Migraine attacks increase following stress ‘let-down’

Migraine sufferers who experienced reduced stress from one day to the next are at significantly increased risk of migraine onset on the subsequent day, according to a new study conducted by researchers at the Montefiore Headache Center and Albert Einstein College of Medicine at Yeshiva University. Stress has long been believed to be a common headache trigger. In this study, researchers found that relaxation following heightened stress was an even more significant trigger for migraine attacks. Findings may aid in recommending preventive treatments and behavioral interventions. The study was published online in Neurology, the medical journal of the American Academy of Neurology.Migraine is a chronic condition that affects approximately 38 million Americans. To examine headache triggers, investigators at the Montefiore Headache Center and Einstein conducted a three month electronic daily diary study which captured 2,011 diary records and 110 eligible migraine attacks in 17 participants. The study compared levels of stress and reduction in stress as predictors of headache.”This study demonstrates a striking association between reduction in perceived stress and the occurrence of migraine headaches,” said study lead author Richard B. Lipton, M.D., director, Montefiore Headache Center, professor and vice chair of neurology and the Edwin S. Lowe Chair in Neurology, Einstein. “Results were strongest during the first six hours where decline in stress was associated with a nearly five-fold increased risk of migraine onset. …

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Discovery May Lead to New Drugs for Osteoporosis

Scientists at Washington University School of Medicine in St. Louis have discovered what appears to be a potent stimulator of new bone growth. The finding could lead to new treatments for osteoporosis and other diseases that occur when the body doesn’t make enough bone.Osteoporosis affects 55 percent of Americans age 50 and older. Of that age group, one in three women and one in 12 men are believed to have osteoporosis, a condition responsible for millions of fractures each year, mostly involving the hips, wrist or lower back vertebrae.”We have been looking for new ways to stimulate bone formation,” said principal investigator Fanxin Long, PhD. “The tools we already have are very good at slowing the breakdown of bone, but we need better ways to stimulate new bone growth.”Studying mice, Long focused on a pathway involved in bone formation. The so-called WNT proteins carry messages into cells and regulate embryonic and adult tissue in mammals, including humans. The WNT proteins enter cells from the outside and then can activate multiple pathways inside those cells.Long’s team reports Jan. 30 in the journal that a specific member of the WNT family of proteins dramatically enhances bone formation, and it works through a mechanism that has not been well-studied in bone before.It’s called the mTOR pathway, and it interprets a cell’s surrounding environment, and nutritional and energy status.”By analyzing that information, mTOR can determine whether a cell should go into a mode to make lots of stuff, like proteins or, in this case, new bone,” explained Long, a professor of orthopaedic surgery. “Bone formation is an energetically expensive process, so it makes sense that some regulator would tell a cell whether there is sufficient energy and material to manufacture new bone.”Long and his colleagues studied mice that made either normal levels or an extra amount of WNT proteins. They found that a particular WNT protein, WNT7B, is a potent stimulator of bone formation in mice. …

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American families taking ‘divergent paths’

