Tuesday, 21 April 2020

The Migraine World Summit: Day 5


*This post is not sponsored by the Migraine World Summit but I am a participant in the Migraine World Summit affiliate program. This means I earn a commission from any qualifying purchases of the summit made through my link. http://www.migraineworldsummit.com/?afmc=1k

Why can’t people with chronic migraine skip meals?
The migraine brain does not tolerate any change in routine well.

Why is intermittent fasting dangerous for chronic migraine?

-        Normal things already trigger a migraine so easily such as exercise and menstruation
-        If you are fasting on religious grounds and you have CM then please speak with your church leader as you shouldn’t be fasting and normally allowances are made for medical reasons.

Is weight associated with migraine?
-        Overweight association with more migraines

Why? (possible hypotheses)

-        ­fatty tissue – inflammation – promotes migraine
-        Obese – leaky gut syndrome
-        Postural factors – more pressure on lumbar and cervical spine
-        Fatty tissue modifying hormones

Migraines association with weight gain also contributed by medications that can cause weight gain as a side effect.

Topiramate – only 10- 15% will experience weight loss.

How to lose weight if you do have migraine?

-        PATIENCE
-        Drop calories
-        Glucose regulation
-        Drink more water
-        Increase your protein and veggie intake
-        No refined sugars
-        Reduce portion size

Sleep is key for weight loss.

Focus on why we eat! Is there an emotional component to our eating behaviours?

Exercise helpful for both mood and weight loss!

How about the Ketogenic diet?

-        Some evidence – regulate sugars – help migraine
-        Not safe diet for everyone and very difficult to stick to

Hydration?
-        Hydration is so important

Vomiting & dehydration?

-        Acute therapy to control
-        Sip on electrolytes
-        Sometimes iv fluids are necessary

Food and drink to boost hydration?

-        Vegetables. Careful with fruit as lots of sugar
-        Water and herbal teas
-        Add some lemon, mint or cucumber to your water to add some extra flavour
-        Coconut water? Why not.
-        Gatorade? For mild to moderate exercise its not necessary

Should I focus more on healthy lifestyle or food triggers?

-        HEALTHY LIFESTYLE FIRST
-        Trigger lists are rarely effective unless patient knows specific foods
-        Worrying over food triggers tends to increase anxiety and the lists of potential ones are endless.

What is CGRP?

Calcitonin gene related peptide

-        Small protein made up of 37 amino acids
-        Increased during migraine attack
-        Induce a migraine in health participants

Central nervous system (CNS) – Brain & spinal cord

Peripheral nervous system – outside of the CNS. Connecting the CNS with organs and blood vessels

Is CGRP all bad?
Maybe helpful in protecting against high blood pressure

Triptans?

-        Restricting vasal constriction
-        Inhibits the release of CGRP

Gepants?

-        New drug
-        Antagonist receptor of CGRP
-        Binds to CGRP receptor (stops CGRP doing its thing and inhibits binding)

Antibodies?

-        Binds to the molecule itself (Ajovy & Emgality)
-        Binds to the receptor (Aimovig)

Will there be issues of MOH with the gepants?
-        Hopefully not the case as with other pain meds as works differently

CGRP side effects?

-        In clinical trials – no real side effects
-        Don’t have enough data yet to know potential longer-term side effects
-        Cardiovascular safety?
-        In clinical practice – mild side effects (constipation and injection site reaction)

Pros & cons?

-        PRO: first drug specifically for migraine. Tolerability is very good.

-      CON: Need to know more about long term safety. Access to treatment is tricky for some. Doesn’t help everyone (not a cure).


Photophobia

-        Extreme sensitivity to light
-        Light makes pain wore (aggravates the pain)

Light is painful to blind people. This is why they wear sunglasses.

Vision and pain are two different pathways so doesn’t make sense?

Optic nerve – required for photophobia or trigeminal nerve?

1)     Blind patients with no optic nerve – no photophobia
2)     Light without sight patients – photophobia

In order for photophobia to occur, optic nerve must communicate with migraine pathway.
Neurons in a distinct area of the thalamus (which process pain), receive a direct input from the retina through the optic nerve into these neurons. We can see that these neurons fire up with light.

Why migraine patients have visual disturbances?

Visual cortex
75000 websites about filtering out blue light. Only true for blind patients. If you only block out blue light it won’t make a difference.

Blue and red light make head more painful.

Yellow and white also painful but less so than blue and red.

In contrast green light has the opposite effect. Green light decreases headache and autonomic symptoms.

Light increases the intensity of pain by about 20-25%.

-        Sunlight uncomfortable for migraine patients
-        Flickering lights – exacerbate headache

Can we get green light to help us?

-        YES. Green lightbulb currently $250. It will get cheaper over time. Already come down in price a lot.
-        Company aims to bring green light to migraine patients who need it

Testing green light in real life?

-        When patients exposed to green light for 2-2.5 hrs their pain goes away or is improved by 80%.
-        Patients also report that they feel less anxious, brain fog lifts and their cognitive function improves.

Should we be using glasses/screen filters?

-        Cutting down on blue light is a good thing for everyone
-        To filter it out properly would cost thousands of dollars
-        They filter out some of it but not all of it

Sleep in the dark is important.

Emotional component – aversion to light better definition than phobia.


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