Migraine Linked to Double Risk for Silent Stroke

Adults with migraine have an increased risk for ischemic silent brain infarction relative to their migraine-free peers, a new study confirms. Migraine is a neurovascular condition of the brain, with a small increased risk of silent brain infarctions, a risk factor for clinical stroke.

Migrane

While the risk may be small, migraine patients with vascular risk factors should be treated for stroke risk factor reduction, including healthy lifestyle behaviors that include regular exercise and plenty of fruits and vegetables according the AHA/ASA [American Heart Association/American Stroke Association] guidelines.

For this report, the NOMAS investigators quantified subclinical brain infarctions and white matter hyperintensity volumes (WMHVs) in 546 men and women. Their mean age was 71 years, and 65% were Hispanic.

Hypertension, a risk factor for stroke, was more common in patients with migraine, but the association between migraine and silent brain infarction was also seen in normotensive participants, the researchers say.

This study confirms the association between migraine and silent brain infarctions in an older, diverse, predominantly Hispanic population. “Previous studies of silent brain infarctions and migraine were conducted in predominantly white populations,” she noted. “While these lesions have an ischemic stroke appearance, the exact etiology of lesions is unknown in patients with migraine.”

Compared with people without migraine, those with migraine (confirmed by International Classification of Headache Disorders-2 criteria) had a 2-fold increased risk of subclinical brain infarction (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0 – 4.2).

The association between migraine and silent brain infarction was independent of socio-demographic and cardiovascular factors, and was stronger in the subgroup of patients with migraine without aura (OR, 2.6; 95% CI, 1.3 – 5.5), the researchers note.

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Vitamin D Gets Mixed Results in Prospective Asthma Trial

Vitamin D supplementation has no significant effect on the overall rate of first treatment failure or exacerbation in patients with asthma and low vitamin D levels, according to the Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma (VIDA) trial.

vitamins & asthma

However, in subjects who reached normal vitamin D levels, there were significant reductions in exacerbations and the rate of first treatment failure.

Retrospective studies have linked serum 25-hydroxyvitamin D levels below 30 ng/mL to airway hyper-responsiveness, impaired lung function, increased exacerbation frequency, and reduced corticosteroid responsiveness. It has also been suggested that vitamin D enhances the anti-inflammatory effect of corticosteroids.

Dr. Castro and colleagues evaluated 408 adults with symptomatic asthma and a serum 25-hydroxyvitamin D level below 30 ng/mL at 9 medical centers in the United States that belong to AsthmaNet, the National Heart, Lung, and Blood Institute asthma network.

Patients were randomized to receive an initial dose of 100,000 IU of oral vitamin D₃ followed by 4000 IU/day for 28 weeks (n = 201) or placebo (n = 207). At 28 weeks, there was a significant difference in cumulative ciclesonide dosing between the vitamin D and placebo groups (111.3 vs 126.2 µg/day; P = .02).

In addition, “the overall asthma treatment failure was significantly reduced and the exacerbations were significantly reduced in subjects that got to a normal vitamin D level,” said Dr. Castro reported.

Dr. Castro’s “gut feeling” is that vitamin D supplementation will prove to be useful in at least some people with asthma who have low vitamin D. He said he plans to study exacerbations in children who achieve sufficient vitamin D levels.

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Parents Can Learn to Help Relieve Pain During Vaccinations

vaccination

Parents who worry about the pain caused by needle sticks might choose to delay or avoid vaccinating their children, which could undermine immunization, the study authors warn.

According to the new study from The Hospital for Sick Children in Toronto, breastfeeding babies or giving them sugar water during the actual needle stick, using topical anesthetic creams on the injection site and holding babies and older children close can help relieve pain from shots.

34% of mothers who received the pain education program reported using one or more pain relief methods compared to 17% of those in the other group, according to the results published online April 7 in the Journal called Pain.

Women in the pain education group also knew more about pain relief methods and were less satisfied with pain management interventions during their child’s vaccinations. The authors report that 12% of parents were blocked from using pain relief methods, usually breastfeeding, because the clinicians giving the vaccines didn’t approve.

It’s concerning that about one in 10 mothers are put off breastfeeding during immunization because of disapproval and ignorance about infant choking. Efforts need to be made to increase awareness about pain management and ensure that these evidence-based methods to reduce pain during immunization become part of routine care.

Over the Counter Options May Alleviate Some Severe Migraines

over the counter

Ibuprofen and Excedrin both relieve the pain and symptoms of severe migraines better than placebos, according to a new study. Researchers re-analyzed data from a clinical trial and found that more than half of the people taking either of the two non-prescription drugs reported some relief, though Excedrin, containing caffeine, performed best.

Excedrin, a combination of acetaminophen, aspirin and caffeine, is currently recommended only for mild or moderate headaches, as is ibuprofen. Migraine medications like Imitrex, for severe migraine, are only available by prescription in the U.S.

In a blinded manner, the migraineurs had been randomly assigned to receive either Excedrin, ibuprofen, or placebo. Based on the recent study, people who took Excedrin or ibuprofen both reported more pain relief than those who took a placebo. Excedrin users reported more pain relief than ibuprofen users from 45 minutes through four hours post medication.

At the two-hour time point, 62% of Excedrin users reported some headache relief from the medication, compared to 54% of ibuprofen users and 47% of placebo users, according to the results published online April 14 in Cephalalgia.

Aside from being backed by the pharmaceutical company, the study was a post hoc analysis, which weakens the results, and a large number of people in the placebo group reported some headache relief. Excedrin may be appropriate for severe migraine headaches in situations where (sufferers) may not be able to access other medications or may not want to take narcotics.

Utilization of combination analgesics is dangerous. Taking six to eight pills per day is not the way to utilize any analgesic product. It is widely recognized now that overuse of pain medications that are available without a prescription can lead to rebound headaches, thereby increasing the frequency of migraines.