Day 5 of the Migraine World Summit focuses in on Triggers. The interviews dive into trigger education and management, dietary habits, advances with CGRP, and new treatments based on light.
Weather, Food, and More: The Truth About Triggers – Interview with Vince Martin MD
Triggers are by in large the most controversial area when it comes to understanding migraine. For so many people, a magazine article discussing chocolate and red wine is the closest to migraine education as they get, and so removing what we consider to be “triggers” from our life should simply make migraine go away.
Dr. Martin helped to dispute common myths within his interview, while also touching on more difficult triggers like weather and hormones – his main areas of research. In studies, it has been demonstrated that most triggers, when presented in isolation, will only cause a migraine 30% of the time. This points to the theory that the migraine brain becomes hypersensitive, and the build up of multiple trigger factors or a trigger being presented when an individual has a lower threshold will lead to a migraine.
He touches on the idea that many triggers can be managed by either repetition or avoidance. So say red wine clearly triggers a migraine, avoiding it may be best. Whereas bright light may be manageable after increasing exposure and allowing your brain to rewire itself to allow for a higher threshold. This is something I personally did last year, where I laid outside in the sun for an hour or so each day and slowly increased the light in my space. Now, even during relatively severe attacks, I can still have my blinds open on a sunny day while I rest on the couch.
Specifically to hormones and weather, studies have demonstrated for estrogen and barometric pressure, that you can predict migraines when levels are low and falling. For barometric pressure, this also translates to the opposite, where if pressure is high and increasing, a migraine may come on.
Although Dr. Martin is hoping for more research to identify triggers and brain pathways, so that trigger targeted therapy could become available, I found it rather disheartening that my main trigger: weather, was something that he didn’t see much hope for in terms of being able to reduce it’s impact on increasing the risk for a migraine attack.
How Fasting, Weight, and Dehydration Affect Your Brain – Interview with Elizabeth Leroux MD
I almost didn’t watch this video, and I’ll be honest the intent of educating around weight and hydration and fasting’s impact on the migraine brain is wonderful, but the impact is not. Aside from a good 10 minutes straight of fat shaming based on hypotheticals, not science, the lack of care towards communicating such a complicated subject disappoints me.
So, rather than a long sassy reflection, here are the key things you should know:
- Fasting or skipping meals goes directly against the migraine brain’s desire to maintain an equilibrium.
- Eating healthier will always benefit your health, and it isn’t because some diet is a cure.
- Transitioning to a diet like Mediterranean Diet is easier than attempting to go full Keto.
- Work with a nutrition specialist to address your dietary needs.
In relation to hydration, this section of the interview was very enlightening. Our bodies need a set amount of water, but its specific to our own biological makeup. It stood out to me when Dr. Leroux mentioned that in some cases, after a series of dehydrating attacks we do in fact need to go to the ER to have fluids reintroduced into our system. I think this is the most effective explanation of emergency care that we cannot supplement in our own homes.
My own notes on hydration that I think are worth mentioning, that weren’t brought up in this video:
- Nausea and abortive medications tend to dehydrate you. Same with say, an allergy med. You’re going to want to increase your fluid intake to balance out the medication.
Overall, I didn’t like this video. I’m very disappointed in those who put together the Migraine World Summit for actively joking about medications like Topiramate and the “benefit of weightloss” as for some migraine patients, losing weight is deadly. You cannot address weight by shaming individuals or by alienating those with an already complex relationship to food and weight.
Pros and Cons of Blocking CGRP – Interview with Antoinette Maassen Van den Brink PhD
This interview spent a large portion of time explaining how CGRP works in our bodies and how Triptans led to the investigation of blocking CGRP receptors. If you aren’t a scientific researcher, most likely your eyes would gloss over like mine did.
Although I personally reacted severely to the first CGRP antibody – Aimovig – I’m trying to approach it from simply an educational perspective rather than a personal one. One thing I learned from Antoinette was that one of the new Gepants – the acute treatment versions of the drug – has actually been shown to have acute and preventative benefits. This is not something we’ve seen from other drugs, and the risk for medication overuse seems to be very low.
This was more of a scientific interview than a patient-education focused pros and cons as I was expecting, but the main pros were that these drugs are designed specifically for migraine and they appear to have good tolerability and minimal side effects. Cons on the other hand include price and questions regarding long term safety.
The Science of Light Sensitivity and How to Manage It – Interview with Rami Burstein PhD
Contrary to discussions surrounding light sensitivities in the triggers interview, Rami Burstein explores a more scientific type of light: wavelengths and light colors.
This interview was almost a sort of myth-buster combined with understanding how data was interpreted. Many studies on light originated from clinical trials with blind people. The discovery was that even if you cannot see, there are still retina receptors that interpret light and can cause increased sensitivities, specifically related to blue light. Patients reported their most painful migraine days were on cloudy, snowy days. These studies regarding blue light and blind patients however, were interpreted incorrectly and created a huge market for blue light blocking glasses and technology.
The blue light receptors however, are not the same for the sighted population, rendering special lenses and filters relatively useless. Further studies have shown that both ends of the spectrum – red and blue light – are most problematic, followed by yellow and white light. On average, the addition of light increases migraine pain by 20%, and the omission of light reduces pain by 20%. Hence the reason many individuals hide in a dark room during a migraine attack.
One light in particular, green light, actually demonstrated opposite results that decreased pain and symptoms. This discovery has led to the invention of the Allay Lamp which uses a narrow wavelength of green light to reduce, and even eliminate migraine pain and symptoms.
Day 5 really highlighted a large portion of the migraine world that is deserving of much more research. Many of the specialists interviewed expressed specific areas where they wanted to expand their research, and hopes for the future based on having these new questions to ask.
Personally, I’m left feeling as if much of the controversies that exist because of misinformation simply point us as people living with migraine to focus a little less on what everyone else expects, and more on our own bodies. Migraine research is rapidly expanding and we have a wealth of new treatments – both pharmaceutical and non-invasive devices – that we can explore as more research is being conducted.
I’m disappointed in the lack of understanding between weather and migraine in terms of having adequate abortive response, but with the other developments like light therapy, perhaps relief will come unintentionally.
If you’re interested in watching the Migraine World Summit interviews you can access them with an Access Pass on the migraineworldsummit.com. The views in this blog are solely my takeaways and are not meant to summarize any of the interviews.
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