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New technique zaps away migraine pain

December 3, 2008 12:00:00 AM PST
Debilitating migraine pain disrupts lives and force many to rely on powerful pain medications. Now a new technique zaps away pain before it starts. It happens at the worst times.

"Migraines are pretty inconvenient for me," said Richard Higgins.

Richard Higgins has suffered from migraines since he was a kid. Now the biomedical engineer often gets them at work.

"My first symptoms are auras, which are small blind spots in my vision, and over the course of 10 to 15 minutes that blind spot grows so much so that I can't read or I can't drive safely," said Higgins.

There may be a way to relieve Richard's pain without medication.

"This is a very exciting and important option," said Dr. Yousef Mohammad, neurologist.

It's called a transcranial magnetic stimulator or TMS. The device sends magnetic pulses during the aura phase. The phase often described as an electrical storm.

Researchers say instead of using chemicals, it's like fighting electricity with electricity.

"We're interrupting this electrical storm or current in the brain before it leads to the headache," said Dr. Mohammad.

At the New York Headache Center some doctors and patients prefer botox as a remedy for migraines. It decreases headaches because it relieves muscle tension. Dr. Alexander Mauskop isn't sold on fighting head pain with electrical pulses.

"You don't wanna walk around with a device and zap your brain when you have a migraine. And there are some potential side effects such as epileptic seizure, so it's not ready for primetime, it's not ready for commercial use," said Dr. Mauskop.

But studies performed over the past three years shows no serious side effects. Thirty-nine percent of patients were pain-free two hours after the treatment compared to 22 percent who got sham electrical pulses.

"Using a device that can disrupt my migraine without taking medicine I think is for me a much safer way to deal with the symptoms," said Higgins.

According to Dr. Mohammad, the TMS device could be approved in the next few months. If approved, it will probably be much smaller than the one used in the research trials.

Web Extra Information:
BACKGROUND:

More than 28 million people, or one in eight Americans, suffer from migraines. The condition afflicts women more frequently than men. Up to 17 percent of women have had a migraine compared to up to 6 percent of men. According to the Mayo Clinic, although researchers are still working to uncover the cause of migraines, some believe they're a result of alterations in the trigeminal nerve system, a major pain messenger of the nervous system. In addition, they think imbalances in brain chemicals play a role. During a headache, serotonin levels decrease, which may cause the trigeminal nerve to emit neuropeptides that go to the brain's outer layer and cause blood vessels to dilate and inflame, causing pain.

Migraines often trigger the sympathetic nervous system to respond, which can cause nausea, vomiting and diarrhea. Sympathetic activity can also slow the stomach from emptying into the small intestine and prevent oral medications from being absorbed. This is a common reason some migraine headache medications are ineffective. According to Yousef Mohammad, M.D., M.Sc., a professor of neurology at The Ohio State University Medical Center in Columbus, Ohio, only 50 to 60 percent of migraine patients respond to traditional migraine drugs.

The two most common migraine classifications are migraine with aura and migraine without aura. Auras are sensory warning signs that usually precede migraines, but can also occur during the attack. Auras can include flashes of light, blind spots or a tingling sensation in the arms or legs. According to the Mayo Clinic, about 20 percent of individuals with migraines experience an aura. Most commonly, auras are visual. An electrical or chemical wave moves across the visual cortex of the brain to produce visual hallucinations that typically last 10 to 30 minutes.

LIGHT AT THE END OF THE TUNNEL:
While there's still no cure for migraines, treatment has improved dramatically in the past decade. One of the newest treatments is being studied by Dr. Mohammad and his colleagues. They are using a novel electronic device to "zap" away migraine pain before it starts. The noninvasive transcranial magnetic stimulator (TMS) device works by interrupting the aura phase of the migraine before it leads to a migraine. It is based on the late 1990s hypothesis that migraines were a result of the neuronal hyperexcitablility in the brain.

The device sends a strong electric current through a metal coil, producing a powerful magnetic field for roughly one millisecond. The device is held against a patient's head so the magnetic pulse can create an electric current in the brain's neurons and interrupt the aura. A multi-center randomized clinical trial tested the device on 164 patients. Two hours after being treated, 39 percent were pain free, compared to 22 percent of the patients receiving placebo pulses. Early studies involved a bulky TMS device, but the team created a portable, hand-held tool for at-home use.


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