Research - Migraine / Headache
Effect of lavender essential oil as a prophylactic therapy for migraine: A randomized controlled clinical trial
- Shahram Rafiea,
- Forough Namjoyanb,
- Fereshteh Golfakhrabadib,
- Fatemeh Yousefbeykc,
- Alireza Hassanzadeha
There is no cure for migraine, but preventive treatments are usually applied to reduce the frequency and severity of headache attacks. The purpose of this study was to investigate the effect of lavender as a prophylactic therapy for migraine in a randomized controlled clinical trial. This double-blind and placebo-controlled study was conducted over a period of three months. Patients were assessed for migraine impact at the baseline and at the end of the study, using the Migraine Disability Assessment Scores (MIDAS) questionnaire. In the case group, after three months of lavender therapy, the MIDAS score was reduced. The reduction in MIDAS score was significant (P < 0.05), when compared to the baseline and also control group. During the treatment, participants did not report any complaints or side effects. The results of this present study report that the frequency and severity of migraine incidents were reduced in those participants using lavender therapy during the three month trial.
Source : Journal of Herbal Medicine
Link to Full Article
Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study
Toni Hesse,1 Laura G. Holmes,2 Vicki Kennedy-Overfelt,3 Lynne M. Kerr,4 andLisa L. Giles5
Recurrent headaches cause significant burden for adolescents and their families. Mindfulness-based interventions (MBIs) have been shown to reduce stress and alter the experience of pain, reduce pain burden, and improve quality of life. Research indicates that MBIs can benefit adults with chronic pain conditions including headaches. A pilot nonrandomized clinical trial was conducted with 20 adolescent females with recurrent headaches. Median class attendance was 7 of 8 total sessions; average class attendance was 6.10 + 2.6 . Adherence to home practice was good, with participants reporting an average of 4.69 (SD = 1.84) of 6 practices per week. Five participants dropped out for reasons not inherent to the group (e.g., extracurricular scheduling); no adverse events were reported. Parents reported improved quality of life and physical functioning for their child. Adolescent participants reported improved depression symptoms and improved ability to accept their pain rather than trying to control it. MBIs appear safe and feasible for adolescents with recurrent headaches. Although participants did not report decreased frequency or severity of headache following treatment, the treatment had a beneficial effect for depression, quality of life, and acceptance of pain and represents a promising adjunct treatment for adolescents with recurrent headaches.
Source : Evidence Based Complementary and Alternative Medicine
Link to Full Article
Effects of the Kampo Formula Tokishakuyakusan on Headaches and Concomitant Depression in Middle-Aged Women
Masakazu Terauchi,1 Shiro Hiramitsu,2 Mihoko Akiyoshi, 2 Yoko Owa,2 Kiyoko Kato, 2 Satoshi Obayashi, 2
Eisuke Matsushima,and Toshiro Kubota 2
1Department of Women’s Health, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo 113-8510, Japan
2 Department of Obstetrics and Gyneco logy, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo 113-8510, Japan
3 Department of Psychosomatics, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo 113-8510, Japan
Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23),a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression.
Methods. We examined cross-sectionally the baseline records of 345 women aged 40–59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment.
Results. The women were classified into 4 groups on the basis of their headache frequency, andno significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women’s headaches were their age (adjusted OR 0.92 (95% CI 0.88–0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39–2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment.
Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms
Source : Evidence Based Complementary and Alternative Medicine
Link to Full Article
American Academy of Neurology, American Headache Society Recommend Special Butterbur Root Extract for Migraine Prevention
In a joint report published in April 2012 by the American Academy of Neurology (AAN) and the American Headache Society (AHS), researchers concluded that a proprietary extract of butterbur (Petasites hybridis, Asteraceae) root is effective in reducing the frequency of episodic migraines.1 The finding, published in the journal Neurology, was part of the organizations’ updated evidence-based treatment guidelines, which specifically examined the efficacy of what they term “complementary treatments” and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.
“Non-prescriptive treatments are important for many patients,” said Frederick Freitag, MD, a co-author of the new guidelines and medical director of The Headache Center of Baylor Health Care System in Dallas, Texas (email, July 25, 2012). “As with any treatment for migraine, appropriate discussion with the patient’s clinician regarding choices and subsequent monitoring for safety and efficacy can be very beneficial.”