Sep. 11, 2013 — After a period of relative calm during the 1990s, rapid changes in American families began anew during the 2000s, a new analysis suggests.Young people delayed marriage longer than ever before, permanent singlehood increased, and divorce and remarriage continued to rise during the first decade of the century.But the most troubling finding, researchers say, may be how American families have taken divergent paths: White people, the educated and the economically secure have much more stable family situations than minorities, the uneducated and the poor.”The state of American families has become increasingly polarized,” said Zhenchao Qian, author of the new study and professor of sociology at The Ohio State University.”Race and ethnicity, education, economics and immigration status are increasingly linked to how well families fare.”Qian said the end result of the continuing changes he found in the 2000s is that “there is no longer any such thing as a typical American family.”Qian’s analysis, based on data from the 2000 U.S. Census and the 2008-2010 American Community Survey, among other sources, is contained in a new report for the US2010 Project, sponsored by the Russell Sage Foundation and Brown University.Qian said the Great Recession of the late 2000s played a large role in the changes he saw in American families during the decade covered by this study.”There is no doubt that the gap between America’s haves and have-nots grew larger than ever during the 2000s,” he said.”This gap has shaped American families in multiple ways. It influences the kind of families we live in and the kind of family environment in which we raise our children.”The recession may be a big reason why young people delayed marriage longer than ever before, with many moving back with their parents as they search for work or weather financial difficulties. In 2008-2010, 43 percent of 20- to 24-year-olds and 19 percent of 25- to 29-year-olds lived with their parents.Meanwhile, the percentage of U.S.-born women aged 20-24 who have ever been married declined from 31 percent to 19 percent between 2000 and 2008-2010. For men, the decline was from 21 percent to 11 percent.By ages 50 to 54, 13 percent of American-born men and 10 percent of women remained unmarried.Divorce and remarriage also increased during the decade. Among currently married men, the proportion who were married more than once increased from 17 percent in 1980 to 25 percent in 2008-2010. Similar results were found for women.”We’re seeing more evidence of a ‘marriage-go-round’ in which people go from marriage to divorce to remarriage, sometimes multiple times,” Qian said.But all of these results mask the important differences in family outcomes depending on race, education, immigrant status and economic status. Race was especially important.African Americans had the lowest percentage ever married at every age group, the highest proportion of permanent singlehood by ages 50-54, lower levels of cohabitation, highest divorce-to-marriage ratios, and a larger share of remarriages.”A lot of this can be linked to the poor economic circumstances of African Americans,” he said.”Unemployment, underemployment and poor economic prospects have a strong negative effect on whether people get married and stay married. African Americans are more likely than other groups to experience all of these problems.”Education also had a strong role in family life. …

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Four common genetic variants associated with blood pressure in African-Americans

Sep. 10, 2013 — Case Western Reserve University is part of a landmark study that has discovered four novel gene variations associated with blood pressure. The 19-site meta-analysis, involving nearly 30,000 African-Americans, also found that the set of genetic mutations are also associated with blood pressure across other populations.Epidemiology and biostatistics professor Xiaofeng Zhu, PhD, is co-senior author of the paper, which appears in The American Journal of Human Genetics. The Continental Origins and Genetic Epidemiology Network (COGENT) consortium conducted the research, which is the largest genome-wide association study of blood pressure in individuals of African ancestry. Most gene discovery studies to date have been performed using individuals of European ancestry. Previous genome-wide association studies using samples from individuals of African descent failed to detect any replicable genes associated with blood pressure.”In addition to their disproportionate suffering, hypertension occurs earlier in life for African-Americans compared to individuals of other ancestries,” Zhu explained. “Therefore, it is important to study this population to better understand genetic susceptibility to hypertension.”Zhu and his colleagues also confirmed that previous findings regarding other genes whose presence correlates with increased hypertension risk.”Although it is unknown how the genes regulate blood pressure,” Zhu added, “our findings contribute to better understanding of blood pressure pathways that can lead to future development of drug target for hypertension and may guide therapy for clinical care.”Experts estimate genetic make-up accounts for roughly 40-50 percent of individuals’ susceptibility to hypertension. Other factors associated with the disease include lifestyle, diet, and obesity. Compared to Americans of European-ancestry, African-Americans’ increased hypertension prevalence contributes to a greater risk of stroke, coronary heart disease, and end-stage renal disease.”We anticipated that individuals of African ancestry share similar biology to other populations. However, differences in genomic make-up between African ancestry and other populations have uncovered additional genes affecting blood pressure, in addition to genetic variants that are specific to individuals of African ancestry,” said Nora Franceschini, MD, MPH, nephrologist and research assistant professor of epidemiology at the University of North Carolina at Chapel Hill and first author on the paper.The next phase of study involving the newly discovered gene mutations will investigate their function using human blood samples at the molecular level. …

