From: ((Steven B. Harris))
Subject: Re: migraine
Date: 23 Jun 1995

In <3scrs4$56h@netaxs.com> rhonag@netaxs.com (Rhona Gerber) writes:

>Does anyone know of any herbal preparations that relieve migraine? Or any
>types of  food allergies that might cause it?
>rhonag@netaxs.com


Feverfew is the herbal mentioned most often (and the subject of at least
one good study).  You might also try daily magnesium supplementation,
500 mg of oxide twice or three times a day with food.

                                             Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: migraine
Date: 23 Jun 1995

In <3seoia$sia@lace.Colorado.EDU> MORAVCSIK@CLIPR.COLORADO.EDU (Julia
Moravcsik) writes:

>> Feverfew is the herbal mentioned most often (and the subject of at least
>> one good study).  You might also try daily magnesium supplementation,
>> 500 mg of oxide twice or three times a day with food.
>>
>>                                              Steve Harris, M.D.
>
>I posted something on feverfew on alt.folklore.herbs a while ago.  Here
>is the jist of it.
>
>I looked up feverfew on Medline and found:
>
>a) there have been several good double blind experiments showing that
>feverfew does indeed help migraines.
>
>b) BUT there have also been studies that have found that feverfew
>PERMANENTLY, IRREVERSABLY affects the ability of smooth muscles to
>contract and relax.  I suppose this could account for its effect on
>migraines (i.e. the blood vessels in the brain can no longer contract or
>relax as much as they once did) but until they have figured out what is
>going on I would not take feverfew for any reason.



Oh, dear.  Have you got a citation for the last that I can use?

                                                Steve Harris, M.D.

From: ((Steven B. Harris))
Subject: Re: Feverfew
Date: 26 Jun 1995

In <7896199081201@apx.com> momentum@apx.com writes:

>******************
>***  Feverfew  ***
>******************
>
>Feverfew (Chrysanthemum parthenium) is known to contain the chemicals
>Parthenolide, Pyrethrins, and Santamarin.  It is known to kill insects,
>decrease the thickness and increase fluidity of mucus from lungs and
>bronchial tubes.  It also is known to stimulate uterine contractions.
>
>The unproved, but speculated benefits, include the treatment of menstrual
>disorders and the common cold, indigestion and diarrhea, appetite
>stimulation, easier childbirth, removal of intestinal parasites, and
>increased intestinal health.  Many users report it to be effective in the
>treatment of migraine headaches.
>
>Sources:  The Complete guide to Vitamins, Minerals, & Supplements, H.
>Winter Griffith, M.D., Fisher Books, Tucson, AZ, 1988; Whittaker's Health
>& Healing, Dr. Julian Whittaker, 1995.
>
>WARNING:  According to professionals, do NOT take this product if you are
>allergic to pyrethrins, are pregnant or plan to be in the near future.
>This information is provided for educational purposes only.  It is
>derived from primary and secondary sources considered to be reliable.
>This information is not provided for diagnostic, prescriptive or the
>treatment of any disease.
>
>THERE IS NO SUBSTITUTE FOR THE PROFESSIONAL CARE OF A PHYSICIAN.
>
>Information about this and other herbs is available by sending private
>e-mail to:
>          to:    herbs@apx.com
>          subj:  MOM_INDEX
>          text:  any, none is necessary
>This file, MOM_INDEX, will give you a list of documents like the one
>above
>available via email.


We're still waiting for the reference on the possible dangerous effects
of feverfew due to perment changes in smooth muscle cell contractility
(I assume) found in vitro.  Anybody?  Until this is resolved I wouldn't
give the stuff to anybody.

                                               Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 6 Apr 1999 10:52:46 GMT

In <3709B844.BFD811C5@one.net> KB <kbrauer@one.net> writes:

>Hillary Gorman wrote:
>
>> I just saw a commercial for a product called "Excedrin Migraine." In
>> fine print at the bottom of the TV screen were the words "for mild to
>> moderate migraine pain." Eh? Come again? "Mild to moderate" migraine
>> pain? As a long term migraine sufferer, I'm baffled. Does this mean
>> that not only am I unlucky enough to be stuck having the worst
>> headaches known to man, but I can't even get a break to get the "mild"
>> ones now and then??!! I never heard of such a thing as "mild" migraine
>> pain. I thought all migraines were horribly painful - well, aside from
>> those weird "ocular migraines" that sometimes occur.
>> 
>> What's a "mild" migraine?
>
>Well, you probably already know that there are a buncha different types
>of headaches, and lots of them get confused with migraines.  A mild
>migraine is probably a headache that the patient thinks is a migraine,
>and for which he or she would like a pill in a container that says
>"migraine" .
>
>That Excedrin Migraine product is probably more proof that the FDA ain't
>what it used to be.  Just my prejudice, I guess.


