MARK YOUR CALENDAR
This year’s Migraine World Summit runs March 8-16, 2023.
Now in its 8th consecutive year, the Migraine World Summit is the largest worldwide online event for migraine and headache disorders. Whether you live with migraine or another headache type, or want to understand more about this complex disease, we can’t wait to see you there.
You’ll hear directly from 32 internationally recognized migraine experts. They come from top-tier hospitals, universities, and headache centers, and they’ll talk about the latest medical research in understanding, preventing and treating migraine. They will distill clinical findings and years of experience into knowledge that will have a meaningful impact on your life.
We designed the Summit to be accessible and to create hope. The Summit is free during the live event and is also available to purchase for lifetime access.
Starting March 8 and running for eight consecutive days, the all-virtual Summit features four 30-minute expert interviews per day. Join us for a live highlights webinar on the last day (March 16th) where you can interact with us directly.
The schedule, topics, and speakers are now available at migraineworldsummit.com
How the Migraine World Summit works
From now until the Migraine World Summit, you’ll hear from us about what to expect during the event. We’ll share more about the Migraine World Summit hosts, topics covered at this year’s event, and how you can watch the Summit at your own pace.
Each day of the Summit features interview sessions with internationally recognized professionals. Our interviewers ask the questions you suggested during our public topic-and-question voting several months ago. See the 2023 Migraine World Summit schedule.
The Migraine World Summit can be viewed on any internet-capable device that supports video. Each day you’ll receive a link to that day’s session. You can access these free sessions for 24 hours beginning at 3:00 pm Eastern Standard Time (New York, USA), or the equivalent in your time zone. Wherever you are in the world, you will have 24 hours to view each day’s interviews.
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‘Tech neck’ and ‘text claw’ – what humans could look like in the year 3000 from ITV news
Future humans could have smaller brains, second eyelids and hunched backs due to overusing technology, new research claims.
It’s thought looking down at mobile phones and spending hours sat at a computer screen could impact on how we develop over time.
After collecting scientific research and expert opinions, the US technology company TollFreeForwarding.com has created a 3D model of a potential future human called ‘Mindy’.
Mindy, who is from the year 3000, has a body which has changed significantly because of smartphone, laptop and technology usage.
The researchers said the “exaggerated” changes to the body show the potential harm of using technology too much, both physically and mentally.
The full changes to the body include:
- Hunched back
- Text claw
- 90-degree elbow
- Tech neck
- Thicker skull
- Smaller brain
- Second eyelid
Researchers say this is an exaggerated version of what the future human could look like due to technology usage. Credit: TollFreeForwarding
A more arched back and neck is one of the potential changes the study said technology could cause to the body.
By looking down at phones or up at office screens, our posture changes and our body becomes under more strain.
Caleb Backe, a health and wellness expert at Maple Holistics, said looking at phones “throws your spine off balance”, while neck muscles have to “expand extra effort to support your head”.
Mindy also suffers from so-called ‘text claw’, according to the study.
The condition occurs after gripping your smartphone and curling your fingers into an unnatural position for long periods of time.”Text claw” is a condition that results from excessively holding your mobile phone. Credit: TollFreeForwarding
The other change that could affect future humans’ arms is having a 90-degree elbow, also known as ‘smartphone elbow’.
It is caused by holding a smartphone too much – either for general use or when making phone calls.
Scientifically, this position stretches nerves and can cause “weakness in the hands”.
Thicker skull and smaller brains:
The study also explored the potential damage of smartphone radiofrequency radiation.
This concerns a 2011 World Health Organisation report which classified smartphone radiation as “possibly carcinogenic to humans”.
A number of studies are seeking to establish the long-term impact, but the research by TollFreeForwarding proposes that Mindy has a thicker skull to protect her from harm.
Future humans will also have a smaller brain inside of that skull, according to the study.
In 2010, cognitive scientist David Geary said that human cognitive ability may decline because of technological advances in agriculture, health and more, meaning humans have to do less to survive.
