It’s just in the trial stage. But – what actually is it? Well, it’s the continued evolution of migraine-fighting devices:
The device above is currently called Mi-Helper, and it may not be what you expect. No, it’s not a CPAP, but there are some similarities.
Mi-Helper comes from previous technology known as CoolStat. CoolStat, primarily being developed for hospital use, is a small portable device that provides clean air to a patient at a specific temperature, allowing doctors to keep the body at a specific target temperature without changing the environment of the whole room.
Mi-Helper will also be a drug-free device, and it works similarly to the CoolStat, though it will be developed specifically for migraine patients.
ObvioHealth, the company which will be carrying out the clinical trial, explains Mi-Helper this way:
The small Mi-Helper device* delivers a controlled stream of conditioned air with a nebulized mist to the mucosa membranes in the nose, providing relief from migraine-related pain and associated symptoms such as nausea and photosensitivity. *Mi-Helper is for investigational use only and has not yet obtained FDA clearance
The treatment is estimated to be about 10 minutes, when you feel a migraine attack coming on.
Cooling and oxygen methods for migraine have been around forever, and are very effective. If this device can provide targeted home treatment to the patient, it could be a significant way to fight an attack after it’s started. If this device works well and can be widely distributed, it has great potential.
ObvioHealth hopes to begin recruiting for clinical trials this summer.
For more information, check out the video interview (which actually has some very interesting insights into medical device development) and pictures at Key Tech: CoolTech Medical Mi-Helper
The Nerivio neuromodulation armband from Theranica is a migraine-fighting device that now has a few years of success under its belt. Currently, it’s an abortive, used to fight the migraine attack when it comes. But could it also be adapted as a preventative?
Research published in the journal Headache earlier this year suggests that it can. Participants used the Nerivio device every other day for eight weeks, and discovered that they had 4 fewer migraine days each month – a significant reduction, although of course this was only a short trial.
In the press release, the company gave a good summary of the device as it is today:
Nerivio is a novel, physician-prescribed treatment for migraine that is discreet and non-disruptive to everyday living. Controlled with a smartphone and self-administered, Nerivio wraps around the upper arm and uses non-painful remote electrical modulation (REN) to activate peripheral nerves, inducing the internal pain management mechanism called conditioned pain modulation (CPM) in remote body regions. In simpler terms, the upper arm is stimulated to control the migraine pain in the head. Each treatment lasts 45 minutes and is recommended for use every other day for prevention or at the start of a migraine attack for acute treatment.
If you’re looking to cut down on or even eliminate the drugs you’re taking now for migraine, this may be something to talk to your doctor about. It does need to be prescribed, but now many more patients may find it helpful.
For more about abortive migraine treatment and the real-world evidence behind it, check out this post from 2020 – Nerivio Device: New Approval and Real World Evidence. There’s lots of useful information on the official site (check out the FAQ): Nerivio
The World Journal of Otorhinolaryngology ? Head and Neck Surgery recently published a review of the link between migraine and tinnitus. It’s an extensive review, but here are a few things that stand out.
The link between migraine and tinnitus has been explored before. A large percentage of patients with tinnitus also experience migraine attacks. If you include hearing loss and all auditory symptoms, it may be that most migraine patients experience some kind of auditory symptom.
The authors of this review (from the University of California) were particularly interested in tinnitus that “fluctuated”.
As you probably know, tinnitus refers to hearing ringing or other noises in the ears. Sometimes this is “objective” – there is actually something making noise in you body, that your doctor can detect. But most often it’s “subjective” – only you can hear it. That doesn’t mean there’s no physical cause or trigger, simply that it can’t be detected by anyone else.
Tinnitus may be fairly steady, but often times it is temporary, or it fluctuates. This may be because of something you ate, the weather – or even a migraine attack. Tinnitus that fluctuates with headache of course suggests a connection, but sometimes the tinnitus and headache or migraine may have a common trigger – such as weather changes.
The authors suggest that both migraine and tinnitus may have some common treatment paths. Some of the most interesting ones:
Dehydration: Staying properly hydrated (and this means a proper balance of hydration and salt in the body) may decrease both migraine attacks and tinnitus.
General Health: Improving exercise and diet may help decrease both conditions.
Sleep Health: Sleep problems can be huge in both migraine and tinnitus. A sleep test and follow-up treatment is something to look into.
Supplements: The review briefly mentioned 400mg magnesium and 200mg vitamin B2 (riboflavin) twice daily. Both of these are well-known migraine fighters.
Medications: There are certain medications that may help with both conditions, such as nortriptyline and topiramate.
