Headache Journal

9 September 2021

Patients Explain: Why is Migraine “Bad”?

A recent study attempted to summarize real patients’ responses to migraine, and the results are fascinating.

There are some great resources out there that truly capture what migraine patients have to say, such as the brilliant book Migraine Expressions. This study takes a more scientific approach, collecting and indexing interviews with patients, and attempting to summarize what most concerned them.

Here’s a quick summary of Learning the full impact of migraine through patient voices: A qualitative study, published in the journal Headache. First, 90% reported that migraine had a negative impact on overall life. 68% identified specific areas of life that migraine affected. And 52% zeroed in on migraine’s effect on emotional health.

The study summarized the effect of migraine into 6 categories:

global negative impact on overall life
impact on emotional health
impact on cognitive function (trouble concentrating or communicating)
impact on specific domains of life (work/career, family, social)
fear and avoidance (pain catastrophizing and anticipatory anxiety)
internalized and externalized stigma

Next, the study summarized how patients basically explained why migraine attacks are bad. I’m sure you can identify with some of these:

Migraine controls life
Migraine makes life difficult
Migraine causes disability during attacks
Migraine causes us to experience a lack of control
Migraine causes us to attempt to “push through” in spite of the symptoms
Migraine leads to isolation
Migraine leads to anxiety
Migraine leads to frustration/anger
Migraine leads to guilt
Migraine leads to mood changes/irritability
Migraine leads to feelings of depression/hopelessness

Understanding these common issues helps doctors understand which treatments to prioritize, and helps patients to understand that they’re not alone. It also helps family members, friends and caregivers understand just a little of the “size” of migraine – how it truly affects all of life in many different ways. As the common saying goes – it’s not just a headache.

We would love to hear your comments – is there anything you would add or change, based on your personal experience?

Special thanks to Kerrie Smyres at The Daily Headache for pointing this study out. Be sure to check out her blog.

25 March 2021

Magnesium via Food or Supplement – and fewer Migraine Attacks

James Discoveries & Stats, Treatments 0

A new study, published in the journal Headache, once again points to magnesium as a key migraine-fighter.

*Did you know?* Spinach is super-high in magnesium!

We’ve talked a lot about magnesium in the past few years. And I haven’t kept track, but I’m pretty sure that of all the “thanks so much” emails I’ve received, the magnesium tips have been at least in the top 5 solutions that people have found for their migraine attacks.

This “cross-sectional analysis” is basically just an analysis of information that was gathered in the National Health and Nutrition Examination Survey. It’s only showing correlation – in other words, there is a connection – the study doesn’t “prove” that raising your magnesium levels tends to fight migraine. What it does do is match perfectly with previous studies as well as reports from many doctors, specialists and patients – that making sure you’re magnesium is at a proper level is key to fighting your migraine attacks.

The study showed that those who had the “recommended amount” of magnesium (current RDA in the USA) were at lowest risk of migraine. Those in the lowest quarter of the group, those who had the lowest intake of magnesium, were the ones who were at the highest risk of migraine attacks.

An interesting note was that the magnesium could be supplemented – in other words, it wasn’t just those who were getting all the magnesium from their diet, but also those who got some from supplements, who benefited.

There’s a lot more to read here at Headache and Migraine News about magnesium – such as dosage and why you shouldn’t take it with calcium. (if you’re taking it for migraine), a reminder that the type of magnesium you buy really matters, and which supplements some of our visitors have recommended.

For more on this particular study, see Dietary magnesium and migraine in adults: A cross?sectional analysis of the National Health and Nutrition Examination Survey 2001–2004

16 March 2020

Headaches After 10 Years – Will I Improve?

James Discoveries & Stats, Tips 0

A new study takes a look at an important question – after 10 years, which migraine patients have significantly improved – and why?

It’s important to remember that when it comes to conditions such as migraine, patience is important. A true, lasting, significant improvement can take time – but it’s worth it.

