Sublingual feverfew and ginger combination can abort a migraine

Posted on September 8, 2011 by Dr. Jonathan

It’s long been known that the herb feverfew (Tanacetum parthenium) can reduce the frequency and intensity of migraine attacks if taken ahead of time on a regular basis, but alternatives to triptan medications for acute application are in short supply. Therefore I’m glad to see a study just published in Headache: The Journal of Head and Face Pain offering evidence that the novel sublingual preparation of feverfew plus ginger LipiGesic M™ can rapidly abort or ameliorate a migraine headache. The authors state:

“Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high-end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the “gold standard” of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open-label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack.”

Pursuant to this they designed the double-bind placebo-controlled study reported here that included 60 patients who self-treated 221 attacks of migraine with either the sublingual feverfew/ginger preparation or placebo. Additionally…

“All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2-6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non-migraine headache.”

Subjects were randomized to receive either sublingual feverfew/ginger or a matching placebo, and told (but not required) to initiate treatment as soon as they recognized that a migraine was starting. What were the results?

“Sixty subjects treated 208 evaluable attacks of migraine over a 1-month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation…At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain-free. At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain-free or mild headache) vs 39% for placebo. Pain level differences on a 4-point pain scale for those receiving feverfew/ginger vs placebo were −0.24 vs −0.04 respectively. Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event.”

This is clearly palliative treatment rather than therapy designed to address the underlying causes of migraine (see forthcoming posts regarding the functional medicine approach to migraine). However, an effective palliative that is wholesome and free of serious side-effects as implied in the authors’ conclusion is welcome news:

“Sublingual feverfew/ginger appears safe and effective as a first-line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.”

Inflammation, mitochondrial dysfunction and neurodegeneration in major depression

Posted on August 21, 2010 by Dr. Jonathan

Is depression mainly a disorder of serotonin regulation? A paper just published in Progress in Neuro-Psychopharmacology and Biological Psychiatry reminds us that, of course, it is not. The authors state:

“For many years, a deficiency of monoamines including serotonin has been the prevailing hypothesis on depression, yet research has failed to confirm consistent relations between brain serotonin and depression.“

They observe that there is a relationship between depression a number of other conditions with a common set of underlying causes:

“…depression is one of a family of related conditions sometimes referred to as the “affective spectrum disorders”, and variably including migraine, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia and generalized anxiety disorder, among many others.”

What do these disorders have in common?

“…we present data from many different experimental modalities that strongly suggest components of mitochondrial dysfunction and inflammation in the pathogenesis of depression and other affective spectrum disorders. The three concepts of monoamines, energy metabolism and inflammatory pathways are inter-related in many complex manners. For example, the major categories of drugs used to treat depression have been demonstrated to exert effects on mitochondria and inflammation, as well as on monoamines. Furthermore, commonly-used mitochondrial-targeted treatments exert effects on mitochondria and inflammation, and are increasingly being shown to demonstrate efficacy in the affective spectrum disorders.”

In the functional approach, the evaluation and treatment of depression is not complete without addressing the factors that contribute to neuroinflammation, neurodegeneration and mitochondrial dysfunction with the appropriate tests and physiological interventions.

Migraine and strokes in women

Posted on November 30, 2009 by Dr. Jonathan

Ladies, if you suffer from migraine here is more inspiration for finding a sound solution. As this recent paper published in The Journal of the American Medical Association reports, migraine attacks can be associated with pathological changes in the brain. The association held true only for migraines with aura, and only for women. The authors conclude: “Migraine with aura in midlife was associated with late-life prevalence of cerebellar infarct-like lesions on MRI [infarct = death of tissue due to interruption of blood flow]. This association was statistically significant only for women. This is consistent with the hypothesis that migraine with aura in midlife is associated with late-life vascular disease in the cerebellum and in women.”