cbd oil tablets for migraines

CBD For Migraines: What Should You Expect?

There are many arguments in favor of and against the apparent medical potential of CBD. Those who believe CBD can help with various medical issues point to its effects on the cannabinoid receptors in our endocannabinoid system (ECS). They also suggest that it is safer than prescription medication with fewer side effects and hardly any chance of addiction.

Certainly, it is becoming popular amongst individuals with migraines. According to the National Institute of Health, an estimated 36 million Americans suffer from migraines. Let’s see if CBD oil can help if you are among this number.

Conventional Migraine Treatments and Their Side Effects

Before discussing CBD oil for migraines, let’s look at the most popular over-the-counter and prescription medication options and their potential side effects.

Many doctors admit their first recommendation for migraine sufferers is a simple over-the-counter combination analgesic like Excedrin. This drug is effectively a mixture of acetaminophen, aspirin, and caffeine. This medication is relatively safe if taken sporadically. However, frequent use could lead to ulcers, kidney damage, and even stroke or heart attack.

In more severe or chronic cases of migraine, physicians usually prescribe a class of drugs called triptans.

In more severe or chronic cases of migraine, physicians usually prescribe a class of drugs called triptans like Imitrex or Treximet. These drugs work by increasing serotonin levels and constricting blood vessels in the brain. While they’re effective, they’re prone to causing dizziness, nausea, extreme drowsiness, and/or tightness in the chest.

Another class of migraine medication called ergotamines, and mild opioids like morphine and Oxycontin are also common prescriptions for acute migraine sufferers. However, the side effects of these drugs are truly devastating. Opioid overdose deaths have quadrupled since 1999. Meanwhile, ergotamines like Migranal and Ergomar could promote various serious medical conditions. These include heart attack, stroke, congenital disabilities in pregnant women, and even toxicosis if taken along with antibiotics or antifungal medications.

Preventative (as opposed to acute onset) treatment options are also common. These include drugs like verapamil (a calcium channel blocker), amitriptyline (an antidepressant), and anticonvulsants, which act by “calming” overactive nerves in the brain.

These drugs are not as dangerous as ergotamines or opioids. Nonetheless, preventative treatments can produce a sweeping array of side effects. These include nausea, low blood pressure, weight gain, and a decreased libido (low sex drive).

CBD for Migraines: What Is CBD?

For the uninitiated, CBD (cannabidiol) is the non-intoxicating component of cannabis. This means that, unlike THC, it doesn’t get you high. Rather, it works by interacting with an endogenous (naturally occurring inside the body) network of cannabinoid receptors, specifically, G-protein coupled CB-1 and CB-2 receptors in the central nervous system.

Under normal circumstances, these receptors interact with naturally occurring endocannabinoids. They influence such factors as – among other things – pain sensation, appetite, memory, and immune response.

If there is a deficiency or lack of naturally occurring endocannabinoids in the body, the CB-1 and CB-2 receptors will have nothing to bind to. Therefore, they can’t carry out the chemical pathways required for healthy, normative functioning.

This is where CBD comes in. It acts as a supplement or “replacement” in the instance of an endocannabinoid deficiency. Unlike THC, it can “do its job” and function perfectly well without having to entirely overwhelm the cannabinoid receptors (i.e., without you becoming intoxicated).

Imagine you visit the doctor and discover that the chronic muscle cramping you’ve been suffering from is due to potassium deficiency. A simple enough fix, right? You eat some bananas, and the muscles can now function as they’re supposed to.

It is the same with CBD. Perhaps the migraines you have are due to an endocannabinoid deficiency in a particular area of the brain. Migraines are possibly related to endocannabinoid deficiencies. A simple CBD regimen could potentially help quell the pain.

Current Research on CBD for Migraine Treatment

The major underlying problem with considering CBD as a viable option for migraines is simply a lack of data and scientific research available to ‘quantify’ its effectiveness.

However, there are studies on CBD oil for migraines. Forbes published an article on a recent study out of the European Academy of Neurology. It showed the active compounds in CBD were more effective at reducing acute migraine pain than prescription medications. Moreover, it also had fewer side effects than both amitriptyline and verapamil, which were the prescription meds in question.

The active compounds in CBD were more effective at reducing acute migraine pain than prescription medications.

All of this only backs up a host of earlier publications that have showcased nearly identical results.

Some of the key numbers, in case you’re wondering:

Out of 121 adult participants, those who used CBD daily reported decreased overall migraines per month. Their rate of migraines decreased from 10.4 a month to 4.6.

There are a handful of publications we can reference from. However, CBD is still a far cry from receiving the kind of clinical attention necessary to become a first-choice treatment option in a general medical setting. For the time being, we’ll have to continue relying on the minimal research available. We can also look at the results reported by millions of people who have already used it (and are still using it) to provide relief.