We’ve talked about the opposite before – what makes migraine worse? Specifically, what makes it become chronic? Genetics plays a big part, but there are other factors, such as sleep disorders, depression, obesity, and poor treatment.

This study published last month in the journal Headache looked at the progress of over 380 migraine patients after ten years. The study is titled How Does Migraine Change After 10 Years? A Clinical Cohort Follow-Up Analysis.

First of all, the bad news. Less than half of patients were significantly better. Now, that’s not quite as bad as it sounds – the researchers were looking for a significant improvement – days with migraine at least cut in half.

Still, that percentage is way too low, and there is good reason to believe that good information and quality treatment could have made things much better.

That being said, it was helpful to see a couple of the key things that made a difference:

NOT SMOKING: One of the biggest commonalities among those who improved significantly vs. those who did not was that the improved group did not tend to be smokers. This issue has been discussed for a long time in migraine research, but probably not enough. And it should be noted that turning to vaping is not the answer – vaping commonly triggers headaches. Your goal, even if it’s a longer term goal that you’re aiming for, should be to avoid smoking and vaping altogether, if you want to be free of migraine attacks.
MEDICAL FOLLOW-UP: Another major factor was something as simple as going back to the doctor. Just showing up. There could be a number of reasons for this. But as we mentioned above, migraine treatment is usually a long term process (as with many neurological issues). Going to a doctor and getting a prescription and never doing anything else is apparently a huge barrier to actual significant long-term improvement.

Another note on #2. Patients who started with more migraine attacks per month were also more likely to see significant improvement. Part of the reason could be that these patients are more likely to take migraine and its treatment more seriously. But remember, even a couple of days a month lost to migraine has a major impact over the course of a year – and a lifetime! Everyone should take fighting migraine seriously.

Although treating migraine may take time, and does require patience, don’t assume it’s going to take many years. It is hoped that migraine treatment for most people will bring an improvement in much less time.

And now we’ve learned two more keys – make a plan to quit smoking if you do, and don’t give up on improving your treatment as the years go by. There is hope – don’t give up the fight!

(Speaking of not giving up, remember that the Migraine World Summit starts this week – click the link to register for free, and make it your next “virtual” follow-up doctor’s appointment, with some of the world’s foremost experts!)

27 November 2017

Researchers Looking for Predictors of Botox Success in Migraine

James Uncategorized 1

Excuse the complicated title to this article, but this is what it means in plain language. Botox, or onabotulinumtoxinA, has been very helpful for patients with chronic migraine. But it certainly helps some people more than others. Researchers want to know why, and they also want to know if there is an easy way to predict which patients will respond best to Botox.

Blood Tests and Botox Today, patients need to go through all the treatments before they know if they will work. But what if you could go for a simple blood test which would tell you ahead of time that your treatment had a – say – 87% chance of success? Or maybe a 16% chance of success? That would save everyone a lot of time and money.

A study published earlier this month in the journal Headache found that certain markers may predict Botox success.

First, CGRP levels. We’ve heard a lot about CGRP (calcitonin gene-related peptide) lately, because of the new migraine medications that are coming out. CGRP levels an important part of the trigeminovascular system, and seem to play a role in communicating pain messages in the body. Levels were higher in patients who responded well to Botox treatment. (This is not the first time this has been observed – see Botox and CGRP – and the Future of Migraine Treatment

Second, PTX3 levels. High PTX3 (pentraxin 3) levels have been linked to inflammatory and vascular issues. Patients with higher PTX3 levels were also more likely to respond to onabotulinumtoxinA treatment.

Though this is likely one of many studies that need to be done, this kind of information will not only help us predict who is most likely to benefit from Botox treatment, but should also help us understand both disease and treatment better, so that we can make better options available in the future.

Read the study abstract here: CGRP and PTX3 as Predictors of Efficacy of Onabotulinumtoxin Type A in Chronic Migraine

17 July 2017

Could Stress Levels Predict Migraine Attacks?

