Portable Device May Prevent Migraines


By Anne Harding

THURSDAY, March 4, 2010 (Health.com) — Help may be on the way for people who experience migraines but haven’t found any relief from pain medications. An experimental handheld device that delivers pulses of magnetic energy to the back of the head may be effective at warding off migraines in some patients, according to a new study funded by the device’s manufacturer.

The technique, known as transcranial magnetic stimulation (TMS), could be the first effective non-drug treatment for the excruciating headaches, as well as the first treatment with the potential to prevent migraine before the pain begins.

The study participants were instructed to give themselves two pulses to the back of the head within an hour after experiencing an aura, the visual disturbances that signal an oncoming migraine in up to 30% of patients.

“I think this device is a really good option for people who want to avoid taking medication, or who have contraindications, side effects, or lack of response to available medications,” says lead study author Richard B. Lipton, MD, a professor of neurology at Albert Einstein College of Medicine, in the Bronx, N.Y.

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Neuralieve, a start-up company based in Sunnyvale, Calif., manufactured the devices used in the study. The company also funded the study, and Dr. Lipton and several of his co-authors have stock options in Neuralieve, or other financial connections to it.

The U.S. Food and Drug Administration (FDA) has not yet approved the device, but if it does earn approval, migraine patients could use it as an alternative to drugs, or in conjunction with medications, Dr. Lipton says.

The FDA has already approved a TMS device to treat depression. Unlike that device, which is heavy and found only in doctor’s offices, the migraine device could be used at home.

Dr. Lipton says he’s not sure how much the device would cost, but that people probably would be able to lease or rent it inexpensively, before buying, to see if it worked for them. “Purchasing a device if you don’t know if you’re a responder doesn’t make any sense to me,” he says.

In the study, published in the Lancet, 82 people who suffer from migraines with aura received a TMS device, and the same number received a fake (or “sham”) version of the device, which looked—and vibrated—just like the real thing, but did not deliver the magnetic pulses.

Next page: TMS outperformed sham device

Thirty-eight percent of the patients who used the real device had no pain two hours later, compared to 22% of those who used the sham device; they also showed greater pain relief 24 and 48 hours later. According to the study, patients given the device also had measurable reductions in other migraine symptoms, including nausea and sensitivity to light and sound, compared to the sham group.

A comparable percentage of people in each group believed they had received the real device both before and after the treatment, which suggests that the participants did not know which device they had.

“The use of TMS could be a major step forward in patients in whom presently available drug treatment is ineffective, poorly tolerated, or contraindicated,” Hans-Christoph Diener, MD, of University Hospital Essen, in Germany, noted in an editorial accompanying the study. But “many research questions remain unanswered,” he added. For example, it has yet to be seen how many pulses are most effective, whether the device will be cost-effective compared to the widely used migraine drugs called triptans, and whether it’s safe for people with epilepsy.

In migraine with aura, many researchers now believe, a wave of electrical activity begins—usually at the part of the brain responsible for vision in the occipital lobe, at the back of the head—and then spreads forward over the brain’s surface. Animal studies have shown that TMS can stop this process, which is likely why it helps some human migraine sufferers.

“What you’re trying to do is arrest the progress, so to speak,” explains Peter Goadsby, MD, a professor of neurology at the University of California, San Francisco, who was a co-author of the study and has also conducted animal research on TMS. Dr. Goadsby has received research funding from Neuralieve in the past, as well as fees for serving as an adviser to the company.

Right now, Dr. Goadsby points out, there is no treatment that can be given to migraine patients during aura; triptans are no more effective than placebo if they are given during aura, before the migraine itself begins.

Dr. Goadsby adds that even though Dr. Lipton and his colleagues didn’t test the device in migraine without aura, the treatment may work for the millions of patients in the U.S. who experience that type of migraine.

