Uncategorized

12 October 2017

Yawning and Migraine: New Insights

Yawning is a common symptom of migraine, in both adults and children. A new study has confirmed the link once again, and is giving us more insight into what kinds of attacks are connected to yawning.

Yawning and Migraine The study looked at 339 patients, of which 45.4% reported repetitive yawning as a part of their migraine attacks. 11.2% reported yawning as a “warning sign” before an attack, with the rest experiencing yawning as either a symptom during the headache phase or a symptom both before and during.

An interesting aspect of the study was how yawning was associated with other symptoms. The symptoms that were more associated with yawning included:

Aura
Nausea and/or vomiting
Osmophobia (hypersensitivity to odors)
Cutaneous allodynia
Sleepiness
Irritability/anxiety
Changes in appetite

The most associated were aura and nausea and/or vomiting.

As the researchers understood, yawning may be associated with drops in dopamine levels. It may be that, for some patients, dopamine drops during a migraine attack (read Why Migraine Attacks may make you withdraw Into Darkness (or, Your Brain on the Holodeck).

Interestingly, yawning is also related to hypoglycaemia/hypoglycemia. Low sugar levels have a complex relationship with migraine, but both have been associated with yawning – and low dopamine levels.

For more, check out this article on Migraine and Hypoglycaemia.

To read the abstract of the recent study, see Migraine and Yawning.

For more strange symptoms of migraine, check out this infographic – Are these the 10 Strangest Migraine Symptoms?

9 October 2017

Coming Soon: The “ADAM” System for Zolmitriptan

James Uncategorized 0

Triptan medications have helped a lot of people with both migraine and cluster, and as the technology and research improves, more people who can benefit are able to use them.

Zolmitriptan in particular has been useful for both migraine and cluster headache, even for children with cluster headache.

A new delivery system for zolmitriptan is being tested under the drab name of M207, but also using the magnificent name The Adhesive Dermally Applied Microarray (ADAM) Zolmitriptan System.

Most of that simply means that it’s a sticker or patch. “Microarray” actually refers to a system of tiny needles – a word that is understandably avoided. Actually, from what I’ve heard so far, most patients do not experience pain from this patch (some of you who have been in the trials may want to comment).

How does it work? You take a small unit and apply the small round patch to your arm (it kind of reminds me of one of those bingo daubers – but of course it applies a sticker in this case). The patch gets the medication into your system very quickly – which is the main point.

ADAM System for Zolmitriptan - Application

ADAM System for Zolmitriptan - Applied For both migraine and cluster headache, you want the medication to get into your system as efficiently and quickly as possible. Many people have not benefited from zolmitriptan simply because they’ve taken it orally – and the medicine hasn’t gotten to where it needs to go on time – if ever.

So far the results have been good. Many patients have experienced full relief within an hour, more than half within three hours. This is with a dose of 3.8mg.

These results tell us that most people should benefit, but more importantly a few people should experience significant relief very quickly.

We’re talking about cluster headache, even though that is not the focus of the current trials. Finding better ways to administer this medication should help people with cluster as well, so we’ll watch for future developments.

There will be a new trial of the ADAM System for Zolmitriptan opening soon for adults with episodic migraine. The trial will investigate safety over 12 months, and see how the patch does in treating other symptoms such as nausea, photophobia and phonophobia.

If you’re interested in the trial, find out more here: A Study to Evaluate the Long-Term Safety of M207 in the Acute Treatment of Migraine (ADAM)

25 September 2017

More Ways to be a Better Doctor

James Uncategorized 0

Doctor, are your patients staying away from you because of your “bedside manner”, or because of something that doesn’t happen in your conversation at all?

We want patients to get the best care possible, and so if good doctors are losing patients because of small things that can be improved – they should know about it.

An interesting little analysis of data was recently done by Zocdoc, a platform designed to help patients find good doctors and make appointments. After every appointment, patients are asked for a review. What do those reviews tell us?

This was one of those simple reviews of words and numbers, which admittedly can only tell us so much. However, there are some clues here that might help doctors improve their ratings.

First, which words are common in positive reviews? Here are some examples: More Ways to be a Better Doctor

Friendly – that’s the top one. Ok, pretty obvious.
Thorough – of course, we don’t want the doctor to rush us out with a prescription of 2 aspirin before she really took the time to understand our symptoms.
Questions – interesting. This might relate to the one above. Taking time to answer? Asking good questions?
Knowledgeable – Yes, that’s a biggie. How many hours did your doctor spend studying headache conditions? Certification helps here.
Appointment – Was it easy to get one?
Concerns – I can make a good guess here. Did the doctor actually listen to your concerns? There are many other related words down the list… caring, explained, answered, informative, attentive, listens…

Of course, sometimes the negative reviews tell us more than the positive ones. So, let’s head over to that side. What did the bad reviews have to say?

