A New Nasal Spray, and some Tips (podcast)
A new podcast from Headache and Migraine News – hope it’s a help to you!
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News
MSG and Headache – A Myth?
Late last year, an article in Lifehacker caught my attention – Stop Being Afraid of MSG. People with headaches and migraine may either be relieved or shocked by the claims that follow:
If you’re still afraid of the seasoning MSG giving you headaches, you should know you’ve bought into a decades-old myth.
Words like “afraid”, “bought into” and “myth” certainly make one feel like they should change their opinion immediately, and order a bottle of MSG (affiliate link conveniently provided in the above article).
But on the other hand, many headache sufferers swear that, every time they eat MSG, they get a headache.
So what’s the truth? First, in spite of the fact that MSG has sometimes pretty much been blamed for the imminent fall of civilization, it doesn’t seem to have an obvious, immediate effect on most people. And long term effects of that kind are extremely difficult to measure.
So the real question is, does it bother some people, perhaps those predisposed to migraine?
Almost anything bothers somebody, so we’re actually looking for something more widespread than 6 people in Berlin who get sick if they eat MSG.
So here’s what many of you really want to know. Yes, there are many people who feel that MSG gives them headaches. You will hear lots of stories. That doesn’t make it a fact, but it’s widespread enough that it seems to be more than a coincidence.
However, the clinical trials have not been conclusive. So why is that? Are the “right” people simply not in the trial?
Part of the challenge is that MSG is noticeable. That means placebo effect. So a well designed study is difficult to do with MSG, and trials in the past have often been poorly designed from a scientific point of view.
In 2016, a useful review of the studies of MSG was published in the Journal of Headache and Pain (Does monosodium glutamate really cause headache? : a systematic review of human studies). The study pointed out some of the problems with previous studies.
Falling short of claiming that MSG headaches are “myth”, the researchers concluded that the evidence was not strong enough from clinical trials to prove a direct causal relationship:
Because of the absence of proper blinding, and the inconsistency of the findings, we conclude that further studies are required to evaluate whether or not a causal relationship exists between MSG ingestion and headache.
Interestingly, the study actually interacted with the beta edition of the International Classification of Headache Disorders 3rd edition (ICHD-3 beta), which listed monosodium glutamate (MSG)-induced headache as one type of “Headache attributed to a substance or its withdrawal”. The cited studies were investigated more closely, and again, the studies did not seem robust enough to prove the relationship between MSG and headache.
The editors of ICHD-3 seemed to agree, dropping the mention of MSG altogether when the document came out of beta.
If someone gets a headache after eating foods with MSG, what does that mean? Is it possible that other issues (such as high salt content in general) could be causing the headache? In some cases, yet. It is easy for individuals to assume that one thing is causing their headache, when it’s something else altogether – and that’s something that happens frequently.
On the other hand, it would seem difficult to use these studies to “prove” that there is no causal relationship. So that leaves us with two practical issues.
First, you are the only one who is going to “test” the relationship on yourself. Keep an open mind, and if you’re convinced that MSG is a problem for you, stay away from it. If you’ve read the evidence and would like to give it another try, go ahead.
We should probably be a little cautious before we start labelling the MSG headache as a con or myth. And laughing at the silly woman who still lives in the bronze age and thinks that MSG causes her headache would seem to be counter-productive. We really don’t have the evidence to know if MSG bothers her or not. And when new research comes out, who knows if our minds will change.
New Migraine Meds in a New Year – and should I care?
Although I wouldn’t recommend that anyone pin all their hopes on the up-and-coming migraine medications, yes, there are some reasons why you should care about the new meds that are out, and the new ones we may see this year (and beyond).
So let’s take a quick look at what’s been happening:
Over the past few months, three medications have hit the market. All three are CGRP inhibitors, a new class of targeted migraine medication.
- Aimovig (erenumab) – self-injections once a month as a migraine preventative.
- Ajovy (fremanezumab) – self-injections either monthly or quarterly for migraine prevention. May also be useful for episodic cluster headache.
- Emgality (galcanezumab) – self-injections monthly. Has shown promise for both chronic and episodic migraine.
Yes, although all the same “class” of medication, each of these is different, with advantages and disadvantages. One may work where another may not. Readers may especially notice from the above list that Ajovy can be taken quarterly instead of monthly – that’s 8 few injections a year.
So what can we expect next from this class of medications? Here are three more that should hit the market in the months ahead:
- Ubrogepant – this one is an oral abortive – swallowed when needed to stop a migraine attack.
- Eptinezumab – self-injection, quarterly. Showing promise for chronic and episodic migraine. Already being promoted as a very “fast acting” option.
- Rimegepant – oral medication, used either as an abortive or a preventative.
A lot of the differences between these medications aren’t listed above – and some will vary from patient to patient. However, notice that now we have more oral options, and more abortives (taken when the attack hits). So those who hate injections (even though injection technology is improving quickly, and is not as bad as it once was) have hope.
What else does this mean, besides the fact that one may work and one may not for you?
A lot of people are speculating what this will mean for price. At the moment, each of these are similarly priced. However, at the very least, it’s important to be aware of the special programs each of company will put in place, and how they will change. Especially early on, these companies will want to gain customers. There are ways to save money.
Also, these companies will want to promote what they see as benefits of their particular brand – so watch for that. Also, many are trying to gain customer loyalty by providing other services, such as helpful info or apps for your phone. Watch for that as well.
