Venturing in to the second half of this series marks a turning point in the Summit. The talks on during the second half the aim really seemed to refocus on simply educating about types of migraines and began focusing much more on the patients.
Day 5 and 6 really dive in to treatments – both medical and alternative and showed a wide array of options that exist and should be explored by migraine patients. A lot of what was covered were topics I have touched on in previous blog posts so many of you may be familiar with things I reference.
Day 5: Alternative Treatments
Can a Ketogenic Diet Prevent Migraine?
This talk started out with pointing out that our diet is truly the foundation of our health. Most of our population is obese and we rely on a lot of processed foods – meaning the nutrients our bodies need aren’t always being given to us. Although migraine patients have tried a variety of diets and worked to eliminate foods that serve as “triggers” often we struggle with consistently eating due to nausea or not being able to tolerate more than a simple piece of toast.
What initially stood out was the concept that food triggers truly have caused anxiety surrounding what we eat. In relation to almonds it was suggested that one or two almonds may not trigger a migraine, but in larger quantities or served with a meal may serve to be more of a trigger. It was also suggested that once migraines are under control, reintroducing various foods is doable and can be done in moderation without also increasing our migraines.
When describing how the Keto diet can be beneficial a lot of the grounds of it had to do with what our body’s actually need to function. We don’t need carbs and sugar can be produced by our body without actually eating sugar. So the basis of eating primarily protein and fat adjusts how our body gets its nutrients, but also redirects our energy source to be our body rather than relying on the foods we are consuming to jump start our systems.
One key factor was that carbohydrates tend to be inflammatory in nature, so by relying more on them, any migraines that are releasing more inflammatory hormones piles on and makes the pain worse. The key part of this diet – and not Keto in particular but more “low carb” – is that it is a LOW carb diet, not a NO carb diet.
Primarily this talk stressed having a diet that optimizes your dietary needs, working to exercise to allow your body’s natural insulin to be utilized, and understanding how various foods make levels within your body (such as sugar/insulin) rise and fall. Managing migraines is about consistency, so having a diet that keeps levels within your body more consistent makes a lot of sense.
Our diet needs to be our lifestyle and there is no one “perfect” diet for managing migraines.
How Posture and Massage Effects Migraine
The neck. The shoulders. And migraines. It is no secret that they are connected, but as touched on in the previous days, is treating our neck and shoulder tension or other neck ailments really effective in terms of treating the migraine?
The biggest thing I got out of this talk was that although neck pain and tension exist with our migraines, perhaps it exists more because of other factors. We sit at desks all day and our posture isn’t great. Our pain limits our exercise. The best way to increase strength of our muscles is to use them, and exercise does just that – but as people who often are unable to exercise the neck pain and tension simply continues to increase and it’s understandable why we try and connect the pain to our migraines as either a trigger or a symptom.
What we as patients should be doing is striving to exercise between our attacks. To me, this is a much more reasonable goal and can be adjusted to each migraineur’s personal abilities at varying pain levels.
On the basis of massage therapy, the concept was described as a passive intervention of sorts and although our muscles may release and chemicals may move through our body, it is truly considered more a short term treatment – as described by Dr. Braschinsky, a treatment that really only is effective for minutes.
A more active treatment – such as simply walking for a period of time, is said to have a longer effect.
These treatments were not said to be bad, but it reinforced that they can’t be our “sole” methods of treating and managing migraine. It also really clarified that in using these methods, it has to be regular and part of our routine for real any real benefit to occur.
Migraine and Exercise: Trigger or Preventative?
The first thing clarified in this talk was that exercise has been scientifically proven to improve migraines. But, for migraine patients how do we go from being extremely limited in physical activity due to how often we’re in pain or how exercise exacerbates our symptoms?
Aside from obvious benefits of improved sleep, higher energy, and maintaining healthy muscle/bone structures, exercise truly can serve as a therapy for migraines. It was said once again that it shouldn’t be done on our high pain days, but “there is always tomorrow.” It was also pointed out that simply moving our bodies and barely breaking a sweat is enough. High intensity work outs are NOT something we should be exploring unless we know it is something we can handle.
Aerobic type exercises were the primary suggestion for the type of exercise. The guideline was that 40 minutes of exercise is a good goal, and that time includes stretching before and after.
