By Alan Bavley

 

For migraine sufferers who’ve had a hard time taming the throbbing pain of migraine attacks, two Kansas City-area eye doctors are suggesting a new route to relief.

It’s the eye drops that they’ve prescribed routinely for years to their glaucoma patients. Although more research is needed, for at least some people one or two drops in each eye just at the start of an attack appears to stop migraines in their tracks, the doctors say.

In the latest edition of the journal Missouri Medicine, ophthalmologists Carl V Migliazzo and John C Hagan detail the experiences of seven patients who’ve gotten complete or nearly complete relief from their migraines by taking the eye drops.

All of the patients are women, as are most migraine sufferers. Some use the eye drops alone; others take them along with conventional pain medications. All had suffered from migraines for years, even decades, before trying the eye drops.

One 61-year-old in their report has had migraines for about 30 years. They start on the right side of her head with throbbing pain that radiates to her neck and shoulders. Left untreated, the migraines can last as long as two days.

The woman had tried medications but had stopped taking them because they didn’t provide enough relief. The eye drops, she said, eliminated the pain.

Migliazzo said he discovered this use for the drops through serendipity more than a decade ago. One of his specialties is glaucoma, a condition in which fluid buildup in the eyes can destroy vision. The drops reduce production of the eye fluid, and Migliazzo prescribed them routinely.

“People would report to me spontaneously. ‘You know, doctor, my headaches started getting better after I started on this medication,’” he said.

Since then, Migliazzo has prescribed them to eye patients who complain about migraines. He has recommended them to nurses with whom he works.

“My wife uses them,” he said. “She swears by them. She keeps them in her purse.”

But the eye drops can’t be considered a sure thing, as the doctors themselves are quick to admit.

Migliazzo and Hagan haven’t reported any data on how often the eye drops actually work. And among the patients who said they were helped, there’s always the possibility that the placebo effect played a role in turning the eye drops into a migraine killer — even sugar pills can reduce pain if you’re told ahead of time that they will be effective.

“Case results like this aren’t really science,” Migliazzo said. “It’s all anecdotes, and anecdotes people don’t pay much attention to.”

Migliazzo wants to see the eye drops put through controlled studies, where migraine sufferers get the real drops or “sham” placebo drops so the effects can be compared. “It doesn’t have scientific validity unless it’s controlled,” he said.

Migraine attacks may start with flashes of light or visual disturbances that give the appearance of looking through a broken mirror. Then comes pain, like an explosion in the head. Along with the throbbing headaches may come nausea and vomiting.

There are about 38mn migraine sufferers in the US. That includes about 18% of women and 6% of men. While some people experience migraines only occasionally, chronic sufferers may have several per month or many more.

The dozens of medications used to treat migraines range from over-the-counter ibuprofen to prescriptions that can run more than $30 per pill. But patients often have a hard time finding satisfactory relief. They may try alternative treatments such as acupuncture, chiropractic care, special diets, even copper bracelets.

One survey found that nearly 80% of migraine sufferers were willing to try new treatments.

The eye drops may have a number of things going for them. Their long history in eye patients has shown that they’re safe, and the side effects, aggravating asthma and lowering the heart rate, are already well known. And they’re cheap. The drops go for about $4 per bottle, a small fraction of the cost of some popular migraine medications.

There also is a reasonable scientific explanation for why the eye drops may work, and that’s attracting the attention of researchers. Hagan has been in contact with a neuroscientist in Luxembourg about pursuing a study. And a neurologist at the University of Kansas Medical Center also is expressing interest.

“I feel it would be a good project for our team,” said KU neurologist Manoj Mittal. “It has a good rationale behind it.”

That’s because the drops contain beta blockers, a group of drugs first developed to treat high blood pressure and other heart conditions.

Through another case of medical serendipity, beta blocker pills have become a first-line drug for the prevention of migraine headaches. During a study of one beta blocker, a patient told researchers that he not only had fewer chest pains, but fewer migraines as well. His migraines returned only after he was switched to a placebo.

About 50% of migraine sufferers who take beta blocker pills are able to reduce the number of migraines they experience each month by more than half. But research has failed to show any benefit from the pills for stopping migraine attacks once they’ve started.

The beta blocker pills may not get into the bloodstream fast enough to stop a migraine, Mittal said. But the eye drops quickly drain into the nose, where they’re rapidly absorbed into the bloodstream through the mucus membrane.

“If you can get something in their system as soon as possible, you have a better chance” to stop migraine attacks, Mittal said. — The Kansas City Star, MCT

 

Melanoma risk higher for flight crews that work at 40,000 ft

 

Attention pilots and flight attendants: For your safety, please fasten your seat belts, note the location of the aircraft’s emergency exits — and be sure to apply plenty of sunscreen to reduce your risk of melanoma.

