James

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Posts by James Cottrill:

12 August 2025

Medication Apps

There are a host of available apps available to remind you to take your meds. Every one of them has its pros and cons. But here are a few to consider…

First, I should note that although I use a ridiculous amount of apps on my phone, I hate to add another app that can do something that I can already do with an app I already own.

If you have an app for your to-do lists, or a calendar, or even a notebook app that allows reminders (such as Evernote), you can set it up to remind you to take your medications. Apple’s Health app also has a medication reminder feature.

Second, I should admit that I’m not fond of subscription apps. I know why they exist, it entirely makes sense as a business model, but I just don’t have the cash to keep doling out more each month. But more power to you if you find the perfect subscription app.

For example, for years I used Medisafe Pill Reminder, and it’s excellent. I recommend it. But when it went to a subscription model, I began looking elsewhere.

There are also specific migraine trackers, that can track the medication you take, and even remind you to take preventatives. N1-Headache is one of these – an excellent app that especially excels in finding your true triggers. We’ve talked about it before – also highly recommended.

If, however, you want something more focused on medications, here are a couple of suggestions. I should also add that I’ve used apps like these for family medications. If you want to keep track of a parent’s meds or a child’s or whatever, this is the way to go.

MyTherapy Medication Reminder is a highly customizable medication reminder. You can add personal notes, get reminders when you need refills, “game-ify” your treatment by earning rewards, and even track symptoms and general health information. Also, you can easily export information for your doctor.

This much ability to add information and customize means that you could actually track things like headache level, giving you a lighter-weight way to track all meds but also specifically some headache info.

But the app that I’ve settled on at this point in my life is Pill Reminder – All in One. This is an extremely flexible app in which you can add multiple users, multiple medications (including abortive “as needed” meds – perfect for migraine), unique sounds for your alerts (which I really like), and easy-to-read views. It also has many of the additional features I mentioned for the previous app, such as exporting information for your doctor.

This one has a very small one-time cost if you want to add more than two alerts.

And here’s another bonus – no data is collected at all from this app. Privacy is a priority.

There’s no reason why you can’t download a couple of these and try them out to see what works best for you.

If you’ve found something else you love, leave a comment!

2 July 2025

Migraine and Visual Cortex Excitability

James Discoveries & Stats 0

We’ve known for a long time that people with migraine tend to respond differently to visual stimuli. But we’re not the only group.

As a matter of fact, Dr. Daniele Piscitelli (Department of Kinesiology, University of Connecticut) didn’t start out studying migraine, but studying stroke. But he noted that there was some overlap with migraine research.

So he started studying migraine and cortex excitability – that is, how the brain responds to stimulation. He studied motor excitability – related, of course, to body movement, and visual excitability, related to what we see. The findings were published in the journal Restorative Neurology and Neuroscience.

Without getting into the details (which you can read in the actual study, Effects of Pattern-Reversal Visual Stimulation on Brain Activity in Migraineurs and General Population), the researchers didn’t find any difference in motor cortex excitability between the control group and the migraine group. However, the migraine brain did tend to have more visual cortex excitability.

This is all very technical, of course, but it does confirm some things. For one, the researchers found that this was the case not only with migraine but with other types of headaches. We’ve known for a long time that tension-type headaches and migraine aren’t so different after all, and may even have a common basis. This confirms the connection again.

Another thing we’ve known (and not completely understood) is that there’s a link between epilepsy and migraine. Some drugs common to both can reduce visual cortex hyperexcitability. So if your doctor recommends an anticonvulsant drug for your headaches, they’re on solid scientific ground (although of course every person is different when it comes to which medication, if any, they should take).

This is only another study in a long line that are helping us understand how migraine works and how it’s related to other conditions.

To read more, check out the press release from the University of Connecticut: Migraine sufferers’ brains respond differently to visual stimulation

20 June 2025

Shades for Migraine Time!

James News 0

Shades for Migraine is back for another year!

If you’re not familiar with this campaign, Shades for Migraine encouraged people to wear, you guessed it, shades – sunglasses – on the 21st of June (this Saturday), to raise awareness.

I love their video and graphic – this graphic shows some of the “hidden” reality of migraine (click to see the full version on their site):

The video clarifies:

So, this Saturday is your chance to get involved! Feel free to post a picture and tag it #ShadesforMigraine – or, just start a conversation with your ordinary, or even crazy and wild – sunglasses!

For more information, go ahead and visit:

Shades for Migraine

4 June 2025

Science Fraud: A Faster way to Detect It?

