Treatments

20 April 2020

GammaCore Device Approved for Migraine Prevention

The GammaCore device was approved late last month by the FDA in the USA for migraine prevention. It was already approved for preventative and acute treatment for cluster headache, and acute (as-needed) treatment for migraine.

GammaCore is a vagus nerve stimulator, a device which is non-invasive and drug free. The recommended treatment is three times a day, with two two-minute treatment each, as explained in this graphic from the official site:

GammaCore migraine prevention treatments

Nerve stimulators have been available for a long time, but often at a very high price, and they are often implanted surgically.

GammaCore is a small device that you can carry with you, to either use at the onset of migraine pain, or to use daily as a preventative. It’s simply placed against the neck when you need a treatment.

Side effects from this device seem to be rare and mild, and clinical trials have shown a lot of promise for quick and lasting pain relief. If you’re interested in a drug-free option, there is a lot of information on the official site of GammaCore here.

13 April 2020

VR for Headache: Time for an Update

James Information, Tips, Treatments 0

Back in 2006, we were already talking about using virtual reality to fight pain. One of the pioneers was a VR program known as “SnowWorld”, an immersive “cooling” experience.

So where has VR treatment come since then? Unfortunately, clinical trials probably haven’t kept up with the technology. A study published in 2019 brought together some of the information that is available today. Here’s a summary of what we know:

VR is very promising when it comes to “acute” pain. For example, if you had a bad burn and you had to have your wound cleaned, virtual reality is probably going to help lower your pain levels. This would seem to be promising for shorter term headache as well, or for use during the peak of a headache condition.
VR may help with chronic pain conditions, but we really don’t have enough information yet. It seems to help most when you’re actually in the VR world, but will it provide benefit between “treatments”? Maybe. But we have a long way to go before we really know enough about the dosage (how long the treatment should be) and the frequency of treatment.
Migraine patients in particular are a challenge because of the common symptom of photophobia. In other words, someone having a migraine attack will likely be sensitive to light, and will be seeking a dark room, not an immersive screen experience. However, this doesn’t rule out VR – there may be ways to have a low light immersive experience that includes sound. (A simple example – I recommend an app called Environments for iOS or Android. It’s just a picture, and sound – but go to “Alpine Blizzard”, take a glance at the picture, then close your eyes and listen with headphones. Seriously.)

So the update is that VR still has a lot of promise when it comes to treating pain, but clinical research is lagging behind.

Have you found that VR helps you with any symptoms? Reducing tension, decreasing pain? Let us know.

Meanwhile, here’s more detailed information from the recent study: Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. You might also want to check out this recent article from the New York Times: Virtual Reality as Therapy for Pain

3 February 2020

A Green Lamp for Migraine?

James Resources, Treatments 0

A unique lamp has been developed specifically for migraine – using pure green light.

Back in 2017 we discussed some research on coloured light (see Migraines and Blue Light – Or Maybe Green Light…). Are there certain parts of the spectrum which make migraine symptoms worse – or better?

Of course, any light can cause problems when it comes to migraine. But if you need some light, what colour is best?

Blue light is a common culprit – and you can read the article above to learn about some ways to minimize or block blue light at the right time (blue light is actually good for you – most people won’t want to block all of it out all of the time!). Red light also seems to bother some people, although we tend to have more “excess” blue light than red.

But some studies, as well as anecdotal evidence, point to the fact that green light may even lessen some migraine symptoms. So the best advice today seems to be – if you need a little light during a migraine attack, make it as green as possible!

And so, the Allay Lamp was created, which emits a completely pure green (which a tinted bulb can’t do). It was designed specifically for migraine sufferers based on research from the Harvard Medical School, and so has some very useful features:

Power/brightness can easily be controlled
An adjustable shade can direct the light where you want it, and even shield you from direct light
Fully portable – charges via USB and then lasts up to 32 hours!
Even has a “regular light” mode

It’s obvious that some serious thinking has gone into this light.

This is obviously not a cheap lamp, but it does come with a 40 day guarantee, so you should be able to give it a decent try before really committing.