The biggest question was what to do when we know exercise is making our migraines worse or bringing on a migraine attack… There really wasn’t much research, but it was suggested to figure out if any other factors may be playing in such as heat or lack of hydration. Or is it the lights or sun you’re exposed to while working out? In addition, we can strive to avoid working out in the period of time prior to an attack – when we know it’s coming. This can be predicted if you have menstrual migraines, or your migraines cycle like mine or you notice warning signs.
The most important clarification was that most of this advice was for episodic patients. When it comes to chronic migraines, there isn’t data showing that exercise is beneficial. The goal is to reduce our migraine days, and then slowly introduce exercise to continue the reduction, but for chronic patients other therapies will prove to be more effective.
CGRP and Butterbur: Comparing the Evidence
CGRP is the newest class of migraine related medications and is the first medication designed specifically for migraines.
With these new drugs, patients should expect to see relief within 2 – 3 months of starting the medication which means trying the drug for 6 months to a year as suggested by some physicians is truly not worth the time or the money. It was also mentioned that it is truly unclear if trying a second CGRP is worth while if the first one doesn’t work.
The biggest concern with this treatment is the associated cost which is extremely high. As we know migraine doesn’t just go away and is often present for 20+ years, a high cost treatment simply isn’t feasible for much of the population.
My biggest frustration with the first part of this talk is that in terms of side effects, the constipation and injection site irritation are still the only ones being mentioned. By now, a simple google search can bring up 20+ serious adverse side effects that many patients are experiencing and it is difficult that even though we may be a minor percentage of patients, these side effects NEED to be recognized and available to people considering the medications.
Butterbur is a supplement that is available in some countries and some migraine patients swear by it. The key thing to note is when purchasing it, you should look for a PA-free butterbur.
Feverfew is another supplement that can be taken and there are suggestions that it can have some sort of preventative properties when it comes to migraines.
Day 6: Treatments
Treatment Spotlight: Drug-Free Devices
So, huge news to me, there are 3 devices that exist that are for migraines… Cefaly, gammaCore, and sTMS mini.
This device reminds me a bit of a tens unit I had, and it basically provides electrical stimulation to the nerves above your eyebrows and between your eyebrows. Supposedly, this device has shown that abnormal brain activity and nerve stimulation has been normalized after using this device.
This device is approved for use in both preventative and acute therapies meaning it can be used daily and at the onset of attack.
The next device discussed was the gammaCore. This device is intended to stimulate a nerve in your neck – if you place your fingers on your neck and try and locate your pulse, this is where the device will be used.
This device is more targeted towards cluster headaches, but is also approved for the use as an acute treatment in migraine patients. It has been shown that in 60% of cluster patients, within 15 minutes some level of pain freedom is achieved. In migraine patients that percentage is closer to 40%.
This device is used for preventative and acute treatment and involves sending a “pulse” to the back of your head. This device had roughly a 50% responder rate in reducing pain.
The most important thing to note about all three of these devices is that in the US you need a prescription for them and they come with a hefty price tag ($500 – $700) and for the second two devices you cannot own them, they must be rented.
They also are not ideal for anyone with metal implants or devices – electricity duh – or for people who may have cardiovascular conditions.
I will be getting the Cefaly device in the near future and was truly thankful for these talks as they shed light on some non-invasive options of treatment that I can begin exploring.
Botox: Separating Fact From Fiction
It’s no secret that Botox is a cosmetic procedure, but the application of treating migraines came about as an accident as patients realized “hey my migraines are better when I’m getting Botox”…
My key takeaways from this talk were that physicians need to stick to the 31 proven injection sites that came from the multitude of trials for migraine. Often times doctors aren’t doing this and a main component in people not having success with Botox comes from doctors not administering it properly. A primary issue is that injections are done too deeply and it results in what I experienced – total muscle paralysis of my neck muscles… This weakens the neck and will make the patients worse. (I am literally exhibit A – this is the only review of Botox that will be done because all you need to know if my injections made me worse).
An interesting concept was the idea that once migraines are well managed – to the point of being a few times a month – patients can be tapered off Botox to see if it is still a necessary treatment.
