11 ms·

Pioneering work that has changed our understanding of migraines

144 points by robaato 5y ago

newbamboo 5y ago
Many migraines are not migraines but stem (no pun intended) from spinal cord problems that chiropractors can easily treat. Doctors hate this fact and will gladly put people on meds or tell them to change their lifestyle or their career rather than tell them to visit a chiropractor. Doctors are not immune from the effects of ego and hubris.
- jonny_eh 5y ago
  > from spinal cord problems that chiropractors can easily treat 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/beware-the-spinal-trap/ https://simonsingh.net/media/articles/alternative-medicine/b... https://www.health.harvard.edu/heart-health/chiropractic-neck-adjustments-linked-to-stroke 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.
  - newbamboo 5y ago
    Not interested in arguing this because I used to suffer from the same false impression. But here are a few questions for you and others to consider. Insurance will pay for chiropractic treatment most of the time. Why? Another question worth pondering: people go back to chiropractors for repeated treatment. Many swear by them and credit them with fixing problems that doctors couldn’t. It’s extremely common. Why? 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.
    - jonny_eh 5y ago
      > But here are a few questions for you and others to consider. Insurance will pay for chiropractic treatment most of the time. Why? 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.
      - newbamboo 5y ago
        How exactly do blind or placebo test chiro treatment? I’ll give you the benefit of the doubt but a blind, let alone double blind!, placebo controlled test of chiropractic treatment strains credulity. Again I’ll give you the benefit of the doubt. 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.
  - EricE 5y ago
    Doctors of Osteopathy (DO) can be thought of Chiropractors with an MD - but that would be selling them a bit short IMNSHO. https://osteopathic.org/what-is-osteopathic-medicine/what-is-a-do/ 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.
    - newbamboo 5y ago
      I strongly agree about DOs and note that many MDs denigrate the DOs as being less than. My experience is that they are much better than MDs on average. Ymmv 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.
- techrat 5y ago
  > Doctors are not immune from the effects of ego and hubris. 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.
01acheru 5y ago
I suffer from migraines and that article could have been interesting, but I cannot stand those ten page long storytelling articles anymore
- billfruit 5y ago
  Yes, this is so tedious a practice, where everything needs to spun out into 10/20 pages of storytelling, and cliffhangers etc. Low information density articles are such a drain on all of us.
  - munificent 5y ago
    Some readers consider the human interest part "information" too.
- codeulike 5y ago
  There's actually very little in the article about the 'pioneering work' and how it happened, what the breakthroughs were etc 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
  - starkd 5y ago
    I can recall reading articles making that claim going back at least thirty years now, claiming they need to take a fresh look because it has not been taken seriously. It's just a pitch for more research dollars. There's likely no one cause for the illness. Migraines can due to wide number of things.
    - deleted 5y ago
      [deleted]
- rocketbop 5y ago
  I found the same when I came across the article a couple of days ago. There was no real revelations, but the doctor in question has worked on some new medications which work better than previous medications and are now coming on stream.
pzg 5y ago
my migraines started when I was about 7 years old (possibly earlier but my memory of my earlier years is too fuzzy to be sure) - I can remember the very first one while I was sitting on a swing in the first grade. thankfully I don't get any auras only a splitting headache that can appear in any or all parts of my head but seemingly prefers the lower back part of my head or just behind the eyes. during my education and early career everyone (even my doctors) thought I'm just coming up with this to evade school or work. however things became serious by my late twenties when I would get 3 to 4 days of migraines A WEEK. finally a neurologist in my early thirties recognized and accepted the fact I have migraines and gave me some medicine which kind of helped but I since I had 3 attacks a week I was going through a box of medicine in about the same period. my doctor actually got worried about the amount of medicine I was taking, my neurologist got pregnant and got on a leave of about a year and a half and I ended up taking non-prescription NSAIDs to be able to have a normal life. I went through a box of NSAIDs in about a week for YEARS with the last