Once again, it’s important for your doctor to know if you’re suffering from migraine and tinnitus, because there may be treatments that will be a higher priority for you. Start by making sure you’re hydrated each day (check out the app for iOS – Waterlogged. There are many similar options.). Check your sleep satisfaction to see if treatment in that area would help. And consider supplements such as B2 and magnesium.
Also, talk to your doctor about medications. Some may help, but there are others which may make the problem worse.
It’s good to see researchers paying more attention to neck pain as a symptom of migraine. One example is a study being published this year in the journal Toxins.
In this case, the study focused on onabotulinumtoxinA treatment, commonly known under the brand name of Botox. Botox has become a well-known treatment for chronic migraine, although we still have a lot to learn about the best way to use it.
This study focused not only on headache pain, but also neck disability and pain. Researchers used the Neck Disability Index (NDI), a ten-question survey filled out by patients to measure just how much neck pain is affecting their lives (see this example). For example, do you have trouble driving because of the pain? Are you avoiding recreational activities? Is neck pain robbing you of sleep?
A single onabotulinumtoxinA session did significantly decrease neck pain and disability in the patients over the next three months. Significant disability due to neck pain became mild, and headache pain decreased as well.
The authors of the study noted that this could mean a significantly better quality of life. These were patients who, at the beginning, were significantly disabled by both headache and neck pain.
This was a short-term study, so the researchers would like to see if these improvements hold over a longer period of time, with further treatments.
Still, there are a couple of things that can be taken from this study. First, be aware of neck pain and stiffness, during and in-between your migraine attacks. This is a symptom which may be causing you a lot more trouble than you realize. Second, if you have chronic migraine and have considered Botox as a treatment, this might be a further reason to give it a try. Be sure to keep track of both your headache and migraine symptoms and your neck pain, and share your results with your doctor.
Last month a meta-study was published in the Journal of Oral & Facial Pain and Headache, focusing on the use of melatonin supplements for migraine. The results are pretty encouraging for a supplement that is generally considered safe in small doses.
The helpful thing about this new study is that it didn’t just evaluate if melatonin “helped”, but it got specific into the “how”. Researchers found the following benefits:
Less frequent migraine attacks
Shorter migraine attacks
Less severe migraine attacks
Less use of “painkillers”
Why exactly melatonin works so well is not entirely understood. Obviously, if melatonin helps you sleep, improved sleep will certainly help fight migraine. But there may be more to it than that.
Melatonin is also an antioxidant, which may provide a number of benefits. Headache researchers have especially honed in on the anti-inflammatory powers of melatonin. More recently, melatonin gained traction as part of the COVID-19 fighting toolbox (see for example this study).
Melatonin is, of course, produced naturally in your body. At a 2019 Migraine World Summit event, migraine expert Dr. Christine Lay provided some very helpful advice for migraine patients:
I think there are ways to promote your own melatonin. When we come home after a busy day, I encourage patients to keep their room dim. And so not to have every single light on in the house, every, you know, television going, but rather to keep the room fairly dim and to use lamp lighting, perhaps, rather than overhead lighting so our own natural melatonin will kick in. But for some patients supplements can be very effective. I think we have to be mindful as migraine patients that you’re not spending all of your money on the most expensive one but you’re not buying the cheapest one because we know these things are not really mandated. We don’t know about quality control, necessarily. So you want to make sure you’re buying a good product.
The other thing I think is important: there are sometimes what we call sublingual, or melt-in-your-mouth, melatonin. I tend to tell patients to avoid those because they usually have additives in them or they may have an artificial sweetener which could then provoke a migraine attack. So they need to stick, primarily, with tablets or pills. In terms of amounts, it’s quite variable. There’s a lot of research showing that melatonin can help patients with chronic migraine, even chronic migraine people who feel like they don’t have a sleep problem. There’s something positive about melatonin. It may actually have even an antiinflammatory benefit to some degree. So melatonin can be very effective. I usually have patients start at a lower dose, perhaps three milligrams, and then work slowly to build up depending on how they tolerate it. I don’t think patients, without discussing with their doctor, should go beyond 10 milligrams because you have to be mindful of how much you’re taking. And most experts will say you need a melatonin break. It’s something that’s naturally produced in our brains by the pineal gland, and so, if you’re continually supplementing the melatonin, your brain might get used to not making its own. So you do need to take periodic breaks every few weeks or couple of months.
Dr. Christine Lay
Dr. Lay also recommends foods with melatonin, such as walnuts. (Make yourself some Morning Glory Muffins. Seriously.)
For a highly-rated melatonin without a lot of the additives that Dr. Lay talks about, try Natrol Melatonin. It’s very inexpensive right now, and has even bigger savings with Subscribe & Save. Be sure to get this particular version – Natrol has various others, such as the fast dissolve version that has additives that you’ll want to avoid.