The World Migraine Summit begins online tomorrow. It's the biggest opportunity to learn about Migraine disease all year. The Migraine World Summit will bring together over 30 top experts, doctors and specialists to share new treatments, research and strategies for Migraine and chronic Headache.
World-Leading Experts: At the Migraine World Summit, you’ll learn first-hand from over 30 of the world’s top migraine and headache experts, doctors, specialists, from leading institutions including the Mayo Clinic, Harvard Medical School, Cleveland Clinic, Stanford, John Hopkins Hospital, and the International Headache Society.
Full Access: Many of these world-leading experts have long waiting lists and fees that are beyond the affordability of the average insurance policy. Skip the waiting period and get straight into the room with these experts.
Free: The event is entirely free whilst live from April 18-26. Visiting dozens of specialists in one field would take years and costs thousands of dollars. This is an incredible opportunity to hear from dozens of leading experts in migraine for free during the week. After April 26 transcripts and interview copies are available to order.
I'm thrilled to have been asked to be part of this year's Summit. You can see my presentation, They Don’t Get It: Educating Family & Friends on Migraine, on Saturday, April 21.
It's important to get your free ticket NOW by following this link.Once you've requested and received your free ticket, you'll receive an email each day with that day's schedule.
From April 18-26, you will be sent a link each day to watch the speakers.
You will have 24 hours to listen to each day’s program, regardless of your time zone. After 24 hours, those interviews will be replaced by the following day's speakers. This is so that as much content as possible can be included in the Summit without exhausting bandwidth restrictions, slowing speed or having to limit volumes during the week.
If you miss some of the sessions, or if you'd like transcripts and videos of the sessions, they'll be available. For your ticket to attend free, or to check out transcripts and videos, just follow the link below.
Over the years, I've worked on several sites and blogs about Migraine disease, among them, MigraineDisease.com. Mostly due to lack of time, MigraineDisease.com has never been as good as it could be. Well! That's changing!
On May 1st, 2018, an all new MigraineDisease.com will be launched. I've teamed up with Migraine and headache patient educator and advocate Tammy Rome and her husband Brian to build the ultimate site for education, support, and advocacy/awareness. Here are some things to know about our new site:
All of the content on the site will be original content, not content copied from other sites and writers.
Every piece of content is reviewed by a UCNS certified Migraine and headache specialist for accuracy.
Our experienced patient educators have a total of 300+ continuing education hours in "headache medicine."
We have a medical advisory board consisting of practicing physicians and psychologists who specialize in treating patients with Migraine and other headache disorders.
We're Migraine and headache patients too. We know what it's like to live with these diseases/disorders.
For 18 years, I've written Migraine and headache content for About.com and the HealthCentral Network. Don't get me wrong — they've been good years, and I continue to write part-time for HealthCentral. But, it's also a dream come true to write for a site where my partners and I will set the editorial direction for the site and make our own decisions about editorial and other issues.
I've had Migraines since I was six-years-old. Have gone back and forth between episodic and chronic Migraine, with times during which I had a Migraine every day. Tammy has both chronic Migraine and Cluster Headaches. We both feel incredibly fortunate to be able to attend the same continuing education conferences that Migraine and headache specialists attend, to have built a network of colleagues we can call upon for information and explanations, AND to be able to write content that allows other patients to better understand their Migraines and/or headaches and be better prepared to work as treatment partners with your doctors. We'll also be continuing to develop ways to offer you the support you need to retain hope and live better. Finally, MigraineDisease.com will always provide you with awareness and advocacy information so you can participate in those efforts — in simple, quick ways and in more in-depth ways, depending on your circumstances and wishes.
We're working hard to be ready to launch our new site on May 1st. For now, please visit MigraineDisease.com, and sign up for email updates and announcements.
Three generations of John Robert: John Jeffrey, John Marshall, & John Emry
Good morning, and happy Sunday to my extended Migraine and Headache family.
As some of you know, John Robert, my husband, died unexpectedly on September 18 last year. What many people don't realize is that John was quietly, but steadfastly very supportive of the Migraine community. He started out being very supportive of me in my struggles with Migraine disease. Then, both of our sons married women who have Migraine, and five of our nine grandchildren have Migraine.
