Life with migraine during COVID

What is life like with migraine during the COVID crisis? We asked a man in his mid-70s:

I had successfully used preventives to control my migraine disease. But when the pandemic hit, my anxiety rose, especially considering my susceptible age group. I slept less well, struggled with broken routines, and had to stay distanced from many of my closest family members and friends. The frequency and intensity of my attacks increased, and I crossed the threshold into chronic migraine, my medication no longer effective. The hospital where my neurologist worked would not allow her to meet me in person. I felt the tools I had used to manage my migraines had slipped away.
Does this feel familiar? According to a study by the Headache and Migraine Policy Forum, 70% of people with migraine reported an increase in attacks during the pandemic.

The study also found that:

84% of the 1,000 people surveyed experienced more stress in managing their disease.61% were afraid to seek care.74% hesitated to go to an emergency room during an acute attack, especially when they knew that emergency departments and hospitals were overburdened.
Added stress, worry about friends and loved ones, more time in front of a computer, job uncertainty and financial insecurity have all complicated the already complex challenge of living with migraine. Difficulty getting longer supplies of medications, increasing anxiety and depression among school-age children, and inability to seek in-person care and treatment have compounded what for many was already a debilitating disease.

Women, especially women of color, have borne a disproportionate brunt of the COVID fallout. The pandemic has shone a light on inequalities in health care, employment, and caregiving. And since women experience migraine at three times the rate of men, the 70% increase in attacks hardly feels surprising.

There are proven coping strategies, however. At an earlier Migraine World Summit, Dr. Amaal Starling spoke about SEEDS for Success. SEEDS reminds us of the key lifestyle changes we can make to control our migraine attacks, along with preventive or acute medications we may be taking. It stands for Sleep hygiene, Eating regular and healthy meals, Exercising regularly, keeping a headache Diary, and Stress management. What can be added in today’s pandemic world are finding alternate sources for social interaction and learning to adapt to the use of telemedicine.

The world has changed entirely in the past year. One thing that remains constant is the commitment of the Migraine World Summit to reduce the global burden of migraine. We hope you’ll join us from March 17 to 25 to learn about the latest advancements in migraine and headache medicine, and to brush up on strategies for migraine best practices.

Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com

Life with migraine during COVID

What is life like with migraine during the COVID crisis? We asked a man in his mid-70s:

I had successfully used preventives to control my migraine disease. But when the pandemic hit, my anxiety rose, especially considering my susceptible age group. I slept less well, struggled with broken routines, and had to stay distanced from many of my closest family members and friends. The frequency and intensity of my attacks increased, and I crossed the threshold into chronic migraine, my medication no longer effective. The hospital where my neurologist worked would not allow her to meet me in person. I felt the tools I had used to manage my migraines had slipped away.
Does this feel familiar? According to a study by the Headache and Migraine Policy Forum, 70% of people with migraine reported an increase in attacks during the pandemic.

The study also found that:

84% of the 1,000 people surveyed experienced more stress in managing their disease.61% were afraid to seek care.74% hesitated to go to an emergency room during an acute attack, especially when they knew that emergency departments and hospitals were overburdened.
Added stress, worry about friends and loved ones, more time in front of a computer, job uncertainty and financial insecurity have all complicated the already complex challenge of living with migraine. Difficulty getting longer supplies of medications, increasing anxiety and depression among school-age children, and inability to seek in-person care and treatment have compounded what for many was already a debilitating disease.

Women, especially women of color, have borne a disproportionate brunt of the COVID fallout. The pandemic has shone a light on inequalities in health care, employment, and caregiving. And since women experience migraine at three times the rate of men, the 70% increase in attacks hardly feels surprising.

There are proven coping strategies, however. At an earlier Migraine World Summit, Dr. Amaal Starling spoke about SEEDS for Success. SEEDS reminds us of the key lifestyle changes we can make to control our migraine attacks, along with preventive or acute medications we may be taking. It stands for Sleep hygiene, Eating regular and healthy meals, Exercising regularly, keeping a headache Diary, and Stress management. What can be added in today’s pandemic world are finding alternate sources for social interaction and learning to adapt to the use of telemedicine.

The world has changed entirely in the past year. One thing that remains constant is the commitment of the Migraine World Summit to reduce the global burden of migraine. We hope you’ll join us from March 17 to 25 to learn about the latest advancements in migraine and headache medicine, and to brush up on strategies for migraine best practices.

Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com

Study on increase of teeth grinding, or Bruxism in COVID-19 Lockdown

Background: In late December 2019, a new pandemic caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection began to spread around the world. The new situation gave rise to severe health threats, economic uncertainty, and social isolation, causing potential deleterious effects on people’s physical and mental health. These effects are capable of influencing oral and maxillofacial conditions, such as temporomandibular disorders (TMD) and bruxism, which could further aggravate the orofacial pain. Two concomitant studies aimed to evaluate the effect of the current pandemic on the possible prevalence and worsening of TMD and bruxism symptoms among subjects selected from two culturally different countries: Israel and Poland.

Materials and methods: Studies were conducted as cross-sectional online surveys using similar anonymous questionnaires during the lockdown practiced in both countries. The authors obtained 700 complete responses from Israel and 1092 from Poland. In the first step, data concerning TMDs and bruxism were compared between the two countries. In the second step, univariate analyses (Chi2) were performed to investigate the effects of anxiety, depression, and personal concerns of the Coronavirus pandemic, on the symptoms of TMD, and bruxism symptoms and their possible aggravation. Finally, multivariate analyses (logistic regression models) were carried out to identify the study variables that had a predictive value on TMD, bruxism, and symptom aggravation in the two countries.

Results: The results showed that the Coronavirus pandemic has caused significant adverse effects on the psychoemotional status of both Israeli and Polish populations, resulting in the intensification of their bruxism and TMD symptoms.

Conclusions: The aggravation of the psychoemotional status caused by the Coronavirus pandemic can result in bruxism and TMD symptoms intensification and thus lead to increased orofacial pain.

Osteopaths are open for treatment of Bruxism

Fighting for Cluster Headache relief.

Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

  • What does a cluster attack feel like?
  • What is the difference between migraine and cluster headache?
  • What is the difference between episodic and chronic cluster headache?
  • Does cluster headache typically decline in occurrence or stop altogether as you age?
  • What are the latest treatments approved for cluster headache?
  • How does oxygen work as a treatment for cluster headache?
  • How are psychedelics used to treat cluster headache?
  • Do triptans, ditans and gepants work for cluster headache?
  • What are the biggest advocacy challenges currently facing those with cluster headache?
  • How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..

Fighting for Cluster Headache relief.

Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

  • What does a cluster attack feel like?
  • What is the difference between migraine and cluster headache?
  • What is the difference between episodic and chronic cluster headache?
  • Does cluster headache typically decline in occurrence or stop altogether as you age?
  • What are the latest treatments approved for cluster headache?
  • How does oxygen work as a treatment for cluster headache?
  • How are psychedelics used to treat cluster headache?
  • Do triptans, ditans and gepants work for cluster headache?
  • What are the biggest advocacy challenges currently facing those with cluster headache?
  • How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..

Fighting for Cluster Headache relief.

Cluster or suicide headache is said to be one of the worst pains known to humans. Cluster attacks have been among the most stubborn to treat, but that’s beginning to change, thanks to the advocacy efforts of Bob Wold,founder and president of Clusterbusters, the largest cluster support and advocacy nonprofit in the United States. 

Bob is a board member of the Alliance for Headache Disorders Advocacy. His work with Clusterbusters has involved collaborations with Harvard, Yale, National Geographic as well as television, radio, and press coverage.

Pictured: Bob Wold, Founder and President
Clusterbusters
What is the difference between migraine and cluster headache?

Bob Wold: Whereas a migraine might last all day, cluster headaches typically consist of a series of short-lived but extremely painful episodes, lasting maybe 45 minutes to an hour, and repeating four or five times a day. This might happen every day for six weeks or even three months before there’s a period of respite. They occur on one side of the head, usually starting around the temple and behind the eye and perhaps extending into the jaw line. Besides the pain, the eye on that side may droop, it may tear, that side of your sinuses may drain. 

Another difference from migraine is that a cluster attack will always last a specific amount of time for each person. So, if one cluster attack lasts 57 minutes, all attacks for that person will. However, there is some overlap between cluster and migraine. Some people can have both conditions; and some can have cluster headaches with migrainous features, such as some degree of pain persisting between attacks, or the presence of photophobia or nausea.

What are the latest treatments approved for cluster headache?

Bob Wold: One CGRP has been approved for Cluster (at the time of recording), Eli Lilly’s Emgality. We haven’t had much feedback yet from the cluster community on its efficacy. Some people have tried other CGRPs that were previously approved for migraine rather than cluster, but they haven’t had a lot of success with them because the dosages aren’t set specifically for cluster headache.

