allodynia

7 July 2022

Did You Quit Your CGRP Preventative Too Soon?

Typically, it seems to be a good idea to try any new treatment for three months. But a new study from Italy is suggesting that some patients may be quitting certain treatments too soon.

In this case, we’re talking about CGRP inhibitors that are used as migraine preventatives.

The study was presented at last month’s annual American Headache Society meeting. The study followed patients who were taking anti-CGRP medication for 48 weeks (about 11 months). The overwhelming majority of patients did indeed respond to the medication within 12 weeks. But depending on the medication, between 7.6% and 15.5% responded in weeks 13-48, the median time of response for the “late responders” being 20 weeks, or about 4.5 months.

Studies like this, though preliminary, raise some interesting issues. Dr. Deborah Friedman (from the University of Texas Southwestern Medical Center), quoted in an article in Neurology Today, gives her response to some of the online chatter that’s been happening:

There are colleagues of mine who said anybody who would keep somebody on a medication that didn’t work longer than three months, it’s unethical. Well, I keep my patients on it for four to six months and that’s what we did with Botox, because I’ve seen people respond late.
Dr. Deborah Friedman

Unethical? Why unethical?

Think about it. Even if there are a few people who may respond late, your chances of responding to the medication do significantly drop after 12 weeks. So if every patient is now put on a trial of 20 weeks or more (some are suggesting 6 months to a year), the drug company selling the product certainly benefits. The insurance company may not be so sure. And most of the people taking the medication for those extra weeks will never benefit from it, and so are only dealing with any side effects with no benefit at all. That’s the cold number crunching.

But the fact remains that some patients may be missing out because they’re only trying the medication for 12 weeks.

All right then, is there a way we could identify those patients – the ones that will benefit eventually – thus improving the odds?

The study has perhaps started to point the way. The researchers did note some tendencies among the late responders:

More likely to have a higher average body mass index
Slightly less likely to have one-sided pain with allodynia (more on this below)

Of course, this works both ways. If you have one-sided pain with allodynia, you may be a little more likely to benefit from an anti-CGRP preventative. Because basically the late responders were simply a little more like the non-responders.

This is a long way from a way to identify which patients will respond late. But what the study does tell us is that we should be looking closer to find out how we can identify those patients – it shows us that there may be a way, eventually.

Right now, it’s probably best to have a good relationship with a specialist you trust, and let them help you decide if it’s worth it to try your medication (or other treatment) for longer. They know you best, and know your medical history.

To delve further into this topic, check out the article at Neurology Today by Thomas R. Collins: Late Migraine Responses Seen for Anti-CGRP Therapy

Also the National Headache Foundation has put out a video on the optimistic side, explaining this study:

3 September 2020

Women with Migraine: Different Symptoms?

James Discoveries & Stats 0

So we all know that the risk of migraine is higher in women, and that the difference is often blamed on hormones (although it’s likely more complex than that). But what about symptoms? Do women experience different symptoms than men?

A study published last year is saying “Yes”. Here are some of things that seems to be worse/more intense for women than for men:

Attacks tend to last longer
Nausea/vomiting
Vertigo/dizziness
Sensitivity to odours (osmophobia)
Allodynia
Higher disability from migraine (based on the MIDAS test)

As mentioned above, women were more sensitive to smells during an attack. Interestingly, they were also more likely to have an attack triggered by odours.

There were also more comorbid conditions – conditions that tend to go along with migraine – in the female group. Depression and allergy were the ones that stood out.

You might ask, because of the common hormonal hypothesis, whether these differences go away after menopause. The answer is mostly no. The differences were still significant, with the exception of nausea. After menopause, the nausea was about the same in both male and female groups.

Of course, these are more descriptions of the attacks. Attack frequency does tend to be less after menopause, although that is not always the case.

What about the Men?

So what items were more significant in the male group? Although generally other factors were the same in both groups, or someone worse for the women, one trigger stood out in the male group. Excessive sleep was more likely to trigger an attack for the men.

Of course this study is not saying that Emily’s migraine attacks are necessarily worse than Jacob’s, but there is a general trend here. We’re fighting against migraine for everyone. However, it’s good to know the areas in which the women tend to suffer more, because it can lead to better understanding and treatment.

To read the full study and the comments of the authors, click here: Sex Differences of Migraine: Results of a Nationwide Home-based Study in Turkey

5 April 2019

Your Symptoms/Special Abilities (poll results)

James Website news 0

Our most recently completed poll question was: Which of the following symptoms (or special abilities!) have you experienced?

In this case, you were able to choose up to three answers. It’s interesting that some symptoms are indeed “special abilities”, such as being able to smell things before anyone else does. So – let’s look at the results.

The Three Winners

These three were almost tied (all about 18%), but here they are in order, starting with the top answer:

Trouble speaking or writing or understanding words – this one is both a common symptom of migraine and also a symptom of some medications. A very big concern among migraine patients.
Ringing in the ears – Tinnitus. Here’s a quick overview of tinnitus. There are medications that can cause tinnitus as well – talk to your doctor.
Smelling things that no one else can smell – yes, surprisingly common. This does not necessarily mean the smell is a “hallucination” (although it could be). You could just be smelling something others don’t notice or can’t smell yet.