Because TMS has already been shown to be safe for the treatment of depression—and at much higher doses (i.e., the number of pulses)—it offers a “gigantic margin of safety” to migraine patients, Dr. Lipton says.

Study: Weather Change Can Trigger Throbbing Headaches

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By Kate StinchfieldMONDAY, March 9, 2009 (Health.com) — Most people who are prone to headaches or migraines suspect that certain things, such as red wine or strong perfume, can trigger their head pain. Now a new study suggests that rising temperatures could trigger headaches, too.

According to a study published Monday in the journal Neurology, a spike in temperature may be enough to land some headache-prone people in the emergency room. The researchers found that for every 5-degrees-Celsius increase in temperature, the risk of a hospital-related headache visit went up 7.5 percent in the next 24-hour period. And a drop in barometric air pressure, which tends to happen before it rains, was also linked to a greater risk of headaches in the next 48 to 72 hours.

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While people may think they’ve got a handle on their migraine triggers, in truth, weather changes may be to blame for at least some of those headaches, says Kenneth J. Mukamal, MD, the study’s lead author and an associate professor of medicine at Harvard Medical School in Boston. “In the summer, you may think that ice cream set off your migraine,” he says. “But it wasn’t the ice cream—it was the temperature increase on that very hot day that led you to eat the ice cream.”

Dr. Mukamal’s team looked at 7,054 patients diagnosed with headaches in the emergency room of Boston’s Beth Israel Deaconess Medical Center over a span of seven years; they compared factors like temperature, barometric pressure, humidity, and pollution for the period immediately preceding and following each patient’s hospital visit. While temperature and barometric pressure were linked to headaches, pollution—which is linked to a greater risk of heart attack and stroke—was not associated with migraines. But Dr. Mukamal isn’t ruling out the possibility. “Our city was not big enough to say for sure that air pollution is off the hook,” he says, adding that a similar study performed in Los Angeles (where air pollution levels are considerably higher) might yield different results.

Next page: How to avoid temperature change-related migraines

The study isn’t without limitations, though: It excluded migraines that did not result in a trip to the hospital, says Ellen Drexler, MD, associate professor of neurology at the Mt. Sinai School of Medicine in New York City.

Migraines affect up to 18 percent of women and 6 percent of men in the United States. So do the headache-prone need to stay indoors when the temperature starts to climb? Not necessarily, experts say.

Instead of holing up in an air-conditioned home, a migraineur may be able to take medication to prevent head pain. For example, taking beta-blockers is one way to prevent a migraine. But many people don’t like taking routinely taking prescription drugs to prevent migraines, says Dr. Mukamal. “Migraines often happen to younger people, who have a particular reticence to daily medication,” he adds.

Not all experts would recommend using medication to prevent temperature-change-related migraines. “I certainly would not suggest that a patient take symptomatic medication such as a triptan just because of a weather prediction—especially considering the track record of our weathermen,” says Dr. Drexler. “Although a dose of a simple analgesic in the morning might be helpful for some people.”

Overall, the weather probably is not as a big a migraine trigger as, say, a glass of Cabernet, explains Dr. Drexler. She recommends that patients keep pain diaries and log in weather conditions as well. If a patient finds that weather is, in fact, a trigger, he or she can potentially avoid a migraine by taking extra precautions to avoid other triggers (such as caffeine) on those days.

Read more about headaches and migraines

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Facial Surgery May Offer Migraine Cure

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By Heather MayerMONDAY, Aug. 3, 2009 (Health.com) — Facial surgery that targets and removes small portions of migraine-triggering muscle or nerve tissue may offer permanent relief for some people with the debilitating headaches, a new study suggests.

“Other migraine treatments either temporarily prevent the symptoms or they may reduce the symptoms after the migraine headaches start,” says Bahman Guyuron, MD, a professor and the chair of the department of plastic surgery at the University Hospitals of Cleveland and Case Western Reserve University. “What we are offering is essentially a cure.”