In absence of some good pharmaceutical therapies, people with cluster resort to other types of treatments. Can you talk about some of those?

Bob Wold: There’s a study going on at Yale, looking at psilocybin, a psychedelic, for treating cluster headache. We’re very hopeful that’s going to work out well, but in the meantime people can only access it by growing their own mushrooms, as psilocybin is not approved for prescription. Taking two or three doses of mushroom powder often breaks the cluster cycle and ends it completely. 

Another effective treatment is high-flow oxygen, which can end an hour-long attack after only five minutes, with no side effects. The disadvantages are that oxygen can prove difficult to access, and it must be on hand as soon as the attack starts, at a high flow rate. Triptans can work but they’re short-lived. Because patients are limited to only a few triptans a month, they can’t get enough to be able to treat all of their attacks.

Key questions covered in the interview:

  • What does a cluster attack feel like?
  • What is the difference between migraine and cluster headache?
  • What is the difference between episodic and chronic cluster headache?
  • Does cluster headache typically decline in occurrence or stop altogether as you age?
  • What are the latest treatments approved for cluster headache?
  • How does oxygen work as a treatment for cluster headache?
  • How are psychedelics used to treat cluster headache?
  • Do triptans, ditans and gepants work for cluster headache?
  • What are the biggest advocacy challenges currently facing those with cluster headache?
  • How does Clusterbusters deal with suicide attempts in its community?

Watch Bob Wold’s interview preview here, or order it as part of the 2020 Migraine World Summit package..

Migraine & Nutrition


With a myriad of information available about the best diet for people with migraine disease, choosing what to eat to avoid an attack can feel overwhelming. Should people with migraine avoid gluten? Are all sugars bad for migraine? Is a ketogenic diet recommended?

Dr. Cynthia E. Armand keeps the conversation around food and migraine simple. Dr. Armand is an assistant professor of neurology at Montefiore-Einstein, fellowship director, and director of the Holistic Migraine Lecture Series at the Montefiore Headache Center. She was also named an emerging leader in headache medicine by the American Headache Society.

Pictured: Cynthia E. Armand, MD, Neurologist and Headache Specialist, Montefiore Headache Center
Is there a migraine diet, or a diet specific for people with migraine?

Dr. Cynthia E. Armand: There isn’t one universal migraine diet, but there are certain ingredients or ways of eating that can help. The brain is always working and needs to be protected from stress, particularly cellular stress and oxidative stress. Foods such as salmon, tuna, nuts, berries, and dark chocolate are good for the brain, as are green leafy vegetables like broccoli, kale, and cauliflower. 

Processed foods can cause inflammation, so people with migraine should focus on eating a range of unprocessed foods that are as close to the food’s natural state as possible. Whole foods help to build and repair the brain and protect against stress. The Mediterranean diet could be a great option for some people because it includes many anti-inflammatory foods, good carbohydrates, olive oil, and good fats, which are all good for the brain.

How do sugars cause inflammation?

Dr. Cynthia E. Armand: When a person eats sugar, the body produces insulin to decrease the amount of sugar in the body and keep sugar levels stable. When insulin levels rise, it can trigger inflammatory messengers that can cause inflammation. People with migraine don’t necessarily have to eliminate sugar from their diet completely if they’re mindful about which sugars they eat. Refined sugars and artificial sweeteners can cause problems, while sugar from simple carbohydrates keep blood sugar levels stable, preventing the insulin spikes that can cause inflammation. 

How do we determine which foods could cause migraine?

Dr. Cynthia E. Armand: Keeping a diary is a great first step. To start, people should record the foods they eat every day without changing their diet or eating habits. They should also record their migraine attacks, headaches and other symptoms to help identify connections between their diet and how they feel. Because identifying food triggers can be challenging, keeping a diary over a few months can help identify any patterns.  

When they do start to see some patterns, they should visit their health care provider, who can help them dive deeper into any issues they have with certain foods. Their health care provider may suggest some changes to their diet, or even an elimination diet to target specific foods.

Key questions covered in the interview:

Is there a migraine diet, or a diet specific for people with migraine?Is the research on diet and migraine reliable?What is inflammation, and how does it relate to pain?Why are processed foods bad for us?How do sugars promote inflammation?Are dairy foods pro-inflammatory?How do we determine which foods could cause migraine?What herbs or spices are recommended for migraine?What are some “migraine superfoods”?What are some good foods to eat during a migraine?Will migraine treatments in the future include a recommended diet?
Watch Dr. Cynthia E. Armand’s interview preview here or order it as part of the 2020 Migraine World Summit package.