   Nah, it's just that the FDA is too busy driving up prices of useful
new drugs to be able to do much regulating of the old and cheap ones.

   A mild migraine, btw, is a headache caused by caffeine withdrawal,
in people habituated to it <g>.  I'm mostly not kidding.  Excedrine
Migraine cures this kind of headache (undoubtedly the most common type
in America) just fine.

                                     Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: Tue, 06 Apr 1999 15:05:56 GMT

On 6 Apr 1999 02:49:04 GMT, hillary@hillary.net (Hillary Gorman)
wrote:

>I just saw a commercial for a product called "Excedrin Migraine." In fine
>print at the bottom of the TV screen were the words "for mild to moderate
>migraine pain." Eh? Come again? "Mild to moderate" migraine pain? As a
>long term migraine sufferer, I'm baffled. Does this mean that not only am
>I unlucky enough to be stuck having the worst headaches known to man, but
>I can't even get a break to get the "mild" ones now and then??!! I never
>heard of such a thing as "mild" migraine pain. I thought all migraines
>were horribly painful - well, aside from those weird "ocular migraines"
>that sometimes occur.
>
>What's a "mild" migraine?

There is a common misconception that a migraine headache is by
definition severe.  This is not the case.  Differentiation between the
different types of headaches is complex but generally does not involve
the severity of pain (cluster headaches and those caused by
intracranial disasters such as infection or bleeding being the
exceptions.)

The two most common types are tension headaches and migraine
headaches.  Briefly, tension headaches feel like a tight band
symmetrically around the head and can last for days, whereas migraine
headaches are a dull ache or throbbing pain, usually unilateral,
sometimes preceded by an aura, that resolves in a few hours to a day
or with sleep.  Also, migraines frequently run in the family.

I frequently get mild unilateral throbbing pains that resolve in a few
hours or with sleep, and years ago I also thought I couldn't call them
migraines since they don't hurt so bad.  Then I got a tension
headache.  YEOW!  My tension headaches hurt a lot worse than the mild
migraines I frequently get!  Give me a migraine any day.

--
Jonathan R. Fox, M.D.

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: Tue, 06 Apr 1999 14:16:49 -0400

mjdgdc wrote:
> It's neither the aspirin nor the caffeine in Excedrine that
> allowed the manufacturer to put "migraine" on the label. It's
> the Tylenol.

Umm, no.

What allowed this labelling was a study in the 2/98 Archives
of Neurology which compared Excedrin (i.e. OTC strength
aspirin+acetaminophen+caffeine) to placebo for migraine relief
and showed a significant benefit to the combination pill.

--
David Rind
drind@caregroup.harvard.edu

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 7 Apr 1999 09:18:56 GMT

In <7ed47g$doi$1@mtinsc01.worldnet.att.net> "mjdgdc"
<mjdgdc@worldnet.att.net> writes:

>>   A mild migraine, btw, is a headache caused by caffeine withdrawal,
>>in people habituated to it <g>.  I'm mostly not kidding.  Excedrine
>>Migraine cures this kind of headache (undoubtedly the most common type
>>in America) just fine.
>>
>>                                     Steve Harris, M.D.
>
>Proposing Excedrin as a cure for caffeine withdrawal is interesting, given
>the fact that Excedrin contains caffeine.



   It's not only interesting, it's also true.  If you define "migraine"
rather broadly.  And, as a matter of fact, sometimes even if you don't.


>It's neither the aspirin nor the caffeine in Excedrine that allowed
>the manufacturer to put "migraine" on the label. It's the Tylenol.


   If so, the FDA is even dumber than I take them for.


> No, the FDA
>is not asleep at the wheel (when will you people quit knee-jerk
>bashing the FDA and bother to do a little homework?) Over-the-counter
>meds, like any other meds, are tightly regulated for claims. The
>manufacturer of Tylenol finally put together enough data to satisfy
>the FDA that Tylenol was mildly effective in treating migraines (but
>not very effective, granted).

    Caffeine has been a known treatment for migraines for dozens of
years, a component of already-FDA approved meds like caffergot.