The TollFreeForwarding research claims this may mean humans “shrink”. Mindy the future human has developed a second eyelid to prevent harm from technology and screens. Credit: TollFreeForwarding
A Second Eyelid
The research also suggests human eyes may adapt to the harm screens can cause.
Adapting to prevent headaches, eye strain and blindness, Mindy has developed a “larger inner eyelid to prevent exposure to excessive light”.
The study also added technology could mean humans are more vulnerable to anxiety and stress related issues.
So how do you stop yourself from looking like Mindy – the future human?
- Take regular breaks from technology
The study added that employers can help employees by encouraging breaks or offering free gym memberships.
How many of us have had an entire day ruined by the wrong scent? Some with migraine need only walk by a perfume store, fill up a gas tank, or attempt to cook salmon for dinner and suddenly debilitating nausea, vomiting, and extreme pain ruins the entire night. While not talked about as frequently as light or sound issues, hypersensitivity to scents, known as osmophobia, is a major component of migraine for some, and it can be equally taxing.
Dr. Frederick Godley is an ENT-otolaryngologist and is the co-founder and current president of the Association of Migraine Disorders, a not-for-profit organization.
What’s osmophobia and how prevalent is it for people with migraine disease?
Dr. Godley: Osmophobia describes heightened sensitivity to smell that can either be unpleasant or repulsive. About half the people with migraine disease report having osmophobia, some describing odors that trigger an attack, and others who become sensitive to smell during their attack. There’s further variability because some have sensitivity during every attack, while others note that it only occurs some of the time. Osmophobia and anxiety strongly overlap as comorbidities. Our receptors transmit smell to a part of the brain that enables us to detect different scents, but also to other parts of the brain that relate memory to smells that have caused problems before, as well as to the pain-causing trigeminal nerve. This overlap produces anxiety: when the olfactory system becomes hyperactive, it also causes hyperactivity of our fight-or-flight reaction.
What are some of the most problematic scents?
Dr. Godley: Scents that we use to add pleasant smells—perfumes and colognes, aftershaves, deodorants, air fresheners. For many with migraine, these are triggers. Volatile chemicals are a second category, such as cleaning products. Finally, anything that has smoke, including engine fumes, cigarette smoke, vapors from burning plastic or wood, and even burned food can trigger an attack.
What can we do about hypersensitivity to smell?
Dr. Godley: The first strategy would be avoidance. You can use any barrier that works, including masks or regulating airflow, such as a fan. Since we can’t always control the environment outside of our homes, it’s essential to inform employers that the workplace can have odors that trigger migraine attacks. As with other forms of migraine, clinical psychologists can teach coping skills through cognitive behavioral therapy, and we can employ relaxation techniques to reduce anxiety. Medications can also help, including the anti-epileptics, venlafaxine, phenytoin, gabapentin, and acute anti-migraine medications, specifically the triptans.
Watch the full interview for answers to:
What is osmophobia and how is it related to migraine?What other conditions is osmophobia associated with?How prevalent is osmophobia among people with migraine?How do you know whether smells trigger a migraine attack, or whether someone with migraine is hypersensitive to smell during an attack?How does the brain perceive smell?
How is osmophobia related to depression and anxiety?Why are some people more sensitive to smell than others?Why are women more prone to osmophobia than men?
Are natural smells less apt to trigger a migraine attack than artificial smells?What are “phantom smells” and why do they occur?What other neurological conditions are associated with phantosmia?What can we do to overcome osmophobia?
Are there any medications or therapies for it?Can osmophobia worsen with age, or even with the progression of migraine?
Watch Dr. Godley’s interview preview here or order it as part of the Migraine World Summit package from this page.
When new medications are introduced, many of us are eager to try them, hopeful that one will free us from pain. Yet many of us are concerned about the long-term effects and may wait, despite the impact of migraine on our lives. The last few years have seen many advances in migraine-specific treatments. What do we know about their long-term effects?
Robert Cowan, MD, is a leading migraine researcher who has conducted dozens of clinical trials on new medications. He is Professor of Neurology & Neurosciences, Chief, Division of Headache Medicine, at Stanford University School of Medicine, and is both a skeptic and a champion for better patient treatments.
