Migraines: IPhones Allow Monitoring of Sleep, Eating and Mood Triggers

PainRelief.com Interview with:
Kathleen R. Merikangas, Ph.D.
NIH Distinguished Investigator

Chief of the Genetic Epidemiology Research Branch
Intramural Research Program at the National Institute of Mental Health
Adjunct Professor of Epidemiology
Johns Hopkins Bloomberg School of Public Health 

PainRelief.com: What is the background for this study? What are the main findings?

Response: We have been studying differences in patterns of migraine in males and females and how it changes across the life span. We focus on recruiting people from the general community rather than those who come to clinical settings who tend to have more severe cases of headaches. This allows us to gather information that can generalize to the community.  We have taken advantage of the widespread use of mobile phones to administer assessments of physical and mental health in real time naturalistic settings.

The question that we addressed in this paper was whether we could identify changes in mental or physical health that may be related to the onset of headache on the next day. identifying potential triggers of headache attacks can help us to avoid them when possible, to intervene as early as possible in the progression of headache attacks, and to gain insight into the underlying biologic and environmental factors involved in migraine.

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UCLA Study Finds Distinctive Vascular Eye Changes During Migraines

PainRelief.com Interview with:
Katherine Podraza MD, PhD
Headache medicine specialist at Hartford HealthCare Headache Center
Assistant Professor of Neurology
University of Connecticut School of Medicine

PainRelief.com: What is the background for this study?

Response: We know migraine is a complex and disabling neurovascular neurological disorder that has to do with the dysfunction of cortical networks in the brain. The eye given its direct connections to the brain through neuronal and vascular supply may also show changes related to migraine.

We studied changes in blood vessel structure and perfusion in the eye during migraine attacks using a non-invasive imaging technology called OCTA (Optical Coherence Tomography Angiography). As part of the study, patients with migraine (both with and without aura) were scanned both during an attack as well as between migraine attacks. In addition, we scanned healthy controls for comparison.

Our goal with the interictal scan (scans done when patients are not having an attack) was to find out if we can find imaging biomarkers for migraine. Our second goal was to use OCTA to find out if there are any changes in perfusion during a migraine attack. This could lead to a better understanding of the pathophysiology of migraine.

For the analysis, we specifically focused on two important regions in the retina, the fovea which processes our highest acuity vision and the parafovea which is the surrounding area and provides additional visual processing support. The fovea has the largest density of cone photoreceptors and also includes the foveal avascular zone which is devoid of blood vessels.

The parafovea surrounds the foveal region and is an area that has the thickest layer of retinal ganglion cells which transmit inputs from photoreceptors to various regions of the brain via the optic nerve. This region, given the complex interaction of neuronal cells and vascular inputs, was a perfect location to investigate migraine mechanisms.

New Migraine Headaches Linked to Increased Motor Vehicle Crashes in Older Adults

PainRelief.com Interview with:
Carolyn DiGuiseppi, MD, MPH, PhD
Professor of Epidemiology
Colorado School of Public Health
University of Colorado Denver
Aurora, CO 80045

PainRelief.com: What is the background for this study?

Response: Migraine headache is a leading cause of disability worldwide and affects many older adults in the US and globally.

Some of the symptoms of an acute migraine, like fatigue, impaired concentration, headache, or dizziness, could affect older adults’ ability to drive safely.  In fact, past research has suggested that people with migraine are at higher risk of having injuries resulting from motor vehicle crashes (compared to people without this diagnosis). We wanted to learn whether the risk of crashes depends on whether people have had a migraine diagnosis for some time or have been recently diagnosed, and whether being treated with migraine medications affects the risk of crashes.

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Some Headaches May Really Stem From Neck Muscles

PainRelief.com Interview with:
Nico Sollmann, M.D., Ph.D.
Resident in the Department of Diagnostic and Interventional Radiology
University Hospital Ulm, and the
Department of Diagnostic and Interventional Neuroradiology
University Hospital Rechts der Isar in Munich, Germany

PainRelief.com: What is the background for this study?

