Anticephalgic Photoprotective Premedicated Mask
Many clinicians are seeking topical treatment modalities for migraine and/or tension-type headaches. Treating headaches topically would, of course, improve safety profiles and vastly reduce deleterious systemic effects from the medications. Such treatment may also reduce narcotic dependence and rebound headaches. Clinicians have studied various topical treatments, including botox injections, topical lidocaine, and topical salicin. Naturally occurring substances derived from plants have had a relevant place in drug discovery. The medieval Persian physicians have provided a long list of plants they used to treat migraine and tension headaches.1 In 2005, M. Etemadifar published an article regarding the preventative role of topical timolol in the treatment of migraine headaches.2
Furthermore, peripheral sensitization is a major contributory to the mechanism of prolonged headache. In his presentation, “Sensitization of Peripheral and Central Trigeminal Vascular Pathways: New Insights into the Pathophysiology of Migraine Pain,” Dr. Rami Burstein of the Department of Anesthesia at Harvard Medical School in Boston, Massachusetts, explained that neuropeptide release from C fiber pathways leads to plasma extravasation particularly with mast release into an “inflammatory soup.” The “inflammatory soup” includes substances such as bradykinin, serotonin, prostaglandin E2 (PGE2), and histamine which sensitize meningeal nociceptors.3
Centrally mediated peripheral sensitization can worsen pain during physical activity, particularly with meningeal stimulation of nociceptors. Calcitonin gene related peptide (CGRP) glutamate and other neuropeptides are released after C fiber or afferents are activated. Central sensitization and/or induction of further peripheral afferent pathways affect secondary brain stem neurons as a reaction to the “inflammatory soup.” Peripheral sensitization is manifested by increased pain with running, walking, bending, or other exertions. Further allodynia of cranial structures, such as skin and even hair, can lead to even more pain. Thus, normally non-painful stimuli, such as water, wind, light touch, or temperature changes, can be painful to migraineurs. Peripheral and central sensitization have been implicated in the pathophysiology of rebound headaches and so-called chronic daily headaches, chronic daily migraine, and chronic daily tension headaches.3
Ninety percent of migraineurs suffer from photophobia. Furthermore, a very large proportion of patients with so-called tension headaches also suffer from photosensitivity.4-6 Therefore, treatment which targets not only peripheral sensitization, but also photosensitivity, may be extremely effective in aborting migraine and/or tension headaches and reducing the need for addicting and potentially toxic and expensive oral and/or parenteral medication. Hyson established the efficacy of salicin in conjunction with the photoprotective mask in 1998.7
Subjects and Methods
An open label study was performed, utilizing the anticephalgic mask with a topical cream containing bryonia and rhus toxicodendron. There were 33 patients, all suffering from migraine and/or tension headaches. None had suffered significant head trauma and none of the patients were pregnant. All were patients of a neurologist seeking treatment for their severe headaches. Age range was from 20 to 65. The patients had suffered from headaches for at least one year. They were all prescribed either prophylactic and/or abortive oral medications and/or parenteral medications for the headaches. All patients suffered from at least one severe headache per month. All patients had associated photophobia.
The patients received an anticephalgic mask which was opaque and protected from light and also applied some pressure on the painfully distended temporal arteries. They were given a tube of topical cream containing the bryonia and rhus toxicodendron. All patients were instructed to apply the cream to their frontalis and/or temporalis regions and to put on the anticephalgic mask. They were advised to also take their customary oral and/or parenteral medications. All of this was done at the onset of their headaches. Afterward, the patients filled out a form in which they were asked the time and date that they used the treatment, the period of time it took before they experienced significant relief (defined as reduction in pain from severe/moderate to mild/pain-free). In addition, they rated the treatment on a zero to 10 scale: zero if ineffective, 10 if totally effective in the treatment of the headache. They were asked to indicate how long it took before they experienced significant relief. They were also asked to make comments. At the close of this study, each patient was simply asked if this treatment helped or not.
Thirty out of 33 patients stated the mask and topical cream were effective in treating the headaches (see Table 1 for summary). Three out of 33 patients stated the system was ineffective in the treatment of the headaches. Of the 33 patients, the mask and cream were used a total of 240 times. The average rating was 7.7 per patient. There were no significant side effects, no allergic reactions, and no deleterious effects from the medication and mask. Many of the patients began using the mask and cream preventatively every night.
|Number of Patients (n)||33|
|Average Rating||7.7 per patients|
|Total Number of Applications||240|
|Average Time to Relief||39.98 min.|
Patients and physicians have been attempting topical treatment for headaches for hundreds of years. Pressure applied during headaches is an ancient remedy. Binding of the head was used in Sumeria and ancient Egypt. It was a commonplace treatment long afterward as illustrated by Shakespeare who had Desdemona say, upon hearing from Othello that he had a headache, “Let me bind it hard. Within this hour it will be well.”8 Blau and Dexter found that 28/50 migraine sufferers gained some headache relief from occluding the scalp circulation with fingers or a blood pressure cuff.9 Drummond and Lance noted that one-third of their 66 patients with migraine had relief by compression of the temporal artery.10 Lance has employed a machine which pulls the circumference of the head and neck to 2°C and one with a vertex of 41°C. He reported that 15 of 20 migraine sufferers had less severe headaches using this “Migra-Lief” apparatus.11