Accessing Resources for Empowerment

Wednesday, 01 April 2009 09:54 - Treating Migraines with HCG

Wed, 01 Apr 2009 14:54:07 +0100

Introduction

Hormonal migraine headaches are defined as a typical migraine headache that occurs in a periodic fashion around the time of the menstrual cycle. The preventive treatment outlined here was first described by Nevil Leyton MB LRCP in London England in the 1940's. Dr. Leyton noticed that migraines could be induced in some individuals who were given estrogen by injection. Subsequently he developed the idea that an 'anti-estrogenic' hormone such as that found in the chorion of the placenta might prevent attacks. This was supported by the fact that for many migraine patients the headaches disappear or markedly improve during pregnancy, when Human Chorionic Gonadotropin (HCG) is secreted by the placenta in high levels.

He subsequently went on to treat migraines using both this approach and that of histamine or prostigmine desensitization at his Harley St. Clinic and the London Clinic. Over thirty years Dr. Leyton treated over 10,000 patients from all over the world. This approach was never accepted by the mainstream medical profession, even though he published three books on the subject (now all out of print). The treatment was first described in the Lancet in 1942(1), and subsequently in the Medical Press and Circular in 1944 and 1952(2,3). Dr. Leyton also authored three books on the subject: two medical texts entitled "Migraine and Periodic Headache - A Modern Approach to Successful Treatment"(4); "Headaches - The Reason and Relief"(5); and a lay text "Migraine"(6). The treatment was so successful that another book written by E. Harvey-Sutherland entitled "Migraine Clinic - An Eight Year Survey of Preventive Treatment" described the advent and growth of the Putney Migraine Clinic and was published first in 1957 with a second addition in 1958.(7)

I have used his HCG treatment for the past 20 years in my practice with good success, but have not used the histamine or prostigmine part of the protocol. I prefer to use food avoidance and stress reduction as adjuncts. This is a preventive treatment - it is not to be used in acute attacks.

History

The following clinical history points are helpful in deciding whether you will respond to HCG treatment:

migraines began at or shortly after menarche
migraines are made worse by oral contraceptive, or other estrogenic hormones
migraines are absent or markedly reduced during pregnancy
migraines are limited to the peri-menstrual period. This is not an absolute condition for a trial of HCG
migraines are reduced or absent after menopause, but resume with hormone replacement therapy
the migraines are 'classical' vs. cluster type headaches

Side Effects

One side effect is a risk of ovarian cysts - I have not observed this in 20 years - it is only a theoretical risk. The menses may be affected - they may be delayed at higher doses of HCG, but this delay can be avoided by giving the injection at least 1 week before the expected date of the onset of menses.

The Protocol

In Canada HCG is available on prescription sold as Profasi HP® in 10,000 IU vials as a dry powder with a diluent of 10 ml. The treatment is administered according to the following schedule, after obtaining your informed consent:

Week 1: 0.1 ml. (100 IU) intramuscularly into the deltoid twice. (eg Mon. & Thurs.)
Week 2: 0.2 ml (200 IU) intramuscularly into the deltoid twice.
Week 3: 0.3 ml. (300 IU) intramuscularly into the deltoid twice.
Week 4: 0.4 ml. (400 IU) intramuscularly into the deltoid twice.
Week 5: 0.5 ml. (500 IU) intramuscularly into the deltoid twice.
Week 6-11: 0.5 ml. (500 IU) intramuscularly into the deltoid weekly for six weeks
Week 12-23: 1.0 ml. (1000 IU) intramuscularly into the deltoid every two week
Month 6-12: 1.5 ml. (1500 IU) monthly until the patient has had a year of injections

As you reach the 500 IU level try to avoid having the injections less than one week pre-menstrually, although this is not critical. You will usually notice an effect by the time 12 weeks are up. This effect is usually a decrease in frequency, severity or duration, or all of these. You may be completely free by then. Any improvement should be a sign to continue, hoping for further improvement. At the end of one year you can be given the option of stopping the treatment, but I usually do not advise this, as the migraines often return in a few months. The treatment can safely be given indefinitely. You might want to stop at menopause. If you stop and the headaches return, you should begin at the low dose again. In Dr. Nevil Leyton's experience, the second attempt at treatment after discontinuation may not be as successful, possibly due to anti-HCG formation.

