I don’t know about you, but to me it feels like the last few years migraine has been ignored. Don’t get me wrong, I know there are a lot of other things to be concerned about. But once again I’m hoping that we can encourage and promote the Migraine World Summit, and get people’s heads back into finding better treatments for migraine!
And yes – the dates have been announced – 8-16 March! Not only that, the full schedule is out. Check it out here:
As past participants know, the schedule is important because you probably won’t want to attend every single session. So you need to find your top few, the ones that will best fit your situation, and be most helpful for you.
There is an incredible line up this year, with some very 2023 topics, and topics that many of you have been requesting! If you have never attended before, you’ll be amazed at the amount of expert, practical information.
You’re more likely to associate altered consciousness with conditions like epilepsy, or something sudden like a stroke. But sometimes the diagnosis should be migraine.
EEG
Migraine certainly can feature some unusual symptoms, and different levels of consciousness is one of them. This is most often associated with a type of migraine called migraine with brainstem aura. But because it’s unusual, it can lead to misdiagnosis, as happened recently.
A 16-year-old was experiencing attacks where she would get a severe, throbbing headache with vertigo. She would fall down, and even temporarily lose the ability to speak. Then the episode would pass.
Not surprisingly, an EEG was ordered, and she was diagnosed with a kind of epilepsy. But the medications for epilepsy didn’t work – and the attacks continued, 2-5 times a month.
Finally, the diagnosis was changed to migraine – and migraine treatments did work.
There is a lot of discussion about the relationship of migraine with epilepsy. And sometimes the differentiation isn’t as clear as we would like. Research certainly needs to continue, so that we can understand both conditions better.
But in the meantime, the important thing for patients is finding a treatment that works. If the common treatments for something aren’t working, it would be a good time to rewind and take another look at the symptoms, and also the medical history of the family (in this case, the patient’s mother did suffer from headaches).
Headache specialists and researchers may be interested in looking at more of the technical details of this particular case. It was published this month in Acta Epileptologica: A case of migraine misdiagnosed as epilepsy.
In its clinical description, there’s no doubt that the symptoms of cluster headache are quite different from migraine. There has been some confusion in the past (such as the unfortunate term “cluster migraine“), but we’ve talked more than once about the differences.
All that being said, “migraine” is not one thing either. There are many different types of migraine with different symptoms, and in some cases with different treatments. Since we’re still learning about what causes the migraine chain reaction, and what really causes cluster headache, the question arises – is there actually a similar cause? Is this one disease that manifests itself in different ways? If so, although treatment options are quite different now, might there be some future treatments that address both?
The article discusses some of the challenges when it comes to making a hard-and-fast decision. There are certainly a lot of similarities, but also a lot of differences. There is no symptom that only appears in migraine and cluster and nothing else (it would be easier if you knew that, as soon as your nose turns purple, it’s either cluster or migraine). Should we look more at treatments – diagnosing based on which treatments work? This is fraught with complications as well.
The authors give us a helpful summary, so here’s a summary of the summary. Yes, cluster and migraine share not only some symptoms during the attack, but also symptoms in-between attacks (such as visual hypersensitivity – being sensitive to bright light between attacks, for example). There are also genetic similarities, similarities in demographics (what “kinds” of people get migraine or cluster), and similarities in certain triggers (they’re basically talking about triggers in a lab – give Joe this drug, it will trigger a cluster attack. Give JoAnn the same drug, it will also trigger an attack).
But these are overlapping similarities. There are some genetic features the same, and some different. There are some symptoms the same, and some different. Cluster is also triggered “more quickly” – telling us that perhaps the “chain reaction” that leads to the symptoms is different for each.
So basically, we need to know more about each. For the time being, we still look at what has “worked best”, we still recognize that everyone is an individual and so needs individual treatment. But we do encourage further discussion and research, because the more we understand, the better treatments can become.
If you’d like to get deeper into the topic, check out this actual video debate between Dr. Anja S. Petersen and Dr. Kuan-Po Peng. They talk not only about the scientific evidence, but also the practical implications of a more or less marked divide between the two.
Today I was reading an article related to headache, and I’m pretty sure it was written by AI, even though the author’s name was right there.
