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!
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.
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.
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.
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”.
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.
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.
You can still watch the Migraine World Summit recap for free! I’m not sure how long the extended version will be available, but it’s right here.
The summit also announced that there is an extended discount if you would like to own the full 2025 library of migraine-fighting information. The discount is available until the 6th of April, and can be accessed right here: Access Passes
Funds raised through the access passes will be used to further cutting-edge migraine research and advocacy.
We’ve talked before about vitamin B12 as a possible migraine-fighter. You may have had your vitamin B12 levels tested, and found in the normal range. But is the “normal range” wrong?
Of course this will very much depend on the lab that does the test, or the country you’re in. A recent study published in the Annals of Neurology (February 2025) turned up problems in people with “acceptable” B12 levels – acceptable, but in the lower range.
Dr. Alexander Mauskop of the New York Headache Center commented on the study:
The current normal levels for vitamin B12 were determined decades ago, and it is not clear how reliable the research that led to these values was. Quest and Labcorp, two major chains of laboratories, define normal levels as 200 – 1,000 pg/ml and 232 -1,245 pg/ml, respectively. The WHO considers 480 pg/ml to be the bottom of the normal range, while it is 500 pg/ml in Japan. Some experts suggest these higher standards may contribute to lower rates of Alzheimer’s and dementia in Japan.
Dementia is only one possible result of low B12 – weakness, anxiety, and even numbness may be symptoms. And of course we’re concerned about headache and migraine, which is related to overall brain health.
It may be wise to have your levels checked, and to ask for the actual number. If you’re “normal” but in the low range, try at the very least to increase the vitamin B12 in your diet, or talk to your doctor about supplements.
Vitamin B12 deficiency is fairly uncommon, but it wouldn’t be surprising if at least 1 in 25 people had a deficiency, and the number may be even higher if the “acceptable” levels are wrong.
Low levels may be caused by diet, or be more common with age. But there are other possible causes, such as certain medications (e.g. metformin and antacid medications) and especially gut/stomach conditions and diseases. Alcohol abuse can also cause problems with B12 absorption.