In a study published in Plastic and Reconstructive Surgery, Dr. Guyuron and colleagues looked for people who had migraines that started in a specific region on the front, side, or back of the head. The researchers injected Botox into these trigger points to temporarily paralyze the muscle; if the injections helped relieve the migraines, the patients were randomly divided into two surgical groups.

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After the Botox wore off, one group had a face-lifting surgery combined with the removal of muscle tissue or nerves in the area that triggered the migraines. Fat or muscle was used to fill in the area after tissue was removed.

The second group had a sham procedure, in which incisions were made but all muscles and nerves remained intact. A total of 75 patients were involved in the study.

In the year after the procedure, 57% of those who had the actual surgery reported the complete elimination of migraine headaches, compared with just 4% in the sham surgery group. In addition, 84% of those who had the surgery reported at least a 50% reduction in migraine pain compared with just 58% in the sham group.

Next page: What were the side effects?

As for side effects, one surgery patient had persistent numbness of the forehead, and 10 of 19 patients who had the procedure on the side of the head had a slight but persistent hollowing in their temple region.

More than 30 million Americans experience migraine headaches. However, Robert Kunkel, MD, a consultant at the department of neurology at the Cleveland Clinic, says this surgery probably won’t become a common procedure, despite the results.

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“This may be a technique that will help a small number of migraine patients who have responded to Botox, but it’s certainly not a procedure for generally treating migraines,” says Dr. Kunkel, who was not involved in the new study. He points out that people who had the sham surgery probably suspected that they were in the placebo group, since the face-lift would most likely have reduced wrinkling. If a treatment isn’t completely blinded, it can skew a study’s results; if patients suspect they’ve had a sham treatment, they may be less likely to say their migraines are cured.

However, nearly 60% of the people who had the sham procedure reported some migraine relief too. Dr. Guyuron believes this could be related to a placebo effect, or the incisions could have disturbed some of the nerve branches and actually relieved migraines in some way.

Overall, there was a 92% success rate, notes Dr. Guyuron. “This study offers powerful evidence to the plastic surgeon, the neurologist, and the insurance companies that this operation is effective,” he says. “Not only are they headache free, depending on the trigger site, but they also may look younger.”

The Migraine Foundation, the Plastic Surgery Education Fund, and the Prentiss Foundation funded this study. Some of the study coauthors have consulted for Allergan or have been paid speakers for pharmaceutical companies.

7 Surprising Things You Don't Know About Migraines

June is Migraine Awareness Month, putting the spotlight on the pounding, nausea-producing headaches which afflict some 28 million Americans. While there’s an awful lot we do know about migraines, what you don’t know will surprise you:

1. They’ve been linked to suicide riskSeveral studies have now linked migraines with an increased risk for suicide attempts and even completed suicide. The risk may be even higher among people with migraine with aura or the flashes of light and other sensory symptoms that can accompany the headaches. It’s not clear why migraines and suicide are related, but depression and migraine share a similar biology, says Dawn Buse, PhD, a health psychologist with Montefiore Medical Center in New York City. Migraine sufferers need to know that “they’re not alone. They can get help,” says Buse.

2. Your medication could be making migraines worseAlthough drugs are meant to help ease the pain of migraines, in some cases this strategy can backfire–badly. Too-frequent use of migraine medications can result in what’s known as “medication-overuse headaches” and a quickly spiraling vicious cycle. This type of headache can occur with many different medications, including narcotics, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen) and triptans, a class of drugs used specifically to treat migraines. The solution? Try not to use migraine medication, even over-the-counter varieties, more than twice a week.

3. Lightning and migraine can strike togetherA study of migraine sufferers in Ohio and Missouri found that the risk of migraine went up on days when there was lightning nearby compared to days when there wasn’t. And weather-related factors such as barometric pressure and humidity, both of which have been linked with migraines in the past, couldn’t explain all of the elevated risk. The study authors speculated that electromagnetic waves from the lightning could be triggering the headaches or that lightning might increase the production of ozone or fungus spores, either of which might spur a migraine.