When it comes to the risks of flying, skin cancer may not be the first health hazard that comes to mind. But a new study in JAMA Dermatology says that pilots are 2.22 times more likely than folks in the general population at large to be diagnosed with melanoma. For members of the cabin crew, the risk was 2.09 times greater.

Melanoma is the sixth most common cancer in the United States, according to the National Cancer Institute. Although other types of skin cancer are diagnosed more frequently, melanoma is more likely to be fatal, the American Cancer Society says. An estimated 76,100 Americans will be diagnosed with melanoma this year, and about 9,710 will die from it.

Dozens of studies have examined melanoma risk in flight crews, since working at 40,000ft means greater exposure to cosmic rays and ultraviolet radiation. For the new study, researchers from the University of California, San Francisco combed through data on 266,431 participants in 19 published studies to see whether the danger was real — and if so, how big it was.

They found that for pilots and flight attendants, the risk of developing melanoma was more than double the risk seen in people who worked on the ground. However, only pilots faced an increased risk of death from the cancer — their mortality risk was 83% greater than for those in the general population. (For those who worked in the main cabin, the risk of dying from melanoma was actually 10% lower.)

The study authors noted that exposure to cosmic radiation is not likely to be a factor for melanoma. Many studies have measured the cosmic radiation that finds its way into a plane, and the amount is “consistently below the allowed dose limit of 20 mSv/y,” or 20 millisieverts per year. (A typical American is exposed to about 3.6 mSv per year, according to this report from the Environmental Protection Agency.)

UVB radiation probably isn’t the culprit either, since fewer than 1% of this radiation can penetrate aircraft windshields, the researchers wrote.

UVA, on the other hand, can penetrate glass, and the higher a plane flies, the more intense UVA radiation becomes. When planes fly above clouds or snow-covered mountains, they are exposed to even more UVA reflected from below, the researchers wrote. Studies of cells in lab dishes and in animals show that UVA damages DNA, causing the mutations that can lead to cancer.

It’s possible that when they are on the ground, pilots and flight attendants are bigger fans of activities that would increase their risk of melanoma, such as frequenting tanning salons. So far, there’s no hard data suggesting that this is the case, the UC San Francisco researchers wrote.

Instead, they noted that multiple studies have found that the more hours a member of the flight crew spends in the air, the more likely he or she is to be diagnosed with melanoma. — By Karen Kaplan, Los Angeles Times, MCT

 

Diets work, but brands don’t make much difference: study

 

Which diet is the best for you? Whichever one you can stick with, according to a new meta-analysis of 48 different trials involving nearly 7,300 overweight and obese adults.

The findings, described in the Journal of the American Medical Association, or JAMA, show that there’s relatively little difference in the effectiveness of various low-fat or low-carb diets, including the branded ones, from Atkins to Zone.

“Our findings should be reassuring to clinicians and the public that there is no need for a one-size-fits-all approach to dieting because many different diets appear to offer considerable weight loss benefits,” the study authors wrote.

Diet fads come and go, each claiming to tap into some secret advantage that previous weight-loss strategies did not. But it’s difficult to tell which diets are actually most effective — and that’s crucial information for overweight or obese individuals looking to successfully shed pounds by changing what they eat.

To provide some data-driven answers, a team led by Bradley Johnston of the Hospital for Sick Children Research Institute in Toronto examined 59 papers involving 48 randomised trials and sized up the examined diets’ average weight loss.

Low-carbohydrate diets edged out the low-fat diets (echoing an Annals of Internal Medicine study released recently). Low-carb diets were linked to 8.73kg of lost weight (19.25lbs) at 6 months, and 7.25kg (15.98lbs) at 12 months. The low-fat diets were close behind, with 7.99kg (17.61lbs) lost in the first half-year and 7.27kg (16.03lbs) at the one-year mark.

Among individual, brand-name diets, the weight loss differences “were minimal,” the study authors wrote. For example, the Atkins diet nosed past the Zone diet at six months with just 1.71kg (3.77lbs) more weight lost.

“This supports the practice of recommending any diet that a patient will adhere to in order to lose weight,” the study authors wrote. In other words: Pick the one that’s easiest to stick with over the long haul.

Linda Van Horn of Northwestern University in Chicago, who was not involved in the paper, praised the study in a commentary. She noted that a healthful diet is ultimately about more than just macronutrients such as carbohydrates, fats and proteins.

Choosing the right foods with the right micronutrients — such as calcium, iron or folic acid — is key. “Choosing the best diet suited to an individual’s food preferences may help foster adherence, but beyond weight loss, diet quality including micronutrient composition may further benefit longevity,” Van Horn wrote. — By Amina Khan, Los Angeles Times, MCT