James News 0

Go to the source – read the clinical trial results – check the science – . Well, it all sounds like great advice. But what if the clinical trials themselves are frauds? Or – perhaps – they’re not quite what they seem to be, even with good intentions.

We’ve talked about this growing issue before (see The Case of the Missing Studies: Patients missing critical information and Are Clinical Trials Still Being “Hidden”?).

Sure, if the clinical trial doesn’t come out the way you want, you can just … not publish it … at least not yet. But that’s only part of the problem. There are misleading statistics. There are downright fake numbers that are published. It’s a huge problem.

Early in the days of my migraine research there was a lot of discussion about PFO closure. Of course, the possibilities of PFO closure are still being discussed.

But back ten years ago, it was discovered that Andrew Dowson, then director of headache services at King’s College Hospital in London, was suspended for “serious breach of professional standards” – dishonesty. And a special device that was being promoted for PFO migraine treatment turned out to be possibly useless and potentially dangerous. (BMJ: Migraine doctor loses appeal against findings of dishonesty. See also the discussion in My life as a whistleblower: Q&A with Peter Wilmshurst)

It’s shocking that these studies, which should be used to help people, are only being used to help a few make money.

One problem is that it can take a long time to really study all the many studies and reports that are out there, even if they are published. But The Center for Scientific Integrity wants to speed things up, using the tools of their Retraction Watch to…

…leverage the tools of forensic metascience — using visual and computational methods to determine a paper’s trustworthiness — to rapidly identify problems in scientific articles, combined with the experience and platform of Retraction Watch to disseminate those findings.
Retraction Watch (June 2025)

This could potentially be a great use of modern computational capabilities. Not to set aside human investigation (after all, computers can be used for selfish purposes as well!), but to provide a quick way to identify possible problem studies.

This doesn’t address all the “science fraud” out there, but it may be another way to publicly investigate and find even “small errors or mistakes that have an outsized impact on clinical results”.

7 April 2025

New Migraine Treatment Guidelines Announced

James Discoveries & Stats, Medications, News 1

The American College of Physicians (ACP) has just announced new guidelines for the treatment of migraine, which will interest doctors and specialists in the USA and around the world.

Headquarters of the American College of Physicians — *Adapted from image by AhlqACP2024*

The guidelines are specifically for “acute” migraine, that is, an episodic migraine attack.

These kinds of recommendations do not, of course, replace your personal interactions with your doctor, who knows your condition and your medical history. However, announcements like this do help us to gauge which treatments might be worth “trying first”, or what might work for a wide variety of patients.

After a survey of the current scientific studies, the ACP has these two recommendations:

“ACP recommends that clinicians add a triptan to a nonsteroidal anti-inflammatory drug to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to a nonsteroidal anti-inflammatory drug (strong recommendation; moderate-certainty evidence).”
“ACP suggests that clinicians add a triptan to acetaminophen to treat moderate to severe acute episodic migraine headache in outpatient settings for nonpregnant adults who do not respond adequately to acetaminophen (conditional recommendation; low-certainty evidence).”

It’s somewhat surprising that acetaminophen (paracetamol) is still such a strong recommendation. But note that the second item doesn’t have the strong evidence behind it that the first does.

Attention has largely gone away from triptans with the introduction of CGRP related medications for migraine. However, triptans have a strong track record. Guidelines like these are not likely to include newer medications simply because they can’t have the same long-term evidence behind them.

Remember that this advice may not be the best for you. But it may be worth a try, especially if you haven’t tried it before. If your doctor has tried increasing your dose of acetaminophen or an NSAID (still at a safe level), and you’re not experiencing relief, it may be time to add a triptan.

The ACP did suggest that other medications be tried if these don’t work.

Another important recommendation was to never put the full focus on a “pill”. There’s no doubt that medication is not saving us. The ACP adds:

Highlight the importance of lifestyle modifications with patients, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity (preferably moderate to intense aerobic exercise), managing stress with relaxation techniques or mindfulness practices, and, where applicable, pursuing weight loss for those who are overweight or obese. Also, explore modifiable migraine triggers or contributing factors during a detailed history.
Pharmacologic Treatments of Acute Episodic Migraine Headache in Outpatient Settings

It’s worth noting that some of these items are far more powerful than today’s medications in the long term.

To read more, especially if you’re a specialist, doctor or patient, go straight to the full report here.

For an article with a summary of the recommendations, see Updated migraine treatment guidelines ‘a long time coming’.