How do new medications make it to market?
Dr. Cowan: In the U.S., the pharmaceutical industry—pharma—does the actual testing of drug efficacy and safety, as opposed to the Food and Drug Administration (FDA). The FDA monitors how pharma tests and develops new drugs, determines if there are general adverse effects, what’s safe dosing, what the side effects are, and whether there are any drug interactions. This process occurs over three distinct phases: Phase 1 determines if there is toxicity; Phase 2 considers the optimum dose; and Phase 3 studies actual patient populations. On average, it takes ten years—and sometimes decades—for a new drug to come to market, and the FDA only approves about one in 5,000 being tested. However, because pharma develops drugs to meet significant medical needs, there can be a great deal of political push to get these new medications approved before we understand their actual long-term impact.
What do recent studies show about Aimovig, the first anti-CGRP medication to be introduced, and therefore the longest in use?
Dr. Cowan: As an anti-CGRP medication, Aimovig is unique in that it binds to the receptor; the others inhibit CGRP from getting to that receptor. Because of the way it functions, it has a months-long half-life (the length of time when its effects continue to work in your body). One side effect of Aimovig for some is constipation. We also know that next to the brain, CGRP is most prominent in the gut, where it’s involved in the continuous process of healing the gut lining. People with Irritable Bowel Syndrome (IBS), a disease that many people with migraine have, can have diarrhea, but some have problems with constipation. If you’re a person who experiences constipation, you should consider a different medication because you don’t want to impact the gut further as well. It is essential that your doctor understands your health history so that you can make decisions about Aimovig, or any medication, based on science and in consideration of your own individual health issues.
What’s the best way for someone to make a determination about the long-term risks of a medication?
Dr. Cowan: If you have particular concerns about a medication in relation to your own health history, I suggest that you wait and see, especially when there isn’t sufficient data. The approach I use with patients is: a) if you’ve tried everything else; b) you’re not getting any better; c) your migraine attacks strongly and negatively impact your life; and d) you would’ve qualified for a clinical trial (meaning you were between the ages of 18 and 65, and don’t have other significant comorbidities), I would say it’s reasonable to try it. If you are not in that general group that’s been studied, but your health is heavily affected, you can still decide to use a medication with the understanding that we don’t yet know the long-term effects. You should always exercise caution, but you also must consider the impact of migraine disease on your life as you make a judgment.
Watch the full interview for answers to:
What kinds of studies are done to test the safety of new medications? How do new medications make it to market?Are there aspects of clinical trials that might ensure the success of a drug but that also could be harmful to patients in the long run?
When is it a good idea to try a medication for which we don’t yet know the long-term risks?
How do patients and clinicians weigh the tolerability and side effects of a medication?How do clinicians find out whether migraine medications cause complications or interact with a patient’s other medical conditions, such as thyroid issues?What have recent studies shown about some of the newer CGRP medications?Have studies been conducted on the long-term effects and possible dependency issues of CGRP medications?Can these findings be applied to other similar drugs?
Why do CGRPs potentially affect the GI tract?
How are side effects of a drug monitored after clinical trials are over and it’s on the market?Which types of migraine medications are contraindicated for patients with heart risk?
When would a CGRP medication be preferable to a triptan?What recommendations are there for people who might be afraid to try some of the newer targeted medications and are instead relying only on their standard ones?
What is the best way to find out if a medication has long-term side effects, and then to determine if the benefit outweighs any risks?
Watch Dr. Cowan’s interview preview hereor order it as part of the Migraine World Summit package from this page.
We can feel like our brain is under siege when bombarded by frequent migraine attacks. How can we optimize brain function when we experience chronic pain? Can we reverse the damage we’ve had? How do we know if our perceived cognitive decline is due to the natural process of aging, migraine itself, or the treatments we take for migraine? Whatever our diagnosis, brain care is for all of us.
