Patest strategies for chronic migraine

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?

Watch Dr. Carrie Dougherty’s interview preview here, or order it as part of the Migraine World Summit package from this page.

Light Sensitivity and Therapy for Migraine

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?

Watch Dr. Friedman’s interview preview here, or order it as part of the Migraine World Summit package from this page.

Headache And Migraine In Later Life

We often hear that migraine improves with age, but unfortunately that’s not the case for everyone. For some people, migraine continues into older age and is complicated with concerns about medication safety and other comorbidities. For others, new migraine symptoms and headache disorders develop with age. 

Matthew Robbins, MD, addresses some of the challenges of headache and migraine in later life. Dr Robbins is an Associate Professor of Neurology and Residency Program Director at Weill Cornell Medicine, New York Presbyterian Hospital. He is the secretary on the executive board for the American Headache Society, directs all resident education programming and is a resident and fellow section editor of the journal, Headache. 

How does migraine typically change in middle and older age?

Dr. Robbins: Migraine symptoms can change over time. For example, for some older people, a non-headache symptom like aura can occur on its own without a migraine attack, or an aura may be a brand new symptom. When a person was younger, they may have experienced overwhelming symptoms such as nausea and light or sound sensitivity, which may lessen as they age. Older people may have a more general aversion to eat, or just feel queasy, rather than more severe nausea and vomiting. Migraine triggers can also change with age, and once you remove hormonal fluctuations after menopause, it may be possible to pay more attention to other potential triggers.
Are triptans still safe for the older population with migraine?
Dr. Robbins: Triptans as a family of medicine can cause symptoms such as tightness, tingling, and a sense of warmth or discomfort, not just in the chest, but anywhere in the upper body – arms, shoulders, neck, throat, scalp, and face. If someone older develops any of these symptoms for the first time, that should be a cause for an urgent evaluation. People with migraine have more cardiovascular risk factors than people without migraine, so if an older person is having side effects with a certain triptan, there are other medicines within the triptan family that don’t seem to cause those side effects.  The newer medications, such as gepants and other CGRP blockers, activate a different type of serotonin receptor than do triptans and don’t seem to cause that pattern of side effects.
In someone with a history of migraine, what are some factors that might lead to increased frequency of attacks in middle age?
Dr. Robbins: Hormonal changes during perimenopause, the transition time to menopause, can make women more vulnerable to increased migraine frequency, and sometimes that migraine frequency increase remains as they get older. Migraine has a lot of different risk factors for changing from episodic to chronic migraine. As people age, they may experience sleep disturbances or coexisting pain problems that keep the brain overly activated and grease the wheels for migraine attacks to become more frequent. Older people may have musculoskeletal problems such as lower back pain or neck pain that affect migraine frequency.

Watch the full interview for answers to:

What are the most common headache disorders in people over the age of 50?How does migraine typically change in middle and older age?
Is it true that migraine improves with age?
Are triptans still safe for the older population with migraine?
How common is it for an older person to get a new diagnosis of migraine?
In someone with a history of migraine, what are some factors that might lead to increased frequency of attacks in middle age?
What are some alternatives if triptans either stop working for someone, or become unsafe to use?
How safe are some of the typical migraine medications for people older than 50?
Why do some people with migraine become more or less responsive to their usual medications as they age?
What are the risks of a long-term migraine history and the long-term medication use that may accompany it?
Are the newer medications safe for older people with migraine?
What nonmedicinal options exist for migraine after 50 years of age?

Watch Dr. Robbins interview preview hereor order it as part of the Migraine World Summit package from this page.

If you’ve previously purchased the 2021 Migraine World Summit, you are all set to log in to watch the full interview.

Meningitis Awareness Week 2021

13th – 19th September 2021

Be part of this historic moment.

On 28th September, the Global Roadmap to Defeat Meningitis will be launched by the World Health Organization (WHO). For the first time ever, countries will unite behind a global effort to defeat meningitis and provide meaningful aftercare to survivors and their families.

The launch provides an opportunity for your voice to be heard by global leaders at this once in a lifetime Roadmap launch. We need to show them how much people want to see meningitis defeated – the more voices we get, the stronger the call to action.

This Meningitis Awareness Week, you can help #DefeatMeningitis.Join the many voices sharing their support now for defeating meningitis

The real voices of meningitis.

We meningitis strikes, feelings of isolation and disconnection are common. Whether the disease has struck you or someone you are close to, it can feel like you are completely alone. But, as long as we are here, you are never alone.

This Meningitis Awareness Week, we are proud to launch Meningitis & Me. This is a unique platform for videos made by, and for, people affected by meningitis. Whether you have a lost loved one, experienced amputation or are dealing with invisible after-effects, you will find practical tips and advice for adjusting to life after meningitis. Our first set of videos is now available to view, and we’ll be uploading new content throughout 2021.

