Ask the Doctor: Migraines; Neuropathic Pain; Hypertension

Expert views on healthy living.

Q. I have suffered from migraines most of my adult life. Do migraines increase the risk for cognitive decline?

A. A recent study may put your mind at ease about the long-term cognitive effects of migraines. Researchers tracked 286 migraine sufferers for nine years and compared scans of their brains with scans of similar individuals who did not experience migraines. The results showed that, while study participants with migraines showed more evidence of brain changes that appeared as bright spots, (hyperintensities) on brain scans, these participants were comparable in measures of attention, concentration and memory over the nine-year study period to participants who did not suffer from migraines. What’s more, there did not appear to be a clear relationship between the hyperintensities and the type or frequency of migraine attacks or migraine treatment methods, according to the study, which was published in the Nov. 14, 2012 issue of the Journal of the American Medical Association.

Q. What is neuropathic pain, and what causes it? Can it be treated?

A. Neuropathic pain is chronic pain that affects the nervous system, and it is most often associated with damage to nerve fibers caused by disease or injury. The damage leads to dysfunctional transmissions from the damaged nerve fibers to other pain centers. The pain may involve sensations of burning, “pins and needles” or coldness and may be continuous, episodic, or a mix of both. Phantom limb pain is a good example of neuropathic pain. Common conditions associated with neuropathic pain include diabetes, spinal cord injury, physical damage to a peripheral nerve, herpes zoster infections, nutritional deficiencies such as B12 deficiency, shingles, cancer, certain chemotherapy agents, and some strokes. Treatment for neuropathic pain can be challenging. It focuses mainly on relieving pain symptoms as much as possible using any of a variety of therapies including antidepressant and anti-epileptic medications, Botox injections, and even deep brain stimulation. Topical administration of lidocaine, capsaicin, or anti-inflammatory agents and, on occasion, opioid analgesics may also be helpful. Since neuropathic pain can interfere with the ability to concentrate, and affect your mood and ability to carry out everyday activities, it’s important to work with a medical care provider to establish a pain management program that works for you.

Q. Please tell me about the type of kidney surgery that is intended to establish  more normal blood pressure levels in people with treatment resistant high blood pressure.

A. Individuals with treatment resistant hypertension have persistently high blood pressure levels despite taking at least three prescription blood pressure medications, including a diuretic. As many as one-third of people being treated for high blood pressure are considered to have treatment resistant hypertension, which puts them at greater risk for a brain-damaging stroke, as well as a heart attack or heart failure. An experimental, minimally invasive, catheter-based procedure called renal denervation addresses this problem by using heat generated by high frequency radio waves to disrupt the communication of the nerves leading into and out of the kidneys. The renal nerves are part of the sympathetic nervous system, which controls blood pressure. Results of an 18-month study presented at a European Society of Cardiology meeting in August 2012 suggest that renal denervation can safely promote a sustained reduction of the top (systolic) measure of blood pressure by an average of about 30mmHg. Stage 3 trials of renal denervation are currently underway in the U.S., and with a positive outcome, may lead to FDA approval within a few years.

Maurizio Fava, MD, Editor-in-Chief

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