4. Migraines are linked to other serious health problemsPeople with migraines have an elevated risk of stroke and of other cardiovascular problems when compared with the general population. The risk of stroke, in particular, is higher still when the migraine is accompanied by aura and in women aged 35 or over, especially those who use oral contraceptives or who smoke. Researchers aren’t sure why stroke and migraines are linked but, regardless, “a history of migraine with aura should be considered an important risk marker for stroke,” says Buse.

5. A drop in your stress level can bring on a migraineIf you think that finishing your finals or having that big work presentation out of the way will reduce your chance of a migraine, think again. Research by Buse’s team actually found a 20% higher risk of migraines after someone’s mood changed from sad or nervous to happy or relaxed. These “let-down” migraines may be caused by a sudden, dramatic drop in hormones. How to reduce the likelihood of being let down in this way? Try to avoid peaks of stress in the first place. If it’s finals week, do some yoga or take copious breaks.

6. Sex can trigger migrainesThat’s right. Intense physical exertion, including sexual activity, and sometimes even just arousal can actually cause a migraine. Normally this type of migraine is more common in young or mid-life men and, fortunately, usually goes away as the person ages. One obvious solution is to avoid sexual activity but there are easier ways to prevent the migraines. Some doctors will actually prescribe blood pressure medications known as beta blockers to prevent these migraines. And bear in mind that some research suggests sex can actually ease a migraine.

7. Migraines can blow in with the windIn addition to humidity and barometric temperature, some people swear that an ill wind lies behind their migraine pain. At least one scientific study backs this up. Researchers in Alberta, Canada found an increased risk of migraine on days preceding chinook winds and on days when the winds exceeded 23 miles an hour. Chinooks are warm winds hailing from the west. Overall, about half of migraine sufferers are sensitive to weather factors such as temperature, humidity and barometric pressure, according to another study.

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5 Weird Migraine Treatments

It’s no secret that migraines are a serious pain. About 37 million Americans get migraines, and women are three times more likely to have them than men, according to the National Headache Foundation. Ouch!

If you’re plagued by migraines, you’ve likely popped different pills to ease the throbbing. But would you ever try a high-tech headband or a battery-operated patch to soothe your aching head? Yes, such treatments exist. In honor of Headache and Migraine Awareness Month, here are five wacky migraine fighters explained. (The first three are available by prescription only.)

Cefaly headbandThe U.S. Food and Drug Administration recently approved the Cefaly headband, which was found to reduce patients’ number of migraine days by 30% in a clinical trial published in the journal Neurology. The headband has an electrode that presses against the middle of your forehead, delivering a round of electric impulses that work to stimulate the nerves above the eyes. It’s safe to use for 20 minutes a day, and some experts believe that daily use could help prevent migraines before they start. “In my practice, this device has helped quite a few patients, cutting headache days per month in half or more,” says Richard Lipton, M.D., Edwin S. Lowe Chair in Neurology for the Albert Einstein College of Medicine.

Transcranial magnetic stimulation (TMS)Now that’s a mouthful! A portable device with TMS technology uses a pulse of magnetic energy to target migraines with aura, which plague about 20% of migraines sufferers, according to the National Headache Foundation. “A patient with visual aura might report seeing spots of light, zig-zag lines, or a graying of vision lasting 10 to 60 minutes,” says Dr. Lipton, who tested the treatment himself in a clinical trial for Lancet Neurology. When these visual symptoms appear, just hold the TMS device against the back of your head and press the button. A magnetic pulse will help target your occipital lobe, the brain’s center of visual processing, and help relieve aura symptoms. Just don’t go overboard with this machine: You should only use it once a day, per the FDA, which approved the treatment just last year.

