Pioneering work that has changed our understanding of migraines
theguardian.com
theguardian.com
Over the years they tried many things which didn't really help, or seemed to help but then didn't, or were inconclusivbe.
About a year ago they started on Ajovy (fremanezumab), a CGRP inhibitor. Its been like magic. A simple injection every month (you can do it yourself - they courier them over and you keep them in the fridge) and barely any migraines. Sometimes one or two towards the end of the month when the next jab is due. And no real side effects as far as can be told.
Its unusual to come accross a medicine that works so well for something as intractable as migraines.
UK specific: Originally they were paying for the Ajovy after getting prescribed it by the brilliant National Migraine Center (https://www.nationalmigrainecentre.org.uk/) - its expensive. But after it was shown to work managed to get it on the NHS via a referral to a specialist.
Here is some more info on considerations to be had for near-future breakthroughs in the oral administration route. The key is in preserving the biologic structure long enough for it to reach the intestine where, in contrast to the stomach, it would be able to enter the bloodstream with the aid of agents that enhance permeability. https://otd.harvard.edu/explore-innovation/technologies/oral...
Edit: The field of cheminformatics is currently utilizing machine learning to help discover novel drugs in the various search spaces, such as that of kinase inhibitors. They have the ability to function in a multi-target regime. That is, there exist drugs that can be effective for several pathologies.
In 2018 I started Aimovig (later switching to Emgality). I now average between 0 and 1 migraine a month.
Low information density articles are such a drain on all of us.
It's an excellent series for anyone interested in science and engineering, he does a great job of showing just how varied science is, and also how varied the routes into science can be. Many of his interviewees end up in their specialisms thoough often very circuitous routes.
The Wadsworth Constant for text.
Edit: although to be fair, the gist of it is that migraine has only recently started to be taken seriously due to a kind of medical sexism, so it's not so much a scientific breakthrough as a social one
https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptid...
So what's the catch?
1. These drugs are relatively recent (approved within the last 3 years).
2. It's not a pill but injection (although you can be trained to give it to yourself), once a month on average.
3. The medicine is relatively expensive (€500 per injection). So unless your country subsidizes one of these or you can afford such amount once a month, you will probably look for alternative treatments for now.
But those monoclonal antibodies aren't really wonder drugs. Sure, they help a lot of people, but for others they don't or at least they don't do it for a long time. It's a better, dedicated medication than just using pain medication or anti-depressants off-label, but we're far from every migraine sufferer finally getting a totally reliable off-switch.
I started erenumab (a CGRP antagonist, brand name Aimovig) around 8 months ago, and it's been absolutely amazing! I've went from having several migraines a week to almost none, and never while sleeping.
It really is expensive though - here in the UK it costs the NHS £386 per injection pen! As a result, I had to fight with my neurologist for over a year to let me have it.
Doing subq injections yourself sounds daunting, but it's not so bad once you've done it a couple of times. Apart from...
...as an aside, the Aimovig branded injector pen is shit - it hurts like absolute hell, and somehow always seems to cut me, like it "slides" before the needle goes in. I've done subq injections with a regular needle before, as well as using another kind of pre-filled injector pen for a different medication, and they were so much better!
This is why everyone should be able to have tax-free health savings accounts and more control over their healthcare rather than having to go through insurance/governments :p
I have a high deductible plan that lets me have a health savings account. Anything I put in is tax free and if I use it for healthcare anything I use it for is tax free. Insurance is there solely for routine care that it covers as well as major medical - if I have to go into the hospital, get cancer, etc. Everything else I negotiate out of my HSA. It's amazing the price differences you can get when you pay cash and insurance is not involved!
Over time I started learning the patterns of my migraines and I’ve avoided the auras for 10 years. Biggest impacts for me are staying hydrated, not starving myself and avoiding prolonged sun exposure (as in 3hs under the sun in summer)
I've also not had auras for several years though I do get headaches still. I had extremely low vitamin b-12 levels and I think the auras disappeared after I took shots for b-12.
