Mayo Clinic

5 November 2024

Get Ready: AI, rPPG, and Migraine Prediction

The prediction and diagnosis of migraine is changing fast, although in some ways it’s not changing at all.

Since the dawn of time, patients and doctors have been able to predict headache attacks to a certain extent, and to notice what prevents them or triggers them.

But then along came more sophisticated computers. The computer can analyze large amounts of data all at the same time, in a way a human can’t. As long as it’s fed numbers, it can search for patterns. Huge medical studies have shown us new patterns that we never would have noticed as humans, even if we had collected all the information together.

Then along came the ubiquitous smart and surveillance devices. The ease with which we can take certain measurements of ourselves and others means more data for the computers, and so the discovery of new patterns.

So ever since the smartphone came along, developers have been trying to come up with apps that could predict migraine attacks, identify triggers, and even recommend personalized treatments. An early success what N1-Headache, formerly Curelator, which began to question some common beliefs about migraine triggers.

Subtle changes in the body can tell us a lot about headache. After all, many patients have noted that their dogs seem to be able to predict migraine!

One area of interest that you need to know about is rPPG – that is, (brace yourself), remote photoplethysmography.

So imagine this. You’re on a video chat with someone, and their computer is actively analyzing the video feed. On the other end, information starts popping up on the other person’s screen:

This person is nervous about what you just said.
This person will probably have a migraine attack within the next 24 hours.
This person is at high risk of [a certain disease]

Or perhaps you’re not even on a video chat. Maybe there just happens to be another camera in the room, watching you. Or maybe a computer is going over your social media posts and photos.

Remote photoplethysmography is one method of measuring visible changes in your body, such as in your cardiovascular system.

Now I’ve started out presenting this in a rather negative light. The positives are obvious for you personally, and for the medical community. Gathering huge amounts of data about migraine patients will hopefully lead to some leaps forward in migraine treatments.

Collection of personal data can help you customize your own treatment, and sharing that data – even anonymously – can help you compare your situation to other similar patients. This is much more powerful that an online forum where you meet someone with similar symptoms!

The use of AI to go through the huge amounts of data out there is a developing area of research, as you can see for yourself with a quick search online. Although in many ways it’s not so new, it is becoming much more powerful. How will you use it? How might you try to limit the sharing of your data, or do you care? It’s time to think all this through, because the future is here.

Here’s a quick video from the Mayo Clinic, talking about AI in migraine treatment.

1 December 2021

Migraine or Stroke? New Stats.

James Discoveries & Stats 0

Yes, sometimes migraine looks like stroke. But let’s lay some important groundwork.

Most strokes are ischemic stroke. When there is a blockage to an artery going to the brain (such as a blood clot), the brain won’t get the oxygen it needs. Very quickly, brain cells begin to die. It’s a medical emergency.

Stroke is one of the leading causes of death worldwide, as well as a major cause of disability.

Typical symptoms include slurred speech or trouble understanding what others are saying, numbness or paralysis (often on one side of the body, such as half of the face), vision problems, dizziness, and a sudden headache. More helpful information can be found at the Mayo Clinic article about stroke. Scroll down for tips on what to do if you suspect a stroke.

Yes, other conditions can “mimic” stroke – but be on the safe side. If you have good reason to suspect a stroke, get the person to emergency treatment immediately.

To further complicate matters, migraine patients may be at increased risk of stroke (see for example these estimates).

But although it’s important to check for stroke right away, doctors and patients need to be aware that other conditions may mimic stroke. A recent study from Hungary gives us some more information.

For example, peripheral vestibular dysfunction was found to be the most common stroke mimic. This means dizziness, which can also mean problems walking properly, and nausea. This alone accounted for almost a quarter of the stroke mimics.

Migraine was down the list, but it still accounted for almost 8% of the stroke mimics. So to put this in perspective, if it looks like someone is having a stroke, less than 2% of the time, it may be migraine.

But there’s a way we can further narrow things down. If the patient is young, female, and at low risk of stroke, there’s a much higher chance that the symptoms are not, in fact, from stroke.

Why does this matter? You still need to go to the emergency room, right?

Yes, but it matters because once you’ve ruled out stroke, you still need to find out what’s going on, and treat it. Migraine is one of the main alternate culprits, because it, of course, can cause headache, but also dizziness, vertigo, paralysis, speech problems, and vision problems. So it’s important to treat, because it is also one of the leading causes of disability.

Find ways to reduce your stroke risk, and be sure to take migraine seriously as well.

Read more about this study here: Ischemic stroke mimics: A comprehensive review

5 October 2021

Headache: Is Your Eye Twitching?

James Discoveries & Stats, Information 1

Have you ever wondered if a “twitching eye” is related to your headache symptoms? Well, researchers have wondered the same thing.