two years getting really really bad where life was just one constant headache. I never realized it could a side effect of the meds I was taking. during this period I also developed spontaneous retina damage in my right eye which just didn't want to heal properly. for such things to heal they have to scrape away the top layer of your retina and then in a period of 7 to 10 days it grows back and it's normally painless BUT I was hyper-sensitive to the lenses that cover the retina and prevent the pain so I would be completely incapacitated for 10 days by both migraines and pain from my half-blind right eye. this repeated 4 times (it's actually a miracle I can still see with my right eye). I was spending about 200 to 500 USD monthly (about 75% of a mean national income for my country!) on various medicine to keep my eyes lubricated during the day and night to prevent new retinal damage. I was waking up exactly every two hours during the night to put drops into my eye. then after a particularly hard migraine attack when I went through a whole box of NSAIDs in a weekend I woke up with ringing in my ears and dangerously high blood pressure. I have developed hemorrhoids. migraine was a daily pain and I have started developing retinal damage in my left eye, too. I also developed unvoluntary twitches in ALL of my muscles and at night couldn't fall to sleep due to very strange sensations of a "mental reset" whenever I was about to fall asleep. I was at an all time low and (this is the first time I ever said this to anyone), I started thinking that death/suicide would be easier on me. 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.
Indy9000 5y ago
That whole article could have been just two sentences.
- gumoro 5y ago
  I recommend the 6th paragraph (4 sentences) in this article: https://newsroom.ucla.edu/dept/faculty/peter-goadsby-migraine-expert-awarded-brain-prize-2021 https://newsroom.ucla.edu/dept/faculty/peter-goadsby-migrain...
- carlmr 5y ago
  I blame schools for teaching kids to reach word limits, instead of how to express themselves concisely. 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.
  - lelandfe 5y ago
    On the web, content length is also typically seen as an SEO signal. Whether that’s a direct signal or just keyword stuffing, who knows.
  - marcos100 5y ago
    > I blame schools for teaching kids to reach word limits, instead of how to express themselves concisely. 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)
  - dorkwood 5y ago
    They can also fit more ads into a longer article. That's arguably the most important thing.
  - 5y ago
rcgs 5y ago
What a meandering read.
abhijat 5y ago
As someone who used to suffer from visual auras (which ranged from a few minutes to 15 minutes at most) due to migraine, a persistent aura which does not go away sounds truly horrible.
- culopatin 5y ago
  Hey here too. The first time it happened to me I was in high school and my professor thought I was lying when I told her I could no longer see my periphery. I had a dentist appointment after school and I had to take the bus. By the time I got on the bus, I could only see through a tiny window so I had a hard time finding the handles to hold on to. I was lucky and my dentist was working with a massage therapist when I got there and the lady was nice enough to give me a massage where my head meet the neck and that seemed to start undoing the effects. Within an hour my vision started getting better. 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)
  - tw04 5y ago
    Same, too much caffeine and being dehydrated are a trigger, too many nights of not enough sleep as well. It's annoying they've gotten more frequent as I've gotten older. 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.
    - culopatin 5y ago
      I avoid acetaminophen altogether. i had a terrible terrible morning because of it. I guess my liver wasn’t doing great which caused a migraine and I added acetaminophen to the mix. 3hs of incapacitating pain followed by 6hs of recovery:m. A wasted day. 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
  - 5y ago
wombatmobile 5y ago
If you don’t want to wade through the preamble in the article, search for “calcitonin” and start at that paragraph.
hdjjhhvvhga 5y ago
What you are looking for is here: https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptide#Medicines 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.
- codingdave 5y ago
  When Imitrex (another migraine med) was new, it was an expensive injection, too. They got it to pill form later, and it got cheaper. These things take time. It isn't ideal, but it how it works.
- mhd 5y ago
  Either one of the existing ones or the new IV version can also be taken as a "combined package" for a few months. But honestly, the injection is the least of the worries. You don't have to pull something up in a syringe, you get a complete injector from the pharmacy. Aim it at your thigh, push the button, no big chances of doing it wrong. Hurts like hell, I'm told. 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.
