Possible Cure for Head Pain May Help With Weight Loss

Oct. 8, 2002 -- If you suffer from migraine headaches, chances are you're a woman. But it turns out an experimental migraine-fighting treatment also has a side effect appealing to many women — it helps them lose weight.

According to ABCNEWS' Medical Editor Dr. Tim Johnson, 70 percent of migraine patients are women, possibly because of the effects of estrogen.

But as if the painful headaches weren't punishment enough, the medications that fight them often have disturbing side effects such as extreme fatigue, dry mouth and weight gain.

Now a new drug called topiramate, also known as Topomax, has been found to not only calm down overactive nerve cells in the brain and help fight migraines. Researchers have also discovered that it can help you lose weight.

In a study of 500 migraine patients using topiramate, Dr. Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, has shown that "in addition to taking away their migraine headaches, on average patients lost almost 4 percent of their body weight."

One Woman Went from Size 20 to Size 2

This weight-loss bonus was life-altering for 30-year-old Catherine Skinner, who has suffered from migraines ever since college and had gained 85 pounds while taking a variety of anti-migraine drugs.

"Everyday I came home from work, and I just wanted to lay down for about an hour or two and sleep. Every afternoon I really felt like I was going to get sick. I really did not feel like I had the stamina to live through everyday," said Skinner. "This went on every single day of my life for a couple of years."

But since she was prescribed topiramate one year ago, Skinnner says the drug not only took away the pain, it took away 90 pounds. She says she went from a size 20 to a size 2.

Researchers who have been testing topiramate are about to present their findings to the Food and Drug Administration, and Silberstein expects it to be approved for migraines by 2003.

The Brain on Estrogen

"Anyone who has ever experienced a migraine will tell you that it's more than just your typical headache; pulsating pain on one side of the head, vomiting, sensitivity to light and sound. Twenty-eight million Americans suffer from this condition — 70 percent of them are women," reports Johnson.

But contrary to early beliefs, this gender imbalance is not due to differing personality traits or societal standards, but rather is an unfortunate side effect of that essential female hormone — estrogen.

"The genes that predispose people to developing headaches are probably equally present in men and women, it's just whether or not they get expressed which has a great deal to do with whether cycling hormones are around," explains Dr. Elizabeth Loder, director of the Headache Management Program at Spaulding Rehabilitation Hospital in Boston.

In other words, many men and women have the same migraine DNA "switch," and estrogen seems to act as a helper that turns the switch on.

Although nobody knows for sure exactly how estrogen makes migraines more likely to occur, researchers have found that falling estrogen levels are associated with more frequent headaches. "For example, right before the onset of the natural menstrual period, the week 'off' the birth control, and right after childbirth," says Loder.

While estrogen's primary role may be in helping orchestrate the female reproductive cycle, this hormone has access to virtually all tissues of the body and can exert widespread effects, particularly on the brain. Estrogen can directly influence nerve cells, alter brain chemicals, and even affect blood vessels inside the head.

Migraine Medications

Several categories of drugs can be used to prevent migraines from occurring; epilepsy drugs like Neurontin and Depakote, blood-pressure regulators such as Inderal, and antidepressants such as Elavil must all be taken on a daily basis to be effective.

"Preventative" treatments like these are usually used only in patients who have frequent or severe migraines that cannot be controlled by "acute" medications, which are used on an as-needed basis to stop a migraine attack once it has begun.

But the preventative medicines for migraines apparently leave much to be desired. They are not as effective as users would like, many have unpleasant side effects, and they can have interactions with other commonly used drugs, cautions Loder.

"You have to make a judgement. Are they frequent enough, severe enough, and long enough lasting to make it worth it to take a preventative medicine every day," says Dr. Richard Lipton, co-director of The Headache Unit at Montefiore Medical Center in the Bronx, N.Y.

To avoid side effects, many patients are now turning to Botox, a toxin which is injected into the muscles of the head and neck, that has the added advantage of smoothing cosmetic lines and wrinkles. On the down side, Botox can cause temporary facial paralysis and drooping, and the safety of its long-term use is still being investigated.

Fortunately, most migraine sufferers do not need long-term preventative treatments and can use one of the many available "acute" treatments for headaches as they occur.

"Anti-inflammatory drugs like aspirin, Advil, etc., also seem to work for low-grade migraines. For stronger headaches, 80 to 85 percent of patients get significant benefit from the triptan drugs [like Imitrex ]," says Loder. "Some patients still use ergotamines, but these have more severe and long lasting side effects. If these all fail, then barbiturates and narcotics are sometimes used as well."

But Lipton warns that "people should not take acute treatments for more than eight or 10 days a month, because it puts them at risk for developing "rebound" headaches that are brought on by overmedication. You get rebound mainly from overusing narcotics, triptans, etc., but all acute treatments can cause rebound headaches. Even aspirin."

Migraine Prevention Lifestyle

Many experts agree that the best — although not the easiest — way to prevent headaches is to lead a healthy and headache-prevention lifestyle and avoid migraine triggers whenever possible.

"Hormonal cycling may prime the brain and make migraine more likely to occur, but it is by no means the only trigger for individual attacks in women," says Loder. "Lack of sleep, altered sleep-wake cycles, and general stress are far more common triggers in patients with migraines."

To help avoid migraines that are concentrated around the start of the menstrual cycle, experts say that over the counter medications like Aleve and Advil can be used in the short term, perhaps a couple of days before flow begins and through the fist couple of days of flow. Triptans taken on a short term basis can be used to prevent menstrual migraines as well.

For women who are already taking birth control pills, there are some new formulations that decrease the amount of time without estrogen, about two to three days instead of one week, which can help prevent headaches triggered by estrogen withdrawal. Another alternative is to take the pill continuously for two to four months and skip the estrogen-lowering placebo weeks altogether.

However, using birth control to control migraines for women who are not already taking them is not recommended, since there are several risks associated with these medications.