Migraine background treatments in Lausanne

When the impact of migraines becomes very significant on patients’ lives (in their private, social and professional lives) and are severely affected by the pain, in-depth treatments can be considered. In particular, the use of background treatments is indicated if migraines are very frequent and disabling, if acute phase treatments are not effective, or if taking these drugs is too frequent and becomes dangerous.

Background medications are administered to reduce the overall impact of migraines, i.e., to reduce the intensity, frequency and duration of attacks.

The first choice among migraine medications is beta-blockers (e.g., Metoprolol and Propanolol). Possible side-effects of beta-blockers include asthenia (fatigue), low blood pressure, nightmares and sexual dysfunction. Beta-blockers cannot be used by patients suffering from asthma and cardiac problems such as atrioventricular blocks (AVB).

The second category of background drugs are anti-epileptics such as Topiramate (Topamax), or Valproate (Depakine, Orfiril). Antiepileptics cannot be used during pregnancy or breast-feeding. Side effects of antiepileptics include possible weight gain or loss, hair loss, renal colic, acute myopia, paresthesias, central adverse effects, hepatitis.

Antidepressants are often also used as background treatment for the possible dual effects of depression secondary to chronic headache and pain. Antidepressants include Amitriptyline (Saroten). Amitriptyline cannot be used for angle-closure glaucoma, adenoma and atrio-ventricular conduction disorders. Side effects of antidepressants include drowsiness, weight gain, dry mouth (xerostomia), constipation and hypotension.

Anti-hypertensive drugs such as condesartan (Atacand) have also been used in some cases as background therapy. Anti-hypertensives should not be used during pregnancy or breast-feeding, or in cases of hepatic insufficiency. The main side effect of anti-hypertensives is arterial hypotension.

More recent studies have focused on alphaCGRP (alpha Calcitonin Gene-Related Peptide) inhibiting antibodies. CGRP, inhibited by these new drugs, has the function of dilating blood vessels and is thus implicated in pain. These antibodies include Erenumab (Aimovig), Galcanezumab, Fremanezumab and Eptinezumab. These drugs are normally administered by subcutaneous injection once a month, in some cases reducing the frequency and intensity of attacks. Immediate side effects are mainly related to constipation. Medium- and long-term side effects are, to date, unknown, since CGRP also has positive effects in protecting brain, heart, intestinal and kidney tissues against ischemia, cell death and vascular inflammation. For example, physical activity stimulates CGRP, with a protective effect in cases of high blood pressure in the heart.

In the case of vascular angina, preventive treatment with high-dose Verapamil (60-120 mg 3x/day) is effective after 2-3 weeks. Corticosteroids can also be prescribed for transitional periods.

CBD

A separate mention, the role of Cannabis (CBD or Cannabidiol). CBD can be used as a background or acute treatment, and can be administered by inhalation or vaporization, tincture (drops) or ointment in capsule form. Although there are not yet a large number of scientific studies proving the effect of CBD on migraines, this does not mean that CBD cannot be useful and effective. Studies conducted to date show a promising effect of CBD in relieving the pain of chronic migraines. CBD is a powerful natural analgesic and stimulates the natural production of Serotonin. Contrary to popular belief, CBD has no hallucinatory effect and will not induce euphoria. The dosage of CBD that is normally effective varies from person to person, and should be increased gradually under supervision.

Natural supplements

There are also natural supplements that can be used with proven efficacy by several studies.

Magnesium is a cofactor for over 300 enzymatic reactions in the human body. It is a mineral that therefore plays a key role in the regulation of many functions, including muscle contraction, blood pressure, insulin metabolism and cardiac excitability. Studies have shown that migraine sufferers generally have low magnesium levels. This deficiency creates post-synaptic neuronal excitation. To evaluate magnesium as a migraine preventative, 81 patients were treated with 600 mg magnesium citrate daily for three months. The frequency of attacks was reduced by 41.6%, compared with only 15.8% in the placebo group. The number of migraine days and the use of medication to reduce migraine symptoms were also significantly reduced. Magnesium is thus considered to be an active ingredient of choice for migraine prevention. Although magnesium supplementation is generally well tolerated, it can cause gastrointestinal disorders and diarrhoea.

Riboflavin (or vitamin B2) is the active ingredient of choice for migraine prevention. Vitamin B2 improves energy metabolism and the formation of energy (ATP), which is directly linked to the mitochondrial dysfunction often observed in migraine sufferers. ATP provides the energy required for chemical reactions, locomotion and cell division in all living organisms. Numerous studies report the efficacy of vitamin B2 for migraines. A prescription of 400 mg riboflavin for three months led to a 50% reduction in attacks for 59% of treated patients, compared with only a 15% reduction for the placebo. The side effects of vitamin B2 are very limited (polyuria, diarrhea).

Coenzyme Q10 has been used for many years in cosmetics as an anti-wrinkle cream. It has also proved its effectiveness in the treatment of heart failure ("Q-symbio" study carried out on 420 patients from 2003 onwards). More recently, however, other applications have come to light, such as in migraine, as this molecule is necessary for ATP synthesis. It is a crucial intermediary in the respiratory chain that ensures energy production for cells. Coenzyme Q10 is not considered an essential nutrient, as it is synthesized by the body. However, its production by the human body declines with age.

Various environmental factors (extreme physical effort, stress, alcohol or tobacco consumption, etc.) can also have a detrimental impact on coenzyme Q10 levels, necessitating supplementation. The effectiveness of this product in preventing migraine attacks has been demonstrated in numerous studies. Based on a 2002 study, a 150-mg dosage a day for three months was defined as effective. The side-effects of taking coenzyme Q10 daily are once again minor: gastrointestinal disorders may occur in very rare cases.

Alpha-lipoic acid acts as a cofactor for certain enzyme complexes. In particular, in the Krebs cycle, it contributes to the formation of ketone bodies used as sources of metabolic energy by muscles, the heart and the brain. Alpha-lipoic acid also acts as an antioxidant, neutralizing free radicals within mitochondria and repairing certain mitochondrial damage linked to oxidative damage. Its use in migraine prophylaxis has been repeatedly tested in randomized, double-blind, placebo-controlled studies.

The 600-mg/day dose seems to achieve the maximum therapeutic effect, according to the studies.

Feverfew (Tanacetum parthenium) is a medicinal plant that has been used for centuries for a variety of purposes. Despite the effects of feverfew on migraine frequency, the results have not been conclusive. It seems that the most significant effects associated with the use of 150mg/day of this substance are linked to a reduction in symptoms associated with migraines (nausea, light, noise, vomiting).

Feverfew should not be used during pregnancy (risk of uterine contraction and premature birth).

Petasites have been used to combat fever, spasms, general pain and lung disease for over 2,000 years.

A study of 245 patients demonstrated the efficacy of Petasides for migraine prevention, especially when taken twice daily at two different times of the day.

The main side effects reported in the literature are gastrointestinal problems such as nausea and flatulence. This plant is generally well tolerated, but should not be prescribed to pregnant women.

In addition, great care must be taken with the origin of this product. Some butterbur extracts may contain pyrrolizidine alkaloids, which are highly toxic to humans. These compounds can cause severe liver poisoning, resulting in loss of appetite, pain, abdominal distension and even enlargement of the liver. The presence of such toxic compounds is prevented by purifying plant extracts. Some suppliers guarantee zero levels of pyrrolizidine alkaloids in their preparations.