John is a great example of why I dislike it when people say that nobody can understand Migraine unless they have Migraine themselves. John seldom had as much as a mild tension-type headache, but he certainly witnessed my Migraines — many, many times. When we were first married, my Migraines were episodic and not very frequent. The first time he was with me during a Migraine, he was on his knees beside me, softly asking what he could do to help me. He helped me get my meds, get into bed, got me an ice pack, darkened the bedroom, and got our sons to the other end of the house, explaining to them that I needed quiet.
One evening, after my Migraines became chronic, he asked me to sit down for a discussion. He said that he knew I wanted to keep working, but that he could see how difficult it was to even try to go to work most days. He wanted me to know not only could we afford for me to not work at that point, but that he really wished I'd quit my current job and concentrate on doing whatever WE needed to do to get my Migraines back under control. He emphasized that my feeling well was more important than the extra income. He promised that, as my partner in life, he was also my partner in dealing with Migraine disease and any other health issues that might come along.
When I needed to see a Migraine specialist, and there were none in our state, he took two days off work every time I had an appointment with my first specialist in Philadelphia, an eight-hour drive from our home. He learned about Migraine with me, voraciously reading everything I gave him about Migraine, treatments, and so on. Extra medical expenses when I wasn't working? He took that all in stride. We cut back on the extras — eating out, cable television, etc. Days when I was so sick I needed him to come home from work? No problem. If I didn't feel well in the morning when John left for work, he usually came home on his lunch break to see if he could do anything for me. Usually, there wasn't anything he could do, but it made me feel better to have him home for a bit.
When I started doing the work I do, John was my biggest supporter. I wasn't sure I could do it, but he was. For the last 18 years, he has been my source of strength and confidence. The deeper I got into my work and the Migraine community, the more John followed both my work and the community. The pay for my work isn't much, but he didn't care. All he ever said was that it would be helpful if I didn't spend more doing my work than I brought in. He didn't mind that I donated a huge portion of my earnings to Migraine and Headache nonprofit organizations. In fact, when my birthday and Christmas came along, he often made donations in my name as gifts to me.
It's taken a while for me to be able to share this with you. I miss John terribly every single day. Today, however, I want to share more of him with you. He was after all, a great supporter of yours too.
Good morning to my extended Migraine and Headache family. I hope last week was as kind to you as possible.
Last week, I learned a valuable lesson from Binx, the cat who owns us. Binx is a young cat, just a year old, so there's still a lot of kitten in him and his behavior.
I believe very firmly that bringing a pet into our home carries the responsibility to do everything possible to see to it that he's healthy and happy. Binx seems to firmly believe that it's his responsibility to follow me everywhere I go when I'm home. It appears that I've become a piece of cat furniture and one of his favorite toys.
A few days ago, I went upstairs from my office to get a glass of tea. Binx followed me and was running in circles around me. When I walked down the hall to our bedroom, he ran ahead of me and jumped up on our bed, where be began attacking imaginary things under the blankets.
Obviously, Binx was in the mood to play. I sat down on the bed, put my hand under the blanket, and let him stalk and pounce on it for a while. Then, he bopped me on the nose with his paw and tore off running down the hall. I did what I was supposed to do at that point, and followed him. As I walked out of the hall and into the dining room, a black flash came out of hiding and wrapped all four paws around my ankle.
After playing with Binx for a good half hour, I went back to my desk. I'd been having trouble with an article I was writing, but suddenly, the rest of it came easily.
What hit me is that I've been so busy lately that I've not only been neglecting Binx, I've been neglecting myself too. We all need "play time," time away from work and the concerns of daily life. So, that's the lesson Binx taught me, and it's amazing how much it's helped me.
Do YOU take time to play and relax? Remember that when we're stressed or not taking care of ourselves, we're more susceptible to our Migraine triggers. Take a bit of time to play, and have a great day!
Good morning, and happy Sunday to my extended Migraine and Headache family!
A few years ago, I met two remarkable women, Jacki Ochs and Susanna Styron. They're award-winning filmmakers, and they were at our annual Headache on the Hill Headache and Migraine advocacy event in Washington, D.C.
The reason they were at Headache on the Hill was the new documentary film they were working on, Out of My Head.