To guide us, here is an Interview with Krystal L. Culler, DBH, MA, the Founder and Creative Director of the Virtual Brain Health Center, is a behavioral health doctor.
Is it possible to make positive changes for our brain and at any age?
Dr. Culler: Absolutely. Brain health is 90% lifestyle and only 10% genetics. And it’s never too late; brain care and brain health are for all of us, despite age and any type of diagnosis or health care concern we have. Brain plasticity is the life-long ability to adapt and change, and that happens through lifestyle choices. We have the ability to sculpt and mold our brains, which can be cumulative over time. We need to manage our health conditions actively, like migraine and any comorbidities, by working with our health care providers and taking a proactive role that enables us to play a part in that process.
What’s the connection between sleep, especially quantity, duration, and consistency for brain health?
Dr. Culler: Sleep is deeply restorative for our brain. At night, we’re able to clean out toxins that we accumulate throughout the day. It helps us restore memories of that day’s events. For that to happen, we need deep REM sleep. We need the optimal seven to nine hours. Many people believe the old myth: “I just need three to four hours, and that’s all I need to function.” That’s not true. You need to spend a third of your life sleeping if you want optimal health and well-being. That’s what brain health research shows.
For many of us, chronic pain or headaches can disrupt our sleep. But doing what we can to make sleep a priority, developing good sleep hygiene and putting a routine in place are priorities. That will help set us up for success.
How do stress management and building resilience relate to brain health?
Dr. Culler: Stress has a full-body impact. You want to think about different tools you can use so you can get your emotional response down, even a little bit. We’re all dealing with different stressors, so developing effective strategies is important.
For example, I encourage five-minute brain breaks. That can be anything that turns your brain off and lets you have fun, something that will uplift your spirit, that lets you play, or brings you joy. For example, go outside, feel the warmth of the sun on your face, explore nature, spend time with pets, put on music, or dance to your favorite song. Do anything that lets you unwind. And take those breaks frequently.
Watch the full interview for answers to:
Does the average person take good care of their brain?How much brain health results from genetics versus lifestyle choices?Can we take steps toward improving brain health at any age?How do we prioritize brain health focus even while managing chronic health conditions?What are 10 top-recommended tips for achieving optimal brain health?What is the connection between sleep and brain health?How do movement and exercise help rejuvenate the brain and what are realistic ways to obtain these benefits even while managing migraine?What impact does stress have on us and what simple strategies can we use to limit its effects on our health?How can we eat in ways that support optimal brain health?How does dehydration affect cognitive performance?What considerations do those living with migraine need to have regarding caffeine and alcohol?How is social connection relevant to health and well-being?What does the pursuit of lifelong learning do for brain health?Why is engaging the brain daily in new ways important?What are some strategies we can use to effectively “work out” our brains daily?Is meditation an effective tool in optimizing brain health?What impact does chronic pain have on the brain?Is migraine a risk factor for the development of dementia?Do migraine medications carry risks of short- or long-term cognitive impairment?Is cognitive decline inevitable with aging? How can a decline be avoided through the development of a “cognitive reserve”?How can people access screening for memory impairments?
Watch Dr. Culler’’s interview preview hereor order it as part of the Migraine World Summit package from this page
We hope you are as excited as we are. The largest virtual patient event in the world for migraine and headache disorders starts tomorrow, Wednesday, March 16, in your local time zone equivalent of 3:00 PM US Eastern Time (New York, USA). The interviews will be available for a full 24 hours in every time zone worldwide.
Check out our quick tips to make sure you’re ready for this once-a-year event:
Is the Summit still free? Yes!
How do I calculate the exact time the Summit starts in my area?
Click here to open a time converter that will show the exact time the program will start each day in your time zone. Just fill in the large blue box with your specific area and the converter will tell you what time 3:00 pm, New York is where you live–the start time of the day’s events. The Summit will start each day in your locality at that time.
How long will each day’s interviews be available?
We’ve made the interviews available for free in every time zone globally for a full 24-hours. For example, if you lived in Auckland, NZ, east of the international date line, and had typed Auckland into the blue box, you would see the Summit starts there on 3/17 at 8:00 am. It will start at that time every day of the Summit and you will have a full day to watch the interviews.