As we’ve talked about before, even as new anti-CGRP meds flood the market, a whole new class beyond that is being developed. Though not expected anytime soon, watch for news about:
- ALD1910 – being developed by Alder Pharmaceuticals (developers of eptinezumab) as a migraine preventative.
- AMG 301 – being developed by Amgen/Novartis (makers of Aimovig) as a migraine preventative.
For another perspective on the class of migraine drugs currently hitting the market, see A Crowded Field for Migraine Therapies, Where Recently There Were None.
Fascinating (and disturbing) New Migraine and Headache Statistics
Last month, The Lancet (a world-renown medical journal) published an article with some new statistics about migraine and headache, from 1990 to 2016. The statistics are troubling as the fight to stop migraine and headache disorders continues around the world.
Researchers used the Global Burden of Disease Study 2016 (GBD 2016) to gain new insights into migraine and tension-type headache in particular. The advantage of using this study is that it has a global focus. It’s true that not every country has equally useful information, but it’s the best estimate we have today.
According to the new study, almost 3 billion people suffered from migraine or tension headache in 2016 (2.93 billion, to be more exact). That’s almost 40% of the world.
Of those, 1.89 had tension-type headache (over 25% of the world’s population) and 1.04 billion had migraine (about 14% of the world’s population).
Statistically, women are more likely to have headaches than men, but they’re a serious problem for everyone. People 15-49 are also at highest risk.
Now, here’s where things get interesting. Researchers had to calculate just how disabling these headaches were, on average. We’ve talked about this before – how both tension-type headaches and migraine are on a scale (it is possible to have a “mild” migraine attack, and a fairly “disabling” tension-type headache. And the two types may have a lot more in common than we once believed.).
But here’s a chart showing the difference.
As you can see, migraine is generally significantly more disabling than tension-type headache (no surprise there). Here’s what the numbers mean – during an attack, someone with migraine loses 43.4% of their health on average (I know, at times during many attacks it’s much higher – remember, this is an average). For tension-type headache, patients lose 3.7% of their health.
But look at it this way – what if you lost that much productivity every day? What if you lose that % of your pay each month, or missed that % of your major family events? Even tension-type headache can be quite serious.
Researchers stretched this into YLDs, or years lived with disability (it’s a technical calculation used to estimate the affects of disability – don’t get caught up in the details right now). But first, how much time are people living with these attacks?
Patients who experience tension-type headaches tend to spend 4.7% of an average year with a headache, migraine patients 8.5% of a year.
So, worldwide, migraine caused 45.1 million YLDs in 2016, and tension-type headaches 7.2 million YLDs. That’s a total of 52.3 million YLDs worldwide – accounting for 6.5% of all YLDs from any cause!
If you’re head is spinning from all this, here’s the bottom line. These two issues alone – not even taking into consideration headaches of other types – leads to 6.5% of the world’s disability. That is a huge number, when you think about all the other causes.
Out of the full list, tension-type headache and migraine were both in the top 10 most prevalent concerns (tension-type headache third after after cavities and latent tuberculosis infection). Migraine especially is one of the main causes of disability worldwide. Migraine is among the top causes of YLDs.
The researchers said “any improvements in the efficacy of headache treatments during this period (which saw the introduction of triptans for migraine) have had no detectable effect”. That’s right – no change. (They suggest that one reason is because of lack of worldwide availability of treatments, and the inability to measure lengths of attacks in this study. Fair enough to some extent, especially the second point. If stopping a migraine after 10 minutes is measured the same as 3 hours of agony, we can see how it would be hard to measure the benefits of triptans in this study. Still – no improvement??)
The researchers suggest that treatment of such a huge population will be a massive job – and that perhaps our focus should be on reducing risk.
Researchers also recommend an increased focus on headache care in health care systems, a focus on simple remedies, more resources given to research, and the development of better cost-effective treatments.
There’s a lot to discuss here, and you can read more for yourself in the links below.
I have seen many people helped by quality information, which is why this blog is here. So I know that change and improvement is possible. But there are many, many, who are still not being helped. As the authors of this study put it: Headache is not limited to the high-income part of the world and, unless action is taken, it is here to stay…
In the USA? Enter to win $100. (And something for everyone.)
Everybody likes free things – this is something free, plus the chance to win something else free.
First, and this is for every human with internet access, not just those in the USA, the National Headache Foundation and Med-IQ (with a grant from Allergan, Inc.) have put up a website which might be useful to you.
It’s called “Living Well With Migraines“. (Not to be confused with the book, “Living Well with Migraine Disease and Headaches“, which is also useful.)
The site gives a quick introduction to migraine and living with it in a series of short articles. They do give a useful overview, though they are at times pretty simplistic. There are also some practical tools – tips for talking with your boss about migraine, a tip sheet for prescription coverage, and an overview of a few migraine apps, for example.
Some of the info will be USA-specific, but a lot of it will be useful to anyone.
Now, we want some winners! Yes, you can win a $100 American Express gift card. In fact, three will be given away. All you have to do is fill out a survey – it just takes a couple of minutes. You will have to check around the website first, though, because the questions are about your response to the site itself.
So go visit the site now, check it out, and fill in the survey. And I hope that all three winners are readers of Headache and Migraine News!
Oh, you’d better hurry. You need to fill it in before the 18th of December 2018.