migraine

5 August 2024

An MRI for Migraine?

So this is a “holy grail” of migraine diagnosis – that is, something that we’ve always wanted to be able to do. But – we haven’t quite found it yet. Or have we?

Let me explain. When a patient comes into a doctor’s office with a broken arm, the doctor can check how your muscles and joints are working, ask you where the pain is, and even take an x-ray. The result is pretty straightforward – you have a broken arm.

But migraine – and remember, there are various types of migraine, and migraine is only one type of headache disorder – is entirely different. Your doctor relies mostly on what you say (especially if you’re not in the middle of an attack right then) – how you describe the pain, what other symptoms you’ve noticed, and so on. They don’t generally give you a scan, or take a blood test.

Don’t blame your doctor for this – these tests wouldn’t usually be of any help, and in some cases might do more harm than good.

Migraine is a complicated disease. We don’t entirely understand why an attack happens. And although we’ve learned a lot about what happens in the body when an attack takes place – we can indeed see certain things happening with various types of technology – we still don’t understand why some people have migraine and others don’t. We have a lot of ideas, theories, and clues – and even a lot of knowledge – but we don’t have the whole picture.

So researchers are still trying to find a way to do test of some kind – to look at something in your body – that will tell them – yes, this person has migraine. Better yet, this person has this type of migraine. That way we would be able to get to the best treatment for you ASAP.

One of those bits of research was just published in June. It involved a type of MRI scan (magnetic resonance imaging scan) called diffusion-weighted imaging (DWI).

DWI is a type of scan that can “see” where water molecules are. Here, let’s let Dr. Alexander Mauskop from the New York Headache Center explain:

The researchers used diffusion MRI, a technique that focuses on the movement of water molecules within the brain’s tissues (fMRI measures blood flow to different areas of the brain). It is particularly useful for mapping the brain’s white matter tracts, which are the pathways that connect different brain regions.
Another MRI study attempts to diagnose migraine

So, as you would normally do in a study like this, they took patients with migraine, and patients without migraine, and compared the two. And yes, there tended to be a difference. Back to Dr. Mauskop:

Significant differences were found in brain regions such as the orbitofrontal cortex, temporal pole, and sensory/motor areas.

Changes in connections between deeper brain structures (like the amygdala, accumbens, and caudate nuclei) were also noted.

Using machine learning, the researchers could distinguish between migraine patients and healthy individuals based on these brain connectivity features.
Another MRI study attempts to diagnose migraine

That sounds pretty amazing, and it actually is. One of the beauties of computer technology is that computers can play with huge quantities of numbers – lots of data – and quickly compare things in a way the human brain can’t.

But don’t run to get your head scanned yet. Your doctor will still probably get a more accurate diagnosis by talking to you. Why?

First, this was a fairly small study. Will this difference continue in other groups of patients? Why the difference? Would there be a difference between patients with migraine and other different headache conditions? Or other conditions in general? And even if we can accurately predict that a patient has migraine, will this be more accurate than a well-informed specialist and a patient who communicates?

We hope that this research will continue, because it would have huge benefits. Meanwhile, instead of getting your head scanned, make sure you have a doctor who takes the time to talk to you. Consider a headache specialist. And watch your symptoms closely – tell your doctor what you’re experiencing, and be sure to share your medical history. Becoming adept at these things today will in most cases do a lot more than having a scan.

27 July 2024

Another Weapon against “Rebound Headache”?

James Discoveries & Stats, Medications, Treatments 0

A major concern among migraine patients (and their doctors) is what we sometimes call “rebound headache” or “medication overuse headache”. The perhaps over-simplified idea is that taking “too much” medication may make your headache symptoms come back worse than ever, or more frequently.

But this explanation can be misleading, partly because the whole concept remains very controversial. Just which medications lead to more headaches? And if migraine medication “causes” migraine, what’s the treatment?

In spite of a lot of misunderstanding regarding these types of migraine attacks, the ultimate goal really isn’t to take “less medication”. The goal is – you guessed it – less migraine! If you’re taking a painkiller or migraine medication and your symptoms are worsening over time, it may simply be time to try something different. Even if you end up taking more pills, you may be able to start a trend of fewer and fewer headaches.

How so? For example, if you find yourself taking a painkiller or more every single day, and your headaches are only getting more severe as the months pass, not to mention side effects from the medication, one option is to try a daily preventative – something that has been tested properly specifically as a daily medication.

Though information is limited about certain types of medication for certain types of migraine, every once in a while a study comes out that prioritizes a certain kind of medication for a certain type of migraine – such as rebound or medication overuse. And that’s the case with a study published in the journal Neurology last month.

The drug is atogepant, a calcitonin gene-related peptide receptor antagonist, sold under the brand name QULIPTA (you can read more about atogepant here). It’s a preventative taken orally each day. And in spite of the fact that rebound type migraine attacks are notoriously difficult to treat, atogepant seems to make a significant difference.

In the study, patients took one or two dose per day (it was the same amount either way – 60mg total). Patients had 2-3 few days a month with migraine, and 3 fewer days with other medications. For those with medication overuse headache, that means about a 50% reduction in headaches for almost half of the patients. Many of the patients actually no longer met the official criteria for medication overuse headache by the end of the study.

The best results overall came for patients spreading out the daily preventative in two doses.

Once again, this is not a silver bullet that works for everyone. But the results are very good considering how difficult this type of condition can be to treat. Study author Dr. Peter J. Goadsby notes:

Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications. This could lead to an improved quality of life for those living with migraine.
Dr. Peter J. Goadsby

This is one of those clinical trials that, although preliminary, can be useful immediately. Any medication showing positive results for medication overuse is worth moving up the list for those who are struggling with increasing headache and migraine symptoms.