Response: Neck pain is very common among patients with primary headache disorders, such as tension-type headache or migraine. However, neck pain is mostly neglected during diagnosis as well as for treatment concepts in patients with such headache disorders. 

Our study revealed alterations of the trapezius muscles in subjects with tension-type headache and subjects with tension-type headache plus migraine attacks by using quantitative magnetic resonance imaging. We suggest that those changes (i.e., increase of T2 values of the trapezius muscles) may be related to subtle edematous changes within the musculature, which might stem from inflammation. .

PainRelief.com: What are the main findings?

Response: Given that we also found significant associations between those muscular changes and the number of days a subject suffered from headache over the 30 days prior to imaging as well as neck pain, our study may provide objective evidence for the interrelationship between the neck area and the brain in headache disorders

PainRelief.com: What should readers take away from your report?

Response: Primary headache disorders may be linked to neck pain, and quantitative magnetic resonance imaging may help to visualize and objectify changes of neck musculature that might be related to subjectively perceived pain. Involvement of neck muscles in primary headache disorders may relate to subtle inflammatory alterations in muscle tissue.

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: The application of quantitative magnetic resonance imaging can objectively detect changes of the trapezius muscles in subjects suffering from headache disorders, thus providing a quantitative biomarker. Such a biomarker has not yet been available, and it could be used to phenotype patients, monitor the disease status, as well as treatment effects.

In a planned randomized controlled trial, we would like to combine quantitative magnetic resonance imaging (for diagnostics) with peripheral magnetic stimulation (for treatment) to provide a comprehensive framework combining a novel treatment approach with therapy monitoring. Such a trial could help to elucidate effects of peripheral magnetic stimulation by an objective method that is targeting the neck musculature in headache disorders, thus providing the possibility to potentially relieve muscular pain and headache.

No disclosures. The study has been published as an open-access article in the meantime for more detailed information. (https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01626-w)

Citation:

  1. RSNA 2023 abstract: https://press.rsna.org/pressrelease/2023_resources/2475/abstract.pdf
  2. Sollmann N, Schandelmaier P, Weidlich D, Stelter J, Joseph GB, Börner C, Schramm S, Beer M, Zimmer C, Landgraf MN, Heinen F, Karampinos DC, Baum T, Bonfert MV. Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain. 2023 Jul 12;24(1):84. doi: 10.1186/s10194-023-01626-w. PMID: 37438700; PMCID: PMC10337094.

https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01626-w

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Study Reports on Adolescent Headaches During Covid Restrictions

PainRelief.com Interview with:
Dr Ayşe Nur Özdag Acarli
Ermenek State Hospital, Karaman, Turkey

PainRelief.com:  What is the background for this study? 

Response: Headache is the most common neurological problem in children and adolescents. Various factors can contribute to headache such as school, sleep, physical activity, electronic devices, mental health problems and socioeconomic conditions.

For young people, the COVID-19 pandemic has had a striking change on every aspect of life such as school closure, online education from home, fewer academic pressures, more self care at home. Early studies, examined shorter-term effects of the pandemic, reported a reduction on the prevalence of headache and chronic pain in adolescents during COVID-19, which was attributed to less school-related stress. However, in my personal clinical experience, young patients suffered more frequent and severe headaches during the pandemic, especially after the first year of the pandemic. However, literature has been lacking in the long term effects of the pandemic on headache in adolescents.

PTSD: Cognitive Behavioral Therapy for Pain Relief from PostTraumatic Headache

PainRelief.com Interview with:
Don McGeary, PhD, ABPP
Vice Chair for Research, Rehab Medicine
Associate Professor, Rehab and Psychiatry
UT Health San Antonio

Don McGeary
Dr. McGeary

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: This was a randomized clinical trial funded as part of the Consortium to Alleviate PTSD.  The primary aim of the study was to test the efficacy of a novel non-pharmacological intervention (called CBT for headache; CBTH) for posttraumatic headache (PTH) attributable to mild traumatic brain injury (mTBI). 

