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Any ‘Natural’ Products Effective for Migraine?

Butterbur for Migraine Prophylaxis

Use of butterbur is more controversial than riboflavin. A randomized, parallel-group study involving over 200 patients found that the group given butterbur had a response rate of 45%, three times better than the response found with placebo. Another randomized controlled trial, this one involving only 33 patients, examined efficacy of butterbur as prophylaxis. Similarly, this study concluded that butterbur reduced the frequency of migraines by 48% in the experimental group, almost double the reduction found in the control group.

A multicenter, open-label trial in just over 100 kids aged 6-17 years found similar results. About three quarters of participants experienced at least a 50% reduction in headache frequency. No serious adverse events were reported.

The most common side effect, reported by 7%, was eructation.

That does not mean that these products are risk-free. Some butterbur products may contain pyrrolizidine alkaloids (PAs) — a major safety concern. According to the National Center for Complementary and Integrative Health (NCCIH), PAs can damage the liver and lungs, and possibly cause thrombosis and cancer. Patients should be counseled to look for products that are PA-free. One caveat, however: The NCCIH notes that those products may not, in fact, really be PA-free. Butterbur should not be taken by pregnant or breast-feeding women.

The 2012 American Headache Society and the American Academy of Neurology guideline stated that the product had level A evidence for use and was a valid option for patients with migraine. However, the recommendation was questioned owing to reported safety concerns and has now been retracted.

Vitamin E for Menstrual Migraine

Although the woman in this case did not report that her headaches were triggered by menstruation, menstrual migraine is another common variant often seen in primary care. Menstrual migraine is associated with increased prostaglandin levels in the endometrium. Does that mean there is a role for vitamin E, an antiprostaglandin, in prophylaxis?

A placebo-controlled, double-blind, crossover trial involving 72 women with headache associated with menses evaluated the efficacy of vitamin E. The women received placebo for 5 days around menses for two cycles. After a washout period, they were then given vitamin E, 400 units daily, for an additional two cycles. During the vitamin E phase, the women reported a decline in pain severity and functional disability (P < .001). Less phonophobia, photophobia, and nausea were reported during the time taking vitamin E.

Vitamin E is generally safe at dosages up to 5500 IU/d. It is also well-tolerated, particularly when taken short term, as would be the case with menstrual migraine.

Douglas S. Paauw, MD, is the Rathmann Family Foundation Endowed Chair in Patient-Centered Clinical Education and a professor of general internal medicine at the University of Washington. He was elected to Mastership in the American College of Physicians (ACP) in 2009. He is a frequent lecturer at the ACP annual meeting, presenting yearly standing-room-only lectures on drug interactions and medical myths.

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dentist

Simon Cowell looks back to his best as he poses with dentist after getting ‘more natural’ veneers on his teeth

SIMON Cowell looked back to his best as he posed with his dentist after getting “more natural” veneers on his teeth.

The Britain’s Got Talent judge, 61, posed alongside Beverly Hills cosmetic dentist Dr Apa to debut his new set of pearlies.

Simon Cowell showing off his new teeth

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Simon Cowell showing off his new teethCredit: Instagram
The star reportedly wanted a more natural look than before

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The star reportedly wanted a more natural look than beforeCredit: Splash News

Simon – who recently recovered from breaking his back – brought in a picture of his original teeth for reference, according to reports.

The photo shows the judge beaming a new smile while laying down in the doctor’s chair. He also held an American Idol sign.

Doctor Apa was also in frame, rocking a brown cardigan, glasses, white chinos and slicked back hair.

The dentist wrote on Instagram: “it official. i’m going to hollywood!! actually DUBAI THIS WEEKEND. and it truly is amazing working with amazing people. thank you @simoncowell for putting your trust in us [sic.].”

Simon poses with the dentist

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Simon poses with the dentistCredit: Instagram
The star is recovering from his back injury

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The star is recovering from his back injuryCredit: Instagram

Simon was reportedly seeking out a more natural smile.

“Turns out, Simon was actually in need of a new set – we’re told he was doing away with older, temporary veneers he’d been rockin’ – but had one request… less Simpson-y and more streamlined,” TMZ reports.

Simon suffered an agonising back injury after falling off his ­electric bike in August.

The X Factor and Britain’s Got Talent mogul had surgery to insert a steel rod to support three broken vertebrae.

Simon's teeth in 2015

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Simon’s teeth in 2015Credit: ITV

His pal Sinitta recently told The Sun that he has broken his vegan diet in order to repair his strength.

Sinitta is in regular contact with Simon, who is holed up at his Malibu mansion with partner Lauren Silverman and their six-year-old boy.

The singer said: “I spoke to him last week and he sounded so much better.

“He wasn’t dazed, sedated or weak. He was really bright, happy and clear. He’s gained a bit of weight and is looking healthier. He said he had to start eating protein, calcium and break his vegan diet to rebuild his strength.

Simon is on his way to recovery

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Simon is on his way to recoveryCredit: The Mega Agency

“That’s the wisest thing. He was bloated and stressed, then he was too thin and exhausted. Now he is fit and relaxed. He’s found his sweet spot.

“He

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