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Obesity kills more Americans than previously thought: One in five Americans, Black and White, die from obesity

Aug. 15, 2013 — Obesity is a lot more deadly than previously thought. Across recent decades, obesity accounted for 18 percent of deaths among Black and White Americans between the ages of 40 and 85, according to scientists. This finding challenges the prevailing wisdom among scientists, which puts that portion at around 5%.”Obesity has dramatically worse health consequences than some recent reports have led us to believe,” says first author Ryan Masters, PhD, who conducted the research as a Robert Wood Johnson Foundation Health & Society Scholar at Columbia University’s Mailman School of Public Health. “We expect that obesity will be responsible for an increasing share of deaths in the United States and perhaps even lead to declines in U.S. life expectancy.”While there have been signs that obesity is in decline for some groups of young people, rates continue to be near historic highs. For the bulk of children and adults who are already obese, the condition will likely persist, wreaking damage over the course of their lives.In older Americans, the rising toll of obesity is already evident. Dr. Masters and his colleagues documented its increasing effect on mortality in White men who died between the ages of 65 and 70 in the years 1986 to 2006. Grade one obesity (body mass index of 30 to less than 35) accounted for about 3.5% of deaths for those born between 1915 and 1919 — a grouping known as a birth cohort. …

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Sugar toxic to mice in ‘safe’ doses

Aug. 13, 2013 — When mice ate a diet of 25 percent extra sugar — the mouse equivalent of a healthy human diet plus three cans of soda daily — females died at twice the normal rate and males were a quarter less likely to hold territory and reproduce, according to a toxicity test developed at the University of Utah.”Our results provide evidence that added sugar consumed at concentrations currently considered safe exerts dramatic adverse impacts on mammalian health,” the researchers say in a study set for online publication Tuesday, Aug. 13 in the journal Nature Communications.”This demonstrates the adverse effects of added sugars at human-relevant levels,” says University of Utah biology professor Wayne Potts, the study’s senior author. He says previous studies using other tests fed mice large doses of sugar disproportionate to the amount people consume in sweetened beverages, baked goods and candy.”I have reduced refined sugar intake and encouraged my family to do the same,” he adds, noting that the new test showed that the 25 percent “added-sugar” diet — 12.5 percent dextrose (the industrial name for glucose) and 12.5 percent fructose — was just as harmful to the health of mice as being the inbred offspring of first cousins.Even though the mice didn’t become obese and showed few metabolic symptoms, the sensitive test showed “they died more often and tended to have fewer babies,” says the study’s first author, James Ruff, who recently earned his Ph.D. at the University of Utah. “We have shown that levels of sugar that people typically consume — and that are considered safe by regulatory agencies — impair the health of mice.”The new toxicity test placed groups of mice in room-sized pens nicknamed “mouse barns” with multiple nest boxes — a much more realistic environment than small cages, allowing the mice to compete more naturally for mates and desirable territories, and thereby revealing subtle toxic effects on their performance, Potts says.”This is a sensitive test for health and vigor declines,” he says, noting that in a previous study, he used the same test to show how inbreeding hurt the health of mice.”One advantage of this assay is we get the same readout no matter if we are testing inbreeding or added sugar,” Potts says. “The mice tell us the level of health degradation is almost identical” from added-sugar and from cousin-level inbreeding.The study says the need for a sensitive toxicity test exists not only for components of our diet, but “is particularly strong for both pharmaceutical science, where 73 percent of drugs that pass preclinical trials fail due to safety concerns, and for toxicology, where shockingly few compounds receive critical or long-term toxicity testing.”The study was funded by the National Institutes of Health and the National Science Foundation.A Mouse Diet Equal to What a Quarter of Americans EatThe experimental diet in the study provided 25 percent of calories from added sugar — half fructose and half glucose — no matter how many calories the mice ate. Both high-fructose corn syrup and table sugar (sucrose) are half fructose and half glucose.Potts says the National Research Council recommends that for people, no more than 25 percent of calories should be from “added sugar,” which means “they don’t count what’s naturally in an apple, banana, potato or other nonprocessed food. … The dose we selected is consumed by 13 percent to 25 percent of Americans.”The diet fed to the mice with the 25 percent sugar-added diet is equivalent to the diet of a person who drinks three cans daily of sweetened soda pop “plus a perfectly healthy, no-sugar-added diet,” Potts says.Ruff notes that sugar consumption in the American diet has increased 50 percent since the 1970s, accompanied by a dramatic increase in metabolic diseases such as diabetes, obesity, fatty liver and cardiovascular disease.The researchers used a mouse supply company that makes specialized diets for research. Chow for the mice was a highly nutritious wheat-corn-soybean mix with vitamins and minerals. …