- auslegung 5y ago
  What I’m looking at here https://migraine.com/clinical/cgrp-gepants https://migraine.com/clinical/cgrp-gepants lists only 2 drugs and they’re both pill form. I’ve done Aimovig which is a self injection but iiuc it’s a different class from the gepants CGPR drugs.
- GordonS 5y ago
  I suffer from chronic headaches and debilitating migraines. I was having several migraines a week - I was able to mostly stop those that started during the day using sumatriptan, but I frequently had migraines start during the night whole sleeping too, which mean that as soon as I woke up, I'd end up lying in the dark, unable to move and wishing I was dead. The pain really is that bad. 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!
WaitWaitWha 5y ago
Article gives me an attack. List of commercial anti-GCRP meds. https://www.drugs.com/drug-class/cgrp-inhibitors.html https://www.drugs.com/drug-class/cgrp-inhibitors.html
codeulike 5y ago
Anecdata: a close friend has suffered from terrible migraines for years. Triptans such as Sumatriptan/zolmatriptan helped, if taken with anti-sickness meds, but they were needing to take them too often and getting dependency headaches from them. 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/ 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.
- the_d3f4ult 5y ago
  These types of discoveries are becoming more and more common with the explosion of novel biologics.
  - amatic 5y ago
    What are novel biologics?
    - datameta 5y ago
      Medication that is past what is considered "large molecule" and in the size and complexity ballpark of proteins. These need to be injected as opposed to taken orally as they're too large to enter the bloodstream otherwise. There is a whole search space out there for medication of this class and we're only just getting started. It's (loosely) like finding out what is possible with a 100MB program vs a 50KB one.
      - dm3 5y ago
mchusma 5y ago
Frequent migraine sufferer, so very interested in content. Horrible article, but I did search for articles on CGRP treatments and may give them a try.
julbook 5y ago
This is not related to migraines, but I have a friend that triggers his allergy with a sneeze. Once he sneezes, he'll have a runny nose for the whole day.
cpncrunch 5y ago
Terrible article, saying that a stress explanation means the patient is crazy, and that we now know something biological is going on. Ever heard of stress hormones? Adrenaline? Cortisol? Of course stress is biological. 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.
- aksss 5y ago
  Stress levels (emotional, physical, both at once) are also known triggers for flare-ups of autoimmune disorders (MS, lupus, etc). These disorders will readily obviate high stress levels, and people with AI disorders learn quickly that managing stress is often their best weapon for managing the disease. 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.
noyeastguy 5y ago
I used to get aura-style migraines. After following a yeast and wheat free diet my migraines went away. I started on the diet based on a small study as a way to suppress hidradenitis suppurativa symptoms. I’ve now been on this diet for 7 years and have not had a single migraine. It’s clear to me that the cause of migraines are inflammation, in my case caused by innate immunity (with a failure to down regulate) to fungi and 1,3, 1,6 beta glucans.
- berdon 5y ago
  I get aural migraines from Niacin and MSG. Most wheat based flour is enriched with Niacin. You might look into seeing if Niacin is your trigger and be able to eat wheat/yeast again.
  - MarkMarine 5y ago
    I actually got an aural migraine while reading the article, and I had a pizza last night which is a rarity (my wife is gluten intolerant and I mostly follow her diet.) Now I’m curious about this, thank you for posting this.
- halfmatthalfcat 5y ago
  My mother has had the same journey. She's had migrations for as long as I can remember and recently removed lectins from her diet. Haven't had a migraine since, it's actually amazing.
tmnstr85 5y ago
When I was 9, I remember grabbing a handful of mini-M&M's from an information table at UCBerkley and we jumped in our rental van to start the family vacation out to the Grand Canyon. About 15 minutes later I couldn't see due to an aura. That was the beginning of my migraines. 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!
everybodyknows 5y ago
Chronic migraine sufferer here, male -- symptoms now well under control. Hope this may be useful to someone. Triggers in my case are almost entirely chemical, with a delay of ~18 hours from ingestion to aura. The list: - 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
yinzer-solomon 5y ago
I’m posting this in case it helps someone: 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.