"Migraine is a devastating but fascinating neurological disease with a compelling story to tell. Alice in Wonderland, Vincent Van Gogh, Sigmund Freud and Saint Hildegard von Bingen all figure into its colorful history.
Our film looks at the entertaining details, and the big questions too — the source and management of illness, the economic cost of human disability, the nature of pain and suffering — while shining a spotlight on the frontiers of neuroscience and the exploration of the brain.
Most importantly, you will hear courageous and wondrous stories directly from migraineurs."
I recently saw the trailer for the film, and it's magnificent. But, don't take my word for it. Watch the trailer yourself:
Out of My Head will debut next month in Vancouver at the International Headache Congress, and I'm excited that I'll be there for its first screening. Plans are underway for more screenings. Keep an eye on The Migraine Project web site for scheduled screenings. You can also find them on Facebook.
Good afternoon to my extended Migraine and Headache family. I hope the day is being as kind as possible to you and your head.
Migraine is a complex neurological disease. As you probably already know there are several types of Migraine, and getting a full and accurate diagnosis is critical to Migraine treatment and management. In the various areas of medicine, it's common for professional organizations to work together to define classification systems for diagnosis. In "headache medicine," the gold standard for diagnosing and classifying Migraine and other headache disorders is the International Headache Society's International Classification of Headache Disorders, 3rd Edition (ICHD-3).
I've been seeing a lot of online discussions with people talking about what type of Migraines they have. Unfortunately, all too many of these discussions include types of Migraine that aren't the "standard" diagnoses from ICHD-3. This can happen when doctors aren't experienced with treating Migraine. It can also happen when people have been reading inaccurate online content.
In any case, I thought it would be helpful to provide you with a list of types of Migraine from ICHD-3:
1.1 Migraine without aura
1.2 Migraine with aura
1.2.1 Migraine with typical aura
22.214.171.124 Typical aura with headache
126.96.36.199 Typical aura without headache
1.2.2 Migraine with brainstem aura
1.2.3 Hemiplegic migraine
188.8.131.52 Familial hemiplegic migraine (FHM)
184.108.40.206.1 Familial hemiplegic migraine type 1
220.127.116.11.2 Familial hemiplegic migraine type 2
18.104.22.168.3 Familial hemiplegic migraine type 3
22.214.171.124.4 Familial hemiplegic migraine, other loci
126.96.36.199 Sporadic hemiplegic migraine
1.2.4 Retinal migraine
1.3 Chronic migraine
1.4 Complications of migraine
1.4.1 Status migrainosus
1.4.2 Persistent aura without infarction
1.4.3 Migrainous infarction
1.4.4 Migraine aura-triggered seizure
1.5 Probable migraine
1.5.1 Probable migraine without aura
1.5.2 Probable migraine with aura
1.6 Episodic syndromes that may be associated with migraine
1.6.1 Recurrent gastrointestinal disturbance
188.8.131.52 Cyclical vomiting syndrome
184.108.40.206 Abdominal migraine
1.6.2 Benign paroxysmal vertigo
1.6.3 Benign paroxysmal torticollis
A1.6.5 Vestiblular migraine
If your diagnosis is simply "Migraine" or "chronic Migraine" it's an incomplete diagnosis. Many of us have more than one type of Migraine. For example, my diagnoses are chronic Migraine, Migraine with aura, and Migraine without aura. What's your diagnosis? If it's an incomplete diagnosis, or if it's a type of Migraine that's not included in the list above, a conversation with your doctor is in order.
Good morning to my extended Migraine and Headache family! I hope all of you are doing as well as possible.
In a more perfect world, everyone would be kind and compassionate, and they'd understand people living with debilitating diseases. The sad fact, however, is that we don't inhabit such a world. We also live in a time when, thanks to examples set by some of our leaders, it seems to be acceptable to criticize people, call people names, and be downright nasty.
Since we have to live in this world, it would serve us well to find ways to educate others about Migraine disease, it's impact, and us - the people who live with Migraine.
I've written about various ways to raise awareness and advocate for ourselves. Last week, I observed some discussions about Migraine that gave me a bit of insight into something we may be doing that weakens our efforts and may cause people to take us less seriously.
What I'm referring to is how we sometimes talk about our pain levels and how ill we feel. Let me offer you a few examples taken from recent online discussions:
"I've had a 12/10 Migraine for three days now."
