Children and Migraine Headaches

During or before an attack in a child, watch for symptoms present in adults; sensitivity to noise and light, swelling of the extremities, also nasal congestion, increased urination or nausea and vomiting. Some children with migraine will suffer from recurrent motion sickness. A small percentage of children with migraine will complain of visual disturbances. Most children with a migraine attack will react by becoming withdrawn, wanting to lie down in a dark room, they often fall asleep and awaken without any migraine present. With infants, continual crying and screaming may be the parents’ only clue to a possible migraine attack. For more information on children and migraines refer to the web site resources located on page 3 col 2 of this news letter.

Treatment of Migraine Headaches

The treatment of migraine headaches is a complex, often difficult process. The patient must be willing to work with the physician in trying various medications until one is found that works best for that patient. Many factors are involved, and it is far too complicated and large an issue to deal with in this article. This article does however provide some common treatments, however, more information is available in the resources listed at the end of this article.

The most common treatments involve medications, recognition of each patient’s individual migraine triggers, lifestyle changes, alternative (non-drug) treatments. Once again, it is very important to realize that a physician’s assistance is crucial, and a patient whether diagnosed with migraine headaches or suffering from undiagnosed headaches should never self-treat through literature, articles, over the counter remedies, other people’s medication, etc.

Medication treatment can involve either prescribed medication from a physician, or over the counter medications such as Aspirin, Tylenol, Excedrin, Motrin and various herbal remedies. It is very important for a person to realize that over the counter medications are just that, medication, even though they do not require a physicians’ prescription.

Prescribed medications will generally fall into these categories: preventative medications used generally for patients with 3 or more migraine attacks per month. These are not pain relievers but medications used daily, whether or not the person has a migraine, and are intended to reduce the number of migraine attacks by correcting biological imbalances within the body that cause migraine headaches. These medications include beta blockers and calcium channel blockers, normally used in the treatment of high blood pressure; and some anti-depressants. Brand names include Inderal which is a beta blocker, and Elavil (amitryptyline) which is an anti-depressant. They are often used at very small doses that would be ineffective in treating the other conditions they are prescribed for, but work well for preventing migraine. The other category is symptomatic medications taken for the migraine attack. The prescribed varieties of these medications are very large, but fall into these general categories: pain relievers such as Tylenol in combination with other drugs such as Codeine (Tylenol #2 & #3), Fiorinal (which includes Aspirin, Caffeine and a barbiturate) and Fiorinal C (same as Fiorinal plus with Codeine). Other combinations include Demerol, and morphine for example. The types of combinations and the examples of these medications are simply too large to list here. These are the narcotic analgesics and must be used carefully to avoid dependency and/or addiction. Another prescribed category includes the ergotamine medications for migraines; these are migraine-specific medications with brand names such as Ergomar and Cafergot, which work by shrinking the swollen blood vessels that cause the pain of migraine headaches. Both of these categories, if over-used, can cause medication-induced headaches, or rebound headaches, which is a serious concern and is fully covered in detail in the resources located on page 3 col 2 of this news letter.

Two other prescription categories exist including DHE, a medication closely related to ergotamine, also used to constrict the swollen blood vessels however it also works on the serotonin system as well. DHE is given usually by injection in the hospital or at home and is prescribed under the brand name Migranal. The other category is the so-called "designer migraine drugs" (described earlier in this article) that work on the serotonin system and include brand names of Imitrex, Amerge and Zomig. It is important to note that these medications, contrary to many peoples’ belief, are not narcotics and are not addictive.

Full and complete details regarding prescribed and non-prescription medications, herbal remedies including feverfew, alternative treatments such as biofeedback, relaxation techniques, chiropractors, reflexology, yoga, lifestyle changes etc. are comprehensively covered in the resources located on page 3 col 2 of this news letter..

