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Novel Treatments Ease Migraine Pain

Both call for stimulation of nerve centers related to pain

THURSDAY, June 26, 2008 (HealthDay News) -- Technology may ease migraine and headache pain, two new studies suggest.

"What this tells us is that there are non-medical, non-drug treatments that are effective," said Dr. Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University Hospital in Philadelphia, who was a co-author on both papers.

One paper found that stimulating the back of the head at the beginning of a migraine attack with a handheld magnetic device significantly reduced pain levels.

The second approach involved stimulating the occipital nerve at the back of the head with an implanted device. This technique would target more "high-end" patients, those who don't respond to other therapies. The magnetic device would be aimed at more "garden variety" headaches, Silberstein said.

Millions of Americans suffer from migraines or other forms of chronic headaches. Many don't respond to standard medications, leading some researchers away from conventional drug therapies to explore other options.

"We're going in a lot of different directions," confirmed Dr. Michael Palm, an assistant professor of neuroscience, experimental therapeutics and internal medicine at Texas A&M Health Science Center College of Medicine and director of the Parkinson's Program and the Headache Program at the Texas Brain and Spine Institute in Bryan. "We're still trying to find the mechanisms."

The studies are to be presented this week at the American Headache Society annual meeting, in Boston.

The transcranial magnetic stimulation (TMS) device, about the size of a hairdryer, is held to the back of the head at the first sign of a migraine aura. Pressing a button twice sends two brief magnetic pulses into the brain. Those pulses, scientists believe, basically short-circuit the abnormal electrical activity that causes or contributes to the migraine.

Previous research had studied a similar, table-top device when administered by health-care professionals. This is the first study to look at patients administering TMS to themselves.

One hundred sixty-four outpatients, aged 16 to 68, were randomly selected to receive either the TMS device or a "sham" device. They recorded pain levels and symptoms in an electronic diary.

After two hours, 39 percent in the TMS group were pain-free, compared with 22 percent in the sham group.

For the second study, 28 patients were implanted with an adjustable neurostimulator, 16 were implanted with a neurostimulator that could not be adjusted, and 17 patients received standard medication therapy with no implant.

In occipital nerve stimulation, an electrode is implanted near the occipital nerve in an outpatient procedure. That device sends electrical impulses into the central nerve system that are thought to block the perception of pain in the brain.

"It stimulates the occipital nerve in an attempt to turn off the pain," Silberstein explained.

Close to 40 percent of patients in the first group had a positive response, meaning at least a 50 percent reduction in the number of days each month they suffered headaches, or a reduction in pain intensity of three points or more on a specific pain scale. Only 6 percent in the second group, and none in the control group had a positive response.

"This group is typically hard to treat," Palm said. "Electrical stimulation sounds like it resulted in improvements in a significant number of people. It's no more invasive than spinal cord stimulation."

Silberstein added: "These patients were, by definition, the worst of the worst and that is why this is so important. These are patients who give up hope."

Now more studies need to be conducted before seeking approval from the U.S. Food and Drug Administration.

More information

The American Headache Society has more on migraines and other types of headaches.

SOURCES: Michael Palm, M.D., assistant professor, neuroscience and experimental therapeutics and internal medicine, Texas A&M Health Science Center College of Medicine, and director, Parkinson's Program and Headache Program, Texas Brain and Spine Institute, Bryan; Stephen Silberstein, M.D., director, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia; June 26-29, 2008, presentations, American Headache Society annual meeting, Boston
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