"My head is going to explode, literally."
"The nurse in the ER rolled her eyes when I told her my Migraine was at least a 13."
"My pain is at a 10, but this aura is totally off the scale; I can't see anything."
I totally understand that the pain and other Migraine symptoms can push us to the edge. But statements such as those above contain huge issues. Let's look at each statement:
"I've had a 12/10 Migraine for three days now." Most people use a scale of zero to 10 to scale pain, with 10 being the worst pain imaginable. It doesn't do any good to say we're beyond 10. If we're talking with a doctor, he's asking us to scale our pain so he can better decide to help us. We're not helping him help us when we exceed 10. If we're talking with other people online for suggestions and support, saying were at 12 out of 10, many people are going to dismiss us, thinking that nobody could be online if they were in that much pain.
"My head is going to explode, literally." Seriously? Nobody's head is going to "literally explode" from a Migraine. Don't shoot the messenger here, but statements such as that one are a good way to get branded as a "drama queen." This type of statement leads to less understanding, not more.
"The nurse in the ER rolled her eyes when I told her my Migraine was at least a 13." Well, the nurse shouldn't have rolled her eyes, but again, that's a result of "exaggerating" and going beyond the limit of the pain scale.
"My pain is at a 10, but this aura is totally off the scale; I can't see anything." I didn't see this one myself. A friend related it to me, and she was wondering how the person could see to post the long post this was taken from if she had a Migraine aura so bad that she "couldn't see anything."
I realize this is a sensitive topic for some of us, but I'm asking you to give it some consideration and not shoot the messenger here. When we're in a lot of pain and/or experiencing other extreme symptoms, it can seem natural to exaggerate a bit for effect. But, such exaggerations shine the wrong light on Migraine disease. Such statements are unlikely to make other people want to understand better. They're more likely to elicit the response someone got from the ER nurse, eye rolling.
When we're seeking medical care, it's important to be as accurate as possible so we can help the doctors and others help us.
There's another potential negative impact of such statements. Instead of reducing the social stigma associated with Migraine, they're more likely to reinforce and perhaps even worsen that stigma.
Let's find ways to express our pain that put people on our side, wanting to learn more, wanting to help us. Many people don't realize that Migraine is a genetic neurological disease... that we can have a Migraine every day... that sometimes the nausea, light sensitivity, and other symptoms can be so severe that they're incapacitating even without the headache. Here's something else many people don't realize - even if our pain level is low or moderate, perhaps a four or five, having that pain day after day wears on us.
Please give this issue some thought. It truly is important.
All of us who struggle with Migraine disease know that there's an enormous need for more research into Migraine. Yes, we need more research to find new and better treatments, but there are other types of research we need also. We need more research into the epidemiology and pathophysiology of Migraine, and we need research to answer specific questions about treating Migraine.
The good news is that there's a trial currently enrolling to answer one of the specific questions about treating Migraine. The trial is the Medication Overuse Treatment Strategy (MOTS) Trial. It's designed to answer questions that are very important to people with chronic Migraine. One of the biggest challenges to all of us with chronic Migraine is that using acute medications more than two or three days a week can very easily lead us to another problem, medication overuse headache (MOH).
Before I tell you more about this important study, let's discuss MOH a bit. First, I realize that the name "medication overuse headache" is a problem for some people. Let me assure you that it's just a name. Nobodyassociated with the study is passing judgement or blaming anyone who finds themselves in an MOH situation.
For anyone who isn't familiar with what MOH is or what can cause it, here's more info. The International Headache Society has set diagnostic and classification criteria for MOH that are quite complete in listing which medications can cause MOH in their International Classification of Headache Disorders, 3rd edition (ICHD-3). For a diagnosis of medication overuse headache, a pateint must experience at least 15 days of headache per month, and meet this criteria:
8.2 Medication-overuse headache (MOH)
8.2.1 Ergotamine-overuse headache Overuse defined as ergotamine intake on 10 or more days/month on a regular basis for more than 3 months.
8.2.2 Triptan-overuse headache Overuse defined as triptan intake (any formulation) on 10 or more days/month on a regular basis for more than 3 months.