Final Thoughts on CBD Oil for Migraine

Research is ongoing, but what we know to date reflects well on CBD’s potential efficacy for helping reduce the severity and frequency of migraines. Whether the cannabinoid will ever ‘replace’ prescription and OTC drugs is another matter.

Before you buy the first oil you come across, bear in mind that some tinctures are higher quality than others. Here’s a quick look at some of the best-known CBD brands if you need something to help with a migraine.

Cannabis Tied to Rebound Headaches in Chronic Migraine Patients

— Study adds to findings about marijuana and migraine

by Judy George, Senior Staff Writer, MedPage Today March 1, 2021

Migraine patients who used cannabis were more likely to develop “rebound” or medication overuse headaches than those who didn’t use cannabis, a single-center chart review suggested.

In an analysis of 368 patients with chronic migraines, current cannabis use predicted cases of medication overuse headache (OR 5.99, 95% CI 3.45-10.43, P<0.0001), reported Niushen Zhang, MD, and Yohannes Woldeamanuel, MD, both of Stanford University School of Medicine in California, in an abstract released in advance of the American Academy of Neurology annual meeting.

Medication overuse headache is a result of frequent use of pain medications for headaches. “Cannabis affects the endocannabinoid system in the brain, which plays a role in pain processing,” Zhang and Woldeamanuel said.

“There is moderate evidence to support the use of cannabis for the treatment of chronic pain,” they added. “However, there is emerging anecdotal clinical evidence that use of cannabis may lead to medication overuse headache.”

Recent research from Washington State University in Pullman showed that inhaled cannabis reduced self-reported migraine severity by 49.6%. That study found no evidence of cannabis leading to overuse headache, but researchers noticed patients using larger doses of cannabis over time, indicating possible tolerance to the drug.

Zhang and Woldeamanuel used the Stanford Research Repository cohort discovery tool between 2015 to 2019 to evaluate adults who had chronic migraines for at least 1 year. Chronic migraine was defined as 15 or more headache days per month. Of 368 patients in the study, 150 were using cannabis.

From each patient’s chart, the researchers extracted data about age, sex, migraine frequency, current chronic migraine duration, current cannabis use duration, overused acute migraine medications, and duration of current medication overuse headache. They used logistic regression to identify variables predicting overuse headache while controlling for the remaining predictors.

Overall, 212 patients had medication overuse headache and 156 did not. Significant associations were seen between current cannabis use, opioid use, and overuse headache.

A bi-directional relationship between cannabis and opioid use also emerged. “Use of one increased use of the other,” Zhang and Woldeamanuel wrote. Analysis showed two clusters of chronic migraine patients, with patients in one cluster being younger and having less migraine frequency, higher overuse headache burden, and more current cannabis and opioid users than the other.

A limitation of the study was its retrospective nature, the researchers noted. Longitudinal studies are needed to further explore relationships between cannabis and overuse headache in chronic migraine patients, they said.

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Zhang and Woldeamanuel disclosed no relevant relationships with industry.

Advocacy Group Calls on Insurers to Modify Step Therapy for Migraine Treatment

The National Headache Foundation (NHF) is calling on health insurers to stop using rigid “step therapy” policies and make it easier for migraine patients to get access to new treatments.

Step therapy is a common practice in the insurance industry to control costs. It requires patients to try cheaper and often older medications first, before “stepping up” to drugs that cost more.

“For too long, migraine patients have been treated differently than others with medical issues as it relates to access to prescription medications. Specifically, clinicians are often forced to use outdated prescription drugs in a stepwise approach to all patients, without considering the needs of the individual patient,” said Thomas Dabertin, Executive Director/CEO of NHF, a non-profit that seeks to raise awareness about migraine and headache disorders.

“Unfortunately, the current care models adopted by payers have not kept pace with the many advances in treatment. As a result, clinicians are using older medications, some of which are not even designed for the specific treatment of migraine, even though new migraine-specific therapies now exist.”

Migraine treatment has been revolutionized in recent years by the introduction of neuromodulation devices and drugs that inhibit calcitonin gene-related peptides (CGRP), proteins that cause migraine pain. CGRP inhibitors cost several thousand dollars a year, while neuromodulation devices usually cost several hundred dollars.

Older drugs used to treat or prevent migraine, such as triptans, antidepressants and over-the-counter pain relievers, are much cheaper and often come in generic formulations. Many Insurers require patients to try at least two of the older medications first — and for months at a time — before authorizing newer therapies.

“NHF believes it is inappropriate to require all patients to follow this ‘try two and fail’ model before they may be offered treatment with any FDA-approved migraine preventive, including neuromodulation devices, with established lower adverse event profiles,” the NHF said in a position statement.

“For patients who are highly impacted or disabled by migraine, clinicians should not be directed to deliver outdated models of care that apply a predetermined algorithm in a stepwise approach to all patients, without considering the needs of the individual patient, and that encourage the use of older preventive drugs when targeted and migraine-specific therapies now exist.”