144 points by robaato 5y ago

Many migraines are not migraines but stem (no pun intended) from spinal cord problems that chiropractors can easily treat. Doctors hate this fact and will gladly put people on meds or tell them to change their lifestyle or their career rather than tell them to visit a chiropractor. Doctors are not immune from the effects of ego and hubris.

jonny_eh 5y ago
> from spinal cord problems that chiropractors can easily treat 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/beware-the-spinal-trap/ https://simonsingh.net/media/articles/alternative-medicine/b... https://www.health.harvard.edu/heart-health/chiropractic-neck-adjustments-linked-to-stroke 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.
- newbamboo 5y ago
  Not interested in arguing this because I used to suffer from the same false impression. But here are a few questions for you and others to consider. Insurance will pay for chiropractic treatment most of the time. Why? Another question worth pondering: people go back to chiropractors for repeated treatment. Many swear by them and credit them with fixing problems that doctors couldn’t. It’s extremely common. Why? 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.
  - jonny_eh 5y ago
    > But here are a few questions for you and others to consider. Insurance will pay for chiropractic treatment most of the time. Why? 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.
    - newbamboo 5y ago
      How exactly do blind or placebo test chiro treatment? I’ll give you the benefit of the doubt but a blind, let alone double blind!, placebo controlled test of chiropractic treatment strains credulity. Again I’ll give you the benefit of the doubt. 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.
- EricE 5y ago
  Doctors of Osteopathy (DO) can be thought of Chiropractors with an MD - but that would be selling them a bit short IMNSHO. https://osteopathic.org/what-is-osteopathic-medicine/what-is-a-do/ 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.
  - newbamboo 5y ago
    I strongly agree about DOs and note that many MDs denigrate the DOs as being less than. My experience is that they are much better than MDs on average. Ymmv 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.
techrat 5y ago
> Doctors are not immune from the effects of ego and hubris. 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.

01acheru 5y ago

I suffer from migraines and that article could have been interesting, but I cannot stand those ten page long storytelling articles anymore

billfruit 5y ago
Yes, this is so tedious a practice, where everything needs to spun out into 10/20 pages of storytelling, and cliffhangers etc. Low information density articles are such a drain on all of us.
- munificent 5y ago
  Some readers consider the human interest part "information" too.
codeulike 5y ago
There's actually very little in the article about the 'pioneering work' and how it happened, what the breakthroughs were etc 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
- starkd 5y ago
  I can recall reading articles making that claim going back at least thirty years now, claiming they need to take a fresh look because it has not been taken seriously. It's just a pitch for more research dollars. There's likely no one cause for the illness. Migraines can due to wide number of things.
  - deleted 5y ago
    [deleted]
rocketbop 5y ago
I found the same when I came across the article a couple of days ago. There was no real revelations, but the doctor in question has worked on some new medications which work better than previous medications and are now coming on stream.

