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14 December 2017

Discuss: The Challenge of Long Distance Doctor Visits

A recent poll here at Headache and Migraine News highlights a challenge that we don’t often talk about. It’s this – we often have to travel, sometimes quite a distance, to see a doctor or specialist.

Boy with map As nice as it would be to live in a big city with excellent migraine or headache specialists, that is not the reality for many. In fact, everyone who took our poll has had to travel at least to another town or city in order for treatment or consultation.

A little less than half at least didn’t have to travel too far – a nearby town or city was the farthest they had gone.

But 52% travelled farther. 40% travelled out of their home state or province. 12% travelled out of the country – with half of those actually going to another hemisphere!

Some people would benefit greatly from travelling to see another specialist, but they simply can’t afford the expense. Many headache disorders are complex, requiring multiple visits to the specialist just to get a good handle on a proper diagnosis.

Not only is there the cost, there’s the time. And the fact that travel can end up triggering symptoms, making travel a very painful option to someone already suffering from a lot of pain.

What can be done about this problem? Thankfully, there is more information and education available than ever before. Doctors have the opportunity to get more good information and training, so that more doctors with more knowledge are available. Plus, patients are learning to become savvy investigators themselves.

Also, with video conferencing and cheap phone calls, and apps and computerized data sharing, it’s becoming more possible for specialists to help patients from a distance.

If you’re travelling to see a specialist, one of the first things you should do is see what options are available for follow up. Your doctor may be willing to help you from a distance at least part of the time.

If you have felt the need to travel a fair distance to see a doctor for a headache condition, how have you minimized the problems? Share your ideas with us!

11 December 2017

Lipoic Acid for Migraine

James Discoveries & Stats, Tips, Treatments 0

Some doctors have recommended lipoic acid as a supplement treatment for migraine. So what exactly is it?

Alpha-lipoic acid (also known as thioctic acid or ALA, or there is also RLA, the naturally-occurring version) is a chemical that is found in some plants, and actually is made by your own body. It’s an antioxidant, and so helps keep your body healthy while it fights inflammation. It also helps your body maintain proper levels of vitamin C and vitamin E. Both of these may play a major role in fighting migraine and headache.

Broccoli and Lipoic Acid Now, we’re all for antioxidants and healthy foods, but why ALA in particular? And why haven’t you heard about it from your doctor?

The evidence for ALA for migraine is still fairly sparse, just because there haven’t been many studies on it. A study in 2007 suffered because not enough patients were recruited for the study. However, the study seemed to show fewer headache days, and less intense headaches, with ALA. This was over 3 months (see A randomized double-blind placebo-controlled trial of thioctic acid in migraine prophylaxis..

ALA is much better known as a treatment for diabetics, to decrease nerve pain. In that case, patients take 600mg or more per day in two doses. It’s also taken for weight loss and mental clarity. (Lots more information here: Alpha Lipoic Acid: Improve Insulin Sensitivity & Fight Diabetes!. Also see Alpha-Lipoic Acid.)

600mg was also the amount used in the migraine study.

Because lipoic acid comes from food, your best bet is probably to eat more ALA-rich foods. Broccoli is one of the best all-round foods for a migraine patient. Also try organ meat (liver, heart), spinach, and tomatoes.

So here are some things to consider:

Get ALA from food. This is almost a no-brainer, since we already know that foods like broccoli have so many benefits. Also try adding peas, brussel sprouts, carrots and beets to your diet.
ALA can be taken as a supplement for general health. You could try 50-100mg per day.
If you would like to try ALA specifically for migraine prevention, talk to your doctor about a 600mg dose.

Which supplement? An excellent version of thioctic acid is Country Life R-Lipoic Acid. It contains no gluten or milk or preservatives and is vegetarian. It’s also one of the less-expensive versions of RLA, and was tested and approved by Consumer Lab.

If you’re taking a higher dosage, an even less expensive version (also tested by Consumer Labs) is Vitacost Alpha Lipoic Acid. This would be a good option if you’re going the 600mg route, because you can take it in two doses.

Finally, if you’re looking for one of the highest rated brands on Amazon, Doctor’s Best has a whole series of lipoic acid products to choose from. The reviews themselves are an interesting read, if you want to hear about how this supplement is actually helping people.

