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    • 16 JUL 16
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    Migraine Treatments

    Updates to Promote Optimism in Migraine Treatments

    Migraine is never a pleasant experience, which is why it would be practical for its sufferers to constantly look for the condition’s treatments. The various methods involved in treating migraine may vary and it’s mostly helpful for you to the advice of your doctor. This way, you can gather the solutions which can effectively help you to get better.

    However, it is important to note how some drugs may lead migraine patients to suffering from cognitive Impairments or even Dementia for older adults. This is why it’s additionally necessary for you to consider the long term impacts of your chosen medicines, so you can ensure they’ll provide you with more good than harm.

    First appeared here: (

    Cognitive impairment and dementia in older adults have been linked to anticholinergic drugs, which block the neurotransmitter acetylcholine, in an increasing number of studies over the last decade. Some popular antihistamines, antidepressants, and anti-nausea meds used as migraine drugs have anticholinergic effects.

    The research may not be cause for alarm, which I’ll explain in a moment. The first question you want answered is likely: Which drugs put me at risk?


    Migraine Drugs With Anticholinergic Effects


    This list contains drugs I’m aware of people using for migraine, but it is not an exhaustive list of anticholinergics. Indiana University has a more complete list of anticholinergic drugs (PDF). A JAMA article on the topic also includes Vivactil (protriptyline) and Compazine (prochlorperazine). ACB score refers to “anticholinergic cognitive burden,” which determines if a drug has mild or moderate anticholinergic effects.


    Anticholinergic Drugs, Cognitive Impairment, and Dementia: The Research


    Keep in mind that:

    1. These studies do not provethat anticholinergic drugs cause cognitive impairment or dementia. They have found that a link exists between taking the drugs and cognitive impairment or dementia.
    2. All published studies have focused on older adults, most with an average participant age in the early 70s. It is speculated that increased age makes the body more susceptible to these effects, possibly because these drugs permeate the blood-brain barrier more readily in older people.


    Risk depends on strength of cholinergic effect


    Drugs with a mild cholinergic effect (an ACB of 1) can cause cognitive impairment in older adults within 90 days of continuous use. Those with a strong cholinergic effect (ACB of 2 or 3) can cause cognitive impairment in 60 days of continuous use. Non-continuous use can also have an impact, though the exact length of time varies. Cognitive effects were increased with the number of anticholinergic drugs a patient took. (See Just 2 Months’ Exposure to Anticholinergics Affects Cognition)


    Dose matters (somewhat)


    The higher the drug’s dose, the greater the risk, according to a study published in 2015. However, even at the minimum effective dose, taking the drugs for prolonged periods were linked to a greater likelihood of cognitive impairment or dementia than for those not taking anticholinergic drugs. “This is not excessive use,” said the lead author Shelly Gray, PharmD, from the University of Washington. “Many of these agents are used chronically, and chronic use—even at low doses—would put you in the highest risk category.” (See ‘Strongest Evidence Yet’ Links Anticholinergic Drugs, Dementia)


    Changes in the brain


    Brain imaging found lower brain metabolism and reduced brain sizes among participants taking anticholinergics, as reported in a study published this week. Participants taking the drugs also scored lower on cognitive tests than those not taking the drugs. This is the first study looking at the underlying biology of the link identified by earlier research. (See IU Scientists: Brain Scans Link Physical Changes to Cognitive Risks of Widely Used Class of Drugs)


    Age of participants


    The published studies I found are focused on older adults. Researchers believe that a person’s central nervous system becomes more sensitive to anticholinergic medications with age. It could be that younger patients don’t have the same risks, but that’s uncertain. This warning from Dr. Gray haunts me: ‘There is no data on how these drugs may affect younger people, but I personally will avoid taking anticholinergic agents.”


    I found one study presented at a conference that looked at the ACB of younger patients with chronic pain. Participants with chronic pain had significantly higher ACB scores than healthy participants and their cognitive function appeared to be affected. The burden was greatest in patients aged 30 to 39. (See Pain Patients at Cognitive Risk From Anticholinergic Burden?)


    Cognitive Impairment vs. Dementia


    Cognitive impairment and dementia are very different things. Several studies show that cognitive impairment due to the drugs could be reversible. The drugs could magnify symptoms of an already present mild dementia or bring symptoms on earlier than would have happened otherwise. However, brain atrophy, as found in the study published this week, doesn’t sound reversible.


    What’s the Actual Risk?