pzg 5y ago

my migraines started when I was about 7 years old (possibly earlier but my memory of my earlier years is too fuzzy to be sure) - I can remember the very first one while I was sitting on a swing in the first grade. thankfully I don't get any auras only a splitting headache that can appear in any or all parts of my head but seemingly prefers the lower back part of my head or just behind the eyes. during my education and early career everyone (even my doctors) thought I'm just coming up with this to evade school or work. however things became serious by my late twenties when I would get 3 to 4 days of migraines A WEEK. finally a neurologist in my early thirties recognized and accepted the fact I have migraines and gave me some medicine which kind of helped but I since I had 3 attacks a week I was going through a box of medicine in about the same period. my doctor actually got worried about the amount of medicine I was taking, my neurologist got pregnant and got on a leave of about a year and a half and I ended up taking non-prescription NSAIDs to be able to have a normal life. I went through a box of NSAIDs in about a week for YEARS with the last two years getting really really bad where life was just one constant headache. I never realized it could a side effect of the meds I was taking. during this period I also developed spontaneous retina damage in my right eye which just didn't want to heal properly. for such things to heal they have to scrape away the top layer of your retina and then in a period of 7 to 10 days it grows back and it's normally painless BUT I was hyper-sensitive to the lenses that cover the retina and prevent the pain so I would be completely incapacitated for 10 days by both migraines and pain from my half-blind right eye. this repeated 4 times (it's actually a miracle I can still see with my right eye). I was spending about 200 to 500 USD monthly (about 75% of a mean national income for my country!) on various medicine to keep my eyes lubricated during the day and night to prevent new retinal damage. I was waking up exactly every two hours during the night to put drops into my eye. then after a particularly hard migraine attack when I went through a whole box of NSAIDs in a weekend I woke up with ringing in my ears and dangerously high blood pressure. I have developed hemorrhoids. migraine was a daily pain and I have started developing retinal damage in my left eye, too. I also developed unvoluntary twitches in ALL of my muscles and at night couldn't fall to sleep due to very strange sensations of a "mental reset" whenever I was about to fall asleep. I was at an all time low and (this is the first time I ever said this to anyone), I started thinking that death/suicide would be easier on me. 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.

Indy9000 5y ago

That whole article could have been just two sentences.

gumoro 5y ago
I recommend the 6th paragraph (4 sentences) in this article: https://newsroom.ucla.edu/dept/faculty/peter-goadsby-migraine-expert-awarded-brain-prize-2021 https://newsroom.ucla.edu/dept/faculty/peter-goadsby-migrain...
carlmr 5y ago
I blame schools for teaching kids to reach word limits, instead of how to express themselves concisely. 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.
- lelandfe 5y ago
  On the web, content length is also typically seen as an SEO signal. Whether that’s a direct signal or just keyword stuffing, who knows.
- marcos100 5y ago
  > I blame schools for teaching kids to reach word limits, instead of how to express themselves concisely. 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)
- dorkwood 5y ago
  They can also fit more ads into a longer article. That's arguably the most important thing.
- 5y ago

rcgs 5y ago

What a meandering read.

abhijat 5y ago

As someone who used to suffer from visual auras (which ranged from a few minutes to 15 minutes at most) due to migraine, a persistent aura which does not go away sounds truly horrible.

culopatin 5y ago
Hey here too. The first time it happened to me I was in high school and my professor thought I was lying when I told her I could no longer see my periphery. I had a dentist appointment after school and I had to take the bus. By the time I got on the bus, I could only see through a tiny window so I had a hard time finding the handles to hold on to. I was lucky and my dentist was working with a massage therapist when I got there and the lady was nice enough to give me a massage where my head meet the neck and that seemed to start undoing the effects. Within an hour my vision started getting better. 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)
- tw04 5y ago
  Same, too much caffeine and being dehydrated are a trigger, too many nights of not enough sleep as well. It's annoying they've gotten more frequent as I've gotten older. 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.
  - culopatin 5y ago
    I avoid acetaminophen altogether. i had a terrible terrible morning because of it. I guess my liver wasn’t doing great which caused a migraine and I added acetaminophen to the mix. 3hs of incapacitating pain followed by 6hs of recovery:m. A wasted day. 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
- 5y ago

wombatmobile 5y ago

If you don’t want to wade through the preamble in the article, search for “calcitonin” and start at that paragraph.

hdjjhhvvhga 5y ago

What you are looking for is here: https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptide#Medicines 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.

codingdave 5y ago
When Imitrex (another migraine med) was new, it was an expensive injection, too. They got it to pill form later, and it got cheaper. These things take time. It isn't ideal, but it how it works.
mhd 5y ago
Either one of the existing ones or the new IV version can also be taken as a "combined package" for a few months. But honestly, the injection is the least of the worries. You don't have to pull something up in a syringe, you get a complete injector from the pharmacy. Aim it at your thigh, push the button, no big chances of doing it wrong. Hurts like hell, I'm told. 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.
auslegung 5y ago
What I’m looking at here https://migraine.com/clinical/cgrp-gepants https://migraine.com/clinical/cgrp-gepants lists only 2 drugs and they’re both pill form. I’ve done Aimovig which is a self injection but iiuc it’s a different class from the gepants CGPR drugs.
GordonS 5y ago
I suffer from chronic headaches and debilitating migraines. I was having several migraines a week - I was able to mostly stop those that started during the day using sumatriptan, but I frequently had migraines start during the night whole sleeping too, which mean that as soon as I woke up, I'd end up lying in the dark, unable to move and wishing I was dead. The pain really is that bad. 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!

