Friday, September 15, 2006

migraine news roundup 18

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The use of vagus nerve stimulation for treatment resistant depression is viewed as extremely promising by some and another example of dangerous overenthusiasm by others:

Battle Lines in Treating Depression
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Some 21 million American adults suffer from depression, according to the National Institute of Mental Health, a federal research agency. While doctors as far back as the Renaissance speculated that mood disorders had medical roots, it was not until the end of the 19th century that such views were widely accepted. Since then, mental health care has seen innovations in talk therapy, electroshock, surgical procedures, drugs and, most recently, implanted devices.

Along the way, there have been notorious examples of misplaced medical enthusiasm, including adoption of lobotomies to treat depression. Currently, critics complain about frequent misuse of electroshock therapy and the virtually unregulated mixing of potent antidepression and antipsychotic drugs.

Cyberonics, which finally secured F.D.A. approval to market its implant last year, has ventured into the most difficult corner of depression treatment. It says its stimulator can provide relief for many of the four million or so people who suffer from “treatment resistant depression,” or T.R.D., a form so severe that patients fail to respond to drugs and traditional shock therapy. No other product has ever been designed for — and tested exclusively on — such a severely depressed population.

During the last month, some 1,300 doctors, patients and Cyberonics employees have written to the Centers for Medicare and Medicaid Services, asking that the agency grant Cyberonics’ recent petition for Medicare coverage. Public Citizen, a consumer advocacy group in Washington, filed a competing request on Wednesday, asking the agency to deny coverage. The group contends that Cyberonics has relied on misleading advertising and clinical trial write-ups, among other tactics, to secure federal approvals.

“With substantial constraints on the Medicare budget and so many clear needs going unmet, it seems absurd to flush away millions of dollars on this unproven device,” wrote Dr. Peter Lurie, deputy director of health research for Public Citizen, in the group’s petition.

Walking To Managing Your Blood Pressure
Three or four short, brisk walks throughout the day can help you watch your blood pressure more than one continuous episode of exercise.

"You might think, 'I don't have the time to go to the gym or work out for 40 minutes, but I might have the time to do 10 minutes here, 10 minutes here and another 10 minutes here,''' says Janet P. Wallace, a recreation expert at Indiana University.

Wallace, a kinesiology professor, studied the effects of how the benefits of exercise accumulating over time and from one continuous walk affect "prehypertension," the blood pressure readings that are between normal and high.

Her research involved 20 people with prehypertension who walked on treadmills for 40 minutes in one swoop. On another day, they walked for times for 10 minutes, which took nearly four hours in total.

Wallace's study found that both accumulated and continuous walking decreased blood pressure by the same amount for all study participants. On average, their systolic blood pressure dropped about 5.5 points, and their diastolic blood pressure dropped 3.2.

Zomig nasal spray, one of the many triptans used to treat migraines, has been shown effective in treating cluster headaches in one study:

Zolmitriptan nasal spray may be safe and effective in treating painful cluster headaches
Zolmitriptan nasal spray, used to treat migraine headaches, also may be safe and effective in treating painful cluster headaches, according to an article posted online today that will appear in the November 2006 print issue of Archives of Neurology.

Teri Robert has some good content related to National Invisible Chronic Illness Awareness Week on About Headaches/

Our Illnesses May Be Invisible, but They're Very Real

The NTI device may help some migraineurs, but probably isn't going to be the magic bullet for most of us:

Can Tiny Device Help Prevent Migraines?
But, neurologist Dr. David Kudrow with the California Headache Clinic says a device like this may only benefit a minority of migraine patients.

"We who are interested in migraines believe that the susceptibility to migraines comes from the brain not from peripheral sources like the jaw," Dr. Kudrow said.

Dr. Kudrow says the research he's reviewed isn't convincing.

"These studies that they submitted to the FDA were not quite as rigorous as the studies that have been submitted for let's say pharmaceutical products," Dr. Kudrow said.

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