James Discoveries & Stats, Information 0

A study published this month in the journal Headache is suggesting that daily stress could actually predict migraine attacks. Could this be a valid way to predict and even avoid migraine attacks?

The relationship between stress factors and headache and/or migraine is well known. However, concern has been expressed (by myself and others) about the way that this relationship is expressed and used in actual migraine treatment.

Could stress predict migraine? The study is Forecasting Individual Headache Attacks Using Perceived Stress (abstract), based on over four and a half years of information from 95 migraine patients. The patients filled out a daily “stress diary” known as the Daily Stress Inventory (DSI). The DSI is designed especially to measure the common daily stressors we all face.

The study authors, who have studied the link between stress and chronic headache before, believe that stress “let-down” is a major factor when it comes to headache and migraine. In other words, they believe that when you have a lot of stress, after that stress is gone you may experience a “let-down” migraine attack.

The authors were generally encouraged by the results, indeed seeing a connection between stress (or, more accurately, stress let-down) and migraine symptoms.

The authors also point out the benefit of being able to predict a migraine attack – the ability to stop an attack before it starts with treatment.

Up to this point, there would be few people who would disagree. Yes, migraine attacks and stress are related. Yes, being able to predict an attack is very valuable.

However . . .

But bear with me. Headlines such as “Today’s Stress Level Predicts Tomorrow’s Migraine Risk” are going to give you quite a false impression of this study and its implications.

First, the authors admit that this is only the first step in an attempt to create a good predictive model (“The stress model in this analysis should be viewed as representing a first step in the new venture of forecasting headache attacks and not a final model for widespread clinical use.”). In other words, no, they have not created a model that will always or even mostly predict an attack. In fact, they found about a 25% success rate in predicting attacks. This is, as they say, “better than chance”. In other words, it’s significant, it shows a connection, but having a 1 in 4 chance of being right is not a great model of prediction. (They use the illustration of a weather forecast – to say that it will rain tomorrow, and being right only 25% of the time, is not very useful!)

Second, there are a number of reasons why stresses one day could lead to a migraine attack the next day. For example:

Did the stressful events cause you to lose sleep? In that case, did the stress trigger the attack, or did the lack of sleep?
Had the migraine attack actually already started? If there were early non-headache symptoms, such as irritability or fatigue the day before, that could lead to stress. But the stress would actually be a result of the migraine attack, not a cause.
There are a lot of things that can cause stress. Did a lack of sleep lead to stressful situations in the first place? Are you always stressed when you’re at that weekly meeting – when you also drink too much coffee? Does the commute mean not only stress, but missing that healthy mid-day meal? In other words, there are hundreds of factors that could be involved, beyond just stress.

For every stress-let-down headache, we’re also seeing a let-down day with no headache. Why is that?

This is not so much a criticism of the study, but a caution against how we interpret it. This study does not show that stress is the cause of migraine attacks, or even the sole trigger. In fact, in most cases, it may not be a trigger at all.

Why is this important? Let’s use a simplistic example. Emily finds that weekly meeting very stressful. It usually causes her to be late to lunch, and she drinks too much coffee during the meeting.

She has migraine attacks, and the doctor blames it on stress. Sure, she could skip the meeting (could that have career consequences?). It might help. But what if she could just drink one less coffee, and bring a healthy snack?

Do not believe the idea that stress=migraine attacks. Many people with very stressful lives have no more headaches than the rest of us.

Besides, we have a lot less control over stress than we do over other things – bringing along that healthy snack, getting to bed at a regular time, exercising regularly, and getting good migraine treatment. In fact, a life without stress would not be very good for you.

Of course this is a complex issue. But again, taking a complex issue and over-simplifying it by saying,”Migraines? It’s just stress.” is not helpful for the patient.

Studies like this are helpful as we continue to try to understand the physiology of migraine. But let’s not be fooled by the headlines.

The full study is available here: Forecasting Individual Headache Attacks Using Perceived Stress