Migraine Diagnosis interview

Less than half of people with migraine go to the doctor, and of those who do go to the doctor, less than half again receive an accurate diagnosis. Why are patients and doctors seemingly getting this so wrong?


To help us understand this vital question, along with other issues of diagnosis and treatment, we have Dr. Robert Cowan from Stanford Medical School. Dr. Cowan is the chief for the Division of Headache Medicine, where they use an interdisciplinary approach to headache treatment. Dr. Cowan is heavily involved in research and is actively publishing new findings and conducting lectures internationally at headache conferences to raise awareness to educate clinicians and patients.



Pictured: Robert Cowan, MD,
Chief of Headache Medicine and Headache SpecialistStanford University

Why is it so difficult to diagnose migraine accurately?

Dr. Cowan: There are several reasons. General physicians and even neurologists have very little training in headache, even though it’s the most common neurologic complaint in the emergency room. Most physicians are not well trained in it; at best, they may have a general idea that severe headaches are migraines and trivial headaches are tension-type headaches. These contribute to the problem of both misdiagnosis and underdiagnosis — which is a diagnosis of “it’s just a headache.”

Should people who have episodic migraine — which is infrequent and may not be very severe — still go to the doctor?

Dr. Cowan: If they only have occasional headaches and they’re adequately treated with over-the-counter medicines, seeing a doctor may not be necessary. However, like most diseases, if migraine isn’t treated appropriately, the condition will get worse. Two headaches a month can quickly creep up to a headache every week, then two headaches a week, and so on. It develops into chronic migraine, which means that individuals have headaches more days than not.

According to a recent study by the Mayo Clinic, fewer than 50% of people with chronic migraine — which is very frequent and may be disabling — see a doctor about their migraines. Is that concerning?

Dr. Cowan: Yes, it’s very concerning. When there’s a delay in both diagnosis and treatment, it’s much more difficult for us to take care of the patient when we finally see them. They may be taking ineffective medications or have an inaccurate diagnosis, like sinus headache or tension-type headache. It makes our job more challenging and the patient goes through a lot of unnecessary suffering. On average, it takes about 18 months to get the correct diagnosis and it can cost about $12,000, in addition to missing work and time with friends and family.

Some people with migraine might be diagnosed with a subtype of migraine. What are migraine subtypes?

Dr. Cowan: There are two broad categories — primary headaches and secondary headaches. Secondary headaches develop due to another existing condition, like head trauma or an infection, while primary headaches do not. There are three categories within primary headaches: migraine, tension-type headache, and trigeminal autonomic cephalalgias, which includes conditions like cluster headache. The first challenge is to determine whether a patient has a primary or secondary headache. If it’s a secondary headache, we treat the cause. If it’s a primary headache, we need to differentiate within those three broad categories.
Key questions covered in the interview:

Why do so many people with migraine never go to a doctor or receive a correct diagnosis?
Is it always necessary to see a doctor for infrequent episodic migraine?
What are the migraine subtypes?
What are some of the common misdiagnoses for migraine?
What is subacute intracranial hypotension?
Is medication overuse headache a type of secondary headache?
What is the result when migraine is misdiagnosed?
How is underdiagnosis different from misdiagnosis?
What is the future role of artificial intelligence in diagnosing and treating migraine?
How can we be part of this groundbreaking AI research effort?
Watch Dr. Cowan’s interview preview here or order it as part of the 2020 Migraine World Summit package.
If you previously purchased the 2020 Summit, you are all set to login to watch the full interview.

Email: info@migraineworldsummit.com
Web: www.migraineworldsummit.com



Managing Your Migraine virtual event

Managing Your Migraine virtual event

The Migraine Trust

Would you like to know more about migraine and how to manage it? Then come along to our virtual Managing Your Migraine event that’s taking place on the morning of Saturday, 23 January. There’ll be talks about new migraine treatments, vestibular migraine, and migraine and hormones. It’s free to attend but places are limited so register now so you don’t miss out. You can find out more about the event and book a place here.

For Osteopathic treatment of Migraines and Headaches

Relaxation for Osteopaths

david@theosteopath.net

As we enter yet another few weeks of lockdown I worry for the mental state of us all. So to comfort myself I head towards Wandsworth Common and look at our beautiful trees in fabulous autumnal colours. Here we see a Liquidamber styraciflua, other names are Sweetgum or American Red Gum tree in the middle of the kiddies playground with all the maple like pointed leaves rich colours, orange, crimson and purple.