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Skull Drilling for Migraine: So, was it a “thing”, or not?

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I recently read with interest an article at The Conversation (later published at Smithsonian.com as well) regarding the ancient art – practice – of trepanation (or trephination). That is, drilling or scraping a hole through the skull. The article was entitled Drilling holes in the skull was never a migraine cure – here’s why it was long thought to be, written by migraine historian Katherine Foxhall.

Skull from a tomb in Jericho
Skull from an ancient tomb in Jericho. Some of the holes are partly healed, showing that the procedure was not always fatal. Courtesy Wellcome Images
This was a fascinating article with lots of information about the history and the historical perceptions of trepanation.

It looks like trepanation has been around almost as long as humanity has. But the question why? is not always easy to answer.

In fact, the article didn’t offer proof that skull drilling was never used for migraine. It couldn’t, because we don’t always know what it was used for. Many societies never left records for us of the procedure – they simply left … well, skulls with holes in them.

But if a more modern era is any indication, trepanning was indeed done for headache – and hence probably for migraine.

Now, as Foxhall rightly points out, trepanning was used for many other things as well. Epilepsy and head trauma seem to be common examples. But again, for most cases we really don’t know what the purpose was.

In the book Trepanation: History, Discovery, Theory, edited by Robert Arnott, Stanley Finger and Chris Smith, the authors do indeed give examples of trepanation for severe headache.

In the PNG Medical Journal, D.A. Watters published some interesting information on trepanning in Papua New Guinea. The procedure was investigated by Europeans such as explorer and anthropologist Richard Parkinson. Even in the 1800s, trepanation was being used for trauma and – you guessed it, severe headache.

As a fascinating side note, many of these so-called primitive examples of trepanation were apparently quite “successful” – in the sense that the patient lived a long life afterwards. D.A. Waters says that most patients survived, in contrast to London in the 1870s, where most trepanned patients died.

The procedure was used in some parts of the world until quite recently – and may be practised today more than we realize.

So although historic trepanation is mostly shrouded in mystery, it almost certainly has been used to treat migraine.

And yes, doctors still drill holes in the skull today, often due to pressure on the brain as a result of trauma.

In other words – some ancient doctors may have been using a very modern treatment in a very modern way.

But some may just have wanted to “let the evil spirits out” (why bone would hinder a spirit, I’m not sure).

Be that as it may, chances are that a hole in your skull will only make things worse for you. So please, keep your head in tact, and talk to your neurologist about your next migraine treatment.

Yes, Migraine Pain may be Worse than the Pain of Childbirth (and more migraine statistics)

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Earlier this year, Eli Lilly and Company announced the results of a survey on the impact of migraine – appropriately called the Migraine Impact Report. The poll was conducted by The Nielsen Company, a well known data-gathering company in the USA.

So, let’s look at some of the data that they collected. Perhaps one of the most interesting is pain comparison.

So – you’ve experienced childbirth? Broken bones? Kidney stones? How did that compare to your migraine pain?

Now, a typical migraine attack was rated as 7.1 (out of 10) for pain. But what about your worst migraine attack?Pain Comparison ChartRemember, these are just averages from people who have experienced both migraine and the other type of pain.

The impact of the pain and of course other symptoms was the key part of this survey. Over the past month, migraine patients said that there had been almost a week when they couldn’t do what they wanted. That’s 84 days a year, or 2.5 to 3 months of the year!

Take a moment to think about the important events you’ve attended over the past year. Going to the kids’ play. A birthday party. A wedding. Now, cross out 7 or 8 of those events. That’s how many events the migraine patients said they had missed due to migraine attacks.

Now, of course migraine affects you at work. You’re concerned that you might miss that promotion, or simply not be as productive.

Now here’s an irony. 58% said “I worry that my coworkers think I’m faking or exaggerating when I have a migraine”. So, are there thousands of people out there exaggerating their pain at work? Well, 62% said,“I try to hide the true impact of my migraines from people at work or school”.

Hmmmmmm.

So actually, as other answers on the survey indicated, people without migraine actually underestimate how bad migraine is – and it’s partly because we (migraine patients) are generally trying not to make a big deal of it.

So no wonder most people with migraine said that their attacks make them feel “frustrated”. Interestingly, only a little over half said that the attacks usually made them feel “depressed”. (Depression is common in migraine, but not universal by any means.)

People who were not connected with people with migraine generally understood less about the disease – not a surprise. In fact, most were not aware that migraine is a neurological disease.