How can I become more familiar with the Summit schedule?
Each day of the Summit we’ll email you a link to that day’s interviews. If you don’t want to miss an interview, you can add the day to your calendar by using the Add to Calendar button at the top of each day’s schedule.
How do I read the Summit tips?
The Summit Tips Page will help you get the most out of the Summit. Here you’ll find information about how the Summit works, how to comment on an interview, and much more. You’ll also find out about special features of the Summit, including Learning Tracks and how to request further information about a product or treatment mentioned during an interview.
Does the Summit have a Frequently Asked Questions page?
If you have a question about the Summit, our FAQ page may provide the answer. But if not, feel free to send a message to one of our Community Support Ambassadors using the “Let’s Talk” box at the bottom right of any page.
How do I make certain that your emails are arriving in my inbox?
You want to make sure our emails land in your inbox and not in your junk or spam folder. Add firstname.lastname@example.org to your contacts or safe sender list so you don’t miss any emails from us.
What if I want future unlimited access to interviews: when does early-bird pricing end?
If you’d like unlimited access to all the videos, transcripts, audio files, treatment directory and more, this is your last chance to take advantage of early-bird pricing. Get up to 24% off your order. Hurry! Offer ends tomorrow (March 16th) at 3:00 pm Eastern time. You can still purchase unlimited access at any time after that, but without the early bird pricing.
See you tomorrow!
Paula K. Dumas and Carl Cincinnato
Co-Hosts, Migraine World Summit
Here is an excellent article published by The Migraine Trust. Worthy of a read if you are a sufferer.
By: Rachel Baxter, Communications Officer, The Migraine Trust
11th January 2022
With Christmas over and Dry January in full swing, you might be noticing differences in your migraine attacks if you’ve drunk more or less than normal recently. If there seems to be a connection between alcohol and your migraine, you’re not alone. About a third of people with migraine find that alcohol can trigger their attacks, while about 10 percent find it triggers them on a regular basis, according to a 2016 study.
Alcohol-induced migraine attacks can come on quickly after alcohol consumption, within minutes to hours. Even small amounts of alcohol can trigger an attack. People with migraine are also more likely to experience a headache the morning after drinking. In this blog, we answer some common questions about alcohol and migraine.
Why do I get a migraine attack when I drink alcohol?
Unfortunately, we still don’t know exactly what it is about alcoholic drinks that triggers migraine, and the root cause might be different for different people. For example, it may be the actual alcohol itself that triggers attacks – the chemicals it’s broken down into by the body may directly trigger migraine, or its diuretic effect (an increase in your need to urinate) may lead to a migraine attack by causing dehydration.
Alcoholic drinks also contain certain compounds besides the alcohol itself that may trigger migraine attacks – these are the byproducts of alcohol fermentation. Known as congeners, they are thought by some researchers to trigger headaches – as a general rule, darker drinks tend to have more congeners. This could potentially explain why some people with migraine find they can’t drink certain darker drinks like beer or red wine, however, more research is needed to find out.
Alcohol also causes our blood vessels to expand and increases blood flow, which could contribute to migraine attacks. However, while changes to the blood vessels are involved in migraine, research suggests that they are not the cause of an attack. We now know that migraine is a brain disease, not a disease of the blood vessels as it was once thought to be.
How can I reduce the risk of a migraine attack from drinking?
If alcohol is a trigger for you, it may be best to not drink at all. However, if you find that small amounts of alcohol don’t seem to trigger your attacks, be sure to stick to small amounts when you drink. It could also help to drink water as you’re drinking – dehydration is a very common migraine trigger and alcohol is a diuretic, meaning that it causes your body to remove fluids quicker than usual through your urine.
Sometimes you might get an attack because multiple triggers are working in combination. For example, you might have overslept and skipped breakfast, and be tired and stressed from a busy week at work. Adding alcohol into the mix could then tip you over the threshold for having an attack. If you want to drink, it may be best to do so on days where you feel relaxed, you’ve followed your usual daily routine, and you’ve avoided your other triggers, as this could reduce your risk of a migraine attack.