The use of this treatment for male patients is entirely empirical. Obviously they do not have a menstrual cycle so the choice of whther to give this treatment to a male migraineur cannot be based on the above. If a male patient has not responded to diet and stress changes then HCG could be tried. There is no harm to be done at the dosages used, and males have similar pituitary hormones to females.

The Results

The success rate is usually about 70-80% if patients are chosen by the above criteria. Since migraine is a multi-factorial disease, it is important to address other triggers such as tyramine containing foods, dairy allergy, stress, and difficulty expressing anger in conjunction with the above treatment. Migraines do not usually return if the treatments continued.

References

1. Leyton, Nevil. Lancet(1942);1:488

2. Leyton, Nevil. A New Approach to the Treatment of Migraine. Med. Press and Circ. (1944);11:302

3. Leyton, Nevil. Med. Press and Circ. (1951) 226:46

4. "Migraine and Periodic Headache - A Modern Approach to Successful Treatment" by Nevil Leyton MA, MRCS, LRCP. William Heinemann Medical Books Ltd.(1954 - 2nd edition)

5. "Headaches - The Reason and Relief" by Nevil Leyton (Heineman 1958)

6."Migraine" by Nevil Leyton MA, MRCS, LRCP. W & G Foyle Ltd. (1962)

7."Migraine Clinic - An Eight Year Survey of Preventive Treatment" by E. Harvey-Sutherland Saint Catherine Press Ltd. London (1958 - 2nd edition).

Acknowledgements

I would like to acknowledge with pride my father's untiring and creative energy in the prevention of suffering by migraine patients. Please forward any treatment results to holodoc@sympatico.ca, as I hope to publish something on this sometime. Thank you.

Disclaimer

The information provided is for educational purposes only and is not intended to prescribe treatment. Please see your health care provider for details of any treatment. This treatment must be administered by a physician.

Wednesday, 01 April 2009 09:53 - Migraine - Pain that can be prevented

Wed, 01 Apr 2009 14:53:27 +0100

New Ideas in Prevention

The pain of a migraine headache is one of the most excruciating pains that can be felt. A migraine headache is different from a tension headache both in its cause and severity – often intensely throbbing and one-sided. Migraines affect approximately 8% of the Canadian population, females three times more frequently than males, and can cause huge losses in time spent away from work and pleasure. Migraine sufferers (migraineurs), also have to contend with nausea, vomiting, and increased sensitivities to light and sound in addition to the throbbing pain. The headaches can last anywhere from hours to days; and many people end up in the emergency rooms looking for relief. Migraine headaches are vascular - small blood vessels in the brain expand and press on nerves causing the pain; whereas tension headaches are due to muscular contraction.

Although the treatment of migraine has advanced somewhat in recent years with the advent of abortive medications, there is still a huge amount of suffering. As usual, not enough time is spent on creating programs of prevention or alternative methods of treatment other than medication.

From a preventive aspect migraine headaches can be divided into 3 categories:

Allergies/Intolerances
Stress
Hormonal
Some or all of the above

1. Migraines can be triggered by many different substances in the diet. Most commonly these are substances such as sulphites contained either naturally or as a preservative both in wine and some juices, particularly concentrated lemon and lime juice, as well as dried fruits. Here is a partial list of foods that might contain sulphites – check the labels - canned vegetables, pickled foods, dried fruit, potato chips, vegetable juices, grape juice, apple cider, fresh or frozen shrimp, guacamole, maraschino cherries, and dehydrated pre-cut or peeled potatoes. Sulphite-containing ingredients to look for on food labels include: Sulfur dioxide, Potassium bisulphite or potassium metabisulphite, sodium bisulphite, sodium metabisulphite or sodium sulphite. Monosodium Glutamate or MSG, a flavouring used in many prepared foods and often in Chinese food can also precipitate migraines as well as other symptoms.

Migraines can also commonly be triggered by a substance known as tyramine. Tyramine is an amino acid that is often present in larger quantities in aged cheese, fava or broad beans, sauerkraut, pickles, olives dark chocolate and red wine. Any fermented soy products may contain tyramine – for example miso, soy sauce, and teriyaki sauce. Marmite® and Vegemite®, processed fish and meats containing nitrites (such as hot dogs), citrus fruits, and caffeine can also be suspect. Almost any food can precipitate a migraine – I have seen both wheat and diary very specifically bring on a migraine headache.