To assess the effectiveness of non-prescription treatments, a panel of headache and methodology experts conducted a literature review of migraine prevention studies from June 1999 through May 2007. Treatments were considered to have established efficacy if two or more supporting Class 1 human clinical trials existed in the literature. According to its website, Neurology defines a Class 1 trial as a “randomized, controlled clinical trial of the intervention of interest with masked or objective outcome assessment, in a representative population.”2
Only 2 studies of butterbur extracts for migraine prevention met the criteria for inclusion, each of which compared placebo treatment to various dosages of the butterbur root extract supplement Petadolex®(Linpharma Inc., Orlando, FL; manufactured in Germany by Weber & Weber), which has been commercially available in Europe for more than 25 years. It has been available in the United States as a dietary supplement since 1999 (V. Gallichio, email, August 14, 2012).
Both studies concluded that certain doses of Petadolex were significantly more effective than placebo. “Petadolex brand of butterbur root is a reasonable alternative to prescriptive medication and when properly prescribed and monitored can be a very effective and safe preventative treatment for migraine,” said Dr. Freitag.
Although this is not the first case of an American medical organization recommending a specific herbal treatment option for an illness or disorder, it does not happen frequently due to the amount and type of research required for such recommendations. In its clinical practice guidelines, the American Urological Association notes positive outcomes of studies using saw palmetto (Serenoa repens, Arecaceae) berry extract and stinging nettle (Urtica dioica, Urticaceae) for the treatment of benign prostatic hyperplasia (BPH), but it does not offer an endorsement of these herbal options, describing the quality, size, and length of available studies as “suboptimal.”3 Saw palmetto, however, is described as a secondary recommended treatment (“Grade B”) for patients with BPH by the American Association of Clinical Endocrinologists in their medical guidelines for the clinical use of dietary supplements and nutraceuticals.4
In its 2009 review of evidence-based clinical practice guidelines, the Society for Integrative Oncology explains why complementary therapies, including herbal medicine, are often not formally recommended by medical organizations, despite promising research. “A gap exists between the current level of scientific evidence and what we need to know to provide evidence-based advice, but rigorous scientific research is ongoing,” the authors wrote in the report.5 “A demonstrably favorable risk/benefit profile is essential for the use of complementary therapies, as it is for any form of medicine. The advantages of a rigid, evidence-based approach based on reductionism, however, do not translate easily into the holistic approach required for complex health issues.”
The National Center for Complementary and Alternative Medicine (NCCAM) has compiled a list of clinical practice guidelines from a variety of medical organizations on its website, which includes botanicals with varying levels of supporting evidence. The list is available at http://nccam.nih.gov/health/providers/clinicalpractice.htm.
In their 2001 paper in Alternative Medicine Review — one of the studies included in the recent migraine prevention literature review — researchers Werner Grossman and Hanns Schmidramsl explained Petadolex’s presumed mechanism of action.6 “Petadolex is an extract of the rhizome from Petasites hybridus, and petasine and isopetasine are the main components,” they wrote. “It has been shown that petasine and isopetasine are strong vasodilatory substances, whereby this effect on smooth muscle preparations in vitro is equivalent to papaverine.” (Papaverine is a medication prescribed for migraines in adults and children, derived from the opium poppy [Papaver somniferum, Papaveraceae].)
The etiology of migraines, which are 3 times more common in women, is still contested. Once thought to be primarily related to cranial vasculature, new theories — including genetic predisposition, hyperexcitable neurons (particularly the trigeminal nerve), and inflammation — have emerged in recent years.7
In addition to its use for migraine prevention, butterbur root has been used traditionally for pain management, anxiety, fever, and gastrointestinal conditions. In its “Herbs at a Glance” factsheet published in March 2012, NCCAM noted the well-known fact that the butterbur plant contains chemicals known as pyrrolizidine alkaloids (PAs), which have been shown to cause liver damage.8 NCCAM cautions consumers to use only butterbur products labeled as PA-free. European regulatory agencies allow butterbur root and aerial parts preparations to be marketed only if the daily dosages stay within a very low prescribed maximum level of PAs. For example, the German Commission E monograph (under the common name Petasites Root in the English translation) states that the daily dose of butterbur root preparations must not exceed 1 mcg of PAs.9
Accordingly, Petadolex supplements are processed in a manner that reduces PAs to undetectable levels. As stated on the company’s website, “Petadolex is manufactured by a patented method for extracting the beneficial liquid of the butterbur plant without the PAs. This purification process guarantees that Petadolex is free of detectable PAs.”10
In addition to butterbur root extracts, experts involved in the recent Neurology report reviewed studies on antihistamines, Co-Q10, estrogen, hyperbaric oxygen, magnesium, and MIG-99, a supercritical carbon dioxide-extract of the herb feverfew (Tanacetum parthenium, Asteraceae) that is no longer being manufactured (V. Gallichio, email, August 14, 2012).1 A single Class 1 study and 2 Class 2 studies on MIG-99 and migraine prevention were available in the time period reviewed by the authors, which was enough evidence to label feverfew extract a “Level B” treatment (medications that are “probably effective”).