Appointment – Yes, you saw this on the other list. Can you believe it, this was #1! Why? Were there mix-ups? Were appointments delayed? The research suggests that long wait-times, both before the appointment and in the waiting room were to blame. With a little organization, many of these complaints could have been avoided. Time to brainstorm in your office for some solutions!
Insurance – Again, easily making it in the top 2. Although the doctor only has so much control here, the office could make things go as smoothly as possible. Wouldn’t you like to be known as the doctor and team that does everything to help patients get coverage? That would be such a help.
Waiting/Waited – Already talked about this.
Questions – Another one high on both lists. Did the doctor not take the time to answer, or even listen? Rushed also made it high on the list.
Rude – That one should be obvious. But notice it’s a ways down the list!
Unprofessional – That can be improved, surely.

Another interesting thing to note about the negative reviews in particular. Words like “nurse” and “receptionist” were pretty significant. Meaning that the rest of the staff can make a huge difference. And, by the way, how does the doctor treat the staff? Just askin’.

I don’t want to see bad doctors thrown out of the business – I would like to see them become good doctors. But perhaps even more important, I don’t want good doctors to be avoided just because they don’t know how to talk to their staff, or because their receptionist made a mistake in scheduling, or because they haven’t found someone to help them administrate well. There are not enough good headache doctors as it is. Maybe a little feedback, positive and negative, can help make good doctors great.

To see the stats in more detail, check out What Really Motivates Positive and Negative Patient Reviews?. See also How to be a better Headache or Migraine Doctor

6 July 2017

The Low Tyramine Diet for Migraine – Is it time to rethink it?

James Uncategorized 1

One of the most popular migraine-fighting diets over the past 20 years has been the low tyramine diet. Avoiding foods such as soy sauce, salami, aged cheese, nuts and alcohol have been pretty standard. But – is it time to start eating these things again?

Time to rethink the low tyramine diet? There’s no doubt that the low tyramine diet has helped a lot of people reduce their migraine symptoms. But as we have learned over and over again, sometimes something “works” for a completely unexpected reason.

For example, could it be that just avoiding processed foods and being more careful about what you eat is actually the key, no matter what common migraine diet you’re trying? Or is there another chemical or compound in the food that is actually causing the problem, and not tyramine?

For example, the debate about just why some alcoholic beverages trigger migraine attacks in some people is far from over.

The makers of the Curelator app continue to challenge common knowledge about just what triggers attacks – and their latest target is, you guessed it, tyramine.

Taking information from 488 individuals with chronic or episodic migraine, they checked to see if tyramine actually triggered attacks. It did – but not very often.

Tyramine was a “confirmed trigger” in less than 10% of episodic migraine attacks, and less than 5% of chronic migraine attacks.

Now, at first this sounds pretty shocking. But it’s not as simple as it sounds. Don’t forget the “unconfirmed” triggers. And — if we could wipe out 10% of our attacks for sure by avoiding tyramine – or if 10% of migraine sufferers could eliminate their attacks by avoiding tyramine — well, you get my point.

So tyramine does still seem to be a significant trigger. BUT.

But what about all the people avoiding tyramine that don’t need to?

The Curelator researchers found another surprising result. For many people who suspected tyramine to be a trigger, it actually turned out to be a “protector”. In other words, they were more likely to avoid a migraine attack when they ate foods high in tyramine!

Perhaps the biggest take-away from this study is that we’re not always very good at guessing what our triggers are. Life if very complex, and apps like Curelator are heolping us rethink migraine triggers and stop avoiding things that we really don’t need to avoid.

For more on these findings, check out Curelator Headache Presents New Data Underscoring Misconceptions About Migraine Triggers And Protectors At American Headache Society Scientific Meeting

3 July 2017

Wine, Beer, and Headache Tips

James Uncategorized 0

There have been a lot of news articles lately about wine and headaches. Last year we talked a bit about the different theories about why wine may – or may not – trigger headaches or migraine attacks.

Wine, Beer, and Headache Tips There are also a lot of tips out there to help you avoid alcohol induced headaches in general.

For example, Dr. Seymour Diamond has recommended drinking two strong cups of coffee before you move on to alcohol. A little bit of honey in the coffee also may help, because the fructose in the honey helps the alcohol metabolize faster.

Trying something different may also help – some suggest a lighter coloured wine, or white instead of red. Also try wines that are lower in sugar.

Dr. Roshini Rajapaksa recommends a nondrowsy antihistamine prior to drinking wine.

But most of the advice seems to actually be – drink less. This includes not only simply avoiding alcohol, but also drinking water before you drink anything else – or alternating between water and alcohol.

Drinking water afterwards may help with the hangover, according to Dr. Dan Small.

With all the advice, remember that headaches related to alcohol have a number of causes. For example, if you get a headache right after drinking, it’s something different than the next-morning-hangover. If you have headaches like this, or any new headaches or symptoms, don’t just blame it on the drink – talk to a doctor who knows your medical history.

Have you tried any of this, or other advice? What have you found to be helpful?