WaitWaitWha 5y ago

Article gives me an attack. List of commercial anti-GCRP meds. https://www.drugs.com/drug-class/cgrp-inhibitors.html https://www.drugs.com/drug-class/cgrp-inhibitors.html

codeulike 5y ago

Anecdata: a close friend has suffered from terrible migraines for years. Triptans such as Sumatriptan/zolmatriptan helped, if taken with anti-sickness meds, but they were needing to take them too often and getting dependency headaches from them. 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/ 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.

the_d3f4ult 5y ago
These types of discoveries are becoming more and more common with the explosion of novel biologics.
- amatic 5y ago
  What are novel biologics?
  - datameta 5y ago
    Medication that is past what is considered "large molecule" and in the size and complexity ballpark of proteins. These need to be injected as opposed to taken orally as they're too large to enter the bloodstream otherwise. There is a whole search space out there for medication of this class and we're only just getting started. It's (loosely) like finding out what is possible with a 100MB program vs a 50KB one.
    - dm3 5y ago

mchusma 5y ago

Frequent migraine sufferer, so very interested in content. Horrible article, but I did search for articles on CGRP treatments and may give them a try.

julbook 5y ago

This is not related to migraines, but I have a friend that triggers his allergy with a sneeze. Once he sneezes, he'll have a runny nose for the whole day.

cpncrunch 5y ago

Terrible article, saying that a stress explanation means the patient is crazy, and that we now know something biological is going on. Ever heard of stress hormones? Adrenaline? Cortisol? Of course stress is biological. 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.

aksss 5y ago
Stress levels (emotional, physical, both at once) are also known triggers for flare-ups of autoimmune disorders (MS, lupus, etc). These disorders will readily obviate high stress levels, and people with AI disorders learn quickly that managing stress is often their best weapon for managing the disease. 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.

noyeastguy 5y ago

I used to get aura-style migraines. After following a yeast and wheat free diet my migraines went away. I started on the diet based on a small study as a way to suppress hidradenitis suppurativa symptoms. I’ve now been on this diet for 7 years and have not had a single migraine. It’s clear to me that the cause of migraines are inflammation, in my case caused by innate immunity (with a failure to down regulate) to fungi and 1,3, 1,6 beta glucans.

berdon 5y ago
I get aural migraines from Niacin and MSG. Most wheat based flour is enriched with Niacin. You might look into seeing if Niacin is your trigger and be able to eat wheat/yeast again.
- MarkMarine 5y ago
  I actually got an aural migraine while reading the article, and I had a pizza last night which is a rarity (my wife is gluten intolerant and I mostly follow her diet.) Now I’m curious about this, thank you for posting this.
halfmatthalfcat 5y ago
My mother has had the same journey. She's had migrations for as long as I can remember and recently removed lectins from her diet. Haven't had a migraine since, it's actually amazing.

tmnstr85 5y ago

When I was 9, I remember grabbing a handful of mini-M&M's from an information table at UCBerkley and we jumped in our rental van to start the family vacation out to the Grand Canyon. About 15 minutes later I couldn't see due to an aura. That was the beginning of my migraines. 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!

everybodyknows 5y ago

Chronic migraine sufferer here, male -- symptoms now well under control. Hope this may be useful to someone. Triggers in my case are almost entirely chemical, with a delay of ~18 hours from ingestion to aura. The list: - 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

yinzer-solomon 5y ago

I’m posting this in case it helps someone: 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.