While Petadolex has been shown to be effective in reducing episodic migraines, more research is needed on other formulations of butterbur, as well as other herbs that may offer relief to migraine sufferers. Revised guidelines for acute migraine treatment, separate from preventative treatment, are currently in development.
Source : American Botanical Council
Link to Source
Homeopathic Treatment of Migraine in Children: Results of a Prospective, Multicenter, Observational Study.
Danno K, Colas A, Masson JL, Bordet MF. .
Objectives: The study objective was to evaluate the effectiveness of homeopathic medicines for the prevention and treatment of migraine in children. Design: This was an observational, prospective, open, nonrandomized, noncomparative, multicenter study. Setting/location: The study was conducted in 12 countries worldwide. Subjects: Fifty-nine (59) physicians trained in the prescription of homeopathic medicines and 168 children, aged 5-15 years, with definite or probable migraine diagnosed using International Headache Society 2004 criteria were the subjects in this study. Interventions: Physicians were given complete freedom in terms of treatment prescription; thus, prescriptions were individualized for each patient. Outcome measures: The frequency, intensity, and duration of migraine attacks in the 3 months prior to inclusion were compared with those during the 3-month follow-up period. Pertinent data were collected using questionnaires completed by the doctor and the patient or his/her parent/guardian. The secondary outcome measure was the impact of homeopathic medicines on education, measured as absence from school. Results: The frequency, severity, and duration of migraine attacks decreased significantly during the 3-month follow-up period (all p<0.001). Preventive treatment during this time consisted of homeopathic medicines in 98% of cases (mean=2.6 medicines/patient). Children spent significantly less time off school during follow-up than before inclusion (2.0 versus 5.5 days, respectively; p<0.001). The most common preventive medicines used were Ignatia amara (25%; mainly 9C), Lycopodium clavatum (22%), Natrum muriaticum (21%), Gelsemium (20%), and Pulsatilla (12%; mainly 15C). Homeopathy alone was used for the treatment of migraine attacks in 38% of cases. The most commonly used medicines were Belladonna (32%; mainly 9C), Ignatia amara (11%; mainly 15C), Iris versicolor (10%; mainly 9C), Kalium phosphoricum (10%; mainly 9C), and Gelsemium (9%; mainly 15C and 30C). Conclusions: The results of this study demonstrate the interest of homeopathic medicines for the prevention and treatment of migraine attacks in children. A significant decrease in the frequency, severity, and duration of migraine attacks was observed and, consequently, reduced absenteeism from school.
Source : : J Altern Complement Med. 2012 Sep 14. via Laboratoires Boiron, Sainte-Foy-lès-Lyon, France
Link to Abstract
A Double-blind Placebo-controlled Pilot Study of Sublingual Feverfew and Ginger (LipiGesic™M) in the Treatment of Migraine
Roger K. Cady, MD; Jerome Goldstein, MD; Robert Nett, MD; Russell Mitchell; M.E. Beach, BS, LPN, CCRP; Rebecca Browning, BS
Background.-- Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high-end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the "gold standard" of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open-label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack.
Methods/Materials.-- In this multi-center pilot study, 60 patients treated 221 attacks of migraine with sublingual feverfew/ginger or placebo. All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2-6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non-migraine headache. Subjects were randomized 3:1 to receive either sublingual feverfew/ginger or a matching placebo and were instructed but not required to treat with study medication at the earliest recognition of migraine.
Results.-- Sixty subjects treated 208 evaluable attacks of migraine over a 1-month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation. Evaluable diaries were completed for 151 attacks of migraine in the population using feverfew/ginger and 57 attacks for those attacks treated with placebo. At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain-free (P = .02). At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain-free or mild headache) vs 39% for placebo (P = .002). Pain level differences on a 4-point pain scale for those receiving feverfew/ginger vs placebo were −0.24 vs −0.04 respectively (P = .006). Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event.
Conclusion.-- Sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.
Source : Medscape
Link to Source_