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Psychologists say ‘group narcissism’ linked to negative attitudes toward immigrants

Aug. 6, 2013 — Feelings of entitlement and superiority that go beyond patriotism and love of country may be a key predictor for Americans who will feel or behave negatively toward undocumented Latino immigrants, according to a study from The University of Texas at Arlington.Researchers looked at those enhanced feelings of superiority — referred to as group-level narcissism — along with a factor called national in-group identification in a new work to be published in the August issue of the Hispanic Journal of Behavioral Science. National in-group identification happens when a person’s individual identity is strongly tied to and dependent on their membership in a group, like being an American.Previous research has found that strong in-group identity is not necessarily a predictor of negative attitudes toward other groups. The UT Arlington team found, however, that attitudes changed when a strong in-group identity was paired with an average or above average group narcissism. Then, negative attitudes toward undocumented Latino immigrants were more likely.”When you look at the rhetoric surrounding undocumented, Latino immigrants in the United States, the perspectives vary widely — from those who characterize undocumented immigrants as criminals to those who support expanding full citizenship rights,” said Patricia Lyons, a graduate of the psychology doctoral program in the UT Arlington College of Science and a member of the research team. “We were interested in understanding how and why attitudes varied so widely from a psychological perspective.The group narcissism measure gave us a way to understand these attitudes. “Lyons co-authored the study with Jared Kenworthy, a UT Arlington associate psychology professor, and Ph.D. candidate Lauren E. Coursey. Lyons is currently on the psychology faculty at Mountain View College in Dallas.The team surveyed 223 university students with tools designed to measure their national in-group identity and propensity for group-level narcissism, which is defined as “an inflated image of one’s group based on feelings of superiority, entitlement and the need for constant attention and praise at the collective level.”For example, the test assessing group narcissism asked participants to rank how strongly they agreed with statements such as “If America ruled the world it would be a better place” and “America is the best country in the world.”The newly published paper builds on earlier research by Kenworthy and Lyons about the relationship between in-group identification, group-level narcissism and negative attitudes toward Arab-Americans. …

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The rise of deadly insect sting allergies: Is there a cure?

Aug. 1, 2013 — If you think summer insects are done setting their sights on ruining your outdoor gathering, think again. August’s hot and dry climate is the perfect breeding ground for insects, especially yellow jackets. And for the millions of Americans allergic to insect stings, these late summer bugs can be deadly.According to a report released today in the August issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), insect sting allergy is increasing, affecting five percent of the population. But what much of the population may not understand is that there is something that can be done about it.”While it does not always cure insect sting allergy, venom immunotherapy, a form of allergy shots, can almost always prevent severe reactions to stings,” said David Golden, MD, article author and ACAAI fellow. “It usually provides long-lasting immunity even after the treatment is stopped.”Even 10 to 20 years after having an allergic reaction from an insect sting, the chance of having another reaction continues to be up to 70 percent in adults and 30 percent in children. Venom immunotherapy doesn’t completely eliminate the risk of an allergic reaction to insect stings, noted Dr. Golden, but almost all of the reactions that do occur (five to 10 percent) are mild, with less than two percent chance of a severe reaction while on treatment. Protection takes effect as soon as the full dose is reached, usually within 2 to 3 months of treatment.”Allergy sufferers who have had an allergic reaction to an insect sting should be under the care of a board-certified allergist,” said Dr. Golden. …

