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EDITORIALS: Alfred L Clavel, Jr Migraine prevention BMJ 2002; 0: 1030002 [Full text]

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Elimination of triggers as a preventative for migraine

Naomi A Epstein   (1 April 2003)

Holiday-migraine

Kaisu A Viikari   (24 October 2003)

LISINOPRIL AND OTHER ACE-INIBITHORS IN MIGRAINE

CELIO LEVYMAN,MD,MSc   (26 October 2003)

Elimination of triggers as a preventative for migraine 1 April 2003
Naomi A Epstein, Retired Nachal Revivim 19/7 Ramat Beit Shemesh Israel 99641 Send response to journal: Re: Elimination of triggers as a preventative for migraine	This article on medicines to prevent migraine is interesting. There seems to be a reluctance to try and prevent migraines by pinpointig triggers and eliminating them. This gives the patient a much better lifestyle as most migraine preventatives are sedatives, leaving the patients tired all the time. The importance of food triggers is almost completely ignored and most patients who manage to eliminate food triggers do so without help. An elimination diet is vital to provide the information as to which foods are triggers. Some food triggers are present in so many different foods e.g. sodium monoglutamate that the patient may inadvertantly be exposed to triggers everyday and hence have a continuous migaine. The increasing incidence of migraines may be due to the increasing use of prepared foods with an increased intake of triggrrs Competing interests:   None declared
Holiday-migraine 24 October 2003
Kaisu A Viikari, private practice private practice, Rykmentintie 43, 20880 Turku, Finland Send response to journal: Re: Holiday-migraine	New observation on the pathophysiology of holiday-migraine In the seventies I have published two books (1, 2) concerning very comprehensively clinical significance of ocular accommodation. The books contain large number of case reports amongst which the most central are my 1558 migraine patients. Just recently I have learned about a new premonitory symptom of migraine which has not been described previously in the literature. My granddaughter, 33-year-old physician, a mother of two small children, has suffered from migraine since early school years. She has always been extremely caring and responsible person. Probably due to these characteristics, despite of being an offspring of hypermetropic family and all preventive efforts against myopia , she was driven into strong myopia. (-6, -7). She has always worn bifocals prescribed by me; indoors a weaker pair with which eg. driving a car is impossible. She is suffering from more and more frequently occurring migraine attacks. I´ve just learnt that she has a clear premonitory symptom preceding the approaching migraine attack. Her vision suddenly clears up quite bright with her undercorrected glasses. This strongly suggests a significant amount of pseudomyopia, which she in the strain of workdays is unable to maintain relaxed. I find this symptom to be of uttermost importance to all ophthalmologists and neurologists Kaisu Viikari, MD Ophthalmologist References 1. Viikari, K. Tetralogia. Monistepalvelu, Turku 1972. 2. Viikari, K, Panacea. The clinical significance of ocular accomodation. Turun Sanomat, Turku Competing interests: None declared
LISINOPRIL AND OTHER ACE-INIBITHORS IN MIGRAINE 26 October 2003
CELIO LEVYMAN,MD,MSc, Neurologist Neurology and Headache Clinic,Rua Jose Janarelli,199/22,Sao Paulo,SP,Brazil,01124-010 Send response to journal: Re: LISINOPRIL AND OTHER ACE-INIBITHORS IN MIGRAINE	LISINOPRIL AND OTHER ACE-INHIBITORS IN MIGRAINE The paper of Shrader et al is very interesting, but certain things must be recorded. In the 80’s Sicuteri proposed the use of captopril, based in encephalin studies. Federico Sicuteri is one of the greater names in the field of headache treatment. However, most of the drugs in use for prophylactic treatment of migraine are poor understood in regard of they mechanism of action. Sicuteri, Lance, Graham, Antonaci and other great names of the initial neurotransmitter basis of pathophysiology of migraine think most in a serotonin-basis model. Despite the Sicuteri results, other authors could not reproduce the reports of the Florence researchers. When we think in migraine as a receptor disease, and this is of particular useful way to explain triptan effects, we are lost to explain ACE- inhibitors drugs in treatment of migraine. Topiramate seems to work: but in which way ? Although the well designed study, an ancient point must be pointed out: placebo works better than nothing, as all people in the field of pain treatment know: perhaps liberation of endorphins could explain this fact, but the migraine patient produces endorphins with more difficulty than normal ones. All of us, neurologists with special interest in headache and pain, want new drugs to the prophylaxis of the migraine – lisinopril could be one of these drugs, but the placebo effect could not be discharged, and also the pharmaceutical industry interests. We must pray to lisinopril or other drugs acting as ACE-inhibitors could be a good option; in the meantime, propranolol, amytriptiline, flunarizine and even topiramate are the choices of the moment. To study pain treatment is not easy, and subjective factors could also play a role in these studies. Let us treat migraine patients in an individual way, and wait for must studies. Competing interests: None declared