the study either had headaches that interfered with work, study, or daily life; or they wanted to talk to their doctors about their headaches. The patients were referred later to one of 12 specialty headache centers where specialists diagnosed them without knowing the responses to the questionnaire.

Later, researchers compared the diagnosis from the specialists with the nine-question survey and came up with three questions that could solidly determine which patients had migraines. The questions worked regardless of sex, age, presence of other headaches, or previous diagnosis.

The researchers estimate that these three questions would accurately identify 93% of people with migraines.

Migraine headaches are more common than diabetes or asthma. Migraines strike women more frequently than men. The exact cause is unknown. Because the condition is so debilitating, researchers say they hope their simple screening tool will help more people get a proper diagnosis. They note that sometimes headaches have serious causes not identified by the screener, but they say the test should get patients and doctors talking about what is going on.


SOURCES: Neurology, August 2003. News release, Neurology.
 

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Good article on testing for migraine. Some info on rebound headaches can be found at the Mayo Clinic Resources Site

Thanks for the reminder about triptans and SSRI's David.

Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-threatening Serotonin Syndrome

More info HERE
 

ladylore

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Thanks for the replies. I use to get rebound headaches myself so I am careful about what I use.
 

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