7 December 2017

Ocular Migraine Symptoms

James Information 0

Discussing ocular migraine symptoms can be frustrating because the term itself remains confusing. The International Headache Society has provided guidance in the diagnosis of migraine conditions and symptoms through their “International Classification of Headache Disorders”, which lists various types of headache and migraine disorders. But ocular migraine isn’t one of them.

Ocular Migraine Symptoms? So if your doctor is using the term, I would encourage them to refer to the classification system, which will help us all speak the same language!

Types of “Ocular Migraine”

Today, people who are talking about ocular migraine symptoms are typically referring to some type of migraine with aura (yes, there are many types!). But first let’s take a look at the warning symptoms, because visual symptoms can be a sign of various conditions. If you’re having vision problems, and any of the below describes you, see a doctor immediately.

Warning signs:

Visual symptoms last for less than 5 minutes.
Visual symptoms last more than an hour.
Symptom is primarily partial or complete blindness (as opposed to seeing flashing lights, etc).
You have recently had a stroke or brain injury.
The symptoms are new – this is especially a concern if you are over 40.

Even if none of the above is true, if these are new symptoms to you, you should see a doctor. Issues such as transient ischemic attack (TIA) (mini-stroke) and even stroke can closely mimic migraine. Your doctor will need to rule out other conditions before giving you a diagnosis.

Now you’re still experiencing ocular migraine symptoms, and you want to narrow down your diagnosis some more. This will help.

What type of migraine?

Are you experiencing “motor weakness” along with the visual symptoms? Motor or muscle weakness may be a sign that you’re suffering from a type of hemiplegic migraine.
Are you experiencing other strange symptoms, such as jerky movements, trouble speaking, trouble hearing, vertigo, double vision, or even a decreased level of consciousness? Some of these may be typical of migraine with aura, but they could indicate migraine with brainstem aura.
Is the aura strictly visual, and it’s happened several times? Do the visual symptoms always last between 5 minutes and 1 hour? And are they always in only one eye? If so, you may have retinal migraine.

If none of these fit you, you may have typical migraine with aura.

Now, you’ll notice I didn’t say a lot about headaches. Yes, it is common to have headaches along with retinal migraine – but it’s not always the case. It is possible to have retinal migraine attacks with no headache. It is also possible to have typical aura without headache, which is more common and can have more varied symptoms than the more specific retinal migraine.

Underneath many of these types of migraine, there are also sub-types.

If you’re wondering if it’s worth getting a specific diagnosis for your ocular migraine symptoms, it is. Some of these types of migraine have treatments that specifically work with that migraine type.

A neurologist with experience in migraine and headache conditions can help you find a diagnosis and a treatment.

The Mayo Clinic has a brief but helpful article on ocular migraine symptoms here.

Again, if these are new symptoms, you should go to a doctor who can help you rule out various other possibilities. Whether migraine or not, these can be serious and debilitating symptoms.

4 December 2017

New Reports on Visual Snow

James Discoveries & Stats 0

It was interesting reading about some recent reports about visual snow, a phenomenon where patients see constant “static” or “spots”.

As we’ve discussed before, there is a debate about how visual snow is related to migraine. Persistent migraine aura is how we describe visual symptoms of migraine that don’t go away. Visual snow is usually described as a more specific symptom. Read more about both here: Persistent Migraine Aura and Visual Snow?

Treatments such as valproic acid, acetazolamide, lamotrigine and topiramate are typical for visual snow. But according to a recent paper, less than half of patients responded to the medications that were prescribed for them. Which means there’s a lot of work to do.

Many patients tried recreational drugs for visual snow, which tended to make things worse. In fact, hallucinogenic drugs are a common cause of visual snow.

Check out this post from the New York Headache blog for more interesting facts, such as who visual snow tends to affect, when it’s at its worst, and how it may be connected to headache and migraine: Visual snow is related to migraines, can be disabling

30 November 2017

Last Day to Give Your Input for Erenumab Insurance Coverage!

James News 1

ICER input Today (Thursday, the 30th of November 2017) is the last day to give The Institute for Clinical and Economic Review (ICER) your input. This will help your insurance companies make an informed decision about covering this, and possibly future, CGRP targetting drugs.