I found shade 5 sunglasses that are essentially lightweight welding glasses they have been amazing. Unlike most sunglasses they are actually dark.
The first time it happened a doctor recommended Excedrin (HAH!), fortunately I had already suspected caffeine so I skipped that advice and hammered water and laid in bed for a couple hours instead.
Ibuprofen or naproxen for me. Caffeine is risky but present in my day to day, I just have to take double the water even if i know I’m just going to pee it out.
Any energy drink messes me up BAD
It was then that I first learned that my conscious is only a small part of my mind, and not in direct control of everything.
If I would have been stuck with that mode of perception permanently I would have gone crazy.
That's probably the craziest takeaway from these. In my experience, losing half the vision + the middle part was the most often one. However, the craziest attack was when I temporarily lost the control of speech. The mind and thoughts were there, but nothing verbally said made sense when listening to myself. I'm so glad that taking a nap was enough to resolve that...
YES. I get the scintillating scatoma but also a new thing, that I call "the folded magazine page": it looks as if someone folded out the middle of a magazine page and I have to turn my head left & right rapidly to construct the rest of the image.
My brain is like: nope, not gonna show you the middle strip, just gonna cut-and-paste the left and right thirds together in the middle.
I get some sort of hearing perception change and vertigo to the point of vomiting. However the devastating pain makes any examination of the strange hearing changes near impossible.
Anyone who has these last any significant duration has my sympathy.
I also had cluster headaches one summer in college; now those are truly the worst pain in the world. Imagine an electric drill going through your head for 15 minutes once a day, then vanishing.
We're made up of disparate systems that our conscience pilots essentially, even our mental faculties are disparate systems. This can sometimes make it hard to recognize when one of these systems is under-performing or worse-yet failing.
I also gave up alcohol gradually around the same time and the episodes gradually subsided after that (I had noticed that the migraines were pretty bad after drinking). I do not know if the two were related or not.
Hope you get better.
What's worse is that my current doctor says there's no way to know if my last one was a TIA or migraine (all my research shows otherwise) and now wants me to start on baby aspirin. So yeah, every time I have an aura I'm convinced it's a stroke.
A prime example of Goodhart's law, or just finding an easy to check proxy for writing quality.
Of course another reason is that modern journalis has to include at least two paragraphs of enticing fluff so that readers buy the subscription.
I thought the same in the past. But I think it's a good idea to enforce word limits to make them think more about the subject and to practice writing longer and complex texts.
The problem is that the teachers just impose a limit without explaining and then it just looks like some bullshit metric.
I think modern journalism is more about SEO and getting attention, not word limits imposed when we were in school (if you hate word limits, then you probably dind't continue writing longer texts)
At college I helped her with her assignments after she was done writing. I didn't know her topic but just reordering sentences, deleting redundant ones and shortening others.
I started doing this after she failed an assignment and she asked for help. After we were done "post-processing" it, she got a B on it. We hadn't touched any of her technical points, just improved the language.
I now help my sister through something similar. She has the opposite. She'll write 300 words for a 1000 word assignment. Again I know nothing of her subject, but I'll do a similar post-processing. In the process I'll notice there are some gaps in her arguments perhaps, or things that aren't as fleshed out.
So I ask her about it and almost always she can tell me lots about the subject from the books and articles she's read as part of the curriculum. So I tell her to write it down, and after going through the assignment we're suddenly in the position where we have to trim some stuff.
I used to think word limits were somewhat silly, but now I see how they can help focus the unfocused or help tease out the knowledge. Both my SO and my sister improved over time, requiring much less help after a while.
Of course left to their own devices, it would likely be very difficult for them. So there's that.
Incidentally, language was never my favorite subject and I didn't do particularly well. However studying math helped me a lot with writing non-fiction, where things like consistent logical arguments matter.
I could imagine novice teachers who haven't attempted the exercise themselves being off considerably -- over or under -- on the number of words needed to complete an assignment.