Doctors usually talk about hemifacial spasm (HFS), which is a more general term that can refer to painless spasms or “twitching” in your face in general. Usually, the twitching is on one side of the face, and often starts with the eyelid.

HFS can start with twitching or involuntary blinking, just temporarily, and that may be all there is to it. But sometimes it progresses – causing changes to the whole face, and even causing the eye to completely close.

A little bit of twitching for a minute or two shouldn’t be anything to worry about. But you may be wondering, is this related to migraine, or other headaches? And what exactly is causing it?

HFS is usually caused simply by a nerve’s proximity to a blood vessel. The blood vessel pulsates, activating the nerve. This can be simply caused by muscle movement, or in rare but more serious situations could be a sign of a tumour.

In 2012 researchers in Spain did connect HFS with some migraine attacks, and they speculated about why that might be. Dilation of blood vessels? The “hyperexcitability” that happens in the migraine brain? If so, that eye twitching, though not serious, could be considered a “complication” of migraine.

In a recent article at Medical News Today, health writer Hana Ames suggested the possibility that there could be a common trigger, or at least association, between HFS and migraine or other headache conditions. For example, fatigue may trigger both, stress has been associated with both (though perhaps not the “stress” itself, but other changes that go along with it), and even caffeine.

Again, an eye twitching for a couple of minutes is no reason for concern (although – if you’ve noticed a connection to headache or migraine attacks, leave a comment!). However, if the twitching continues or spreads, or you’re noticing additional unusual symptoms, you should see a doctor. In rare but more serious cases, medication or even surgery can help.

For more information on HFS in general, check out this summary from the Mayo Clinic. There is also a good summary from the National Institute of Neurological Disorders and Stroke – Hemifacial Spasm Information Page.

31 July 2020

Warning about New Migraine Meds and Small Vessel Disease

James Discoveries & Stats 0

Researchers publishing in the journal Cephalalgia are warning about the use of CGRP related medications for patients suffering from small vessel disease (SVD).

According to the Mayo Clinic:

Small vessel disease is a condition in which the walls of the small arteries in the heart are damaged. The condition causes signs and symptoms of heart disease, such as chest pain (angina).
Small vessel disease

We’ve learned that the calcitonin gene-related peptide (CGRP) is related to the pain process in migraine, and that suppressing the CGRP can help some people alleviate their symptoms. But as you may guess, CGRP is in your body for a reason, so this treatment must be done with care.

The concern of the researchers is this. CGRP seems to be very important to the way that the cardiovascular system regulates itself. If that “safeguard” isn’t working properly, there could be further danger of stroke and related issues.

We’ve talked about the SVD called CADASIL before, and its relationship to migraine. Although not common, it may be linked to migraine for many patients, and so further trials need to be done to see which CGRP related medications can be used safely in these patients. (SVD is also more common in women, and more common in smokers.)

To read the summary, see: The potential danger of blocking CGRP for treating migraine in CADASIL patients

For more on SVD, see What is Small Vessel Disease (SVD)? (For an interesting discussion of SVD and migraine, see the video linked at the bottom of the page).

20 July 2020

Ubrelvy: Not the Silver Bullet, but Helping Many

James Discoveries & Stats, Medications 0

Ubrelvy, generic name ubrogepant, is a migraine drug that was approved in the USA late 2019. We’re just now beginning to see how it’s working for real people in the real world.

Ubrelvy is an abortive medication, taken to stop a specific migraine attack when it hits. And so far, it’s doing as well as expected – actually, maybe better – for patients that have been taking it in everyday life.

Last month, Dr. Chia-Chun Chiang from the Mayo Clinic presented some preliminary findings at the American Headache Society Annual Meeting. Patients were asked to report on their use of ubrogepant 1 month to 3 months after it was prescribed. Here are some of the results from 57 patients:

So most patients, 66%, were either somewhat satisfied or very satisfied with ubrogepant.

Next, researchers looked at the goal of being pain-free within two hours. Now, you can take another dose after two hours if needed, but ideally you should have significant relief by then. In total, 27% reported that they had general relief in all their migraine attacks when they took ubrogepant. 73% had relief at least one time when they took it, and 32% were free from headache at two hours during at least one attack.

So, for most people it worked some of the time. But for 27%, it provided consistent relief.

The numbers sound a little more impressive when you realize that most of the patients in this study (81%) had chronic migraine. Now, this shouldn’t be your only treatment if you have chronic migraine, because you shouldn’t be taking it that often. But it says something that it was working for many patients who have a very serious migraine condition, and who have probably tried a number of other medications.

So the bottom line is that, so far, this medication does seem to be helping a lot of people. We’ll look forward to seeing more “real world results” in the months ahead.

via: Study collects real-world data on newly approved migraine treatments