This Meningitis Awareness Week, we are proud to amplify the voices of people affected by meningitis, to show other impacted individuals that you are not alone.Visit the Meningitis & Me platformHave you been impacted by meningitis? If so, and if you have tips and advice that you’d like to share with others, we’d like to hear from you. Click here to contact the team.

We welcome your feedback for our existing set of videos. Please click here to let us know your thoughts.

Share thisFurther advocacy and campaigning projectsWe call for positive change as a united voice against meningitis and septicaemia, and a dedicated champion for those it affects. Advocacy & campaigning projects MRF Research projectsSince the charity was founded in 1989, we have awarded 161 research grants. The total value of our investment in vital scientific research is over £19.1 million (€24.7 million).Current projects MRF Action and support projectsWe take action that benefits people directly, including training health professionals and providing support and information services.See our projects The psychological impact of limb lossMike Davies contracted bacterial meningitis in 2017. This is his story.Read the blog 

Connect families affected by meningitis so they don’t feel alone

Connect families affected by meningitis so they don’t feel alone£58 funds one support worker to attend our ‘Meningitis Meet-Ups’ – a chance for families affected by meningitis to meet each other for informal peer support.Donate now

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Finding Work That Works Despite Migraine

Migraine is a disease that’s still widely misunderstood and dismissed, especially in the workplace. Migraine can inhibit your ability to work, even when there are bills to pay and you have no health insurance. During the pandemic especially, some with migraine—especially women—have faced economic hardship.

Melanie Whetzel is the lead consultant of the Cognitive/Neurological Team with the Job Accommodation Network (JAN). Her post-graduate work has been primarily focused on special education. As the lead consultant, Melanie specializes in learning disabilities, mental impairments, developmental disabilities, autism spectrum disorders, and brain injuries. She presents nationally on these topics, and has authored several publications.

What are the challenges of managing a career with frequent and disabling migraine?

Melanie Whetzel: Migraine patterns are very individual. One of the biggest issues is that migraine attacks often occur with little or no warning, impacting both the employer and employee. If they cause frequent absences or an inability to perform optimally, that can cause a problem. Most employers expect that an employee to have consistent, reliable attendance. Migraine disease is also misunderstood. It’s an invisible disability, unlike the loss of an arm, for instance, and many employers and co-workers have no experience of migraine.

What type of work might be best for those with frequent or chronic migraine?

Melanie Whetzel: There are many different accommodation ideas that can help in an office setting. If the issue is lighting, a big office space or a big retail location can be difficult unless you can control the lighting yourself. If you can work from home, you’ve got much more control over the environment. If fragrances are a problem, you don’t want to work in a florist shop or near a bathing products area. With noise, many people use noise-canceling headsets or earbuds, and some install doors or sound absorption panels. We work with employers so they can provide any accommodations until they cause a hardship: something that would be too expensive, too disruptive, or would change the nature of the business. Because migraine can be a disabling condition, you need to decide if you can stay at your current job with reasonable accommodations, or, if you can’t get accommodations or they aren’t feasible, if you need to find new work.
Should you tell your employer or a prospective employer about your migraine disease? 

Melanie Whetzel: Timing is critical. You don’t have to disclose any type of disability or medical condition until you need an accommodation. Understandably, a lot of people don’t want to talk about their disability when they’re being interviewed. Once employers make a conditional offer of employment, however, they can ask medical questions. That’s a good time to disclose so that it doesn’t become too much of an issue. Once hired, you want to be as honest with your employer as possible; you need to be able to state why something’s a problem so they can understand. Employers should then be more willing to look at accommodations that work. However, if there are issues that occur after disclosure, then organizations like JAN have specific steps we recommend to protect yourself.

Watch the full interview for answers to

  • What are some of the challenges of managing a career with frequent and disabling migraine?
  • What type of work might be best suited for someone living with frequent or chronic migraine?
  • When is it appropriate to ask for job accommodations at work?
  • If fragrance is a trigger for someone with migraine, what’s the best way to go about handling a situation in which a coworker wears a lot of perfume?
  • What guidance would you give to someone with migraine who is considering starting their own business?
  • Should you tell your employer or a prospective employer that you have migraine disease?
  • What if you disclose that you have migraine and then face repercussions from your employer?
  • If an issue arises at work that an employee suspects is discrimination because of their disablity, what resources are available to help?
  • Are there accommodations you can ask for when working from home?
  • How should the question “Do you have a disability?” be answered on job applications?
  • What are some things that can be done to raise awareness of migraine in the workplace?