I can't recall any instance where either of them got a low grade for not fulfilling the assignment due to very limited word count. If you have 200 words it's impossible to go into deep details, that's just how it is.
Of course in those cases we often would have to do multiple passes to cut fluff, focus the arguments by cutting out details, find a word which might replace three others etc. We'd typically start with maybe 4-600 the words and work our way down to 200.
Of course as a teacher, if you just failed your entire class, maybe you need to look at yourself and the assignment you gave rather than the students.
I had one instance of that at high school. When handing back the assignments he loudly proclaimed "Well done, you did by far the best in class" as he handed me my assignment. I looked down and saw a D- on the paper.
The following class the teacher explained what he was looking for, and we would explain what we had learned earlier and he then filled in the gaps.
Favorite quote (because I tend to be wordy): “I apologize for such a long letter - I didn't have time to write a short one.” ― Mark Twain
So much nuance in that simple sentence!
None of that. Journalists simply want to feel like they are novelists, because, deep down, that's what most of them really wanted to be.
Now I’m curious about this, thank you for posting this.
List of commercial anti-GCRP meds. https://www.drugs.com/drug-class/cgrp-inhibitors.html
This article just discusses one small piece of the puzzle, but the evidence shows that stress is still a major trigger for many patients.
My wife used to have almost weekly migraines every weekend, but hasn't had one in years now after moving out of a stressful job.
Even without these disorders, your body is still having to cope with and dispose of these conditions somehow. Often this is a crescendo of getting through the week (thanks adrenaline), and suffering massive headaches on Friday night/Sat morning. Not surprising to me that chronic high stress manifested as horrible headaches with your wife, essentially forcing her to shut down for repairs - usually this means crawling into a dark room and staying there until the pain stops. I imagine that far more unseen/unfelt damage was happening that was more easily ignored on a daily basis (blood pressure and chronic inflammation for instance).
Unchecked inflammatory responses, particularly chronic inflammation for months, is highly damaging to the body, even if the effects aren't noticed in real time.
I suppose what I'm trying to say is that yes, chronic high stress sucks, is very unhealthy, and its evident effects are manifested in odd ways which our bodies are are less capable of papering over as we get older.
If someone out there reading this is suffering from chronic headaches, or feels hung-over occasionally even when they have no excuse for it, destress your life systemically - meaning don't just try meditating, but change jobs like above comment said. Structurally remove the elements that are driving your body into such a condition, because it will only get worse as the effects compound and your body ages.
In the spring of 2008, my dad go remarried to a Chocolatier - we don't talk a lot.
It wasn't until I was 26 that I found out about triptans. I had endured years of avoiding chocolate and racing to find the darkest room possible any time I felt so much as a tinge of an aura.
Today, any time we leave the house, I've got triptans and a bottle of Aleve ready to go. Thankfully I'm down to about 2 per year. This science is necessary and this article does a good job of highlighting how and why this topic has been glossed over for decades.
The picture gets even more complicated now that I have kids. both female and one with a traumatic brain injury as a result of bacterial meningitis at birth. I can barely comprehend about how she interprets the world on a daily basis. If she has migraines on top of that, I will be so thankful there are a wider set of options today than ever before.
Goadsby deserves to be celebrated!
I used to suffer fairly severe migraines with aura every month or two until I started taking a chelated magnesium supplement for an unrelated purpose. I found that my migraines dropped by 95% or more, and they are much less severe when they do occur.
I was in my early 30s when I started taking the magnesium, so it’s possible that I just aged out of migraine sensitivity, but the magnesium supplements are not terribly expensive and are probably worth some self-experimentation.
- MSG
- sodium nitrate or nitrite
- celery powder (added by makers of sausage and jerky to dodge disclosure of sodium nitrate/nitride)
- aspartame
- many fermented foods: yogurt, cheese, ...