Zecuity patchMost migraine sufferers are used to taking medicine, but it’s not always the best option. “Migraine sometimes paralyzes the digestive system,” Dr. Lipton says. “Once this happens, oral medications can’t be absorbed until the attack is over.” That’s where this battery-operated patch, approved by the FDA in 2013, comes in handy. For people who can’t absorb their medication properly or find it just plain nauseating, the Zecuity Patch (worn on your arm or thigh) sends the commonly prescribed migraine drug sumatriptan (brand name Imitrex) through the skin, so it bypasses your digestive system completely.

Tinted glassesFor some sufferers of migraines with aura, their pain is triggered by looking at certain patterns. A 2011 study published in the journal Cephalalgia found that precision-tinted eyeglasses helped normalize brain activity for chronic migraine sufferers. All patients (some with and without headaches) were asked to look at high-contrast striped patterns through three different pairs of glasses. Those who regularly battled migraines reported feeling less discomfort when they viewed the patterns using the tinted pair. It’s thought that the visual cortex gets overstimulated during a migraine attack, leading some patients to suffer perceptual illusions, says study author Jie Huang, Ph.D. Tinted lenses help suppress that visual stress and consequently reduce migraine frequency.

Would you believe a line of glasses for migraines already exists? Axon Optics offers frames with FL-41 therapeutic lenses. They use a rose-colored filter to block the annoying blue-green light you’ll usually find in florescent lamps, so people stifled by bright spaces can get a little relief, too.

AcupunctureThis one’s kind of controversial. Though studies have shown that there’s not a large difference in pain reduction between placebo or “sham” acupuncture and the real thing, a study in the Canadian Medical Association Journal found 50 to 75% of patients with migraines felt better after receiving each type, respectively. Acupuncture is a practice based on traditional Chinese medicine where needles inserted into the skin are used to realign the flow of energy, or qi, in the body. Medical professionals still aren’t sure exactly how it works, but it’s possible acupuncture helps stimulate electromagnetic signals in the body to release chemicals that dull pain. Acupuncture may provide some relief to people who haven’t responded to other treatments. “When done by someone good, it’s safe and sometimes very helpful,” Dr. Lipton says.

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Kanye West's Migraine: When to Go to the Hospital for a Headache

Even celebrities like Kanye West have to deal with annoying and sometimes debilitating head-pounders. Sources say that yesterday the rapper was taken to the emergency room with a serious migraine and had an MRI in a Melbourne hospital, where he’s on the Australian leg of his Yeezus tour. The New York Daily News reports West developed an “intense” headache after playing basketball and was rushed to the hospital.

RELATED: 18 Signs You’re Having a Migraine

It appears everything’s fine now as West went on to perform his scheduled gig later that evening. A source for E! News says the ER visit wasn’t tied to a seizure, as some news outlets reported; he “went to the hospital simply as a precaution.”

Though the visit hasn’t been confirmed by reps (or the star himself on social media), West was smart to get his head pain checked out. Excruciating headaches can sometimes be a warning sign of life-threatening health problems. While it’s not that common, you should watch out for headaches that feel very different from normal.

Here are three scenarios where you should get immediate attention:

RELATED: 6 Easy Ways to Keep Migraines Away

You have a stiff neck and fever

These are hallmark symptoms of meningitis (often with nausea or vomiting, too), which is an inflammation of the membranes around your central nervous system, according to the Mayo Clinic. The most common cause is a viral infection, and viral meningitis usually gets better on its own, or with rest and fluids. Bacterial meningitis, on the other hand, can be fatal. In this case, bacteria can cause life-threatening brain swelling, so you’ll need antibiotics right away.

It’s the worst pain of your life

If the sensation is worse than anything you’ve ever felt before, trust your gut and get it checked. A sudden, serious head-pounder could signal a brain aneurysm, a bulge that forms in an artery after trauma (like a car accident) or as the result of lifestyle factors including smoking, high blood pressure, or plaque in arteries known as atherosclerosis, according to the National Institutes of Health. While aneurysms themselves are painless, if they start to leak they can cause excruciating pain and potentially life-threatening bleeding in the brain.