2. Stress can precipitate migraines as well. Sometimes however, migraineurs do not get their headache until after the stress is over. This paradoxical stress response is common. People with migraines often push themselves to do more than they can comfortably manage, and they do well during the stress itself, and the migraine comes on only after the stressful period is over.

3. The hormonal aspect of migraines is probably the most overlooked aspect. We know that the birth control pill can make migraines worse and that it can also precipitate migraines in those who have not suffered prior to taking it. There is a danger in taking the pill if you have migraine, especially if you have an ‘aura’ before the migraine comes on, as there is an increased likelihood of stroke in migraineurs with auras and those who take the birth control pill. Migraines can occur exclusively premenstrually, coming on 7-10 days prior to the beginning of the cycle, and then magically disappearing a few days after the cycle begins.

4. We all tend to look for a single cause for migraines or any illness for that matter, and more often than not it is a combination of factors that can precipitate any illness, and migraine is no exception. This makes prevention somewhat tricky. It means that you have to consider all of the above elements in prevention. As a start I would recommend the following.

The Bottom Line in Migraine Prevention

1. Diet – eliminate all processed foods and pay special attention to the foods listed above that contain tyramine, sulphites, and MSG. If nothing from this elimination helps, then next eliminate milk and dairy first, and then wheat, rye, oats, and barley (all gluten contain foods) from your diet. If you do this around the time of your expected migraine attacks, you should only have to eliminate these for 1-2 weeks before you know if they are having a negative impact. Do NOT eliminate these staple foods for any long period without assistance from a health care practitioner.

2. Decrease stress through a regular relaxation/meditation program (as usual I recommend my “Learn to Unwind & Enjoy Your Life” CD available at Accessing Resources for Empowerment^TM Above all, migraineurs should pace their lives as much as possible, prevent stress and manage it well, rather than actually getting stressed and then having a migraine, if that is your pattern.

3. No migraineur should be on the birth control pill. If your migraines are related to your menses (i.e. they come on within a week of getting your period on a regular basis), and if they were ever absent during a pregnancy, you have a very good chance of preventing any further attacks by having a program developed by my father, Dr. Nevil Leyton of Harley St. London, UK, using a natural hormone called HCG(human chorionic gonadotropin). This treatment is 80% effective in preventing migraine in hormonally induced situations. More details can be found at www.integrativemedicineclinic.ca, and scrolling down to the article "Migraine - a natural preventive treatment for the sufferer of hormonally related migraines”. This treatment must be given by a physician.

4. Consider all of the above as possibilities as well as the following: The use of some herbs has been found helpful – as a preventive feverfew is one found in many health food and drug stores. Recently one vitamin and two notable antioxidants have been found to be useful in prevention. These are important new studies. Two studies have shown that taking a supplement called Coenzyme Q10 in doses of 180 mg/day can reduce attack frequency by 50%. Another study using riboflavin (Vitamin B2) at a dose of 400 mg daily can reduce attack frequency and severity by 50%. Both of these take from 1-3 months to take effect. Nobody has studied these two together, but they both act in the same area of the cell, so they may be synergistic. The other study shows that the antioxidant lipoic acid may have some potential benefit at 600 mg/day, but this is by no means conclusive. Side effects are non-existent in these new treatments.

For those interested in following this research the references to these are below.
Lancet(1942);1:488 Leyton, Nevil.
Med. Press and Circ. (1944);11:302 Leyton, Nevil. A New Approach to the Treatment of Migraine.
Med. Press and Circ. (1951) 226:46 Leyton, Nevil
Migraine and Periodic Headache - A Modern Approach to Successful Treatment by Nevil Leyton MA, MRCS, LRCP. William Heinemann Medical Books Ltd.(1954 - 2nd edition)
Headache 2007 Jan;47(1):52-7 Lipoic Acid A randomized double-blind placebo-controlled trial of thioctic acid in migraine prophylaxis
Neurology 2005 Feb 22;64(4):713-5. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial.Cephalgia 2002 Mar;22(2):137-41. Open label trial of coenzyme Q10 as a migraine preventive Rozen T, et al.
Canadian Family Physician 2003 October;49:1291-3 High-dose riboflavin for prophylaxis of migraine Corinne Breen, MD Adrian Crowe, MD Heather J. Roelfsema, MD, MSC Inderpal Singh Saluja, MD Dale Guenter, MD, MPH

© 2007 Edward Leyton MD FCFP CGPP