The Next Five

These didn’t make the top three, but were also very common.

Very sensitive/painful skin (for no apparent reason) – technically called cutaneous allodynia, this is another one that can be a symptom and also made worse by medication. 13% reported this symptom.
Numbness in part of your body – 10%. May be a symptom indicating a certain type of migraine.
Feeling like things are out of proportion – such as Alice in Wonderland syndrome. Feeling like your arm is too long, or that objects are much farther away than they are, for example. 8% reported this symptom.
Hearing things that no one else can hear – again, could be an auditory hallucination, or a actually specially sensitive hearing. 6% reported this one.
Temporary partial or full blindness – this again may indicate a certain type of migraine (a type of migraine with aura). 5% experienced this.

Just Two More

Of course there are many symptoms that we could have mentioned, but here are two more that, although less common, do still affect many migraine patients.

Out of body experiences – Another one that we’ve talked about before – join the discussion at Migraine and Out of Body Experiences. 3% of respondents.
Hearing voices – a type of audio hallucination. 1% reported this, and you can discuss it here: Do You *Hear Voices* during a Migraine Attack?

An interesting list of experiences! What about you? Have you experienced any of the above, or do you have something to add? Leave a comment and keep the discussion going!

12 October 2017

Yawning and Migraine: New Insights

James Uncategorized 3

Yawning is a common symptom of migraine, in both adults and children. A new study has confirmed the link once again, and is giving us more insight into what kinds of attacks are connected to yawning.

Yawning and Migraine The study looked at 339 patients, of which 45.4% reported repetitive yawning as a part of their migraine attacks. 11.2% reported yawning as a “warning sign” before an attack, with the rest experiencing yawning as either a symptom during the headache phase or a symptom both before and during.

An interesting aspect of the study was how yawning was associated with other symptoms. The symptoms that were more associated with yawning included:

Aura
Nausea and/or vomiting
Osmophobia (hypersensitivity to odors)
Cutaneous allodynia
Sleepiness
Irritability/anxiety
Changes in appetite

The most associated were aura and nausea and/or vomiting.

As the researchers understood, yawning may be associated with drops in dopamine levels. It may be that, for some patients, dopamine drops during a migraine attack (read Why Migraine Attacks may make you withdraw Into Darkness (or, Your Brain on the Holodeck).

Interestingly, yawning is also related to hypoglycaemia/hypoglycemia. Low sugar levels have a complex relationship with migraine, but both have been associated with yawning – and low dopamine levels.

For more, check out this article on Migraine and Hypoglycaemia.

To read the abstract of the recent study, see Migraine and Yawning.

For more strange symptoms of migraine, check out this infographic – Are these the 10 Strangest Migraine Symptoms?

24 October 2016

Predicting: Will This Medication Work?

James Discoveries & Stats 0

Which would you prefer?

You walk into the doctor’s office, and the doctor offers you a medication that happens to interest them at the time.
You walk into the doctor’s office, and the doctor offers you the medication that works with the highest percentage of patients with your condition.
You walk into the doctor’s office, and the doctor checks your statistics and offers you the medication that is most likely to work for you.

I don’t know about you, but I would sure prefer #3. I would take a well-educated #2 if I couldn’t get #3. (And frankly, there are worse things than #1.)

Migraine Medication Predictions At this stage in migraine research, with a good specialist you’ll hopefully get a combination of #2 and #3 (and likely a pinch of #1). But researchers are trying to gather the information we need to offer more customized treatments.

As we gain the ability to gather more information about ourselves (e.g. FitBit and Migraine), the possibility of fitting the treatment more exactly to the patient is becoming a reality.

Perhaps a more immediate benefit is avoiding treatments that aren’t likely to work. Today, there are so many migraine treatments that a patient could spend a lifetime trying them – why start with treatments that probably won’t work because you’re a) a women or b) diabetic or c) suffering from a certain symptom?

A recent study in the USA studied responses from 8233 patients with episodic migraine to see which variables could predict whether or not an abortive treatment would work. Typical go-to medications for migraine are the various types of triptans.

So here’s the question – what types of things should a doctor know, that may predict whether or not a typical abortive treatment will work?

First, symptoms.

How intense is the headache?
How frequent are the attacks?
Does the patient suffer from cutaneous allodynia?
How intense are the symptoms overall?

Second, medical profile.

What comorbid conditions does the patient suffer from? Do they suffer from depression, for example?
Are they taking preventative medications (for migraine)?
Are they overusing any medications?

Finally, certain basic factors come into play, such as

Gender
Body mass index

These and other factors may help us better customize your treatment in the future.

In the mean time, the more information you can keep track of (don’t let it take over your life) the better. Keep in mind your medical history (and family medical history) as well, which can help your doctor a great deal.

To read the abstract of this study, go to Predicting Inadequate Response to Acute Migraine Medication: Results From the American Migraine Prevalence and Prevention (AMPP) Study from the October 2016 edition of Headache.