Watch Melanie Whetzel’s interview preview here, or order it as part of the Migraine World Summit package from this page.

Better Migraine Care

Better migraine care

It’s Migraine Awareness Week (5-11 September), and we have published a new report for it that exposes a broken healthcare system which migraine patients struggle to navigate. While the scale of the problem in migraine healthcare that it reveals is alarming, we hope it is the first step in changing and improving migraine care.

The report, Dismissed for too long, reveals a wide range of issues with migraine healthcare including:

  • Slow diagnosis: People with migraine are often only diagnosed several years after starting to have migraine attacks. Our research found that, of those who have been officially diagnosed, almost a quarter had been experiencing migraine attacks for over two years before they were diagnosed. It also found that over half (52%) of people who say they have migraine haven’t been officially diagnosed with it by a doctor.
  • Lack of access to specialist care: Most migraine patients never see a headache specialist, including those with chronic migraine who are referred to neurologists who may not have an expertise in migraine. We submitted Freedom of Information requests to all Hospital Trusts in England and Health Boards in Northern Ireland, Scotland and Wales to find out what access migraine patients have to specialist care. Only three Health Boards in Northern Ireland (out of five), three Local Health Boards in Wales (out of seven), seven Health Boards in Scotland (out of 14), and 13 Trusts in England (out of 128 contacted), replied and said they had a specialist headache clinic.
  • Lack of access to new drugs: The problems in migraine healthcare have intensified over the last year as many people who are eligible for the new (and first ever drugs developed to prevent migraine) calcitonin gene-related peptide (CGRP) antibody migraine medication have struggled to access it, despite it being approved for use on the NHS. Through Freedom of Information requests we found there was a postcode lottery with accessing these drugs where only one Health Board in Northern Ireland (out of five), two Local Health Boards in Wales (out of seven), seven Health Boards in Scotland (out of 14), and 15 Trusts in England (out of 128 contacted), replied and stated that eligible patients could access CGRP treatment.

Our recommendations on how problems can be addressed

We have set out a range of proposals in the report on how to address these issues that will aim to speed up diagnosis and ensure that those who need specialist care and new treatment can access it.

However, proposing solutions is one step, having those solutions implemented is a much bigger step. Some will be easy to put in place and we would hope that our recommendations will be implemented in the next year. Whereas other solutions will take several years to achieve.

We will need your support for both.

How you can help

We are raising the issue in the media and will be lobbying the government and working with healthcare bodies to have our recommendations implemented.

You can support the campaign by:

  1. Contacting your local representative: Writing to your MP, and Scotland, Wales and Northern Ireland residents can also contact their MSP (Scotland), AM (Wales) or MLA (Northern Ireland) in your regional parliament. You can download a template letter to send to them here.
  2. Writing to your local media: We are running a media campaign that will focus on national and local media which you can support by writing a letter to your local newspaper. You can download a template letter to send to them here.
  3. Sharing your experience on social media: Share the report and your experiences of migraine healthcare on social media using the hashtags #BetterMigraineCare and #MigraineAwarenessWeek2021. We have graphics for Facebook, Instagram, LinkedIn, and Twitter, which you can use for your posts, that you can download here.

Thank you for your support. By working together to highlight the problems in migraine healthcare and campaigning for change, we can ensure that migraine, and people with it, are no longer dismissed in the healthcare system. Our work together will lead to better migraine care.

When Migraine Starts or Stays in Your Neck

Neck pain can be one of the most dreaded symptoms for those of us with migraine. For some, the arrival of neck pain marks the beginning of an attack; for others, it seems like there is always some degree of neck pain. It raises questions: Is the tense, sore neck a trigger for an attack? Is it a sign that an attack is already underway?

How do we know if there’s a structural component causing our pain?

Dr. Sait Ashina, MD, is an assistant professor of neurology and anesthesia at Harvard Medical School, as well as the director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center in Boston. He is a prolific researcher and is board certified in neurology and headache medicine.

How prevalent is neck pain for those with migraine?