> Now any
>product that contains Tylenol (acetaminophen) can be advertised at a
>migraine treatment. The FDA makes manufactures put "mild" on the label
>because people with severe headaches should be evaluated, not popping
>self-prescribed pills while an aneurysm may be about to blow.

    Given that Tylenol works on any mild pain, why do you need to have
some special designation for mild headache pain?  Do you need a study
of pain in the last digit of people's pinky fingers in order to put on
the label of a tylenol bottle that it might be good for mild finger
pain, if occuring in the 5th digit?  But illegal to advertise for pain
in the fourth?

   By contrast, caffeine is a direct vasoconstrictor in the brain.
Migraines and caffeine withdrawal both result in wide open pounding
vessels.  Caffeine's action in this regard is much more specific than
Tylenol/APAP.  And yet, it's not specific at all, in the ultimate
sense.  Caffeine, like other vasoconstrictors, is effective against a
far narrower range of headaches-- basically the vasodilatory vascular
kind.  Hit your head on a cupboard door, and the Tylenol in your
Excedrine will still work on that (somewhat).  The caffeine will not.



                                     Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: Wed, 07 Apr 1999 13:23:04 GMT

On 7 Apr 1999 02:41:43 GMT, hillary@hillary.net (Hillary Gorman)
wrote:

>In
><D225DF67132FD06A.34C933BF67E75DD7.93E53F2A24853A83@library-proxy.airnews.net>,
>Jonathan R. Fox <jrfox@no.spam.fastlane.net.no.spam> wrote:
>
>*>What's a "mild" migraine?
>*
>*There is a common misconception that a migraine headache is by
>*definition severe.  This is not the case.  Differentiation between the
>*different types of headaches is complex but generally does not involve
>*the severity of pain (cluster headaches and those caused by
>*intracranial disasters such as infection or bleeding being the
>*exceptions.)
>
>I can't believe this. Two university student health facilities, three
>neurologists, countless emergency department residents, four primary care
>practicioners -- NO ONE EVER TOLD ME THIS BEFORE! Sheesh. I mean, I knew
>that there are different types of headaches with different etiologies and
>sensations, but I thought *all* migraines were by definition very painful
>(except the ocular ones).

Hrm.  Did you specifically ask them if there is such thing as a mild
migraine, or were you seeing them for your own migraines (which sound
quite severe)?

Not only can migraines headaches be mild, they can be completely
absent!  People can have complicated migraines involving aura and
focal neurologic symptoms and never complain of headache.  My
identical twin brother had a complicated migraine with middle cerebral
artery symptoms (left homonymous hemianopsia and right facial and
right arm weakness and numbness) which resolved in a few hours, and
only in retrospect did he recognize the mild retro-orbital ache that
developed afterwards.  His work-up, including MRI, was normal, of
course, as is consistent with migraine.

Confusional migraine is a variant that can be very difficult to
diagnose, especially when the headache is absent, and can be confused
with toxin ingestion or meningitis.  Children get the controversial
"abdominal" migraine with all the same historical and clinical
features of migraine except they complain of abdominal pain instead of
headache.

As with anything in medicine, most syndromes have widely variable
presentations.

--
Jonathan R. Fox, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 7 Apr 1999 14:14:30 GMT

In <7efo46$rf1$1@bgtnsc02.worldnet.att.net> "mjdgdc"
<mjdgdc@worldnet.att.net> writes:

 So my comment that caffeine is effective for some
>migraines does not "undermine" my argument, because my argument, and
>the discussion, was about FDA labeling allowances, not actual
>effectiveness (sadly, not always the same thing).


   Okay, we agree.



>
>By the way, why would you recommend caffeine for a caffeine-withdrawal
>headache? Do you recommend Tylenol for acetaminophen-rebound headache?


    I wouldn't (unless perhaps you were trying to wean yourself off
slowly).  My point is that what most people think are mild migraines
are caffeine withdrawal headaches.  This, too, may be semantic debate.
Caffeine habituation and withdrawal precipitates non-classic migraines
of a mild order in many people.  How about that?  Are headaches caused
by lack of aspirin in the blood, asks the naturopath?  No, but many
migraines are caused by lack of caffeine in the blood.  And not a few
by lack of alcohol.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 7 Apr 1999 14:18:23 GMT

In
<835692AAE82443C5.0188782E884D3DFE.8C10649986673EDD@library-proxy.airne
s.net> jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox) writes:

>Hrm.  Did you specifically ask them if there is such thing as a mild
>migraine, or were you seeing them for your own migraines (which sound
>quite severe)?
>
>Not only can migraines headaches be mild, they can be completely
>absent!  People can have complicated migraines involving aura and
>focal neurologic symptoms and never complain of headache.  My
>identical twin brother had a complicated migraine with middle cerebral
>artery symptoms (left homonymous hemianopsia and right facial and
>right arm weakness and numbness) which resolved in a few hours, and
>only in retrospect did he recognize the mild retro-orbital ache that
>developed afterwards.  His work-up, including MRI, was normal, of
>course, as is consistent with migraine.
>
>Confusional migraine is a variant that can be very difficult to
>diagnose, especially when the headache is absent, and can be confused
>with toxin ingestion or meningitis.  Children get the controversial
>"abdominal" migraine with all the same historical and clinical
>features of migraine except they complain of abdominal pain instead of
>headache.
>
>As with anything in medicine, most syndromes have widely variable
>presentations.
>
>--
>Jonathan R. Fox, M.D.



    But, to be sure, if we cleave at all to original defintions, we
eventually get to oxymoron when we expand.  Jumbo shrimp.  Abdominal
migraine.  A word derived once upon a time from "[he]mi-cranial."
Though they don't always have to be.  Now we have bilateral migraines,
too.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 8 Apr 1999 08:34:52 GMT

In <370BDF43.A4193FCA@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>Hillary Gorman wrote:
>>
>> Does this mean that not only am
>> I unlucky enough to be stuck having the worst headaches known to man, but
>> I can't even get a break to get the "mild" ones now and then??!!
>
>Actually, Cluster Headaches are the worst headaches known to man, I
>believe.  They have the knickname "suicide headaches" they get so
>bad, and I've seen videotape of people headbutting a concrete floor
>because the pain was so excruciating, and there wasn't anything that
>could help.


   Yep.  Though sometimes oxygen inhalation does.  These look to be the
sort that the concentration camp commandant (Ammon Guth?  Played by
Ralph Finnes) had, in _Schindler's List_.  And they are bad-- they feel
like somebody is stabbing you in the eye with an icepick.  Slowly.
Guth looked a lot less upset in the movie as they hanged him than he
did having a cluster headache, and probably was.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: 8 Apr 1999 09:07:04 GMT

In <370C2788.9D8F9536@dnai.com> Michael Sierchio <kudzu@dnai.com>
writes:

>"Steven B. Harris" wrote:
>
>> ...Caffeine has been a known treatment for migraines for dozens of
>> years, a component of already-FDA approved meds like caffergot...
>
>Be sure to note the info posted here by some guy named Harris
>on the dangers of ergotamine and other serotonin-agonists. ;-)


   When taken every day, yes indeed (caffergot being best used as a
migraine abortant rather than preventive, though it is still incredibly
labeled for use as the later also).  But the dose makes the poison, and
even I wouldn't argue against 5-HTP used as a very occasional sleep
med.  It's those depressives who use it each and every day for years
who are the ones at most likely risk.

   As for Caffergot, the PDR notes that its toxic properties are due
mostly to the ergotamine component, and notes that there have been
reports of "psychological" dependence (one wonders if this category is
used to include people who get headaches imediately when they stop it).

    And the PDR also notes that "There have also been rare reports of
fibrotic thickening of the aortic, mitral, tricuspid, and/or pulmonary
valves with long-term, continuous use of CAFERGOT (ergotamine tartrate
and caffeine) therapy."  Note that with serotinergics not metabolized
in the lungs by MAO, both sides of the heart are affected.  Otherwise,
it's the same valve pathology as produced by serotonin.

                                      Steve Harris, M.D.

From: jrfox@no.spam.fastlane.net.no.spam (Jonathan R. Fox)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: "Excedrin Migraine"
Date: Fri, 09 Apr 1999 03:16:49 GMT

On Wed, 07 Apr 1999 15:38:00 -0500, Marlena <m-libman2@nwu.edu> wrote:

>Jonathan R. Fox wrote:
>> definition severe.  This is not the case.  Differentiation between the
>> different types of headaches is complex but generally does not involve
>> the severity of pain (cluster headaches and those caused by
>
>Oh, yes it can.  It is often diagnosed via severity and other symptoms
>such as light and sound sensitivity.

You are correct that photophobia and other symptoms such as nausea and
aura help distinguish migraine from other forms of headache, but again
severity of pain is not a determinant.  As noted previously, people
can have complex migraines with aura, focal neurologic symptoms,
nausea, photophobia, and the whole bit, with only a mild ache.

--
Jonathan R. Fox, M.D.