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The dark side of artificial sweeteners: Expert reviews negative imact

July 10, 2013 — More and more Americans are consuming artificial sweeteners as an alternative to sugar, but whether this translates into better health has been heavily debated. An opinion article published by Cell Press on July 10th in the journal Trends in Endocrinology & Metabolism reviews surprising evidence on the negative impact of artificial sweeteners on health, raising red flags about all sweeteners — even those that don’t have any calories.”It is not uncommon for people to be given messages that artificially-sweetened products are healthy, will help them lose weight or will help prevent weight gain,” says author Susan E. Swithers of Purdue University. “The data to support those claims are not very strong, and although it seems like common sense that diet sodas would not be as problematic as regular sodas, common sense is not always right.”Consumption of sugar-sweetened drinks has been linked to obesity, type 2 diabetes, and metabolic syndrome — a group of risk factors that raises the risk for heart disease and stroke. As a result, many Americans have turned to artificial sweeteners, which are hundreds of times sweeter than sugar but contain few, if any, calories. However, studies in humans have shown that consumption of artificially sweetened beverages is also associated with obesity, type 2 diabetes, and metabolic syndrome as well as cardiovascular disease. As few as one of these drinks per day is enough to significantly increase the risk for health problems.Moreover, people who regularly consume artificial sweeteners show altered activation patterns in the brain’s pleasure centers in response to sweet taste, suggesting that these products may not satisfy the desire for sweets. Similarly, studies in mice and rats have shown that consumption of noncaloric sweeteners dampens physiological responses to sweet taste, causing the animals to overindulge in calorie-rich, sweet-tasting food and pack on extra pounds.Taken together, the findings suggest that artificial sweeteners increase the risk for health problems to an extent similar to that of sugar and may also exacerbate the negative effects of sugar. “These studies suggest that telling people to drink diet sodas could backfire as a public health message,” Swithers says. “So the current public health message to limit the intake of sugars needs to be expanded to limit intake of all sweeteners, not just sugars.”

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Can watching an avatar translate to real-life weight loss?

July 1, 2013 — An estimated two-thirds of all Americans are overweight or obese and many find it difficult to lose weight and keep it off. They’ve tried fad diets, exercise programs, diet pills and other methods but the battle continues. Now, a new study suggests that watching an avatar model weight-loss behavior in a virtual community might help some women shed pounds in the real world.”This pilot study showed that you don’t have to be a gamer to use virtual reality to learn some important skills for weight loss,” said Melissa Napolitano, PhD, an associate professor of prevention and community health at the George Washington University School of Public Health and Health Services (SPHHS). “This small study suggests that virtual reality could be a promising new tool for building healthier habits.”If proven effective, such a program might offer an inexpensive way to help millions of Americans — including overweight men–learn the skills and behavior they need to lose weight over the long run.Previous research had suggested that using virtual reality to model skills or provide reinforcement was effective. For example, people who watched an avatar that resembled them run on a treadmill were more likely to exercise the next day than if they watched an unfamiliar avatar, according to a Stanford University study.Napolitano, who did the study while at Temple University’s Center for Obesity Research and Education, in collaboration with Temple’s Sbarro Institute for Cancer Research and Molecular Medicine, and her colleagues, wondered if avatars could be used as a tool to model weight loss behavior for overweight women.To find out, the team first conducted a survey among 128 overweight women. Most of them had tried to lose weight during the last year and the majority had never used a virtual reality game. Despite the fact that most of these women had no experience using virtual reality or even playing online games, the researchers found that 88 percent said they would be willing to use a program with an avatar modeling habits that might give them an edge in the battle to lose weight.Many of the study participants thought that watching an avatar could help them visualize and then put in place healthy behavior, such as taking a walk every day or picking healthy options when food shopping. And in fact, theory and research tells us that modeling or seeing the steps one needs to take in order to achieve a desired goal makes behavioral change easier to accomplish, Napolitano said.But to test the concept, the team first had to create videos that showed an avatar in a variety of different situations such as walking on a treadmill or navigating a cart through the aisles of a grocery store. The end result was a partnership from the treatment side drawing on Napolitano’s expertise as well as the experts on the technical programming front to show the avatars in action. Using their extensive expertise in virtual reality, Director Antonio Giordano, MD, PhD, and Giuseppe Russo, PhD, of Temple’s Sbarro Institute for Cancer Research and Molecular Medicine, developed a virtual reality simulation featuring such an avatar.”With our vast experience in creating custom virtual reality environments for eHealth, we were able to assist Dr. …

