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10 Articles in Volume 8, Issue #2
Anticephalgic Photoprotective Premedicated Mask
Culture and the Ethics of Patient-Centered Pain Care
Interpreting the Clinical Significance of Pain Questionnaires
Intrathecal Therapy Trials with Ziconotide
Iontophoresis in Pain Management
Maximizing Tertiary Effects of Low Level Laser Therapy
Platelet Rich Plasma (PRP): A Primer
Protecting Pain Physicians from Legal Challenges: Part 1
Right Unilateral Electroconvulsive Therapy Treatment for CRPS
Temporomandibular Dysfunction and Migraine

Anticephalgic Photoprotective Premedicated Mask

Report of successful treatment for migraine and/or tension headaches utilizing an anticephalgic photoprotective mask with a topical medication containing bryonia and rhus toxicodendron.

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.

Table 1. Summary of Study Results
Number of Patients (n) 33
Positive Results 30
Negative Results 3
Efficacy Rate 91%
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

The anticephalgic photoprotective premedicated mask (APPM) is an ideal benign delivery system for transdermal analgesic medication while providing simultaneous photo relief and pressure on distended extracranial arteries. Its excellent safety profile affords many advantages over systemic medications. This system can be used frequently, despite nausea or vomiting. There is minimal, if any, systemic absorption. This method of treatment is ideal in treating peripheral sensitization and photophobia. The APPM forces the patient to rest which is a well known adjunctive treatment for migraine and/or tension headaches. Because of the transdermal delivery system, it has a quick onset of response.

The average time for relief was 39.8 minutes. This form of delivery system can be used in the cardiac risk population. It is nonaddicting and has no affect on blood pressure. There are no gastrointestinal, renal, hepatic, or pulmonary affects. It does not induce depression, insomnia, or hypersomnolence. It does not cause chest pain. There are no drug interactions. It can be used abortively or prophylactically. It can be taken on an “empty stomach.”


With 30 out of the 33 patients treated stating the medication and the mask were effective over and above the normal degree of relief they were receiving from their oral and/or parenteral medications, this open label study demonstrates the effectiveness of the APPM in conjunction with topical bryonia and rhus toxicodendron as an adjunctive treatment of migraines and/or tension-type headaches. This form of treatment can be used in conjunction with currently available oral and parenteral medications. It may reduce the need for such large quantities of the oral and/or parenteral medications which are currently required in the treatment of headaches. Ultimately, it may reduce the need for many emergency department visits for parenteral medications. It may reduce the risk of narcotic addiction from which many chronic headache sufferers are afflicted. It is an ideal treatment for photophobia and peripheral sensitization and thus is a direct, effective treatment for migraine and/or tension headaches.

Last updated on: January 6, 2012
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