I mentioned in a previous post, I just returned from the International Headache Congress in Spain. This is a meeting held every two years and is an assembly of the brightest minds in headache research from around the world. The next meeting will be in our backyard, Vancouver, BC during September 6-10, 2017. So if you have a desire to learn what really is going on in headache research I suggest that you attend the next meeting.
I am doing several postings of what I think were the highlights of this meeting. On the last post I discussed the latest information the “Migraine Vaccine,” which is really a humanized antibody to block one of the most important chemicals for starting a migraine, CGRP. In this posting I want to discuss some of the things in the area of what is called “neuro-modulation.” This is where malfunctioning nerves can be brought back “on line” via electrical or magnetic energy, or thermal chilling. This is very different from the pseudoscience of wearing magnets and buying gizmos that medical con artists have used for a hundred years. These ideas are real, make sense and seem to be effective.
This is a device that delivers a powerful magnetic field into the brain within a millisecond. These devices have been worked on for thirty years. This particular device has been approved in Europe for two years and has been approved in the states to stop a migraine after the onset of an aura. The company has not released the device to the public as they want to also demonstrate its effectiveness for preventing headaches as well.
When this is used to stop a headache, one or two pulses are pointed into the back of the brain. As a preventative, 2-3 pulses are done each morning and at night. It appears to be effective and safe. When released in the states the device will be leased to the patient at about $250/month. Insurance companies, (most of which don’t understand headache disorders at all and if they do understand, they don’t seem to care), will not pay for the device. So the expense may sound great, but if it is effective for the patient, it could save them money that they would otherwise be spending on triptans, office visits and things like Botox®. The Spring TMS® should be available by the end of the year. For more information go to their web page at: http://www.eneura.com/springtms.html
This is a handheld that is placed over the neck, near the carotid artery. At that point, nerves within the carotid artery (which is relatively near the surface) are directly linked to the vagus nerve. The vagus nerve is one of the major cranial nerves that leads directly into the brain. It is believed that when an electrical current is applied to this nerve it interferes with the electrical storm that is involved in creating a cluster or migraine headache. This may be done by direct electrical interference or by reducing a brain chemical call glutamate, which is involved in headache development. This device has been use to prevent and stop both migraines and cluster headaches. This device is not available in the U.S. but is available next door in Canada and in most of the rest of the world. You can learn more at their website: www.gammacore.com.
This is a surgical implantable device that has a lead that goes into a nerve behind the nose called the Sphenopalatine Ganglion (SPG). The procedure is minor and could be done in an out-patient surgical suite by an oral surgeon or ENT specialist. The device is very small and conducts a current directly into the SPG by using an external remote control. The SPG is very involved in cluster headache attacks and lessor so in migraine. Studies have shown it to abort a cluster attack in 60 % of patients using it. It is available in Europe and most of the world and may be coming to the U.S. in the future.
This is a thermal device (using cold temperatures) that seems to be effective in stopping a bad migraine without medications. It was invented here in the U.S. for cooling the brain during certain neurosurgical procedures but was also found effective in stopping a migraine. The cooling is done by a catheter that is inserted through the nose. A very cold mist is pumped into the back of the nose, over the surface near the SPG (mentioned above).
This device is available in Europe and will be available in Canada but it is not clear if it will be made available in the U.S. For more information visit their website at: www.benechill.com
Why Are Americans the Last to Get these Treatments?
I want to take a moment to digress with a brief commentary about the availability of these devices. Virtually all of these were invented and/or man manufactured the U.S. However, the U.S. gets these devices years behind the rest of the world if at all. The reason for this is the American culture is far more litigious than any other society on the planet. Every company that makes a device or even a drug is terrified of being sued in America. What if the chilling device was used inappropriately and someone was hurt by that? That is highly unlikely. In most of the world it would be seen as a mistake and mistakes happen. In the U.S. a multi-million dollar lawsuit would quickly develop and then lawyers would be running late night TV ads like “Bad Drugs” or “Bad Devices.”
Americans also demand perfection from the FDA, therefore the FDA has the highest standards in the world for proving that a device or drug is safe and effective. To meet this high standard, a company will have to invest up to one billion dollars for all the required studies to get approval. While this may sound like a good thing, if this is what American’s demand, then they will have to learn to wait or go without effective treatments in the future. The rest of the world, in my opinion, is far more realistic.
J. Michael Jones, MPAS-C