News from Headache Research 5/18/16

Breaking News Items

  • Is Chronic Migraine (CM) totally different from Episodic Migraine (EM)? At this present time, the definition of CM is simply based on frequency. If you have headaches more than 14 days per month it is called CM and if it is less than that (if it is migraine) it is EM.  There is some evidence that the two many not be the same thing at all. For one example, Botox is somewhat helpful to CM but does not work in EM. Also CM has many other comorbidities that regular migraine does not have, including; obesity, depression, chronic sleep problems, menstrual irregularities, hypothyroidism, hypertension, musoskeletal pain, fibromyalgia, cardiac problems and digestive problems. The thought is, could CM be some type of metabolic disorder, of which migraine is only one facet?
  • Maybe, not all things that we us for migraine during pregnancy is safe. If you are pregnant and have bad migraines, it is a dilemma.  Fortunately most women do better when pregnant. If they don’t or do worse, there are few tools that can help. It still appears that propranolol is safe. Things like acupuncture is safe, but not always effective.
    • Magnesium: There is no evidence of  harm from oral magnesium for migraine prevention during pregnancy, yet, however there is evidence that IV magnesium may rarely cause the fetus to have low calcium levels and bone (rickets type) changes.
    • Ondandsetron (Zofran®), which is used for nausea, found an increase in cleft palate in the offspring and possibly heart deformities (the data was not statistically significant).
    • Acetaminophen (Tylenol®) has always been considered safe for pregnant women, however, some recent evidence suggest that there is a higher incidence of Attention Deficit Hyperactivity Disorder (ADHD) and wheezing among children born to mothers who used a lot of acetaminophen.
    • Butalbital (Fioricet®) has not been consider safe for some time but newer evidence (a very small study) suggest that there could be a slight increase in heart defects in children born to mothers who used butalbital during pregnancy.

J. Michael Jones, MPAS-C