    No one knows for sure. The research is concerning, but is far from conclusive. Many questions still remain. Talk to your doctors and pharmacists for advice that’s best suited to you—it will depend on your age, the medications you take and why you take them, how effective the medications are for you, what alternative medications might help you, and other health problems you may have. Please don’t stop taking your medications without first talking to your health care providers—doing so could put you at risk of other problems.


    Other than drugs and medication, there are also various types of wearable technology which can help patients in treating their migraine. These items can aid or even supplement the treatments they’ve been taking. In fact, some patients mentioned how they cannot possibly take oral medications all the time. With the use of certain technologies, patients have found how their migraines became less intense later on. The wearable treatments which they have would be best in conjunction with their other medications, towards a more balanced way of handling their condition.

    First appeared here: (


    Name: Olivia
    Age: 24
    Location: Columbia, Missouri
    Years with Migraines: 4+
    Occupation: Student/Advocate

    How long have you had migraines?
    I’ve had migraines as long as I can remember, into early childhood. They did not become debilitating until I was about 20. I don’t really know why. I was in college, a full-time student, an employee, I had a very active social life and was very active with extra-curricular activities. My doctors presume it was probably my age that triggered them to be worse around that time. My mom’s migraine started and were also more severe around that age period too.

    When do you usually get migraines?
    I’ve had daily migraines for the past 4 years and after recently going to a neurologist/specialist and a clinic that referred me to a head pain unit at a hospital I started to get better. It’s difficult to identify what triggers them. Weather changes, alcohol, sometimes stress, skipping meals, medication overuse, and genetics are factors for me. I have chronic sinusitis, allergies, TMJ, and neck pain, which also can contribute to the migraines; so keeping those conditions under control is important in my treatment.

    What have you tried pre-Cefaly?
    I’ve probably tired almost every medication there is… several preventatives – you name it! Triptans were my main abortive but I’m on different abortive and preventative medications now too. I’m on my 8th round of neurotoxin injections. I’ve done chiropractic care, acupuncture, clinical massage therapy, biofeedback, relaxation therapy, oxygen therapy, occipital nerve blocks, trigger point injections, facial nerve blocks, facet blocks, sphenopalatine ganglion blocks, intravenous therapy, and several different infusions.

    What does your migraine feel like?
    My pain is predominantly behind my right eye, it’s like a stabbing, broadening, unbearable pain and it becomes debilitating, often with severe nausea, sensitivity to light, sound and smell.

    How did you hear about Cefaly?
    I’m pretty involved online and stay up to date with the migraine community. I’m in several online support groups and blog. I was researching online about migraines and came across an article on Cefaly. I had to tell my doctor about it, he hadn’t heard of it but I contacted Cefaly and their awesome customer service explained how to get a prescription and my doctor was very happy that I brought it to his attention and wrote me a prescription for Cefaly!

    What’s your Cefaly experience like?
    I will actually use Cefaly consistently throughout the day, especially if I have a really bad migraine and I can’t bare it. I use it often more, than once a day. Cefaly is a tool that I have. My migraines are very complicated and in conjunction with other treatments and medications the Cefaly is something I have in my ‘migraine toolbox’ at my disposal to use, as I need it both as a preventative and an abortive. It’s something I really rely on. You can only take so many abortives. I always have it in my purse, I don’t leave the house without it. I don’t think I could go a day without it now that I have it. I am currently on a lot less medications, about 1/3 of what I was taking prior to the hospital. It’s tricky to limit your medications when your migraines are daily but using Cefaly as a tool, and having a combination of treatments my migraines are more under control than they have been since becoming debilitating 4 years ago. I’d say my migraines have been better, less intense and my worst migraines are more rare; certainly more manageable with the conjunction of treatments.

    What made you want to share your story?
    I really love the Cefaly. I post about it on social media and I get a lot of questions and inquiries. I’m certain that I’m responsible for at least 5 purchases. People comment that it’s my crown, which I obviously encourage. It’s been so helpful to me I want to take the opportunity to get the word out as much as possible. Cefaly is not a medication. There’s no serious side effects or anything. It has been a life saver for me.


    Thankfully there are many other treatments which can effectively handle the pain related to migraine. It is best to consult with a doctor if you are wondering about your various options for migraine treatments. IntegratedPain takes on a complete approach in treating musculoskeletal related disorders. Its clinics and medical centers are well-distributed, towards finding the most effective ways in treating their patients.

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