How can I treat a migraine attack from drinking?
If you feel an attack coming on when you’ve had alcohol, stop drinking straight away. Drink plenty of water and take your usual rescue medication such as triptans or pain relief. These are generally safe to take if you’ve been drinking but don’t drink any more and be aware that the alcohol could make the medication’s side effects worse – for example, you may feel a bit drowsy or dizzy, so lie down and rest if you can. It’s important to always check the leaflet that comes with your medication just in case it says that you should not mix it with alcohol, or ask your doctor about it when they prescribe it.
Can I still drink alcohol if I live with migraine?
There’s no one-size-fits-all answer to this question, as everyone is unique and experiences migraine differently. Many people find that only certain drinks trigger their attacks, so they only need to avoid specific beverages. However, what applies to one person with migraine might be quite different for another.
Keeping a headache diary will help you determine whether alcohol is definitely triggering your attacks. What is and isn’t a trigger can be tricky to untangle; it might be that you tend to drink when you’re very stressed, and it’s actually the stress that’s the trigger, or perhaps you only drink at the weekend and your weekend sleep habits are to blame. Keeping note of things like stress, what you’ve eaten, your caffeine consumption, your menstrual cycle, and your sleep pattern over a few months will help you identify your migraine triggers. You should also record how much alcohol you drink, what types of drink you’ve consumed, and how much. You can take your diary to your doctor and they’ll help you work out what might be triggering your attacks.
Can I drink during a migraine attack?
Although it’s unlikely that you’d feel like it, it’s best not to drink any alcohol while you’re experiencing a migraine attack. Attacks can last for several hours or days after the headache stage eases. This is known as the postdrome stage and can make you feel very fatigued and ‘hungover’. Drinking while you feel like this may make you feel worse and prolong your attack, so it’s best not to drink until you feel completely back to normal.
If you have questions about your migraine or need further information or support, you can contact our free helpline on 0808 802 0066 or email us at email@example.com.
Here at theOsteopath we continue to assess and treat Migraine triggers that manifest in our body posture and daily activity analysis. For an assessment and treatment of migraine and headaches please contact us at the Clinic.
The ancient practice of yoga has experienced a resurgence in popularity over the past 50 years. A recent study suggests that yoga may significantly reduce the burden of migraine, and lead to a reduction in medication use in some people. What type of yoga is best for people with migraine? When is it safe to practice? To help us learn more is yoga instructor Adriane Dellorco.
Adriane Dellorco has been practicing yoga all her life and living with migraine for 14 years. She is the founder of Yoga for Migraine, an online community that offers yoga practices specifically for people living with headache and migraine. Adriane is a lifelong dancer and yoga practitioner with a 200-hour yoga teacher certification in restorative, yin, and yoga nidra styles.
Adriane Dellorco: Four out of five people living with migraine report stress as a major trigger. Yoga offers a powerful combination of breathwork, muscle tension release and meditation that helps to activate the parasympathetic response in the body. It can help relieve the neck tension that so many people with migraine have. It also serves as a “gateway exercise.” While we know that exercise is a great preventive for migraine, it’s out of reach for so many people who can’t keep up a consistent, moderate exercise routine. Yoga can bridge that gap, because it’s something you can practice even on a high pain day. Yoga also teaches us to observe our body and emotions, making us less reactive to our triggers. And it offers this oasis for just feeling good that helps rewire the pain pathways in the brain that get into a chronic pain rut over time.
What evidence is there to support yoga for migraine?
There’ve been several studies, most recently in May of 2020, published in Neurology. In that study, they compared groups of people with episodic migraine. One group did yoga three to five times a week, and the other group didn’t. They found that the group practicing yoga over a three-month period reduced the intensity and frequency of migraine attacks by 48% and lowered medication use by 47%. This is comparable to many preventive medications. The yoga practitioners in the study also cut their migraine disability index score by 37%, meaning they felt much more able to enjoy their lives.