RELATED: 10 Stroke Symptoms Everyone Should Know

You have difficulty talking, body weakness, or face drooping

Coupled with headache, these could be signs you’re having a stroke, when an artery in the brain is blocked by a clot, or possibly leaks or ruptures, according to the NIH. Lack of blood flow in the brain can damage or kill brain cells, but rapid treatment with clot-busting drugs (generally within 3 hours of your first symptoms) can sometimes prevent the damage caused by a clot.

How to Tell When a Headache Requires a Trip to the ER

How do I know when to go to the ER for a headache?

Most of the time, a headache isn’t an emergency. But in general, you should seek help if it’s the worst headache of your life, or if it’s severe and unlike others you’ve had before.

An extreme headache can be the first sign that you have a cerebral aneurysm, which is a weak area in the wall of a blood vessel in your brain, and it has begun to leak. An MRI or CT scan can detect this problem. It requires immediate medical attention, and possibly surgery, because a leak might lead to a rupture, which can be life-threatening.

RELATED: 10 Stroke Symptoms Everyone Should Know

You should also watch out for a headache that comes with any numbness or facial weakness, as these are symptoms of a stroke. If you’ve recently hit your head, get to the ER if you start vomiting or your headache worsens; that could mean you have a concussion.

Finally, head throbbing plus neck stiffness and fever could indicate meningitis, an infection of the membranes around your brain and spinal cord. If it’s bacterial, you’ll need antibiotics.

RELATED: 21 Natural Ways to Prevent and Treat HeadachesHealth‘s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

New Drugs Might Prevent Migraines Before They Start

By Dennis ThompsonHealthDay Reporter

THURSDAY, June 18, 2015 (HealthDay News) — Competing teams of researchers are closing in on a new class of drugs that can prevent chronic migraines by interrupting the chain of events thought to create the headaches.

The drugs target a biochemical called calcitonin gene-related peptide (CGRP). The results from phase 2 clinical trials show that these drugs can effectively prevent migraine in a substantial portion of headache sufferers, according to the studies.

“It’s very exciting, because this would be a form of prevention that might not have a lot of side effects and would be highly effective for people who have not had good treatment,” said Dr. Thomas Ward, a professor of neurology at Geisel School of Medicine at Dartmouth in New Hampshire. “The hope is these drugs will be clean, reduce the number of headaches people get, and won’t carry a lot of baggage.”

Findings from these studies were to be presented this week at the annual meeting of the American Headache Society, in Washington D.C.

Researchers have known for more than two decades that CGRP plays an important role in migraine headaches, said Dr. Peter Goadsby, chair of the scientific program of the American Headache Society’s annual meeting and chief of the University of California, San Francisco Headache Center.

The body uses CGRP to control the opening of blood vessels, and it also is thought to play a role in the transmission of pain signals, Ward said.

“The last step in the pathway we think to setting off headache is this substance called CGRP,” Ward said. “This material is released by nerves, and when released it causes inflammation in the nervous system.”

Headache drugs called triptans currently are used to stop migraines in progress, and they work by blocking CGRP, Ward said. But until now, researchers have been unable to come up with a way to prevent onset of migraines by targeting CGRP.

Traditional pharmaceuticals have not panned out in heading off migraines by blocking CGRP, Goadsby said. CGRP is widely used throughout the body, and blocking its function entirely can cause serious side effects in a number of organs.

This latest class of drugs reduces levels of CGRP through the use of monoclonal antibodies — laboratory-created antibodies that can be engineered to target any substance in the body.

These are the first drugs specifically developed for prevention of migraines, Goadsby said. Up to now, doctors have repurposed drugs developed for other health problems — for example, high blood pressure — to treat migraine.

“This is the first time that migraine patients will get migraine drugs for prevention,” Goadsby said.