Migraine Triggers

Migraine Triggers are as individualized and personal as the migraine sufferer themselves. A migraine trigger is something (and there are endless triggers) or the omission of something that over time you realize seems to help bring on a migraine attack. It does not cause a migraine. This is an important distinction and worth the time to look at further. As stated before, migraine is a physical chronic illness that begins with a physical predisposition (hereditary factors). This physical predisposition is the cause of your migraine attacks; a migraine trigger merely activates that existing physical potential. In many cases even without the migraine trigger a person would most likely still get a migraine attack. Now you can take steps to notice very obvious triggers that seem to bring on a migraine every time it occurs, for example eating chocolate, and you can avoid chocolate. You may still get a migraine attack despite avoiding chocolate because you cannot undo the physical predisposition to getting migraine attacks. However it is worth the time and effort if you are beginning with a diagnosis of migraine headaches or even if you have had them for years to keep a migraine diary for a while, perhaps a month or so, where you mark down everything you eat, the weather each day, sleep patterns, stress, hormonal factors for women, exercise taken that day, medications taken, and anything else you can think of. After keeping such a diary for a while you may begin to see that you get a migraine attack after certain similar things or omission of things every time. The list of triggers is endless, but here are the common areas to watch for: Dietary, Stress (good and bad excitement, worry, anger etc.), Weather (changes in climate, barometric pressure changes etc.), Hormonal, Changes in Meal Times and Changes to Routine and Sleep patterns. Also be aware that you may have to look back 24-48 hours prior to a migraine attack as the response to a trigger may be delayed by that length of time. Some triggers are very obvious, others are not so at all. Migraine Triggers are covered extensively in the located on page 3 col 2 of this news letter.

FDA OKs New Arthritis Machine

By LAURAN NEERGAARD AP Medical Writer

WASHINGTON (AP) - The government has approved a machine to filter the blood of Americans with severe rheumatoid arthritis, in hopes it can alleviate the debilitating disease.

The Prosorba column, made by Cypress Bioscience, works much like dialysis. Once a week for 12 weeks, a patient's blood is slowly removed, the plasma is separated and treated by the Prosorba machine, and then the blood is retransfused into the body. The machine offers a 30 percent chance of improving the swelling and pain that cripples patients' joints, Food and Drug Administration officials said in approving Prosorba late Tuesday.

The FDA stressed that Prosorba is only for a small proportion of patients - those with moderate to severe symptoms who have failed all other treatments.

``This is not a front-line therapy. ... It's clearly not for lots of people,'' said Miriam Provost, an FDA engineer and lead reviewer of the device. ``It's for patients who have basically failed everything.''

About 2 million Americans suffer from rheumatoid arthritis. This is not the kind of arthritis common in the elderly because of the wear-and-tear of aging. Instead, rheumatoid arthritis is an autoimmune disease. Patients' own immune systems go awry and attack their joints, causing inflammation and stiffness as rogue immune cells eat away cartilage and eventually erode bone.

The disease mostly strikes women, usually between ages 25 and 50. Within 10 years, about half are too disabled to work.

A number of newly approved drugs help diminish the symptoms and may slow progression of the disease.

Cypress Bioscience's blood-filtering machine Prosorba, which has been sold for a decade to treat a rare blood disorder, is aimed at about 10 percent of patients not helped by drugs.

The machine is a column filled with silica and ``protein A,'' a protein from the cell wall of a bacterium that clings to human antibodies. As plasma runs through the column, the protein A separates out a small amount of antibodies before the plasma is retransfused, Provost said. Antibodies are immune cells that in healthy people fight off infections. In rheumatoid arthritis, some antibodies are believed to go out of control. Just how Prosorba works is unclear, because scientists do not know exactly which antibodies it removes from blood. And it doesn't remove enough to account for all of the effect, so the company is doing further research to understand how it helps, said Cypress chief executive Dr. Jay Kranzler.

But Prosorba can work for about 30 percent of patients: In a study of 99 patients, half had their blood run through the machine and were compared with ``sham'' patients, who had their blood removed but not treated. Three months later, 15 Prosorba patients had a significant improvement, vs. just 5 of the sham patients.