What’s the best way to get started with yoga if you have migraine?
Yoga can be very healing, but it’s important to find the right style and the right poses for your body. For people with migraine, start with a very gentle yoga style like yoga nidra, which is a guided, lying-down meditation. Next, try a restorative yoga class. It’s not physically intense. It’s much more meditative and still. And then if you’re having a lower pain day, explore a gentle hatha yoga practice, which involves more of the classic yoga poses and helps build more physical stamina and release of muscle tension. There are yoga options for everyone. Find a teacher that can work with your health challenges and your mobility level. The ultimate goal is for you to be comfortable and aware of your mind and body.
Watch the full interview for answers to:
What is yoga?How can yoga help someone with migraine?What evidence is there that supports yoga for migraine?How do postures and breathing combine to create an effective yoga practice?How can yoga benefit the hyper-responsive nervous system common in people with migraine?Can yoga be practiced during times of high pain?Is there a type of yoga that’s best-suited for people with migraine?Are there certain types of yoga that are better suited for different body types?What type of yoga is most beneficial if the neck is a factor in migraine?What type of yoga is appropriate for people who have migraine with vestibular symptoms, such as dizziness and vertigo?Can yoga help with insomnia?What other conditions can yoga be beneficial for?Is there anyone who shouldn’t practice yoga?What are some reasons that people might be hesitant to try yoga?What is the best way to start a yoga practice for those who are new to it?How can you find a certified yoga instructor who can provide personal feedback?
For those of us who’ve experienced chronic migraine, classified as experiencing more than 15 headache days a month, with eight of those days being migraine, it can feel as though there’s no way out: no relief in sight, and no hope of finding treatments that work.
But there is hope. Carrie Dougherty, MD, FAHS shares her knowledge about how people can recover from chronic migraine and ways to minimize the risk of progressing from acute to chronic migraine. Dr. Dougherty is an associate professor of neurology and program director of the headache medicine fellowship at MedStar Georgetown University Hospital in Washington, D.C. She is a fellow of the American Headache Society and serves as a member of the guidelines committee and the Scottsdale Headache Symposium planning committee.
Is medication overuse a cause of, or an aggravating, factor, for chronic migraine?
Dr. Dougherty: Medication overuse headache is a specific diagnosis for people who have frequent migraine attacks and are regularly using acute medications each month, such as triptans. Overusing acute medications can increase the likelihood that the frequency of your migraine will change adversely over time. However, it’s hard to truly know if a person would or wouldn’t have progressed to chronic migraine if they hadn’t treated all of their migraine attacks with medications, but it may be a contributing factor. We’ve seen evidence that when people stop using medications that may contribute to chronic migraine, their migraine frequency reduces.
What are some of the risk factors for episodic migraine to progress to chronic migraine?
Dr. Dougherty: From epidemiological studies, we’ve found there are a few common risk factors that increase the progression from episodic to chronic migraine. One of those is comorbidities. If a person with migraine also has depression, anxiety, or another mood disorder; if they have other pain issues; if they’re overweight or snore, these can increase their risk. External factors such as stressful life events, history of head injury, or high amounts of caffeine can also increase migraine frequency. Difficult-to-treat migraine attacks are another risk factor.
What are some non-medicinal treatments that might help people avoid or treat chronic migraine?
Dr. Dougherty: Having a big migraine toolbox is helpful. Treatments people can try include lifestyle changes such as good sleep hygiene, mindfulness, meditation, stress management, and exercise. Talking with your family and employer about what you need and what your priorities are, and how they can support you, is helpful. We also use cognitive behavioral therapy and work with pain interventionists to help address all aspects of how migraine affects a person’s life.
Watch the full interview for answers to:
- How many people in the world have what’s considered chronic migraine?
- When and how does chronification of migraine start?
- What’s the difference between chronic migraine and medication overuse headache?
- Is medication overuse a cause of or an exacerbating factor for chronic migraine?
