Discoveries & Stats

20 September 2013

Should I Lose Weight to Fight Migraine?

It’s in the news yet again, thanks to a study from Johns Hopkins University School of Medicine. This time, it’s a link between obesity and episodic migraine (as opposed to chronic migraine).

The study concluded that the obese population was 81% more likely to have episodic migraine (EM) than the general population. Or, about this many in a group of obese subjects would have episodic migraine:

So – naturally – what’s the solution that’s being proposed? Exercise and a healthy diet, of course!

And no one wants to discourage anyone from a healthy diet and exercise, do they?

Well, of course not. And neither do I. In fact, I would suggest that those two things might just out-do any pill that has been invented. Maybe.

But I’m afraid there’s a real danger in over-simplifying the connection.

The study, in fact, shows that there’s an increasing risk of EM as you become more obese. So – the more weight I lose, the fewer migraine attacks I’ll have – right?

Here are a few reasons why we shouldn’t be hasty to draw this conclusion.

Which is a result of which? Does the obesity increase the chance of migraine, or is it the other way around? Just because there’s a correlation does not mean that one causes the other.
Obesity is clearly not the one risk factor or cause of migraine. If it’s one factor in 100, there could be 99 other things that are more important to deal with first. We don’t know. But we can see from the chart above that obesity â‰ migraine.
What about migraine medications? Many meds are known to promote weight gain in some people. Could that alone explain the results of this study?
Dr. Tobias Kurth, interviewed by Reuters, pointed out that historically obesity is on the rise but migraine is not. If there was a strong correlation, why aren’t both rising together?
What about conditions that are comorbid with migraine? Could they be causing the obesity, and not migraine itself?
There are a number of other factors we don’t know about. Would these statistics hold true with younger migraineurs? What about different types of body fat?

So let’s not raise an eyebrow at the overweight person with migraine – assuming that it’s all their fault that they have migraine – if only they’d just get it together….

No no no. There could be many factors leading a person to be obese – in fact, following a doctor’s treatment plan for migraine could have even contributed to the weight gain. So let’s be real careful here before we act like we know what the problem is.

Now, before you run for another bag of candies or a Peppermint White Chocolate Mocha with Whipped Cream, let’s remember a few things. There does seem to be a connection, and it could actually be that weight gain does contribute to your risk. And there’s no doubt at all that a healthy diet and exercise are two of the best migraine fighters out there.

No, we shouldn’t pin all our hopes on weight loss, and aim to lose the pounds at the exclusion of all other goals and at all costs. However, improving our health, including aiming for a healthy weight, simply has to be a part of our overall treatment plan.

3 September 2013

Is Migraine Different if Your Income is Low?

James Discoveries & Stats 4

Just how much do economic problems impact migraine? A new study is providing some fascinating answers…

We do know that economic status is a part of a complex web of factors that relate to migraine. There is some evidence that children in lower income families are more likely to get migraine, for example (read Lower income = more migraine?. You might also remember a poll we ran here back in 2010 showing that headache conditions had a large impact on job/career choices (read: Impact of Migraine/Cluster/Headache on Job Decisions

One of the most challenging questions is this: Why are people with lower income more likely to have migraine? Is it because migraine leads to a lower income? Or does the lower income lead to migraine? Or both?

A study of 162,705 people is providing some major clues. Each person shared information such as: do you have migraine? when did the symptoms appear? what is your household income?

Is there more Migraine among lower income people?

Yes. You can see the differences in the charts below:

Men with Migraine, by income

The study also found that those with low incomes were likely to have more pain and more disability.

But some things are the same…

Now, here’s the interesting bit. Remission rates were the same, no matter what the income. In other words, more people had migraine disease among the lower income brackets. But, once anyone had migraine, they were just as likely as anyone else to stop having symptoms (remission). People with lower incomes do not seem to have migraine for a longer period of time.

Now, maybe you wondered if people with lower income were less likely to get treatment that works. That still could be the case, especially considering that symptoms seem to be more severe for this group. But when migraine went away, whether “naturally” or through treatment, it didn’t go away faster for those with higher incomes.

Researchers suggested that maybe different factors were involved at the start of migraine than at the remission of migraine. At least, when it comes to economic factors.

This also questions just how much influence “low income stress” really has. The author of the study, Dr. Walter F. Stewart, put it this way:

If the stresses of low income were the sole determinant, we would expect low-income people to be less likely to stop having migraines. It’s possible that the start of the disease may have a different cause than the stopping of the disease.

