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Ask Dr. Mike: The New Migraine Treatment that Reduces Pain by 35%

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans. Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

What's this new migraine treatment I've been hearing about?

A study looked at 112 patients, average age of 45, that suffered from migraine and cluster headaches. When doctors asked patients at the very beginning of the study their pain level, the average number reported was an eight.

Doctors then performed a small procedure where they went up the patient's nasal cavity (no sedation necessary) and injected a mixture of lidocaine and an added nasal spray application in the back of the patients'nasal cavity nerves.

The day after the procedure, patients ranked their migraine pain at a four. Researchers also found that with just the one procedure, your migraine pains can be reduced by 35 percent one month after the procedure.

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RadioMD Presents:Healthy Talk | Original Air Date: March 5, 2015
Host: Michael Smith, MD

It's time for you to be a part of the show. Email or call with questions for Dr. Mike now. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. or call: 877-711-5211. What are you waiting for? The doctor is in.

So, my first question really isn't a question. It's a request and it's from a really good friend of mine, Dr. Gary Gonzalez. He's one of the physician health advisors with Life Extension. He's been here about as long as I have, maybe going on about 8 years and he suffers from migraines.

They can be pretty devastating for him and he's tried everything and he just can't get relief. When I say everything, I mean everything. I mean, seriously. He's just gotten to the point where because he has to work, I mean, he still has to function, he just deals with it. I mean, he still has those times when he can't and he has to stay at home. He has to keep light down and stimulants down.

But he came across something that looks pretty interesting, so he wanted me to discuss this. He actually sent me an email and said, "Discuss the new migraine treatment!" with an exclamation point.

So, what this is, I don't know if he's done this. He didn't say and I haven't talked to him since I got the email, but this is a procedure. It's a nasal spray, but it's a little more detailed than that. What they do or what they are doing, at least in this one study which used 112 migraine patients is, they took this mixture of Lidocaine, which is an anesthetic, and through a nasal spray application, it had to be done under a guided procedure with a radiologist. They inject it directly on the nerves in the back of the nasal cavity, this Lidocaine.

The preliminary research looks awesome with it.
What's nice about this nasal spray is it's just one treatment. I'm sure they're going to train doctors, neurologists and radiologists. I mean, most offices have the ability to do image guided procedures now with ultrasound and stuff like that. So, this will be, someday hopefully, an easy in and out procedure. You know, you go in and you get the spray and you're done.

It can reduce migraine pain levels by about 35% for up to one month after the procedure. Dr. Kenneth Mandato, was one of the lead investigators of this. He's out at Albany Medical Center. He said that he views this new procedure as a "clear, simple alternative to standard migraine treatments". He went on to say that the nasal spray option is "safe, convenient and very innovative".

So, here's what they did. They took 112 patients averaging about 45 years of age and it wasn't just migraine patients. They looked at migraine patients and cluster headache patients, which are similar to migraines, but the key thing is migraine and cluster headaches are the most severe types of headaches that people get. At the beginning of this study, they asked each participant to rate their pain when they had a headache on a sale of 1 to 10. The average pain number that the subjects gave was 8. So, the average person--these 112 patients with either migraine or cluster headaches--would say that their pain, on average when they had an event, was 8. Okay? That's pretty severe on this scale.

So, what they did then was when the patient presented with the onset of either a cluster headache or a migraine, they did this image guided therapy which there was a catheter that is inserted through the nostril, in through the nasal passage, and it delivers a dose of Lidocaine to a nerve center known as the sphenopalatine ganglion. Now, ganglion is just a fancy word for a cluster of nerves, okay? A ganglion is a place where nerves come in and nerves go out. It's kind of like in a city where you have a bunch of highways coming into an area and then leaving this area. It's kind of like a place where you can get on and off all kinds of different directions. That's kind of what a ganglion is—a nerve ganglion.

So, they sprayed, using the image guided procedure, they went up into the nasal cavity, to the very back of the nasal cavity and sprayed the Lidocaine right on where about this ganglion is and what was nice about this is no one had to undergo any sedation. The patient is wide awake. You can do that because I think they probably coat the catheter a little bit with the Lidocaine as well. So, that kind of numbs any sort of feeling, so you're able to do this without any major, major sedation. So, they sprayed that ganglion with the Lidocaine and what they found was the day after the procedure...So, the subjects came in with the headache on average ranking at about 8, the day after, they were now ranking the headache—by the way, they weren't doing any other stuff. It was just this--just the Lidocaine nose spray. That was it. The next day, they ranked their pain at 4. So, you're talking about a 50% reduction in pain, at least, based on this subjective scale, okay? A 50% reduction in the first day.

Now, interestingly, around day 2 or 3, most of the pain kind of went up a little bit for people, which makes sense, because the Lidocaine wears off a little bit. It took about 3 or 4 days for the patients to kind of get at the true pain reduction level and most people—most of the subjects—said that the pain was about a 5. That was the consistent report. So, they started with 8, they get the Lidocaine nose spray, right? Image guided procedure, no sedation needed, very easy, in and out. The next day, it drops 50% and then, for most of them, it came up a little bit and averaged out to about a 5. Isn't that awesome? Now I know why Dr. Gonzalez—we call him, "Dr. G", by the way—why he wanted me to review this.

The researchers did note the procedure didn't help everyone. Seven of the patients out of that 112, about 6%, failed to get any benefit. However, they go on to say 88% of those in the study reported needing less standard pain relief medication after the procedure. That's really what's exciting most specialists here. They're not really seeing this as a stand-alone treatment. I mean, this was just preliminary research, but if 88% of the people in a decent sized study, 112 patients, if 88% of them are able to use less and less of the migraine medication, that's really good because it's well-known that the migraine medication just doesn't work as well over time and we also know that a chronic migraine sufferer, using those medications, when they're not using them, they have this rebound effect that can precipitate migraines. So, it's getting them to use less and less of the prescribed medication for migraines and cluster headaches.

That's a big, big step in the right direction. So, I think a lot of doctors are seeing this potential treatment as a temporary solution to back off of the drugs and have to use them less and less. As a matter of fact, Dr. Richard Lipton who is out in New York as well—he's like one of the world renowned headache specialists—he said, "Unmet treatment needs in chronic migraine are huge as are the overuse of medications. When a body gets used to having a chronic headache suppressor, the patient can experience a rebound in the absence of that suppressor. So, developing an effective treatment that can reduce the need for acute medicine would be very, very valuable." That was from Dr. Richard Lipton. So, I think most of your migraine headache specialists are going to be seeing this as a way, maybe, to take away the dependency on some of these very potent side-effect prone migraine and cluster headache medication.

So, this is exciting. I don't know if my friend, Dr. Gonzalez—Dr. G—is going to do this. I'm sure he probably is, knowing all of the problems he has with migraines and the failures of treatment he has had.
So, now, whether or not this is in your area, you'll just have to ask your own doctor if the nasal spray is going to be maybe tested in your area, but maybe you want to check that out.

This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.