Discoveries & Stats

18 November 2025

Coming Soon: A Prescription App…

Yes, you heard right. The app will actually be the prescription. A digital prescription. Sort of.

This past week Click Therapeutics reached a milestone when the FDA approved their application for their digital app, currently known as CT-132. It’s an app specifically designed to treat migraine.

No, you don’t inject yourself with it or hold the phone close to your head to make it vibrate. It’s actually more about helping you with lifestyle changes. Yes, we’ve seen things like this before, but this is a specific app that has gone through clinical trials.

This isn’t Click Therapeutics’ first app. They already have an app available for major depressive disorder, known as Rejoyn. The official website explains: “Rejoyn, when used alongside your antidepressant medication, can help you treat depression symptoms differently. It is authorized by the FDA and provides 6 weeks of brain-training exercises and short skills-based therapy lessons.”

They also have an app for type 2 diabetes. And more to come, but the migraine one is coming soon.

We can expect to see more apps of this type coming.

One of the important measurements for an app of this kind is whether or not people will use it, and keep on using it. Only after that can we measure whether or not it’s helping. CT-132 seems to check both boxes, after a few weeks in the trials.

Of course, this is bit of a different kind of thing to test, when we compare it to taking a pill. But so far it does seem to help. But the real trial will come when it’s available and people in the real world start using it.

What do you think? Would you give it a try?

11 September 2025

Cluster Headache and Deep Brain Stimulation: How’s it going?

James Discoveries & Stats, Treatments 0

It’s been over 15 years (!) since I first wrote about the benefits of deep brain stimulation for cluster headache. It wasn’t a brand-new treatment at that time. However since cluster is fairly rare, it takes a lot longer to collect useful information.

A recent publication in BMC Neurology had a review of studies of DBS, both older and newer. And their findings were positive.

You can read the report for yourself (Exploring the potential of deep brain stimulation in managing cluster headache: a systematic review), but here are some important points:

Not every patient benefited. This is important to say from the start. One of the current and future goals of researchers is to understand why DBS is helpful for some patients and not for others, so that no one has surgery that won’t really help.
That being said, many patients did benefit significantly. The study notes: “Patients who responded positively to DBS often experienced long-term benefits, with sustained reductions in CH symptoms even after several months to years of follow-up. Quality of life measures consistently showed improvements among responders, suggesting that DBS not only reduces pain but also enhances overall well-being.”
Adverse effects were usually temporary and not serious. A common one was double vision (diplopia), but again it was usually only a temporary issue, compared to the long-lasting effects benefits of the treatment.
As mentioned above, “overall well-being” was improved. One notable reason for this was that DBS sometimes seems to cut down on nighttime cluster attacks, improving sleep. That’s a huge benefit.

Research will continue, but in answer to the question “how’s it going?” – it’s going well. Deep brain stimulation is still beneficial to many cluster headache patients.

For a good overview of deep brain stimulation in general, see this article from the Cleveland Clinic.

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

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’.

10 March 2025

“Acceptable” B12 Levels: Too Low?

James Discoveries & Stats 0

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.

B12 levels are especially a concern for those on a vegetarian or vegan diet, or for older people. In this study, the patients were older – median age 71.2. In short, the study did find brain issues in patients with low but “normal” vitamin B12. (See the study here: Vitamin B12 Levels Association with Functional and Structural Biomarkers of Central Nervous System Injury in Older Adults)

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.
Vitamin B12: “Normal” blood Levels are often not normal

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.

Read more here: Vitamin B12 Deficiency (Cleveland Clinic)