- What are some of the risk factors for episodic migraine to progress to chronic migraine?
- What are some of the indications that someone might have transitioned to chronic migraine?
- Why do patients tend to underreport their frequency of migraine?
- What are some of the barriers to appropriate diagnosis of chronic migraine?
- What advice do you give patients who say that triptans are the only thing that works for them, but they are afraid of rebound headaches?
- What are some nonmedicinal treatments, tools, or therapies that might help people avoid or treat chronic migraine?
- What do you tell a patient who says they have tried everything but nothing works?
- What resources are there for people with chronic migraine who are frustrated and overwhelmed with navigating the health care system along with the condition itself?
- How can people with migraine be proactive in treating their condition?
Over 2,000 years ago, a Greek physician wrote that his patients experiencing intense headaches also fled the light. Experienced by 90% of people with migraine, photophobia is a distinguishing characteristic of this disease. What causes this light sensitivity? How does it define the migraine experience? What new therapies are available to address this often-ignored symptom?
Deborah I. Friedman, M.D., M.P.H., FAAN, is a professor in the departments of neurology and ophthalmology at the University of Texas Southwestern Medical Center. A neuro-ophthalmologist, she is chief of the division of headache medicine, and the founding director of UT Southwestern’s Headache and Facial Pain Program. She is board certified in neurology, with subspecialty certification in headache medicine.
What causes light sensitivity in people with migraine?
Dr. Friedman: The retina of the eye has different cells that control our vision, called the rods and cones. The cones are responsible for color and our central vision, and the rods are responsible for seeing light and dark. These and some other small cells transmit back into the brain, to the thalamus, which is like a huge relay station. The thalamus then projects to other places in the brain, including the cortex, where we have awareness of pain and light sensitivity. All the fibers that receive information from those retinal cells are in very close proximity to the fibers that come up from the brainstem and those are part of the trigeminal vascular system that controls pain.
Should someone with photophobia try to avoid light?
Dr. Friedman: This is a very common question. However, it’s not a good thing when people start gradually decreasing the amount of light they’re exposed to because cells in the retina begin to “dark adapt.” Some people install blackout blinds, wear sunglasses indoors, or eat in the dark. While it’s true they’re very light sensitive, the fear of pain increases anxiety, which can also trigger migraine. We try to find the least amount of protection from the light where people can still function normally. Many try using FL-41 tinted glasses or lenses, which block the blue wavelength of light, while some actually do better blocking red wavelengths. While others use super dark glasses, they don’t block the wavelengths that are actually the problem.
Are computer and phone screens a problem as well?
Dr. Friedman: Screen time in general has created a lot of challenges for people with photophobia and migraine. While photophobia comes from migraine and from the brain, it can also be caused by other eye conditions. One of the most common causes of photophobia is dry eyes, and a lot of people with migraine have dry eyes, sometimes medication-related. When you’re reading or working on a screen, it’s normal not to blink as much. That means you’re not lubricating the cornea sufficiently, so it can dry out. And if the cornea dries out, it can cause blurred vision or pain. You might start straining, and then your neck gets sore. Between all that and the exposure to the luminance on the screen, it can make photophobia a lot worse.
Watch the full interview for answers to:
- Is migraine the only headache disorder that has light sensitivity as a symptom?
- Is light sensitivity a premonitory symptom or is it a trigger of migraine?
- Is light sensitivity a chronic condition?
- Is light sensitivity something that can develop from another condition, such as concussion?
- What causes light sensitivity?
- Should people with light sensitivity completely avoid the light, or is it better to learn to adapt to it?
- What protections are there for people with light sensitivity?
- Should people with light sensitivity keep their home environments dark at all times?
- How can you tell the difference between photophobia as a trigger and as a premonitory symptom?
- Are tinted lenses helpful?
- When should someone with photophobia see a specialist?
- What kind of specialist should they see?
- Are the CGRP medications helpful to those with light sensitivity?
- Is our modern world of excessive screen time and “Zoom fatigue” causing more photophobia?
- How can someone tell that their photophobia might be chronic?