9 July 2024

A New Understanding of the Migraine Chain Reaction

James Discoveries & Stats, News 0

A study published this month in the journal Science is making headlines – and with reason. It may be a significant leap forward in understanding just how the migraine “chain-reaction” happens.

Stop sign — *Can we stop the “migraine pain messengers”?*

The study comes out of the University of Rochester and the University of Copenhagen, from researchers who have been studying fluids in the brain for many years. This particular study was with mice, which are commonly used to study the mechanics of migraine.

There are many things that we know about migraine, and many things that we don’t know. We’ve often talked, for example, about the “cortical spreading depression” (CSD), a kind of storm that sweeps across the brain, sometimes causing symptoms such as visual aura (when it passes by the “visual” part of the brain). The CSD is common in migraine.

We also know about some of the biology of headache, in nerves and their communication of pain.

But we know surprisingly little about how and why the brain communicates pain symptoms that are so disabling in a migraine attack. And that’s where the study may have found a key.

What researchers discovered had to do with the proteins in the body’s cerebrospinal fluid. Basically, neurons in the brain release certain proteins into this fluid, which transports them to the trigeminal ganglion, a bundle of nerves that affect the head and face.

Think of these proteins as messengers. Certain proteins will communicate “pain” to your nerves.

You may have already heard of one type of these proteins already – the calcitonin gene-related peptide (CGRP). CGRP has become all the rage in migraine treatment because of a host of new medications that have come out targeting CGRP levels.

But this study helps us understand just how the brain changes CGRP levels, and it also shows that there are other protein levels that are involved in migraine – perhaps in various types of migraine.

That means, of course, that researchers are looking to develop new medications that may target protein flow. Different types of medications may even be able to stop different types of migraine.

This initial study on mice is a long way from a new treatment, of course. But if the results continue to be confirmed by future studies, the information may go a long way toward helping us stop the flow of “pain messengers” to those nerves in your head.

For more information:

Trigeminal ganglion neurons are directly activated by influx of CSF solutes in a migraine model (study abstract)
Brain fluid dynamics key to migraine mysteries, new therapies (ScienceDaily)
Pathway for Migraine with Aura Discovered (NeuroscienceNews.com)

11 May 2024

Rebreathing Devices – The Study Continues

James News, Treatments 0

“Rebreathing” refers to inhaling what you just breathed out – and it’s generally something you want to avoid. A look at the research out there focuses on ways to make sure that it’s not happening, because increasing the levels of CO2 (carbon dioxide) and decreasing levels of oxygen can cause all kinds of problems.

However, we’ve talked about rebreathing in an entirely different context. There is interest in a migraine treatment that carefully controls a certain amount of rebreathing.

The “Rehaler” is an incarnation of this concept. The device uses no drugs – it simply carefully balances CO2 and oxygen. The idea is to use it as an abortive treatment – as you notice a migraine attack coming on.

The Rehaler website explains it like this:

Rehaler works through accurately balanced partial rebreathing, meaning that part of the expired air is captured and subsequently rebreathed together with a controlled amount of atmospheric air. The net effect is an increase of the inspired CO2 percentage to a stable, adjustable level between 1.5 and 3.0%, while retaining normal arterial oxygen saturation (SaO2), no matter how long the device is used.
Rehaler Official Site

CO2 has been shown to lessen migraine symptoms in some people, and there are various reasons why this may be (for more, check out this page about the science of Rehaler). This is not something you can try by just using a paper bag over your face, because the oxygen and CO2 level has to be carefully monitored. But when it is, the device seems to be safe to use when a migraine attack is coming on.

And the advantage would be that it could be used over and over – so far it doesn’t seem to have the same limits of many medications. And, you could use it along with migraine meds if needed.

Naturally, Rehaler would come with an app for your phone, which will monitor and track your treatment, as well as providing instructions.

It’s fascinating to see this research continue. It may lead to a very simple migraine treatment, but it also may give us further insight into how migraine actually works. For more, be sure to visit the official Rehaler site!

13 April 2024

Does Migraine Make You Sleep More – or Less?

James Discoveries & Stats 0

A recent study and review of previous studies came to an interesting conclusion. Maybe migraine headache pain isn’t causing as many sleep problems as we think. But that doesn’t mean migraine and sleep aren’t related.

The study, published earlier this year in the journal Brain Communications, reported on a study with mice to see just how much migraine pain interfered with sleep. And the surprising result was: not much.

Let’s put it this way. Looking at this research and other studies, migraine does seem to affect sleep in certain ways (for example, migraine may affect REM sleep). But we can be forgiven if our perception is an exaggerated connection – when you’re writhing in pain, you’re desperate to sleep – and sometimes sleep just won’t come.

However, for some patients, they do sleep more with migraine. This may be a physical result of migraine itself, or simply because they’re trying to sleep more, and looking for a dark, quiet room.

I would be interested in your comments below, to hear if you have found that migraine pain actually results in less sleep or more sleep overall.

But that’s not the end of the story. The researchers confirmed again that migraine is associated with sleep disorders, and that sleep problems may trigger migraine attacks. In fact, sleep disorders may play a part in migraine becoming chronic. The connection between sleep and migraine is real, but complex. As a simple example, a poor night of sleep may not mean a migraine attack the next day, but it may increase your risk the day after that.

Sleep schedule, along with diet, may be one of the most powerful indicators of future migraine attacks. Though we all get frustrated when we can’t “sleep away” a migraine attack, we should also pay attention to daily sleep patterns in order to prevent future attacks.