This quick little interview by the Guardian has a title which is basically clickbait. However, it’s a nice little overview of some common information about migraine, and a look into what researchers are looking forward to.
It’s less than 17 minutes long. Give yourself a quick refresher on the basics. It is good to see migraine getting some attention in the UK.
A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.
It might be useful to get a quick overview of some of the report’s findings.
Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.
But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.
If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.
Attacks may not be different, but they can change throughout life. For example, many older adults find that:
Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.
Cardiovascular issues in general are important to check as well.
The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.
It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.
Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).
CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.
However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.
Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.
If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.
This month the National Neurosciences Advisory Group in the UK published a paper of recommendations for headache and facial pain diagnosis and treatment. Part of the purpose of the document was to help doctors recognize emergency situations.
Today we’ll take a look at that part of the paper as a reminder of certain signs to look for if you are someone you love is experiencing new or changed symptoms. This is just a summary, you can view the full paper below.
New or changed symptoms are always a reason to get to a doctor as soon as possible. But there are certain symptoms that could especially be signs of an emergency:
This might sound confusing, but it really can be summarized for the most part in new or changed headache, facial pain, or accompanying symptoms.
But whereas some mild changes or progressions might mean booking an appointment, when the symptoms are sudden and show signs of neurological problems and serious illness, going to emergency right away is important. There are also symptoms that may be ongoing that should be watched carefully and continuously.
These symptoms are also an important reminder to be aware of your friends and family. You may notice certain things before they do, and you can help them get the treatment they need.
Headaches are common, but they’re not “normal”. And at times they can be an important warning that immediate treatment is needed. Don’t ignore them.
To read the full report, go to Optimal clinical pathway for adults with headache and facial pain and download the pdf version.
In its clinical description, there’s no doubt that the symptoms of cluster headache are quite different from migraine. There has been some confusion in the past (such as the unfortunate term “cluster migraine“), but we’ve talked more than once about the differences.
For a quick primer, check out this migraine-cluster headache infographic. For more detailed similarities and differences, go to Cluster or Migraine: What’s the Difference?
All that being said, “migraine” is not one thing either. There are many different types of migraine with different symptoms, and in some cases with different treatments. Since we’re still learning about what causes the migraine chain reaction, and what really causes cluster headache, the question arises – is there actually a similar cause? Is this one disease that manifests itself in different ways? If so, although treatment options are quite different now, might there be some future treatments that address both?
The debate was opened up again late last year in The Journal of Headache and Pain, in a review with the appropriate title, “Debate: Are cluster headache and migraine distinct headache disorders?“
The article discusses some of the challenges when it comes to making a hard-and-fast decision. There are certainly a lot of similarities, but also a lot of differences. There is no symptom that only appears in migraine and cluster and nothing else (it would be easier if you knew that, as soon as your nose turns purple, it’s either cluster or migraine). Should we look more at treatments – diagnosing based on which treatments work? This is fraught with complications as well.
The authors give us a helpful summary, so here’s a summary of the summary. Yes, cluster and migraine share not only some symptoms during the attack, but also symptoms in-between attacks (such as visual hypersensitivity – being sensitive to bright light between attacks, for example). There are also genetic similarities, similarities in demographics (what “kinds” of people get migraine or cluster), and similarities in certain triggers (they’re basically talking about triggers in a lab – give Joe this drug, it will trigger a cluster attack. Give JoAnn the same drug, it will also trigger an attack).
But these are overlapping similarities. There are some genetic features the same, and some different. There are some symptoms the same, and some different. Cluster is also triggered “more quickly” – telling us that perhaps the “chain reaction” that leads to the symptoms is different for each.
So basically, we need to know more about each. For the time being, we still look at what has “worked best”, we still recognize that everyone is an individual and so needs individual treatment. But we do encourage further discussion and research, because the more we understand, the better treatments can become.
If you’d like to get deeper into the topic, check out this actual video debate between Dr. Anja S. Petersen and Dr. Kuan-Po Peng. They talk not only about the scientific evidence, but also the practical implications of a more or less marked divide between the two.
Today I was reading an article related to headache, and I’m pretty sure it was written by AI, even though the author’s name was right there.
It was rather vague and not particularly helpful. But the day is coming – perhaps is already here – when AI-written content will, at times, be extremely helpful. Of course, it all depends on the programmer, and whoever gave the AI its prompt, and – well, the accuracy of the sources that the AI is drawing from.
Sometimes helpful and sometimes not helpful, AI has become a regular part of life for most of us, along with many apps and data-sharing services and video conferences – and that brings us to our term of the day: DTx.
DTx is more and more of a reality for headache sufferers. It stands for Digital Therapeutics.
Why the x? Well, that’s a long story, as it turns out. You might be familiar with Rx, which refers to a medical prescription. Rx is short for the Latin term recipere (which is where our word “recipe” comes from), which means “take!” Sometimes it would be shortened as Rc, which makes a lot more sense. But there was a habit of crossing the letter to show it was abbreviated – like this: ?. Sorry, just a little history for you there.
DTx is a term that refers to a whole lot at this point. The term was coined back in 2012, and generally refers to treatments that use software/applications/programming and data-sharing (such as over the internet). Proponents, such as the Digital Therapeutics Alliance, want to emphasize that these are evidence-based treatments and tools. In that case, the little app you downloaded that someone invented to make a buck, but that really doesn’t work, would not be included.
Headache and migraine patients are perhaps already familiar with some of these. Let’s list a few:
We could, of course, go on and on! (And it looks like it might be time for some more app reviews.)
Of course, different people define DTx differently, from the wider use of anything digital that you use for your health, to stricter definitions that refer to therapies specifically approved by regulatory organizations. (For an interesting look at the history of DTx, see Role of digital therapeutics and the changing future of healthcare.)
DTx makes a lot of promises. More patient control, ability to track and understand information from home, access to specialists who aren’t nearby, more detailed information.
But there are challenges as well. It’s nice that I can “visit” a specialist in another state, but we all know that there’s a lot that doctors can tell about you in person that they can’t see on a screen. Also, that specialist still only has so much time – what we really need are more trained specialists!
Privacy is another issue. Yes, it’s important to check out how a company will use your information and how secure it is. But as soon as it’s in digital form on a connected device, there’s a chance that it can be accessed by someone else. In fact, there are ways to hack your device so that someone can even tell what you’re typing. “I have nothing to hide” is a phrase used by those who need to learn the many ways that their information can be used against them.
Another concern is just how useful a DTx is (hence “evidence-based”). A “neat-o” device or app may seem great, but it may simply end up as wasted time and more screen time.
One more issue is deciding where to put all your information. You don’t want to waste your doctor’s time (or your own!) with reams of information from 6 different apps. So effectively using digital technology may require some organization on the part of the user.
A recent study briefly investigated the growth of DTx for migraine – you can read more at Digital Therapeutics in Migraine Management: A Novel Treatment Option in the COVID-19 Era. As the report notices, many of these approaches have exploded over the past few years with the lockdown-fueled growth of digital networking.
What do you think? Do you already use digital technologies regularly for your health? What concerns do you have? Leave a comment.