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Getting a good night’s sleep is a nightmare for many Americans

June 29, 2013 — Summer means more hours of daylight and for many, it contributes to trouble falling asleep. More than 40 million Americans suffer from chronic sleep disorders, resulting in $18 billion in cost to employers due to sleep loss issues.”The inability to get a good night’s sleep can be a complex issue, and is not as simple to cure as telling people to count sheep,” says John Wilson, MD, neurologist at Gottlieb Memorial Hospital, part of Loyola University Health System. Wilson regularly works with the sleep lab to diagnose patients with chronic sleep issues.Omar Hussain, DO, pulmonologist at Gottlieb who is board certified in sleep medicine says, “Many societal trends such as working from home or swing shift workers have economic-based lifestyles that prevent regular sleep patterns.” Obesity, which was recently declared a disease by the American Medical Association, also has a direct link to poor sleep, says Ashley Barrient, RD, who counsels patients at the Loyola Center for Metabolic Surgery and Bariatric Care. One-third of all Americans are overweight, according to the Centers for Disease Control.Here are some healthful tips from Loyola medical experts Wilson, Hussain and Barrient on how to get a better night’s sleep.Do this:Relax. “At least one hour before bedtime, start quieting down and relaxing. Don’t exercise or engage in vigorous acitvities,” says Wilson.Turn off the handheld devices. “The need to text and email is a real problem for many when it comes to sleep,” says Hussain. “Turn the electronic device off and put it in another room. That way, if you wake up in the middle of the night, you don’t automatically reach for the phone but instead turn over and fall back asleep.”Read a magazine. “Lighter content and shorter articles are ideal,” says Wilson. …

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‘Active surveillance’ may miss aggressive prostate cancers in black men

June 25, 2013 — A Johns Hopkins study of more than 1,800 men ages 52 to 62 suggests that African-Americans diagnosed with very-low-risk prostate cancers are much more likely than white men to actually have aggressive disease that goes unrecognized with current diagnostic approaches. Although prior studies have found it safe to delay treatment and monitor some presumably slow-growing or low-risk prostate cancers, such “active surveillance” (AS) does not appear to be a good idea for black men, the study concludes.”This study offers the most conclusive evidence to date that broad application of active surveillance recommendations may not be suitable for African-Americans,” says urologist Edward M. Schaeffer, M.D., Ph.D., a co-author of the study. “This is critical information because if African-American men do have more aggressive cancers, as statistics would suggest, then simply monitoring even small cancers that are very low risk would not be a good idea because aggressive cancers are less likely to be cured,” he says. “We think we are following a small, nonaggressive cancer, but in reality, this study highlights that in black men, these tumors are sometimes more aggressive than previously thought. It turns out that black men have a much higher chance of having a more aggressive tumor developing in a location that is not easily sampled by a standard prostate biopsy.”A report of the study, posted online and ahead of the print version in the Journal of Clinical Oncology, describes it as the largest analysis of potential race-based health disparities among men diagnosed with a slow-growing, very nonaggressive form of prostate cancer.The Johns Hopkins study also showed that the rate of increased pathologic risk, as measured by the Cancer of the Prostate Risk Assessment (CAPRA), was also significantly higher in African-Americans (14.8 percent vs. 6.9 percent). The 12-point CAPRA score is an accepted predictor of biochemical disease recurrence based on blood levels of prostate specific antigen, Gleason score, lymph node involvement, extracapsular extension, seminal vesicle invasion, and positive surgical margins. Schaeffer and his team say their data suggest that “very-low-risk” African-Americans have different regional distributions of their cancers and appear to also develop more high-grade cancers. Researchers added that these tumors hide in the anterior prostate — a region that is quite difficult to assess using current biopsy techniques.All study participants, of whom 1,473 were white and 256 black, met current National Comprehensive Cancer Network (NCCN) criteria for very-low-risk prostate cancer, and were thus good candidates for AS. …