It was rather vague and not particularly helpful. But the day is coming – perhaps is already here – when AI-written content will, at times, be extremely helpful. Of course, it all depends on the programmer, and whoever gave the AI its prompt, and – well, the accuracy of the sources that the AI is drawing from.
Sometimes helpful and sometimes not helpful, AI has become a regular part of life for most of us, along with many apps and data-sharing services and video conferences – and that brings us to our term of the day: DTx.
DTx is more and more of a reality for headache sufferers. It stands for Digital Therapeutics.
Why the x? Well, that’s a long story, as it turns out. You might be familiar with Rx, which refers to a medical prescription. Rx is short for the Latin term recipere (which is where our word “recipe” comes from), which means “take!” Sometimes it would be shortened as Rc, which makes a lot more sense. But there was a habit of crossing the letter to show it was abbreviated – like this: ?. Sorry, just a little history for you there.
DTx is a term that refers to a whole lot at this point. The term was coined back in 2012, and generally refers to treatments that use software/applications/programming and data-sharing (such as over the internet). Proponents, such as the Digital Therapeutics Alliance, want to emphasize that these are evidence-based treatments and tools. In that case, the little app you downloaded that someone invented to make a buck, but that really doesn’t work, would not be included.
Headache and migraine patients are perhaps already familiar with some of these. Let’s list a few:
Nerivio, the migraine patch that comes with an app
We could, of course, go on and on! (And it looks like it might be time for some more app reviews.)
Of course, different people define DTx differently, from the wider use of anything digital that you use for your health, to stricter definitions that refer to therapies specifically approved by regulatory organizations. (For an interesting look at the history of DTx, see Role of digital therapeutics and the changing future of healthcare.)
DTx makes a lot of promises. More patient control, ability to track and understand information from home, access to specialists who aren’t nearby, more detailed information.
But there are challenges as well. It’s nice that I can “visit” a specialist in another state, but we all know that there’s a lot that doctors can tell about you in person that they can’t see on a screen. Also, that specialist still only has so much time – what we really need are more trained specialists!
Privacy is another issue. Yes, it’s important to check out how a company will use your information and how secure it is. But as soon as it’s in digital form on a connected device, there’s a chance that it can be accessed by someone else. In fact, there are ways to hack your device so that someone can even tell what you’re typing. “I have nothing to hide” is a phrase used by those who need to learn the many ways that their information can be used against them.
Another concern is just how useful a DTx is (hence “evidence-based”). A “neat-o” device or app may seem great, but it may simply end up as wasted time and more screen time.
One more issue is deciding where to put all your information. You don’t want to waste your doctor’s time (or your own!) with reams of information from 6 different apps. So effectively using digital technology may require some organization on the part of the user.
It’s good to see researchers paying more attention to neck pain as a symptom of migraine. One example is a study being published this year in the journal Toxins.
In this case, the study focused on onabotulinumtoxinA treatment, commonly known under the brand name of Botox. Botox has become a well-known treatment for chronic migraine, although we still have a lot to learn about the best way to use it.
This study focused not only on headache pain, but also neck disability and pain. Researchers used the Neck Disability Index (NDI), a ten-question survey filled out by patients to measure just how much neck pain is affecting their lives (see this example). For example, do you have trouble driving because of the pain? Are you avoiding recreational activities? Is neck pain robbing you of sleep?
A single onabotulinumtoxinA session did significantly decrease neck pain and disability in the patients over the next three months. Significant disability due to neck pain became mild, and headache pain decreased as well.
The authors of the study noted that this could mean a significantly better quality of life. These were patients who, at the beginning, were significantly disabled by both headache and neck pain.
This was a short-term study, so the researchers would like to see if these improvements hold over a longer period of time, with further treatments.
Still, there are a couple of things that can be taken from this study. First, be aware of neck pain and stiffness, during and in-between your migraine attacks. This is a symptom which may be causing you a lot more trouble than you realize. Second, if you have chronic migraine and have considered Botox as a treatment, this might be a further reason to give it a try. Be sure to keep track of both your headache and migraine symptoms and your neck pain, and share your results with your doctor.
