The fourth day of the Migraine World Summit focuses in on Symptoms. These interviews narrow in on some of our most disabling symptoms like nausea and brain fog, while highlighting conditions we may experience alongside migraine such as various psychological disorders and autoimmune diseases.
Disabling Nausea and Cyclical Vomiting – Interview with Amy Gelfand MD
It’s no secret that nausea is one of my most frustrating symptoms that I manage with my migraines, however this interview shined a light on the reality many face starting in early childhood with Cyclical Vomiting Syndrome (CVS).
Research over time focuses in on how migraine presents itself when we’re young and how we can work to perhaps catch it earlier if we know what may pre-date it. Things like colic in babies and CVS can both be signs that you will develop migraine later on in life.
Dr. Gelfand explained the differences between CVS and abdominal migraine, both of which are commonly found in children starting around age 5. With CVS, you often have a very clear cycle – hence the name – in which you are able to predict when the vomiting attacks will occur and treat accordingly. This is unlike abdominal migraine, as these attacks tend to be more sporadic and unpredictable. Similarly however, are the symptoms which can include nausea, vomiting, abdominal pain, and irritability.
Although the interview mainly focuses on CVS, Dr. Gelfand did get into addressing those of us who regularly deal with what would be considered “chronic nausea” and the various treatment options available. Treating constantly with medicine isn’t always a viable option, and people often use aromatherapy, stimulation devices, and even alcohol swabs to manage the nausea.
Understanding Migraine Related Mood Disorders – Interview with Steven M. Basken PhD
This interview was incredibly enlightening in terms of understanding the connection between various psychological disorders and migraine, while also sharing how treatment is beneficial across the multiple comorbidities.
Steven Basken brought to light the migraine, anxiety, and depression link demonstrating that those with anxiety have a 50% chance of also having migraine, and those with depression a 30% chance. He uses the term “bilateral” to describe that having a diagnosis of migraine or anxiety can eventually lead to a diagnosis of the other – meaning there is no one distinct condition causing the other, rather a likelihood that many of them have the same brain mechanisms working in the conditions.
Other conditions mentioned were Bipolar Disorder, OCD, and suicidal ideations.
My key takeaway from this interview was the overlap in treatments among mood disorders and migraine. When biofeedback is mentioned, it is said to be beneficial to migraine but perhaps less so in those who do have other psychological conditions. Therapies like relaxations therapy, cognitive behavioral therapy, and meditation/mindfulness seem to have a more well rounded benefit to migraines and mood disorders. Its incredibly important that Steven stressed that both the migraine and mood disorder need to be treated and given attention to.
Pain, Memory and Migraine – Interview with Jack D. Schim MD
I have to laugh a bit, as this interview could best be summarized by simply saying “I don’t know.” At first it was a bit deterring, as many of us want answers about our brain fog and memory loss, but Dr. Schim continued to iterate that these aren’t areas he’s specialized in or where research is prevelent.
Except, this demonstrates something often not found in medicine. Doctors often won’t admit when they don’t have a full answer to something, so I really appreciate the way Dr. Schim differentiates between what he’s learned from research studies and what he considers his own speculations.
One critical area that was touched on was the worsening of cognitive impairments as patients have increased migraine attacks. Dr. Schim explained this as our migraines cycling on 3-4 day prodrome, migraine, postdrome cycles, that butt up directly to each other, never truly allow our brain to recover. The various symptoms that we experience in each migraine phase increase our “brain fog” and without breaks from migraine attacks, it only makes sense that the cognitive impacts increase.
This interview also touched on the medications we take and their role in on our cognitive functioning, specifically when we stop taking them. Medicine “half-lifes” focus on the time it takes for a drug to leave our bloodstream, but in practice medicine alters our brain and may have impacts beyond just our blood. This means that even after stopping a medication, it may take longer than we expect for certain side effects to stop.
Autoimmune Disease and Facial Pain – Interview with Hossein Ansari MD
As you’ll recall in my initial Summit blog post, this was one of the talks I was most looking forward to then. Initially, I was curious because I do experience a bit of facial pain and have been exploring dysautonomia which can point to some underlying autoimmune disorder. However, over the last few days, I’ve discovered my nerve pain may be related to Rheumatoid Arthritis, which I’ll write separately on after the Summit. Alas, this interview was an absolute delight.
Dr. Ansari laid out what an autoimmune disease is: essentially our body produces antibodies that attack our own cells. He also pointed out that although headache may be caused by autoimmune diseases, the main area of focus for him is individuals who have both migraine and an autoimmune disorder. He highlighted conditions including: Lupus, Rheumatoid Arthritis, Srogren’s Syndrome, IBD, Celiac, Reynaud Syndrome, Vitiligo, and Thyroiditis as conditions he encounters more regularly as comorbid with migraine.
There are a variety of commonalities between migraine and autoimmune conditions, including their roots in inflammation, and the way both tend to have periods of flares and remission. One thing that stood out to me was how much Dr. Ansari stressed determining what is causing a flare in say migraines, and that is if the migraines are flaring or if the autoimmune disorder, such as Lupus, is flaring. To Dr. Ansari, this determination is critical in effectively treating and reducing the migraine attacks.
This interview does touch on facial pain, as many migraine patients experience pain in their face or jaw. This can simply be migraine, or caused by allodynia. But it can also be a sign of a comorbid autoimmune disorder.
Day Four was an incredibly enlightening day for me as it seemed to really hit on topics that have been at the forefront of my own health journey. Although many of us may not have a lengthy list of symptoms, additional mental health disorders, or known comorbid conditions, I think it’s critical for us to be aware that they exist and how they connect to migraine.
One common theme between all of the talks on Day Four, was the stressed idea that migraine isn’t causing other conditions, and these conditions aren’t in turn causing migraine, they instead exist and progress alongside each other. For some of us, it may be hard not having the ability to place blame on one condition for causing more problems, but for me I think it’s helpful in further understanding that our bodies our unique and flawed and we cannot push all symptoms to one single cause. We also cannot approach treatment from one angle either, and this gives us the opportunity to explore various treatments while research is expanded looking at our conditions through other lenses.
If you’re interested in watching the full Migraine World Summit interviews, you can find them on the migraineworldsummit.com and purchase an Access Pass.
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