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Quick and simple ways to reduce risk from the most common form of cancer

June 11, 2013 — Skin cancer is the most common form of cancer diagnosed in the United States, with one in five Americans expected to develop a form of skin cancer in their lifetime. Fortunately, there are simple steps people can take to reduce their skin cancer risk.”The easiest way to prevent skin cancer is to protect your skin with clothing,” said board-certified dermatologist Zoe D. Draelos, MD, FAAD, consulting professor at Duke University School of Medicine, Durham, N.C. “Keep a wide-brimmed hat and sunglasses near your door so you can put them on before you go outside. Wearing a long-sleeved shirt and pants also can help protect from the damaging rays of the sun.”In addition, Dr. Draelos shares these additional tips for preventing skin cancer:1. Apply sunscreen every day. When you are going to be outside, even on cloudy days, apply sunscreen to all skin that will not be covered by clothing. Reapply approximately every two hours, or after swimming or sweating. Use a broad- spectrum, water-resistant sunscreen that protects the skin against both UVA and UVB rays and that has an SPF of at least 30.2. …

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Migraine surgery offers good long-term outcomes, study finds

Feb. 3, 2011 — Surgery to “deactivate” migraine headaches produces lasting good results, with nearly 90 percent of patients having at least partial relief at five years’ follow-up, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

In about 30 percent of patients, migraine headaches were completely eliminated after surgery, according to the new study, led by Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio.

‘Trigger Site’ Surgery Reduces or Eliminates Migraine Headaches

Dr. Guyuron, a plastic surgeon, developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead-lift procedures. The techniques consist of “surgical deactivation” of “trigger sites” in the muscles or nerves that produce pain.

For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. This procedure may reduce headache attacks by relieving pressure on key nerve in the frontal area. Other approaches target other migraine trigger sites.

Before surgery, each patient was tested with botulinum toxin A (Botox) to confirm the correct trigger sites. For most patients, surgery targeted at least two trigger sites. The five-year results — including standard measures of migraine-related pain, disability, and quality of life — were evaluated in 69 patients.

Eighty-eight percent of these patients had a positive long-term response to surgery. Headaches were significantly decreased in 59 percent of patients, and completely eliminated in 29 percent. The remaining patients had no change in headache activity.

Migraine attacks were less frequent after surgery; average migraine frequency decreased from about eleven to four per month. When attacks occurred, they didn’t last as long — average duration decreased from 34 to eight hours. Migraine surgery also led to significant improvements in quality of life, with few serious adverse effects.

Migraine is a very common problem that interferes with many aspects of daily life for millions of Americans. About one-third of patients are not helped by current treatments. The new surgical techniques have the potential to reduce or eliminate migraine attacks for many patients who do not respond to other treatments. A previous study found good results at one-year follow-up evaluation.

The new report shows that these good outcomes are maintained through five years’ follow-up. The findings “provide strong evidence that surgical deactivation of one or more trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache, and the results are enduring,” Dr. Guyuron and colleagues write. More research will be needed to refine the surgical techniques — as well as to clarify the reasons for the effectiveness of surgical deactivation of trigger sites in relieving migraine headaches.

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