Magnetic Gun to Stop Migraine Attacks
In December 2013, the FDA approved the use of a powerful magnetic pulse generator (Cerena TMS®) gun to stop a developing migraine. It was shown to be as effective as many of our present triptan medications with virtually no side effects. About the time the FDA approved the device, the company (eNeura Therapeutics) developed a more portable prototype called the Spring TMS Device®. For reasons that are unclear, but I suspect it was an agreement with the FDA, this device has not yet been released to the general public but it is available for trial at three headache centers. We asked to be part of that trial; however, they didn’t need more trial sites. I suspect that as soon as the data shows the new prototype to be the same as the one which originally got FDA approval, it will finally be released to the general public. That may not be until the end of 2015.
Cefaly® Transcutaneous Electrical Nerve Stimulation.
This device has been on the market for a year. When used daily for 20 minutes, it can reduce headache frequency for some patients. People ask how effective it is and the answer is that 53% of users said they would buy it again. As far as I know, the insurance companies are still not paying for it.
Zecurity®, Sumatriptan (Imitrex®) Patch
This is a new delivery system for the original sumatriptan that uses a pulsed electrical current to push the medication through the skin from a patch. Its advantage is that it works faster than a pill and bypasses the stomach, which is especially good for patients with nausea. It does not work as fast as an injection, but it is less painful than a needle. It is approved and will probably be launched to the public any day. For follow up, go to their web site here.
Sumatriptan Nasal Powder (formally called Optinose®)
Different from the wet nasal sprays, a dry powder can be more effective and less messy. Avanir Pharmaceuticals, Inc. applied to the FDA for an approval of this new delivery system in 2014 and the approval is pending.
Dihydroergotamine Inhaled (Semprana®, previously called Levadex®)
Dihydroergotamine is one of the most powerful migraine reversing agents and it comes from a natural source, an ergot fungus extract. However, it has always been difficult to get therapeutic amounts in the blood stream as pills are neutralized in the stomach. We use it routinely as injections or intravenously. This inhaler, (think of an asthma type inhaler) has been in development for a decade. While the main ingredient has FDA approval, the canister device has been rejected by the FDA several times as it is poorly made and inaccurate in the doses it delivers. This canister has been remade several times. Application has once again been made to the FDA with a new canister and a decision will be made by the end of 2015.
New Generation Triptans
At least three new generation headache aborting medications that are being explored at this time. They don’t work exactly like triptans and the biochemistry of how they work to turn off a headache (if they work) is too complex to discuss here. These three agents are currently being tested with the hopes that they could be more effective than present triptans and with less side effects.
The Migraine “Vaccine”
I use the term “vaccine” because, while not a true vaccine, these treatments behave like a vaccine. It is an injection either monthly or quarterly (we don’t know how often it needs to be injected yet) of humanized antibodies against the most powerful headache causing chemical (CGRP) in nerve endings. The trials so far show that it is effective in preventing headaches from coming. The side effects of this treatment have almost been nonexistent except for the typical irritation you can get from any injection. These trials are continuing and are showing some promise. It may be two to three years before the first one is brought to the market.
Diet and Migraine
Because migraine is a paroxysmal disorder (meaning that it comes and goes), it is very suspect to superstitions. If someone has a bad migraine on a particular day, they scratch their heads and ask themselves “why.” The real answer is very complicated and poorly understood. While 50% of patients do have identifiable triggers such as menstrual cycle, weather changes, sleep changes, dehydration, missing meals and stress, many have no clear triggers. It has always been easy to blame the diet because most of us eat different things on different days and if a headache comes on, we look back at what we just ate the day before and we erroneously believe that food was the culprit.
In the 1980s, the headache research community did come up with the headache diet which is often repeated today by people who don’t keep up with headache research. However, that diet was not based on any clear research but on what patients were reporting as their trigger. Patients tended to report “guilt foods” such as chocolate, red wine or sweets. But that has never been confirmed in research.
Diets also follow strong fads. In the 1990s it was the Atkins Diet. Now gluten free or paleo diets are in vogue. Once again, these diets have very little or no support in research. Despite this, we are constantly looking for dietary trends that might be related to headaches.
A new study shows a loose relationship with severity of headaches and intake of folate. The trend was barely statistically significant (meaning more than just a placebo effect). But it might be worth considering adding folate to your diet if you are motivated to address your headaches. Previous dietary changes show that adding B2 at 400 MG per day, magnesium 400-600 MG per day or Co Q 10 might be beneficial. We no longer advise patients to take the herbal butterbur because it has been associated with liver irritation. There is a new herbal, Boswellia, that might be effective in migraine but the verdict is still out.
Because headaches bring so much misery to one’s life I suggest that you don’t eliminate foods that you truly enjoy as you do deserve some pleasure. Of course if that food clearly triggers a migraine each time you eat it, then consider stopping it. But don’t follow some outdated diet promoted by Dr. Oz, the many books on the market, or other providers who have never darkened the door of a headache research meeting but base their ideas on hearsay.