In the U.S., more than 37 million people suffer from migraines, according to Migraine.com. Photo courtesy Shutterstock.

Do you or a loved one have chronic migraines? Don’t give up! Evidence-based treatment guidelines released by the American Academy of Neurology and the American Headache Society strongly endorse seven prescription beta-blockers and seizure drugs [see chart: Proof Positive] and one herbal preparation (butterbur) for preventing migraines and lessening symptoms when they do occur. And even Botox, better known for erasing age lines, got the thumbs-up in 2010.

Research also shows that managing common triggers (such as foods, stress, and bright lights), eating well, and getting enough sleep help prevent migraine pain. “But when the steps you can take without going to a doctor don’t work, prescription medicines are well worth exploring,” says Stephen D. Silberstein, M.D., of Jefferson Headache Center in Philadelphia and a Fellow of the American Academy of Neurology.

The point is to do something: Migraines are often undertreated, says Dr. Silberstein. It is estimated that only about one-third of migraine sufferers who could benefit from preventive treatments currently use them.

Click here to review all the guidelines.

Heading Off Migraines The Saturday Evening Post

Botox for Migraines

Injecting Botox around the head and neck about every 12 weeks helps dull future headache symptoms and improve quality of life in people with near-daily migraines, according to a 2011 study of 1,384 adults. FDA-approved for chronic migraine in 2010, Botox has not been shown to work for migraine headaches that occur 14 days or less per month, or for other forms of headache.

Botox for Urinary Frequency

People with overactive bladders or OAB report improved urinary control for six months or more after injection of Botox into the bladder muscle. Experts say the drug (approved in 2011 for OAB resulting from multiple sclerosis or spinal cord injury) blocks signals that activate the bladder muscle, but doesn’t interfere with the function of surrounding muscles.

Botox for Foot Pain

People with aching feet are also opting for Botox—even though it’s not approved for treating the prevalent problem. Small cushions of fatty acids that protect feet from torque and shear are decidedly crucial as we pound through life. But wearing high heels can wear out the fat pad at the base of the toes. And thin-soled athletic cleats and steroid injections for plantar fasciitis (a frequent cause of chronic heel pain) can sometimes shrink padding under the heel and on the outer arch contact area. Aging, having diabetes, or being overweight also put feet at risk.

“Pain occurs when areas of the feet are subjected to unaccustomed strain as the padding deteriorates,” explains New York podiatrist Alan Berman. Botox injections may relieve pain for about three months or the amount of time the drug remains in the system, according to ongoing research. Plumping up sore feet with newer skin fillers (Juvederm, Sculptra) also seems promising. “Wearing supportive insoles such as Lynco or Spenco inserts and well-fitting shoes remain the gold standard for lasting relief,” advises Dr. Berman.

Happy Birthday, Botox! The Saturday Evening Post

Migraines matter, disrupting everyday routines at home and work when sufferers have to disengage from families, friends, or job responsibilities.

“Migraine is an extraordinarily common brain disorder,” says Robert Kaniecki, MD, director of the Headache Center, chief of the Headache Division, and assistant professor of neurology at the University of Pittsburgh. “Approximately 13 percent of American adults are affected by bouts of the disabling headache, robbing them of valuable time from work, family, home, or social activities.”

Fortunately, new and better ways to relieve and even prevent the life-disrupting attacks are on the horizon.

The first major advance in treating migraine hit the U.S. market in 1991 with FDA approval of sumatriptan (Imitrex, GlaxoSmithKline)—a revolutionary prescription drug option that not only eased migraine symptoms, but stopped the attacks.

“Over the ensuing decade, the drug class known as triptans expanded to 7 products, providing relief to millions of migraine sufferers,” explains Dr. Kaniecki. “During that same time period, two anti-epilepsy drugs, Topamax and  Depakote, were also added to the short list of daily drugs with proven benefit in reducing the frequency of migraine attacks.”

Subsequent research, however, had been disappointing—until now.

“It has been nearly 20 years since significant breakthroughs have been made in treating migraine headaches,” Dr. Kaniecki continues. “But we now seem poised for a second wave of new migraine treatments. Many are novel developments while others involve technologically innovative delivery systems for older drugs. For migraineurs who fail to respond to current drug therapies, these new options are reasons for optimism.”

Dr. Sheena Aurora, director of the Swedish Headache Center and assistant professor of neurology at the University of Washington School of Medicine concurs.

“I am excited about new migraine treatments,” Dr. Aurora told the Post. “As a practicing headache specialist, I still find patients who believe that migraine comes from stress. We make them aware that migraine is a biological disorder—they are born with a hypersensitive brain—and stress is one of many triggers. Studies confirm a genetic role in migraine and genomics and proteonomics may yield highly targeted therapies. In addition, we believe that newer trials using topiramate and botulinum toxin A in chronic migraine will pave the path for future research.”

Here are 5 promising new therapies to stop migraines in their tracks that are worth keeping an eye on:

A dissolvable powder form of diclofenac (Cambia). The nonsteroidal anti-inflammatory drug, currently available in tablets, helps reduce migraine-related inflammation and pain.

The Sumavel DosePro (Zogenix). Released in 2010, the innovative device delivers needle-free injections of sumatriptan (Imitrex) by “pushing” the drug into tissue just under the skin. Subcutaneous sumatriptan is easy to use and provides consistent and fast relief, according to Dr. Aurora. Nasal and patch delivery systems for the migraine drug are still in development. Doctors already prescribe sumatriptan tablets, shots, and intranasal solution that relieve migraines by blocking painful nerve signals and restoring swollen blood vessels back to normal size.

LEVADEX, orally inhaled dihydroergotamine (MAP Pharmaceuticals). Migraine sufferers are often unable to digest oral medicines. Now in late stages of clinical testing, LEVADEX is dispensed via an oral inhaler for fast, consistent, and sustained relief of migraine pain and other symptoms. Dihydroergotamine is presently available in nasal and injectable forms.

Calcitonin gene-related peptide (CGRP) antagonist drugs. A novel class of prescription medicines may treat migraines with fewer side effects than conventional therapies by blocking the release of CGRP, a type of protein involved in nerve and blood vessel irritation during a migraine attack. The CGRP antagonist telcagepant (Merck) is in late stages of development.

Transcranial pulse generators. These electronic devices are applied to the skull early in a migraine, sometimes shortening the attack. Surgically implanted devices may generate internal electrical signals to help treat chronic pain, Parkinson’s disease, and migraine headaches.

For a video podcast from the National Headache Foundation that explores some of these options, click here  Video – Dr. Robert Kaniecki, M.D.

Migraines in the News The Saturday Evening Post

The new data are consistent with previous research showing that people with migraines also tend to suffer from conditions that are risky to their hearts—diabetes, high blood pressure, obesity, and high cholesterol.

“Our results provide another reason for people with migraines to reduce other risk factors for heart disease,” said study investigator Marcelo E. Bigal, M.D., Ph.D., with Merck Research Laboratories and the Albert Einstein College of Medicine in Bronx, New York.

In the study, researchers surveyed 6,102 migraine sufferers and 5,243 healthy volunteers about headaches, treatment, general health, and any diagnosed heart problems. Findings show that 4.1 percent of those with migraines reported having a heart attack, compared to 1.9 percent of the control group.

Yet to be discovered is the precise role of migraines in the development of cardiovascular disease, and whether drug therapy to prevent migraines or blood clots might help protect the health of migraineurs.

Dr. Bigal’s study is published in the February 23, 2010, print issue of Neurology® <http://www.neurology.org/>.

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