The great name “Operation Brainstorm” refers to a program from the National Headache Foundation in the USA. If you’re a veteran or on active duty, you may want to check it out.
The goal of Operation Brainstorm is to actually visit various locations throughout the country to host forums, provide education, and even provide “migraine survival toolkits”. For example, the program will make a visit to the American Legion Post 0346 in Farmington on the 11th of October 2023.
There has been a growing understanding of traumatic brain injury and of course post-traumatic stress disorder, which are often associated with headache and migraine symptoms. The National Headache Foundation is able to bring its expertise to good use in these areas.
For more information, check out the poster (click the poster to go the the official site) and the video below.
This month the FDA in the USA approved the very first CGRP antagonist nasal spray, brand name Zavzpret. The drug is known as zavegepant. The new medication should be on the market as early as this July.
You may remember that the “gepant” medications, such as zavegepant, seem to be good abortives – taken during a migraine attack, they fight symptoms at the time (as opposed to preventatives, which of course prevent attacks).
People who would prefer to avoid injections and pills often go to nasal sprays. Many people like the speed of injections, but don’t like the injections themselves. And with migraine nausea, pills can be hard to take.
However, nasal sprays also tend to be very fast-acting. Zavzpret as a medication seems to be pretty fast-acting itself, which is good news for those who want to stop those migraine symptoms from escalating. The most recent study showed relief from pain as quickly as in 15 minutes.
Zavzpret is also very simple to use. It will probably be prescribed as one spray (into one nostril) of 10mg, once. That’s all.
Another advantage of Zaczpret is that there seem to be very few side effects. The most common (though still only a minority of patients experienced it) was a change in your taste – in other words, foods might taste a little funny. This was just temporary.
Clinical trials and professional surveys for cluster headache patients are not very common, so when I was contacted about these two trials I wanted to make sure I shared them with you. Both trials are in for cluster patients in the USA. Both are being led by Dr. Mark Burish through the University of Texas Health Science Center at Houston.
We all know that cluster headache results in serious disability, but measuring that disability is a challenge. This study will evaluate a tool that could help researchers and doctors better understand and to some extent measure cluster disability. It also helps when it comes to getting insurance and funding for cluster headache treatment and research.
Patients can be anywhere in the USA because they complete the survey (actually, three surveys over a period of three months) online. It’s open to “people with cluster headache (either now or in the past)”. You can go directly to the consent form here:
I’m told that this is currently the only non-pharmaceutical clinical trial for cluster in the USA. It’s a six-week study of high-dose vitamin D3 for the prevention of cluster attacks. The trial is for patients currently in their cluster cycle, however they may sign up at any time and begin when their cycle begins. It’s important to know that you should be able to continue with your current treatments during this trial.
You do need to call or email to enroll. Further details of who can enroll, as well as all contact information, can be found here:
This month the National Neurosciences Advisory Group in the UK published a paper of recommendations for headache and facial pain diagnosis and treatment. Part of the purpose of the document was to help doctors recognize emergency situations.
Today we’ll take a look at that part of the paper as a reminder of certain signs to look for if you are someone you love is experiencing new or changed symptoms. This is just a summary, you can view the full paper below.
New Headache
New or changed symptoms are always a reason to get to a doctor as soon as possible. But there are certain symptoms that could especially be signs of an emergency:
A new headache late in your pregnancy, or soon after the birth of your baby.
You’re over 50 years old – your doctor may want to test for inflammation (ESR test)
Neurological symptoms such as problems speaking, hearing, or seeing, or even feeling (numbness, pins and needles…). If these symptoms are getting worse, that’s another urgent sign.
Seizures
Unusual changes in personality or trouble thinking. “Unusual” because we’re assuming this is not a known mental or physical illness. This is something that needs to be noticed by someone else.
Other New Facial Pain
Jaw pain in patients taking bisphosphonates (a group of medications designed to increase bone density)
New pain in your temple, especially if you’re over 50
Other Headaches/Facial Pain
Any headache with a change in consciousness, drowsiness, or fainting
Thunderclap headache (headaches that appear suddenly and are at “full power” in 60 seconds or less)
Headache or facial pain with other symptoms such as fever, vomiting, visual problems, etc.
Headache or facial pain when you already have related medical problems or a history of them
Red eyes with headache (especially in seniors)
Trigeminal Neuralgia – sudden severe facial pain (like an electric shock)
Facial pain with a nosebleed, thick coloured nasal discharge, continuous change in your sense of smell, hearing loss on the same side as the pain
This might sound confusing, but it really can be summarized for the most part in new or changed headache, facial pain, or accompanying symptoms.
But whereas some mild changes or progressions might mean booking an appointment, when the symptoms are sudden and show signs of neurological problems and serious illness, going to emergency right away is important. There are also symptoms that may be ongoing that should be watched carefully and continuously.
These symptoms are also an important reminder to be aware of your friends and family. You may notice certain things before they do, and you can help them get the treatment they need.
Headaches are common, but they’re not “normal”. And at times they can be an important warning that immediate treatment is needed. Don’t ignore them.
The World Journal of Otorhinolaryngology ? Head and Neck Surgery recently published a review of the link between migraine and tinnitus. It’s an extensive review, but here are a few things that stand out.
The link between migraine and tinnitus has been explored before. A large percentage of patients with tinnitus also experience migraine attacks. If you include hearing loss and all auditory symptoms, it may be that most migraine patients experience some kind of auditory symptom.
The authors of this review (from the University of California) were particularly interested in tinnitus that “fluctuated”.
As you probably know, tinnitus refers to hearing ringing or other noises in the ears. Sometimes this is “objective” – there is actually something making noise in you body, that your doctor can detect. But most often it’s “subjective” – only you can hear it. That doesn’t mean there’s no physical cause or trigger, simply that it can’t be detected by anyone else.
Tinnitus may be fairly steady, but often times it is temporary, or it fluctuates. This may be because of something you ate, the weather – or even a migraine attack. Tinnitus that fluctuates with headache of course suggests a connection, but sometimes the tinnitus and headache or migraine may have a common trigger – such as weather changes.
The authors suggest that both migraine and tinnitus may have some common treatment paths. Some of the most interesting ones:
Dehydration: Staying properly hydrated (and this means a proper balance of hydration and salt in the body) may decrease both migraine attacks and tinnitus.
General Health: Improving exercise and diet may help decrease both conditions.
Sleep Health: Sleep problems can be huge in both migraine and tinnitus. A sleep test and follow-up treatment is something to look into.
Supplements: The review briefly mentioned 400mg magnesium and 200mg vitamin B2 (riboflavin) twice daily. Both of these are well-known migraine fighters.
Medications: There are certain medications that may help with both conditions, such as nortriptyline and topiramate.
Once again, it’s important for your doctor to know if you’re suffering from migraine and tinnitus, because there may be treatments that will be a higher priority for you. Start by making sure you’re hydrated each day (check out the app for iOS – Waterlogged. There are many similar options.). Check your sleep satisfaction to see if treatment in that area would help. And consider supplements such as B2 and magnesium.
Also, talk to your doctor about medications. Some may help, but there are others which may make the problem worse.
