HeadWise HeadWise: Volume 6, Issue 3 | Page 19

testing . Histamine dihydrochloride is a product planned to be used by SC injection . Histamine is a chemical found in some of the body ' s cells that causes many of the symptoms of allergies , such as a runny nose or sneezing . It is believed to be involved in the pathogenesis of migraine and cluster headaches . Also , in early testing , is the mineral supplement , magnesium L-lactate dehydrate ( MLD10 ) taken daily . Magnesium has been used for several years for migraine prevention .
In addition to pharmacological agents , various medical devices are also currently being investigated and evaluated . The vagal nerve is the tenth cranial nerve , supplying the heart , lungs , upper digestive tract , and other organs of the chest and abdomen . A hand-held vagal nerve stimulator as well as transcranial magnetic stimulation are non-invasive options in the pipeline that are currently being used or migraine prevention as well as for acute therapy . Occipital ( back of the head ) nerve , supraorbital nerve ( above the orbit of the eye ), and temporo-auricular ( pertaining to the temple and the ear ) nerve stimulation are also being used but require surgical implantation . These devices are considered , at this time , to be investigational . Similarly , a sphenopalatine ganglion ( SPG ) ( relating to the sphenoid bone at the lower part of the skull and the palate ) implantable stimulator is currently being investigated for chronic cluster headache . Could this intervention also , in the future , be considered for prevention of intractable chronic migraine ? In addition , an intranasal kinetic oscillation stimulation device is being evaluated for migraine treatment .
Conclusions
In summary , we have found in the last few years that investigational drugs and devices are being increasingly evaluated for migraine prevention . In my own practice , we are currently involved in the clinical trials of several of these pharmaceutical products and devices . As none of the commercially available agents are effective and tolerable for all migraine patients who need them , any new additions that become commercially available are always eagerly anticipated by patients . It remains most important , however , to remember that these patients first need to be appropriately diagnosed with migraine . Also the patients should be evaluated to determine if preventive therapy is needed in addition to properly utilized acute migrainespecific therapy . Overuse of acute medications must also always be avoided . HW
1 . Lipton RB , et al . Migraine prevalence , disease burden , and the need for preventive therapy . Neurology 2007 ; 68:343-349 .
2 . Silberstein SD , et al . Evidence-based guideline update : Pharmacologic treatment for episodic migraine prevention in adults . Neurology 2012 ; 78:1337-1345 .
3 . Silberstein SD , et al . Therapeutic monoclonal antibodies : What headache specialists need to know . Headache 2015 ; 55 : 1171-1182 .
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