So check it out here on the official website: Allay Lamp

(Obviously the author of this post finds this lamp quite interesting, and this is starting to sound like a sales pitch, so it’s worth noting that he’s not receiving any commission whatsoever. He’s just really impressed with the work that’s been put into this lamp, and wants to let you know about it. 🙂 )

Dr. Alexander Mauskop from the New York Headache Clinic wrote about this lamp and some of the research behind it as well – check out his post here: Light therapy with Allay lamp

27 January 2020

Tulsi Tea for Migraine

James Tips, Treatments 0

Tulsi tea*, a common tea in India, is a traditional headache remedy. But what is it?

Tulsi is a type of basil. Not exactly the kind you typically cook with, which is sweet basil, but a different variety called holy basil (ocimum tenuiflorum). It is sweet and aromatic, and can be used in hot tea or iced tea.

Using basil for migraine is actually fairly common. You may remember that Drs Young and Silberstein mentioned a basil oil massage in their book Migraine and Other Headaches. Some people use it in diffusers, and yes, some cook with it.

Aside from headaches, holy basil may have other benefits that migraine and headache patients may be interested in. It may help decrease inflammation, and help with stress and anxiety. There is even some evidence that it could help prevent cancer. (Read more: 10 Holy Basil Benefits: Tulsi Helps Anxiety, Acne & More and Holy Basil)

You may have noticed this post at Migraine.com of someone recommending tulsi tea as well.

There is some concern that the plant may absorb chromium from the soil, so it’s recommended that you start with an organic leaf, which can easily be purchased in bulk on amazon (also in bags here).

To make tulsi tea*, use about a tablespoon of dried leaves per cup, and pour freshly boiled water over. Brew for 5-10 minutes, or longer. For an iced tea, use double the leaves, let it cool, and add ice.

* Yes, I’m aware that “tulsi tea” is not actually a tea, but a tisane. But it is commonly known as tulsi tea. Which does have a ring to it, even if it’s wrong. However, maybe you should tell your friends that you’re making a tulsi tisane, and impress them with your smarts (which may be another benefit of tulsi tisane – increased mental powers).

2 December 2019

Botox vs. CGRP Inhibitors – the fight begins…

James News, Treatments 0

Are the newcomers to migraine treatment really any better than Botox treatment?

That’s one of the key questions being asked now. And it’s an important one, because it’s affecting migraine patients and their insurance coverage.

Patient and doctors — Are important policies being decided “behind your back”?

For example, in England, NICE (National Institute for Health and Care Excellence) recently decided not to recommend Ajovy (fremanezumab) as one of the drugs provided under the NHS (National Health Service). Why? Because current evidence doesn’t show the Ajovy is that much better than Botox (onabotulinumtoxinA) for patients who have tried several treatments already. And if the difference in success is negligible, the difference in cost is not – onabotulinumtoxinA wins easily.

Botox, once the strange newcomer to migraine treatment, is now an old standard. And it may be difficult for policy makers and insurance companies to accept the newcomers, even if they may be better for some patients.

Interestingly enough, its affect on CGRP may be one of the reasons why onabotulinumtoxinA works for migraine patients, which may explain similar results. But we’re still waiting for some good head-to-head studies to really show us which is “better” – “better”, that is, for most patients in general, not necessarily better for you. Welcome to the real world. (Also see Botox and CGRP – and the Future of Migraine Treatment.)

If new studies confirm that Botox performs as well as CGRP inhibitors, of course doctors may want to recommend Botox first, as a less expensive option, to most patients. But Is that a reason to not recommend the CGRP inhibitors at all? Or not to cover it in an insurance policy?

~~Of course, all this has nothing to do with money and politics.~~ Well, ok, maybe it does. Allergan is busy trying to convince investors that Botox for migraine sales continue strong. And there is some evidence that onabotulinumtoxinA and CGRP inhibitors may turn out to be best friends, because the anti-CGRP drugs may help the migraine-fighting effects of Botox last longer (see Concurrent CGRP Inhibitor and OnabotulinumtoxinA Therapy Boosts Relief in Severe Chronic Migraine).

But with the current expense of the new drugs, and a lack of studies to show long term safety, Botox may still have a surprising advantage.

(You can see in detail the reasoning of NICE in their paper here: Fremanezumab for preventing migraine (pdf). Also see Results of The Migraine Trust’s latest patient survey to inform new migraine drug NICE consultation.)