Since I haven’t been able to post as much as I would like, I’m not doing highlights as often either. So this time we’ll look back over the past 5 months to see which posts have been most popular with guests to this site. Here’s what you might have missed, in case you want to catch up. 🙂 The most popular posts are first in the list…
Bonus… An article that was popular from the past 5 months, but written further back. This time, it’s MS and Migraines: New Research – I would love to hear your comments if you’ve had experience with both.
It would be fantastic if we could all sit down with a few world-class migraine experts and ask them our questions. But maybe a good alternative is to send in your question and see it covered at next year’s Migraine World Summit! But hurry – new topic submissions close on Wednesday, July 13th.
And this is your chance. As you can imagine, it’s a daunting task to collect questions and topics from hundreds of people. So there’s a system, and here’s how it works, according to a recent notice from our friends at the Summit:
Find topic(s) that you’re interested in and vote for them.
Leave specific questions for the expert in the comments section. Questions that benefit the most people are more likely to be selected.
If you don’t see your preferred topic you can submit a new topic and have others vote for it. Be sure to check carefully so you don’t duplicate other suggested topics; we want the results to be accurate.
This is actually a pretty clever system because it helps organizers and experts choose broader topics to discuss in-depth, and also gives them a road map of what we most are interested in.
But what we don’t want is several very similar topics, or several topics that are the same but just worded differently (in that case, the votes will be split, and none of them might make the list). So yes, you can add a topic, but do take the time to look through the list to make sure it’s not already on the list.
Remember, new topic submissions close on the 13th, so add your topics/questions now so that we can make sure the next summit is the most helpful and practical yet.
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.
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.
Dr. John Hickner, editor-in-chief of The Journal of Family Practice, reminded me again of an emerging migraine treatment that you may not have heard of. And one phrase may tell you why – “at a fraction of the cost”. Any treatment that may fight migraine “at a fraction of the cost” of more mainstream medications might not get the press that it deserves.
Dr. Hickner mentioned two recent studies of vitamin D3 for migraine. A 2019 D3 study gave a low dose of D3 to patients for 24 weeks (about 5 and a half months). Migraine frequency did drop compared to the control group. There were no reported side effects at all.
A 2020 D3 study gave patients a higher (though still low) dose of D3 for just 12 weeks. In this case, not only did migraine frequency drop, but patients also found that the attacks were shorter and less severe. Researchers felt that the vitamin may protect patients against neuro-inflammation.
In the case of the second study, patients were given 2000 IU per day.
For Dr. Hickner, the “fraction of the cost” comes in when comparing D3 to CGRP related drugs. He writes:
Two recent randomized trials demonstrated that ? 2000 IU/d of vitamin D reduced monthly migraine days an average of 2 days, which is comparable to the effectiveness of the calcium gene-related peptide antagonists at a fraction of the cost.
The low risk and low cost of supplements like D3 make them very attractive, in spite of the lack of attention they receive. For more on recommended supplements, check out Best Vitamin D Supplements. And remember, another fantastic way to get vitamin D3 is to get outside and enjoy some sunshine! No one makes money when you go for a walk, but it may make your life a whole lot better.
One migraine emergency room treatment that has become a lot more common is dexamethasone. But what exactly is it, and why is it used?
Dexamethasone is a type of steroid called a corticosteroid (not to be confused with the other type – anabolic steroids are the ones that are sometimes used illegally by athletes). Corticosteroids are similar to cortisol, which your body produces naturally.
Like other corticosteroids, dexamethasone is used as an anti-inflammatory. We know that inflammation can be a good tool that your body uses, but inflammation can also get out of control. Dexamethasone can actually be life-saving when inflammation threatens your body’s organs, such as kidneys. It may also be used for less serious situations, such as to lessen inflammation when you’re having your wisdom teeth removed.
In the case of headache and migraine, anti-inflammatories are of course very common, helping to decrease that hot swollen pain. But as doctors began to give it to patients, they started to notice another benefit. Patients who were given dexamethasone were less likely to get another migraine / headache in the near future.
Once a migraine attack is serious enough to land you in emergency, doctors are concerned about a couple of things. First, they don’t want the symptoms to go on and on – they want to see the migraine attack stop. But they also don’t want to see you back in emergency a day or two later.
Dexamethasone is by no means a silver bullet – it would probably only stop that new headache in a minority of patients. But that minority is important, and along with its other benefits, there’s a good reason why many doctors are using it as a part of their treatment.
Avoiding another headache will also help you avoid taking more medication. But of course researchers are concerned that some patients will end up taking too much of the corticosteroid instead. In other words, no problem if we help that patient who has a one-time emergency room visit. But what if they come often? Too many doses of corticosteroids can cause problems. It can weaken your immune system. It can lead to osteonecrosis (a loss of bone tissue).
But used with care, doctors are finding dexamethasone to be useful. In fact, researchers in Canada are investigating its use in children with migraine as well (if you’re interested in taking part in this trial, here’s more information).