PTH is the most common and disabling consequence of mild traumatic brain injury and is a large concern for military service members and veterans in the post-9/11 deployment era because of the significant increase in head injury in this population over the last 20 years.  Posttraumatic headache has been recognized under various labels (including “shell shock” and “hero’s headache”) for over a century, but there are no proven, frontline treatments for PTH. PTH is unique among headache diagnoses because it is classified as a secondary headache (i.e., develops as a consequence of another medical phenomenon, mTBI) and because it is diagnosed based on the injury that led to the headache with no criteria for specific clinical characteristics.  Thus, the “phenotype” of posttraumatic headache is variable with the most frequent reports describing symptoms consistent with migraine AND tension type headaches. 

Unfortunately, because the underlying mechanisms of PTH differ from the primary headaches they resemble, frontline medications (abortive and prophylactic) may not have the same efficacy for PTH as they do for the primary headaches for which they are usually prescribed.  To complicate things further, PTH is often acquired in the context of a traumatic experience (blast, firearms overpressure, motor vehicle accident, other traumatic injury), so PTSD is highly comorbid with these headaches and there is an evolving body of research showing that PTSD can complicate, maintain and worsen pain.

Thus, our study sought to
(1) Test a novel non-pharmacological intervention tailored to PTH rehabilitation and
(2) Assess the relationship between PTSD and PTH to determine if preferred treatment pathways should include PTSD treatment as well. 

This resulted in a three-arm trial comparing CBTH to a gold-standard non-pharmacological treatment for PTSD and usual care in a large VA polytrauma center.

Relivion Stimulator of Both Occipital and Trigeminal Nerves for Migraine Pain Relief

PainRelief.com Interview with:
Oved Daniel MD
Headache and Facial Pain Clinic
Ramat-Aviv Medical Center
President of the Israeli Headache Association
Tel-Aviv, Israel

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Migraine patients experience disabling symptoms, which often left untreated or exasperated by currently available therapies, therefore, a significant unmet medical need for treating migraine pain remains.

Current external nerve stimulation devices only target one nerve and this study assessed the safety and performance of a new external nerve stimulation device that stimulates the two major nerve branches associate with pain (occipital and trigeminal) .

The Relivion MG is a non-invasive device that the patient can wear at home to treat their migraine pain and associate symptoms.

Preclinical Trial Tests Combination of CBD:THC for Migraine Relief

PainRelief.com Interview with:
Andrew F. Russo, Ph.D.
Professor, Dept. Molecular Physiology and Biophysics
University of Iowa
Iowa City, IA 52242

Dr. Russo

PainRelief.com:  What is the background for this study? 

Response: The company Schedule 1 Therapeutics approached us with an interest in testing a combination of CBD:THC in migraine. We thought the topic had tremendous public interest so we teamed up with them and won grants from the Migraine Research Foundation and from the National Institute on Drug Abuse.  

Review of Lidocaine Infusions for Pain Relief from Chronic Migraine

PainRelief.com Interview with:
Eric C. Schwenk MD
Anesthesiology
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

Dr. Schwent

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Patients with refractory chronic migraine (rCM) have typically failed all available medications and many times have nearly constant headache pain and in many cases disability. Aggressive treatment is indicated to provide relief and help break the cycle of pain.

Lidocaine infusions have been used for decades in various acute and chronic pain conditions, including complex regional pain syndrome and pain after surgery. At the Jefferson Headache Center lidocaine has been a mainstay of treatment for such patients for several decades but evidence supporting its benefits is scarce.

The main findings were that patients with rCM experienced acute relief at the end of the infusion and that some relief was sustained at 1 month, although the degree of pain relief faded over time. It was also well tolerated with nausea and vomiting occurring in 16.6% of patients and other side effects occurring less frequently.

Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

PainRelief.com Interview with:
Allison Lee, MD, MS  
[she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

PainRelief.com:  What is the background for this study? 

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.