Dr. Ashina:
Neck pain can be independent of migraine or it could be part of it. When it’s part of an attack, it can occur prior to its onset, during the headache itself, or may happen in the postdrome phase after the attack. There are studies showing that up to 70% of people with migraine report neck pain during their attack, while 48% describe neck pain beforehand. There are also conditions that are common with migraine that may result in neck pain, such as rheumatoid arthritis, herniated disc, arthritis in the neck or spine, fibromyalgia, concussion, whiplash injury, and, rarely, Ehlers-Danlos syndrome and hypermobility. All those conditions are very common in patients with migraine.
How do we know whether neck pain is a symptom of the attack, if it’s the trigger, or something else?
Dr. Ashina: What some think are triggers of a migraine attack are not really triggers, but symptoms of the prodromal phase of a migraine that happens before the actual attack occurs. Migraine has many symptoms, such as the headache itself, light and sound sensitivity, or nausea, all of which can respond to treatment. These treatments can also improve neck stiffness and pain. In terms of other conditions, there is cervicogenic headache, which is a secondary headache, in contrast to migraine, where the headache is a primary symptom. It’s a condition caused by a cervical spine problem or its bony component—a disc or tissue elements, and is usually accompanied by neck pain. Occipital neuralgia is another distinct headache condition involving the occipital nerves that run from the top of the spinal cord and through the skull. If injured or inflamed, a person with occipital neuralgia usually feels the pain in the back of the head and the base of the skull. The diagnostic criteria of the International Headache Society can help to distinguish between these different types of headaches. It’s essential to get the correct medical diagnosis.
How might the neck be treated if it’s aggravating or triggering migraine attacks?
Dr. Ashina: There are different treatments, such as physical therapy and massage, and self-care measures like applying hot or cold packs. There are trigger point injections, which are nerve blocks. If there are more structural problems in the cervical spine, like disc herniations or arthritis, then epidural steroid injections, facet joint blocks, and radiofrequency ablations, which use heat generated by radio waves to target specific nerves and temporarily turn off their ability to send pain signals. Some respond to acupuncture, acupressure and dry needling. Weight loss can help neck pain. Finally, many pain psychologists work with biofeedback, behavioral therapy, relaxation techniques, and meditation. In worst cases, surgeries can help the neck pain, as well.
Watch the full interview for answers to:

How prevalent is neck pain for those with migraine?What is the trigeminal cervical complex?What is the difference between primary and secondary headache?How do we know if neck pain is a symptom of a migraine attack or if it’s triggering the attack?What are trigger point injections?What is a cervicogenic headache?What is occipital neuralgia?How can we distinguish between occipital neuralgia and migraine with neck pain?Can Botox help relieve neck pain with migraine?How do we determine whether neck pain is a symptom of a migraine attack or caused by a structural or neurological issue apart from migraine?What types of imaging studies are done for neck pain?What are the treatments for neck pain that may be triggering a migraine attack?What is radiofrequency ablation (neurotomy)?How does posture affect the neck and migraine?Is it better to use heat or ice for neck pain?Which non-medical interventions are helpful for neck pain with migraine?
Watch Dr. Ashina’s interview preview here, or order it as part of the Migraine World Summit package from this page.

Migraines Headaches & Men

National Football League Hall of Famer and Superbowl MVP, Terrell Davis, is 5’ 11″, weighs 210 pounds and took more than his fair share of big hits during his career. He also has migraine, and said: “Migraine hits you harder than anything you can ever imagine.”

Today, we are bringing to you a topic rarely discussed in the world of headache: men with headache diseases. But equally, this is also for the partners, wives, mothers, and children because men fundamentally need your help. Why? Men are less likely to get diagnosed, seek treatment or even speak to someone about their headache disorder.

This interview has been specially recorded and released on Father’s Day to honor the role that many men have in their family during Migraine and Headache Awareness Month.

Watch the full interview for answers to:

  • Which headache disorders affect men the most? 
  • Cluster headache may affect more men than women, but are there actually more men who have migraine than cluster headache?
  • Are there any other headache conditions that are prominent in men?
  • How well do men cope with a headache disease?
  • What do men do instead?
  • Why is “manning up” the wrong approach?
  • 80% of men have declared that they would seek professional help for backache or insomnia but only 40% would seek medical help for headache (Kluwer-Trotter and Lian, 2012). Why should men care about getting diagnosed?
  • How might someone be putting their child at risk if they aren’t getting diagnosed or treated?
  • Do we know the likelihood that a child will inherit migraine from their father? (i.e. 50%, 25%?)
  • According to Migraine Buddy data, men are 43% more at risk than women of progression from episodic to chronic.
  • Are men who experience frequent headache or migraine attacks likely to have other health issues?
  • What has the research found about men with migraine and heart attack and stroke risk? What’s the level of absolute risk?
  • How can headache disease affect men in their careers and as a parent?
  • Can children and men who have had one or more concussions be at a greater risk for migraine?
  • How should we evaluate whether to let our children play high-contact sports?
  • What’s the bottom line? Final thoughts?

Watch the full interview now, no login or Access Pass required >>


International Headache Society

Migraine is an invisible disability!

People with migraine lose on average 10 work days/year causing £ £ £ in each country’s economy! Spread the word! Visit our website for more info! #migraineawareness2021 #migraineawareness #mham #mham2021 #neurology