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.

Continue reading

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.

Headache: Clinical Trial Finds Oral Atogepant Reduced Monthly Migraine Days

Dr. Trugman

PainRelief.com Interview with:

Joel M. Trugman, MD
Associate Vice President
Neuroscience Development
AbbVie

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

Response: Migraine is a disabling chronic disease characterized by recurrent headache attacks and associated symptoms, including nausea, phonophobia, or sensitivity to sound, and photophobia, or sensitivity to light.

The ADVANCE clinical trial is a phase 3, randomized, double-blind, placebo-controlled trial and examined the safety and efficacy of atogepant, an oral, small-molecule calcitonin gene-related peptide receptor antagonist in patients with episodic migraine. The primary efficacy endpoint was the change from baseline in mean monthly migraine days (MMD) across the 12-week treatment period. This analysis that was recently published examined the efficacy of atogepant using 4 levels of mean monthly migraine day (MMD) responder rates. 

This analysis found that all doses of atogepant significantly increased the proportion of participants who achieved a ≥25%, ≥50%, ≥75% and 100% reduction in mean monthly migraine days over 12 weeks of treatment.

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.  

Infused VYEPTI Provided Pain Relief When Initiated During a Migraine Attack

PainRelief.com Interview with:
Roger Cady, MD
VP Neurology
Lundbeck Pharmaceutical
La Jolla Research Center
San Diego, CA 92121

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

Response: The RELIEF study evaluated how preventive migraine candidates may benefit from a VYEPTI infusion during an active migraine attack when administered within 1 to 6 hours of a moderate to severe migraine attack. VYEPTI is the first and only intravenous (IV) infusion approved for the preventive treatment of migraine in adults.

Continue reading