Thursday 31 May 2018

The Migraine World Summit Summary: Day 1

The 2018 Migraine World Summit has come to an end. It was by far the best yet with shorter more concise talks from a fantastic range of migraine specialists. The audio and video quality were also of a high standard. Gone are the crackly skype calls! Carl & Paula did a great job with the interviews and asked lots of questions which I know myself and many others were keen to have answered.

I’m aware that many of you were unable to watch any of the summit or the talks that were of interest to you due to other commitments or simply not being well enough to watch during that week. I decided I would put together a summary for you of some of my favourite talks that I managed to watch, highlighting the key points that were made.

If you would like to watch any of the summit I believe you are now able to pay for an all access pass  so you can catch up yourself. 

Day 1

Professor Goadsby: The keys to finding new treatments

Prof Goadsby is somewhat of a superstar in the migraine world. He speaks with passion and hope for migraine.

Diagnosis challenges

GP: often reluctant to make a diagnosis due to lack of confidence or certain myths surrounding migraine even within the medical world (for example there is always a visual aura with a migraine).

Family: often accept migraines as simply used to it and talk of being a “headachy” family/person. Level of acceptance is often an issue with diagnosis. People consider their migraines/headaches as “normal” as their mum or dad is a “headachy” person too.

Be your own advocate BUT don’t rub doctors up the wrong way!

Have a headache dairy which is CLEAR and SUMMARISED. Don’t overload the doctor you are seeing with unnecessary information. Let them see the medications you take, dose, side effect etc. Make the information easily digestible so that there is a clear message for specialist to see.

Diagnosis is KEY (appointment with specialist)

1.     What have they got? (medical history, physical tests) By definition test will be normal for migraine patient
2.     Assess burden of diagnosis (quantify the disability using scales such as HIT test or MIDAS form)
3.     Treatment plan

What does success look like?

Even a small improvement for migraine patients often makes a real difference and is appreciated.

Migraine attack – success is pain free in 2 hours
Migraine prevention – 50% reduction in headache days

Important to note that WE ARE NOT AT CURE STAGE.

“Perfection should not be the enemy of good”

Commonly overlooked treatments

Often issues with correct and appropriate dosing.

Aspirin: 900mg
Ibuprofen: 600- 800mg (realistic dose to treat an attack)
Naproxen: 500mg (not the 250mg people often take)
Preventatives: length of exposure and dosage is key
Propranolol: per kg body weight taken twice a day

*Dose appropriate to weight is key when taking preventative treatments.

Tolerability is hard with preventatives. Patience is key! A new preventative medication needs to be taken for 10 weeks plus.

New treatments on the horizon

1.     Neuromodulation (electrical currents change brain behaviour)
2.     CGRP- Antibody (1st anti-migraine preventative treatment)