Another interesting study related to Botox, showed that in patients with anxiety and depression, effective Botox treatment for migraine was also effective in treating the anxiety and depression. It was even shown that in patients who didn’t respond with improved migraines, that anxiety and depression were still improved.
The best advice from this talk was to ensure that your doctor uses all 31 sites. Don’t trust them if they say they use a lower dose and only 20 sites. Also ask the nurses about any feedback they may have received about Botox patients that were treated by that doctor.
Treatment Spotlight: Ditans and Gepants
Ditans and Gepants are new drugs, most of which are in the pipeline and not yet available for use. These new medications differ slightly from the commonly known Triptans as they are not constrictive in nature. This means that these options may open up new treatments to migraine patients who are limited due to cardiovascular problems.
Ditans specifically work with our body’s Serotonin receptors and work to activate them. Essentially, the theory goes along the lines that a portion of migraines are impacted by our blood vessels constricting. This treatment intends to counteract the constrictive nature.
Ditans will be available as acute/abortive treatments and will be primarily for migraines – research is suggesting it will be ineffective in tension type headaches.
Gepants on the other hand work to block the CGRP receptor. This medicine falls in line with other CGRP medications, except it will be an acute/abortive treatment rather than preventative.
These medications simply will provide new options to migraine patients and appear to be similar in effectiveness as triptans.
Although this talk wasn’t as informative as I had hoped, it is extremely promising to know that there are new medications being created to help in the treatment and management of migraines. Triptans were released in the early 90’s so this sense of hope is much needed across the community, as there are still a large number of people who have yet to find what they consider an effective treatment.
The Latest on Medical Marijuana For Migraine
With new legalization and continued improvement in the acceptance of marijuana across the globe, the medical implications of this are huge.
The biggest limitation comes with the classification as a Schedule 1 drug, meaning continued research really isn’t allowed until the classification is changed. The CBD portion of the plant has been proven to have anti-inflammatory properties, while THC has some but not as much. CBD has been removed from many prohibited use lists, hence the reason it is now easily available for people to purchase.
It was suggested that uses of Marijuana for more chronic conditions should be in the form of edibles, rather than smoking/vaping.
The studies for uses are very limited and primarily anecdotal. This is due to the complex nature of the plant and working to find which components play a role in reducing pain. Creating a “perfect” strain will require years of research and testing, so it likely will not be done in the near future.
Some side effects that are being reported include dry mouth, dizziness, and increased appetite. Difficulty concentrating, anxiety, and increased paranoia have also been reported. In states where legalization has occurred, they are finding in some patients that patients are developing intractable nausea and vomiting – noted in another video as the development of abdominal migraines, especially in adolescents.
Day 5 and 6 Reactions
Overall, these two days were full of an incredible amount of information. I was introduced to the new medical devices that have never been offered to me as an option and this I see as incredibly valuable. At the moment, my doctor is out of ideas, but these devices present a treatment that can be added on to my additional treatment plan and may address some of the holes in it. Having an additional abortive that doesn’t increase my risk for medication overuse is huge.
Being introduced to new developments in the field is also extremely valuable as it helps give patients young and old hope for treatments that may help us. I’ve tried so much, and to know that new options are coming is wonderful.
Addressing diet and exercise I thought was extremely important, as both talks took time to focus on the more chronic patients and explain how although it is valuable, doctors know it isn’t feasible until the migraines are better managed.
At the end of the day, there isn’t a perfect treatment, but we truly have not explored all options even if we believe we have and our doctor believes so as well.
Most importantly, cannabis was addressed. This is both good and bad and they discussed both sides of it while continuing to express that more research is truly needed. It isn’t something we can ignore, but like every other treatment, it will not work for everyone and has side effects that will be intolerable for a percentage of individuals.
Day 1 & 2 reflections are available in Part 1 of this series, Day 3 & 4 are available in Part 2.
Day 7 & 8 will wrap up my reflections on the Summit and will touch on the difficult migraine cases along with living with migraine.
The Summit is still available for purchase if you’re interested in owning copies of the videos/transcripts. My reflections only touch on a small portion of what was covered in each talk. Click here to purchase – there’s a 30 day money back guarantee if you’re not satisfied with the content.