There is a lot more information in the survey – I encourage you to take a look. For a quick summery, there’s an infographic. Just click the image below:

Migraine Impact InfographicIf you want to go more in-depth, read Survey Reveals Many People with Migraine Live with Pain Nearly Half of Every Month, and then click on the blue Migraine Impact Report on the right side of the page.

Rugby

Yes, there is a Blood Test for Concussion (but how will it be used?)

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This February in the USA, the FDA approved a blood test for concussion (also known as mild traumatic brain injury). This is a remarkable step forward, but its usefulness may be in the future, not in the present.

Normally, patients who suspect they have a concussion will be evaluated by a doctor, and then they may be given a CT or MRI. If the scans show intracranial lesions (which most of the time they don’t), it will help the doctor know how to treat you.

The new blood test is officially called the Banyan Brain Trauma Indicator. Used within 12 hours of the injury, it measures proteins in the blood, and can predict how likely it is that a patient will have intracranial lesions.

The test is remarkably accurate – almost 99% accurate.

RugbyBut just how this test will be used in the short term isn’t certain. Will it actually help patients avoid a scan? Well, first patients would have to chose the slower choice – waiting several hours for blood test results instead of the much quicker scan. If it seems that the patient is likely to have intracranial lesions, will the doctor call for a scan anyway? And if they’re feeling sick and the test comes back negative, will a CT scan be called for in case they’re the 1% that the test doesn’t work for?

Of course everyone wants to avoid scans, lower health care costs, and have better diagnoses. But it may take some time before this test is actually useful in the real world.

There are a couple things that would be helpful, at first glance. First, this test is approved for adults, not children. But the company is working on a trial for children, so that’s coming.

Second, it would be interesting to see results from this test or similar tests correlated with symptoms. In other words, could a blood test predict how likely I am to have serious symptoms, or long term symptoms, from a concussion?

The problem is that most CT scans come back negative – and so presumably most blood tests would be negative too. But if levels could predict my risk for symptoms, the test could be a lot more useful.

Here are some more resources so you can dig deeper into this new test:

What Do You Hate Most About Migraine? (poll results)

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A recent poll here at Headache and Migraine News asked the question – Besides the pain, what do you hate most about your headache/migraine condition? The answers came from a predetermined list of common answers.

The results show – we hate a whole lot of things, and nothing stands out necessarily more than something else!

There was a winner – though not by a large margin. The most hated are the “other” symptoms of migraine – nausea, dizziness, photophobia – well, the list goes on and on.

Here are the full results:

What do I hate about migraine?Let’s face it, there’s a lot to hate when it comes to migraine. What about you? What do you hate most?

After anti-CGRP Drugs to fight Migraine: anti-PAC 1?

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Are anti-PAC1 drugs the next big thing for migraine treatment?

Based on the evidence we’ve seen so far, the new CGRP inhibitor drugs are likely to help many people with migraine. But for many they’re likely to be a big disappointment.

woman looking to the future...So amidst the ongoing media obsession with CGRP drugs, we have to ask – what’s next?

Of course, that’s probably the wrong question. Many branches of research are going on at the same time, and new treatments are constantly being tested. So what is special about this one?

Hitting the “Target”

As our understanding of migraine has grown, researchers have tried to find more “targeted” treatments. In other words, treatments that only affect the body in ways that specifically fight the migraine attack.

The more “general” (less targeted) a medication is, the more likely it is that it will have side effects.

For example, if we know that a certain chemical is low and causing pain, we could raise the level of that chemical to normal. Of course for migraine, that would be a major over-simplification, but that’s an illustration of the direction we want to go.

So the a lot of the excitement over anti-CGRP is because they’re more “targeted”. But some researchers think that anti-PAC1 drugs may take us to the next level.

PACAP

Recently, pituitary adenylate cyclase-activating polypeptide (PACAP) has been linked with both migraine and cluster headache. Researchers believe that it is an important messenger transmitting pain signals.

The most common PACAP is PACAP38, important in the neurological functioning of the head and face. We know that adding PACAP38 to the body can actually induce headache symptoms.

PACAP38 binds the PAC1 receptor. So blocking of the PAC1 through a PAC1 receptor antagonist could stop the migraine or cluster in its tracks.

In fact, we’ve talked about PACAP before and its genetic connection to cluster.

Incidentally, this treatment could help with other conditions, such as posttraumatic stress disorder.

And so begins the research…

Alder BioPharmaceuticals is already showing interest in this approach with their program to develop ALD1910 to fight migraine. Amgen is also on the brandwagon, with AMG 301.

For more information, be sure to check out this helpful article from Dr. Song Guo from the Danish Headache Center: Breakthroughs in migraine treatment

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Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.