Four drug manufacturers — Alder Pharmaceuticals, Amgen, Eli Lilly and Company, and Teva Pharmaceuticals — currently are testing their own versions of CGRP monoclonal antibodies. Goadsby is helping test Amgen’s CGRP monoclonal antibody.

A drug that effectively prevents migraine could prove lucrative. More than 36 million Americans have migraines, more than have asthma or diabetes combined, according to the American Headache Society. About 4 million have chronic migraine, experiencing more than 15 migraine days a month, according to the society.

In results presented at the American Headache Society meeting:

Teva reported that its drug achieved a significant reduction in the number of headache hours after one week, with more than half of patients in each arm experiencing a 50 percent or greater reduction in headache frequency.

Amgen reported that its drug reduced the number of migraine days by 50 percent in about half the treated patients after 12 weeks.

Lilly showed that its drug could help prevent migraine headaches, compared against placebo.

Alder Pharmaceuticals didn’t present any new findings at the meeting, but has previously published promising phase 2 study results, according to an American Headache Society news release.

The drugs are all administered via injection, said Goadsby.

If the drugs prove successful, migraine patients could get a monthly injection to prevent some or all of their headaches, he said.

“They clearly work for a substantial proportion of people,” Goadsby said. “About half of patients will get 50 percent response, and a fifth will get 100 percent response.”

CGRP monoclonal antibodies so far have shown limited side effects, with only 3 percent of patients dropping out of trials due to adverse events, Ward said.

However, there is some concern about the long-term use of these drugs, given how CGRP is used throughout the body for many different purposes, he said.

“CGRP is so widespread, it’s hard to tell whether it could cause consequences throughout the body,” Ward said.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

For more about migraine, visit the U.S. National Institute of Neurological Disorders and Stroke.

Here's Why You Keep Waking Up With a Headache

I keep waking up with a headache! What gives?

A few things could be going on here. For starters, poor sleep quality can lead to a the next day. So the first thing to do is investigate what, if anything, is interfering with your slumber.

One common culprit is sleep apnea, a condition in which you periodically stop breathing throughout the night. Your body then wakes you up so you’ll start breathing again. You may not even realize that this is happening. Ask your partner or a friend whether you’re a loud snorer—that’s often a tip-off. Either way, your doctor can refer you for a sleep study, which is the most accurate way to diagnose sleep apnea.

No problem sleeping? Teeth grinding overnight can cause soreness in the jaw muscles or temporomandibular joint (or TMJ, which is also the commonly used name for the jaw disorder that sometimes involves grinding). That achiness can lead to a headache. Again, you may not realize that you’re grinding your teeth, but your dentist should be able to detect the problem if it’s there.

It could also have to do with pesky . Exposure to dust mites while you sleep (they love to live in your sheets and mattress) can also leave you waking up with an aching head, due to the sinus congestion it causes. If you suffer from allergies, try using allergy proof bedding—special pillowcases, mattress covers and duvets designed to protect you from exposure to mites—and washing your sheets more frequently. An allergist, if you’ve never seen one, can help you find additional ways to relieve symptoms so you’re headache-free in the morning and sneeze-free for the rest of the day.

Health‘s medical editor, Roshini Rajapaksa, MD, is associate professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

What's Causing Your Headache?

Got a throbbing pain? Help is on the way! Find out if you’re suffering from a migraine, tension headache, or something else with this guide.

If you bonked your noggin skiing or went overboard at happy hour, it’s clear why your skull is pounding. But diagnosing head pain isn’t always such an easy call. A headache can be primary, meaning the headache itself is the problem, or secondary, meaning it must be a sign of an underlying illness, from a sinus infection to scary (and rare) stuff like a brain tumor.

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“A secondary headache must be recognized, as it can be dangerous,” says neurologist Jack Schim, MD, co-director of the Headache Center of Southern California. Follow your symptoms to decode your pain.