For Merrill Meyer of Tempe, Ariz., the improvement was dramatic. She went from being bedridden to, after a year and two Prosorba treatments, an active life.

``Now I'm taking care of my family and myself and looking now to return to work on my art,'' said Meyer, 48, who quit taking arthritis medicine in 1996 after a severe drug reaction. ``It didn't seem radical to be taking part of my blood and ... cleansing out what may be causing the disease.''

Kranzler said Prosorba's price has not been set, but it will be less than the $1,100 per treatment now charged to blood disorder patients. To be treated, rheumatoid patients would go to blood banks or other designated Prosorba centers with experience in blood filtering techniques.

1. http://www.migraine.ca

This is the web site of the Migraine Association of Canada, founded in 1974. According to their literature approximately 17% of Canadians suffer from migraines, this includes, adults and children. As with many statistics, they can be misleading. On this site the following are included:

• Membership availability and local support groups that are available
• Literature available for Canadians (often either not available on US sites or must be paid in US funds), comprehensive information, including a "migraine-free zone" Cookbook, educational materials including books and videos at discounted prices
• 24-hour information line available with a very lengthy and well described list of topics available which you can choose from and instantly be reading just about anything on migraines and related topics, including medications, triggers, alternative therapies, women and children’s issues, and related headaches
• Migraine and the Workplace as well as educational materials for individuals or companies to purchase at a discount
• Migraine and Children, written FOR children in language they can understand.
• A newsletter entitled "Headlines" which is available to anyone who makes a donation.

This web site is sponsored by the Michigan Head Pain and Neurological Institute Resource Centre and covers a wide range of information on headaches and other pain disorders. It offers Frequently Asked Questions and has links to other resources on the Web. Interesting key points on this site include:

• Information on the possible relationship between Chronic Fatigue Syndrome, Fibromyalgia and migraine headaches
• Children and migraines
• Woman and migraines
• Causes of headaches including hereditary; headaches and sleep disorders; rebound headaches; alternative treatments; the role of diet;
• Depression and a possible link to migraine headaches

This is the National Headache Foundation web site, founded in 1970. Their literature suggests that approximately 10-15% of Americans suffer from migraines, but as stated above these statistics can be misleading as this one may not include children and the elderly. An excellent site full of information, some of the key points are:

• Membership availability and local support groups
• Offers topic "sheets" via email and on-line
• Sample articles from the NHF newsletter
• Basic information on headaches and the various types, symptoms, triggers, medications, therapies for headaches sufferers and their families
• "10 Important Steps" article, covering 10 specific steps that migraine sufferers can use to better communicate with their physicians to obtain better treatment; this is very useful for all Chronic Pain Sufferers, not just those with migraine
• Toll-free access to NHF offices
• Educational materials available at a discount including books, audio and video tapes
• Links to Pharmaceutical companies who make products for headache relief
• State by State list of physicians who are members of the NHF (available upon request)

4. http://www.achenet.org

This is the web site of the American Council for Headache Education, founded in 1990. Described as "a non-profit Physician-Patient Partnership to Advance Headache Prevention and Treatment". The site has a wealth of information available both on-line and by mail. Their goal is to provide support for sufferers of chronic headache as well as working to educate the public. Key points on this site include:

• Membership availability to both US and non US citizens
• Sponsors support groups throughout the USA,
• On line support services Newsletter, brochures, book and video
• Kids and Pediatric Headaches including migraines
• "Find a Headache Doctor" feature which lists by state Doctors names and addresses
• Information on various headache types and triggers
• "Ask the Expert" discussion forum
• Pain meds
• "Art Museum" showing drawings and paintings contributed by headache and migraine sufferers

5. http://www.migrainehelp.com

This site is sponsored by Glaxo-Wellcome, makers of the migraine medication Imitrex. It contains good basic information and is worth a visit. It does have very good free literature available upon request only to US residents. Canadians and other nationals are better served by the Migraine Association of Canada and its’ web site for free literature, and secondly by the American Council for Headache Education site, which has membership and literature available for US citizens and also Canadian and foreign citizens as well.

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