8.2.3 Analgesic-overuse headache Overuse defined as intake of simple analgesics on 15 or more days/month on a regular basis for more than 3 months.
220.127.116.11 Paracetamol (acetaminophen)-overuse headache Regular intake of paracetamol on 15 days per month for more than 3 months.
18.104.22.168 Acetylsalicylic acid-overuse headache Regular intake of acetylsalicylic acid on 15 days per month for more than 3 months.
22.214.171.124 Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache Regular intake of one or more NSAIDs other than acetylsalicylic acid on 15 days per month for more than 3 months.
8.2.4 Opioid-overuse headache Overuse defined as intake of opioids on 10 or more days/month on a regular basis for more than 3 months.** Comment:** Studies show that patients overusing opioids have the highest relapse rate after withdrawal treatment.
8.2.5 Combination analgesic-overuse headache Overuse defined as intake of simple analgesic medications on 10 or more days/month on a regular basis for more than 3 months.** Note:** The term combination-analgesic is used specifically for formulations combining drugs of two or more classes, each with analgesic effect or acting as adjuvants.
8.2.6 Medication-overuse headache attributed to multiple drug classes not individually overused Regular intake of any combination of ergotamine, triptans, simple analgesics, NSAIDs and/or opioids on a total of 10 days per month for more than 3 months without overuse of any single drug or drug class alone.
As you can see, any acute medication (medication used to treat a Migraine or headache when it occurs) can, if overused, cause MOH. Even alternating the types of acute medications leaves us vulnerable to MOH (see 8.2.6 above).
More about the study:
This video by Dr. David Dodick, one of the primary investigators of the MOTS trial is a good introduction to the study:
The aim of this study is to compare two real-world strategies for treating patients who have chronic migraine with medication overuse, each with evidence for effectiveness:
Transition from the overused acute medication used during migraine attacks to different acute medication (prescribed with parameters to avoid medication overuse) with optimized preventive treatment;
Optimized preventive treatment without transition from the overused acute medication.
Although both of these treatment strategies are commonly used, there's insufficient evidence to know if one of these methods is superior to the other or if they provide similar outcomes.
Patients participating in the study will be randomly assigned to one of two treatment arms matching the two strategies. It's very important to understand that patients who are randomized into the transition arm, will NOT be left without acute treatments. The treatments causing medication overuse will be discontinued, BUT other treatments will be prescribed to take their place.
There are no experimental treatments being used in this study. Participants must be patients at one of the study locations or become patients at one of them so they get consistent treatment from their own physician during the study. Centers participating in the study include Migraine and headache centers, general neurology practices, and family medicine practices. Centers participating in this study include:
Northern Arizona Healthcare Medical Group; Flagstaff, Arizona
Mayo Clinic in Arizona Headache Center; Phoenix, Arizona
Mayo Clinic in Arizona Neurology Center; Phoenix, Arizona
Pinnacle Internal Medicine and Headache Center; Phoenix, Arizona
Mayo Clinic Thunderbird; Scottsdale, Arizona
Orange County Migraine and Headache Center; Irvine, California
Cedars-Sinai Medical Center; Los Angeles, California
University of Colorado Denver Colorado Headache Center; Aurora, Colorado
University of Colorado Denver Primary Center; Denver, Colorado
Mayo Clinic Florida Headache Center; Jacksonville, Florida
University of Utah Primary Care; Salt Lake City, Utah
University of Utah General Neurology; Salt Lake City, Utah
University of Utah Headache Center; Salt Lake City, Utah
Medical College of Wisconsin; Milwaukee, Wisconsin
The primary investigators for the MOTS trial are Dr. Todd Schwedt and Dr. David Dodick, both at the Mayo Clinic Headache Center in Arizona. I'm honored to be their co-investigator for this trial, my first venture into research. The study is funded by the Patient Centered Outcomes Research Institute (PCORI).
If you have chronic Migraine and medication overuse, I hope you'll consider being part of this important study. It's an opportunity to address your Migraine treatment AND to help answer this important question that so many of us face.
For more information:
Visit the MOTS Trial web site.
Check out the MOTS Trial Facebook page.
Follow @MOTSTrial on Twitter.
Click the "Email Me" button to the right or at the bottom of this page, depending on how you're viewing this post, to send me an email.