- raw onions, garlic
- red grapes, red wine
I normally always read through the meds papers about potential effects and stuff and one day while sitting on the toilet I accidentally took the NSAIDs papers and started reading through and realized that I have most of the unwanted effects described there. I told this to my doctor and she decided that it's probably not side effects but something else. they started thinking it's something neural and possibly an autoimmune disease. they didn't find anything. at this time I decided to make a test myself and stop taking NSAIDs and instead took another (highly addictive) medicine that's very similar to morphine. but since I'm very worried about (medicine) addictions I was very careful with taking this medicine so the next 6 months were pure hell. constant migraine, medicine that you can take at most once a week and would offer at most 10-12 hours of relief. luckily ALL of the above symptoms disappeared and only the migraines remained. even my eyes completely recovered, hemorrhoids went away. everything except the damned migraine. after these 6 months I did a test and took a double dose of NSAIDs I was taking earlier and overnight all the symptoms returned - finally we were sure that it's all side effects of NSAIDs.
so where is this wall of a story going? finally a private neurologist that I was going to because of the muscle twitching told me about a new vaccine based on erenumab was approved and that my health insurance will cover 95% of the price. we did a trial and once it took hold after a week or two life completely changed for me. in three months I only had ONE migraine attack and it was quite mild. I'm now in my fourth month of the self-applied vaccines (one a month) and so far it works like a charm. I can enjoy life once again. I'm now 37 years old and finally I can enjoy life.
looking back on the last 30 years of living with almost daily migraines it's something I wish nobody ever would have to endure. I believe that the people who came up with this medicine/technology should be awarded a noble prize.
once I went through that hell I finally asked my girlfriend to become my wife and we're in the process of moving in together and planning our wedding and thinking seriously about having children. now I know I will be able to be there for her and our children and not in bed listening to calming music all day.
Please no. Chiropractors are mostly pseudo-scientific pretend-doctors that should be allowed anywhere near a nervous system. They are not "back doctors".
In 2021 they're a huge source of anti-vaccine misinformation.
https://simonsingh.net/media/articles/alternative-medicine/b...
https://www.health.harvard.edu/heart-health/chiropractic-nec...
> Doctors hate this fact and will gladly put people on meds or tell them to change their lifestyle
Hating on doctors is no reason to go see a quack.
Doctors often suck. Look into malpractice lawsuits and draw your own conclusion about the perfection inherent in modern medical practice. They’re often bested by the quacks. A rational person should fear a doctor more than a chiropractor, if they’re numerate.
It's popular.
> Another question worth pondering: people go back to chiropractors for repeated treatment
It feels good and they think it helps. But people are very bad at judging whether treatments are effective. That's why we need double-blind placebo controlled trials. And chiro fails those.
From my standpoint, if many people think chiropractic treatment stops their migraine and makes them feel better, I’m inclined to believe them. You and the mainstream medical establishment are free to insist those people are wrong. No real harm in that. I do think it’s a bit absurd to say these people are wrong about it making them feel better, but we can agree to disagree. I’m merely posting my views because maybe another migraine stufferer who has been failed by traditional medicine will read this and decide they’d like to be mistaken in such a way also. Being mistakenly pain free when you’re sufferering from migraine pain is pretty great. Even if you’re wrong, at least you think you feel better.
https://osteopathic.org/what-is-osteopathic-medicine/what-is...
They are the most effective family physicians I have ever had. I go out of my way to find them.
The best take on chiropractors IMO comes from physical therapists who tend to take a more pragmatic view on chiropractic. It can help but shouldn’t take the place of mainstream medical care.
In terms of one of the other comments about chiros being anti-vaccine, so are many doctors, nurses and other highly trained medical professionals. Again, my point isn’t that chiros aren’t quacks, it’s that they often resolve problems that mainstream doctors can’t or won’t, migraine being a good example. That says more about doctors and mainstream medicine IMO than it does about chiros who I acknowledge can be a bit like witch doctors or even worse, immoral witch doctors.
And that's why you recommend someone who isn't a doctor at all for issues with the body?
Sounds like ego and hubris to me: "I can fix things that I've never studied like actual Medical Doctors have simply by twisting someone's back suddenly!"
No thanks.