New treatments for migraines and chronic headaches

Migraines and chronic headaches are wide-spread phenomena.

Twelve percent of the population, three quarters of them women, suffer at least occasionally from migraines and about 5 percent from chronic headaches. New effective methods of treatment were presented at the Congress of the European Neurological Society (ENS) in Rhodos. According to Greek researchers, migraine sufferers can eliminate symptoms altogether if they take higher doses of anti-migraine medicine for a longer period of time than is now customary. Another team of researchers has found that certain psychopharmaceuticals could serve as a new therapy option for persistent chronic headaches.

Twelve percent of the population, three quarters of them women, suffer at least bouts of migraines, that much-feared type of paroxysmal pulsating headache that generally occurs in just one half of the skull and is accompanied by unpleasant symptoms like nausea and vomiting, dizziness or sensitivity to light and sound.

New tools that could relieve these discomforts for millions of people were just presented at the annual Congress of the European Neurology Society (ENS), held this year on the Greek island of Rhodos from June 16 to 20 June.

The new findings are from a group of researchers led by the psychiatrist Dr. Nikolaos Kouroumalos from the Second Department of Neurology of the General Hospital in Chania on the Greek island of Crete: "In treating migraines, optimizing the effect of already available agents is at least as important a task as developing new substances."

Symptoms Eliminated with a Different Rhythm of Preventive Drug Therapy The experts have in fact achieved a breakthrough in the effectiveness of preventive therapies. The standard procedure today is to give migraine patients preventive drug therapy at a dose that just suffices to protect them from further attacks or at least to stabilize their recovery. To avoid habituation effects and side-effects, this therapy is successively reduced after a time and finally ended (gradual reduction of the dose to zero). Dr. Kouroumalos: "As a result, most patients suffer a recurrence or worsening of migraine attacks after a certain time and the preventive therapy has to be started over from the beginning again. Our idea was to resume the preventive treatment after a break of two months and administer the previous maximum dose. This dose was then reduced after four weeks and, after a total of six weeks, another break in treatment occurred, this time lasting three months, and so forth until we arrived at a six-month cycle that we constantly repeated for a minimum of three years. Thereafter it was eventually continued according to each patient's needs.

The approach was a definite success. By regularly "reviving" the preventive therapy, the researchers fully maintained the desired effect of bringing about an end to migraine attacks or at least to reduce their extent over the 24 to 36 month period of observation.

Psychopharmaceuticals Bring Relief from Chronic Headache Pain Four to five percent of the population suffers from chronic headaches. This condition is defined as headaches occurring on average on at least 15 days of the previous three months. They have the disadvantage of having widely diverging causes and of thus requiring widely diverging drugs for treatment.

Dr. Kouroumalos and his team administered neuroleptic drugs, i.e. drugs that are actually used for treating psychoses, to patients who had failed to respond to several attempts of conventional preventive therapy. The retrospective study involved the files of 20 patients who had tried traditional therapy with at least three different migraine agents which did not avail. Half of them were then treated with the conventional neuroleptic Perphenazine and the other half with the atypical neuroleptic Olanzapine.

Both substances brought dramatic relief from headache pain, with Olanzapine doing so to an even greater extent than Perphenazine. "However," Dr. Nikolaos Kouroumalos explained, "more patients broke off the treatment with Olanzapine." The atypical antipsychotic causes fewer motor disturbances than its conventional counterpart but is associated with greater weight gains than is the case with conventional neuroleptics. This side-effect is less significant medically but for many patients, it was too high a price to pay for the peace and quiet in their heads.