It’s been a while since I’ve posted – in fact, even HeadWay has been quiet, and thanks to some technical issues on Facebook, even my daily posts have temporarily disappeared. X is still rolling along!
There’s nothing specific to report personally, except that life catches up with all of us once in a while. This is one of those “once in a whiles” for our family! It’s been a busy few months, with both the expected and unexpected, health-related issues and non-health-related issues. But it’s all made it very difficult to keep posting. I was able to keep up with daily social media posts – except, what’s up Facebook?
Anyway, if anyone is wondering and concerned – yes, I’m fine! Everything is all right, there are just some things that have been keeping me away from the keyboard.
A useful review was published last year in the medical journal Current Pain and Headache Reports, regarding migraine in patients over the age of 60. It was brought to my attention by an article in Everyday Health last month.
It might be useful to get a quick overview of some of the report’s findings.
Many people with migraine are told that their symptoms will likely diminish or go away as they get older. And that is often the case, especially from a strictly statistical standpoint.
But you are not a statistic, you’re an individual. And the fact is that many people continue to have regular attacks into their 80s, or even start having attacks in their older years. The report found that 10% of older adults had migraine, now spread out more evenly between men and women.
If you started having attacks before the age of 18, you’re more likely to continue having attacks in later years.
How is 60+ Migraine different?
Attacks may not be different, but they can change throughout life. For example, many older adults find that:
Their headache pain is now more often two-sided
They may be less sensitive to light and noise
They may experience fewer “cranial autonomic symptoms”, such as congestion or watery eyes during an attack
Sometimes the attacks are less severe
They may experience “stroke-like” symptoms for the first time, including visual aura, trouble speaking, or difficulty with movement
How is 60+ Migraine diagnosis different?
Your headache specialist will want to make sure that you’re not suffering from other problems that become more serious with age. For example, since migraine attacks can mimic stroke, the most urgent thing with any new symptoms is to quickly rule out stroke.
Cardiovascular issues in general are important to check as well.
The report gives some helpful information about the timing of the headache. For example, if you have headaches that get worse at night, brain imaging might help with diagnosis. Headaches worse in the morning may indicate sleep problems, such as obstructive sleep apnoea.
It’s also all the more important for your doctor to know your medical history, and to watch for any current infections or other problems that may be related. It’s also very important that they pay attention to medications and supplements you may be taking, which could affect or even cause headaches.
How is 60+ Migraine treatment different?
Aside from ruling out other conditions, migraine treatment in older adults can be tricky because of concerns about medication interactions, and other contraindications (e.g. medical reasons why a medication may make another condition or risk factor worse).
CGRP related medications, although they don’t have the long-term history of other medications, are looking like a positive treatment for older adults. The study specifically mentioned lasmiditan, ubrogepant, and rimegepant. Candesartan, also used for high blood pressure, may help.
However, many older medications used for migraine may be used. Some, with newer evidence, are not as much of a concern as they used to be. So there are many other options that your doctor may suggest. The report simply gives the good advice that it’s especially helpful if you’re 60+ to start at a low dose and go up gradually. It requires patients, but it’s worth it.
Although the report briefly talks about lifestyle (diet and exercise), it doesn’t spend time talking about many non-drug treatments. These should be discussed with your doctor, but it widens the options significantly with good evidence-based treatments.
If you or someone you love is 60+ with migraine, it’s worth taking a look at this article, and the report – which is more technical, but has a lot of information.
There are a whole host of lifestyle and exercise recommendations for fighting migraine. A fascinating study published this month in The Journal of Headache and Pain looked at how much solid evidence there is for various types of “therapeutic exercise”, and included studies of everything from high-intensity interval training to relaxation techniques.
Each type of exercise was given a grade from B to D. What will especially catch your eye are the specifics about aerobic exercise, so let’s take a closer look.
As I studied, I was surprised to discover that I was a little weak on the actual definition of “aerobic”. Citing The American College of Sports Medicine (ACSM), this article from the National Library of Medicine defines “aerobic exercise as any activity that uses large muscle groups, can be maintained continuously and is rhythmic in nature”. “Aerobic” refers to the use of oxygen, so think of anything that requires extra oxygen. But that’s not necessarily sprinting – it could be much less intensive, such as walking.
Other examples would include jogging, swimming, and stair climbing.
As you can tell, there is actually a wide range of aerobic activity. So what has the best evidence as a migraine-fighter? Several studies recommended aerobic exercise in general, and some specifically “moderate-intensity continuous aerobic exercise”. Low intensity did not seem to do as well as moderate intensity, but it still earned a “C” score on the evidence scale.
So basically, any aerobic exercise is a step in the right direction, with moderate-intensity having the most studied benefits. Moderate aerobics three times a week is the specific recommendation.
The benefits found in the studies included:
Decreased pain frequency
Decreased pain intensity
Decreased pain duration
Decreased disability
Increased quality of life
That may seem vague, but remember that these were studies specifically designed to measure improvement, so this is more than just “I seem to feel a little better”. This is a significant improvement.
For those with migraine, it seems to be wise to start slowly and gradually increase the intensity of your exercise, being sure to stay hydrated. The Cleveland Clinic has a great article introducing aerobic exercise here.
Also, the American College of Sports Medicine has a chart explaining “intensity” more specifically. Don’t get nervous – if you can add any kind of movement to your life, it should help your quality of life. These exercises don’t need to be intense – but you will need to push yourself a little. Here’s the chart: Tips for Monitoring Aerobic Exercise Intensity.
A new book, just published this year, provides another resource for young kids (ages 4-8) who are struggling with migraine.
Recently I enjoyed reading an article by Joanne McPhail, the author of a new children’s book, “Milly Has A Migraine”. Well, of course I don’t “enjoy” hearing about people’s migraine attacks! But there was a lot of insight in a short article. Here’s a bit of it – click the link for the rest.
I am not sure what was worse as a parent; watching them in pain and not being able to fix it, or watching their emotional struggles and not having a band-aid for that either. Having a lot of migraine attacks can be so difficult in so many ways. From people not understanding the whole-body experience of a migraine and wondering why you can’t just carry on with a headache; to people thinking you are exaggerating or making things up. Then there is just being forgotten about (out of sight, out of mind), left out and missing out. My kids were both sports kids, and I cannot tell you how much guilt we all had about practices and games missed. I will say that I probably didn’t help at those times, as I myself felt badly about them missing these things, and likely contributed unwittingly, to their stress. With a little distance, it’s easier to reflect on these things and reflect on what I could have done better.
It is a challenge helping children with migraine, even if – or maybe especially if – depends on how you look at it – you have migraine yourself. And so I’m always interested in resources that will help parents and children alike in the journey. Milly Has A Migraine is one of these – another way to open up conversations with your child about migraine.
If you’re interested in the book, you can pick it up at Amazon here – Milly Has A Migraine. Purchasing through the link will also help the work of this website continue, helping kids and adults alike through the maze of migraine and headache information.
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