For more, check out the study abstract here: Migraine prevalence, socioeconomic status, and social causation, and this article from Science Daily: Does Migraine Affect Income or Income Affect Migraine?

28 August 2013

Drug vs Bright Lights?

James Discoveries & Stats, Medications 2

Having a migraine attack? Bright light bothering you (or any light, for that matter)? What if you could take a drug and solve the problem?

We know that people with migraine are bothered by bright lights (photophobia). Almost all of them, at one time or another. In fact, migraineurs tend to be more sensitive to light even when they’re not having a migraine attack.

There have been some excellent helps for this problem, such as precision-tinted glasses. But what if your other symptoms weren’t too bad – and you could take a drug to eliminate the problem? Would you be able to go to work?

Did you know that humans can sense light even when they can’t see? That means that even a blind person will still have a biological clock aligned to the sunrise and sunset.

What senses the light? Scientists believe it’s melanopsin, a photopigment in the retina. What if we could block the messages that melanopsin sent to the brain?

But researchers wanted a drug that was very melanopsin-specific. They wanted to block melanopsin, not anything else.

Researchers at the Salk Institute for Biological Studies believe they’ve done it. Sulfonamide compounds they call opsinamides seem to do the job, and yes, block “light aversion”.

Researcher Satchin Panda is excited about the possibilities:

There are many people who would like to work when they have migraine pain exacerbated by light. If these drugs could stop the light-sensitivity associated with the headaches, it would enable them to be much more productive.

Maybe so. I know there are many people who could, at times, get a little more (or a lot more) done if the light wasn’t so excruciating.

Could this theoretical drug even stop some migraine attacks by eliminating light as a trigger?

There’s also the possibility that night shift workers could use the drug to more effectively adjust to their new schedule. Considering the accidents and challenges in maintaining productivity with shifts at odd hours, there’s no doubt a solution would be welcome.

And might there be a solution here for seasonal depression?

However, would the temporary blocking of melanopsin cause unforeseen problems? Hopefully we’ll learn more as studies continue.

Study overview: Small-molecule antagonists of melanopsin-mediated phototransduction
Press release: Drug blocks light sensors in eye that may trigger migraine attacks
Also interesting: The Many Roles of Melanopsin
via: Robbins Headache Clinic

26 August 2013

A Migraine Attack: Light – Noise – and more

James Discoveries & Stats 5

What bothers you MOST during a Migraine Attack?

In a recent internet survey, we compared four things . . .

46% said Light

Photophobia – the most common of the four. Studies say about 80% of migraine patients are sensitive to light during some attacks. This is also a common symptom between attacks (interictal).

33% said Noise

Phonophobia – also very common, with around 76% experiencing the symptom at some time. Patients also seem to be more sensitive to sound between attacks than the general population (interictal).

18% said Smells

Osmophobia. Between 25 and 40% may experience this symptom, related to hyperosmia (a heightened sense of smell).

3% said Things Touching Me

This could relate to a number of issues. Cutaneous Allodynia is when skin is sensitive/painful when touched. Haptephobia is a fear of being touched.

Additional notes

These are not the most common symptoms – things like pain and nausea would have to be included. However, they are common.

Percentages vary from study to study, but our survey tended to confirm more or less what studies say. One interesting symptom we didn’t include is taste abnormality, where the sense of taste is affected.

For more information, here are some sources you can check out:

19 August 2013

Migraine During and After Pregnancy

James Discoveries & Stats 2

First trimester

Over 1/2 have fewer attacks.
A significant number experience no change.
Occasionally, migraine attacks get worse.

Second trimester

About 3/4 have fewer attacks.
A significant number experience no change.
About 1 in 10 may get worse.

Third trimester

About 3/4 have fewer attacks.
About 20% experience no change.
Fewer than 10% may get worse.

Women with migraine without aura are much more likely to improve.

3 Months after birth

About 25% are still better than before pregnancy.

1 Year after birth

About 10% are better than they were before pregnancy.

Women who breastfeed are much more likely to have fewer attacks after pregnancy.
(Specifically, it takes longer for their migraine attacks to return)

The above statistics are estimates based on a number of studies (which is why numbers don’t always perfectly line up). For more information, check The Woman’s Migraine Toolkit (in the UK) (by Dr. Dawn A. Marcus and Dr. Philip A. Bain) (2011), and the following studies.