The NHF wants insurers to adopt modified forms of step therapy for migraine sufferers, based on the severity of their disease and the frequency of their attacks.

For patients who have seven or fewer migraine days per month, the NHF recommends that patients be required to try only one generic drug for migraine prevention. For patients who experience 8 or more migraine days per month, the foundation recommends that providers have “unfettered access” to FDA-approved prevention drugs.

For the treatment of acute migraine pain, the NHF recommends that two generic drugs be tried first, but if the drugs fail to work within two hours or have unwelcome side effects, providers be allowed to select “another suitable therapy” based on a patient’s needs.

“The NHF advocates that payers adopt care models that are patient-centric, where the clinician, in collaboration with the patient, is the primary decision-maker and selects a treatment that addresses the patient’s treatment goals and needs,” Dabertin said.

Although the NHF accepts donations from the pharmaceutical industry, Dabertin told PNN the foundation’s new position statement was based solely on input from patients and providers.

Pat Anson

Neuromodulation Device Effective for Most Migraine Sufferers

By Pat Anson, PNN Editor

A wearable neuromodulation device significantly reduced headache pain in nearly two-thirds of migraine sufferers, according to a new study. About one in four participants (22.6%) who used the device had no migraine pain after two hours.

The study findings, published in the journal Frontiers in Pain Research, are based on an analysis of over 23,000 remote electrical neuromodulation (REN) treatments with Nerivio, a device worn on the upper arm that uses mild electrical pulses to disrupt pain signals.

It’s important to note the study was designed and funded by Theranica Bio-Electronics, Nerivio’s manufacturer. Three of the five co-authors are Theranica employees.

“The current analysis of a very large group of patients, over a long period of time and multiple treatments, reinforces that REN provides a safe, efficacious and stable treatment option for acute treatment of migraine, both as a standalone and as an adjunct therapy. This is a very important component in the migraine therapy toolbox,” lead author Jessica Ailani, MD, Director of the MedStar Georgetown Headache Center and Professor of Clinical Neurology, said in a press release.

Nerivio is controlled by a smartphone app that allows patients to set the intensity of their 45-minute treatments at the onset of a migraine. The app also has a migraine diary that allows patients and their doctors to track the effectiveness of REN.

It is from this app that study data was collected from 12,151 U.S. patients from 2019 to 2021. Most had been prescribed REN by headache specialists, indicating their migraines were difficult to treat with pain medication alone. During the study, about two-thirds of patients only used REN, with the remainder continuing to use over-the-counter or prescription medications.

“To the best of our knowledge, this study is the largest prospective real-world evidence analysis of a migraine device to date,” said Alon Ironi, CEO of Theranica.

Migraine affects more than 37 million people in the United States, according to the American Migraine Foundation. In addition to headache pain, migraine can cause nausea, visual disturbances, and sensitivity to light and sound. Women are three times more likely to suffer from migraines than men.

Although migraine sufferers have many new treatments available, such as CBD oil and calcitonin gene-related peptide (CGRP) inhibitors, many find them too expensive or ineffective. Theranica hopes Nerivio can help fill the treatment gap, either as a standalone replacement for medication or as an adjunct.

“While some people with migraine get relief from prescribed or even over-the-counter medications, others do not respond to medications, or cannot tolerate their side effects. There are also people who cannot use medications due to contraindications or being at risk of drug-drug interactions or medication overuse headache,” Ailani said.

The FDA approved Nerivio as a treatment for acute migraine in adults in 2019. Last year the label was expanded to include children over the age of 12 with episodic or chronic migraine. Over 25,000 people in the U.S. have used the device, according to Theranica.

Nerivio is only available by prescription. When purchased wholesale, the listed price is $599 for a twelve-treatment unit, although buyers can save money by enrolling in a patient savings program, depending on their insurance coverage.

Pat Anson

Unusual Head-to-Head Migraine Study Pits Emgality vs. Nurtec

By Pat Anson, PNN Editor

Competition has grown intense between pharmaceutical companies in the $2 billion U.S. migraine market.

You’ve probably seen their TV commercials. Eli Lilly hired Olympic athletes to pitch Emgality, an injectable migraine preventative, while reality star Khloé Kardashian is appearing in commercials for Nurtec, an oral medication made by Biohaven Pharamceuticals

Lilly is now taking the competition a step further, with an unusual head-to-head clinical study – rare in the pharmaceutical industry – that pits Emgality against Nurtec. The company is enrolling 700 adults with episodic migraine in a randomized, double-blind, placebo-controlled trial. The so-called CHALLENGE-MIG study will directly compare the efficacy and safety of the two drugs.

“Lilly’s CHALLENGE-MIG study will help us understand how different types of preventive medications may help people achieve the goals that matter most to them. It’s exciting that insights generated in this first-of-its-kind head-to-head trial will be able to spark treatment plan discussions between people with migraine and their health care providers,” Shivang Joshi, MD, a trial investigator at Dent Neurologic Institute, said in a Lilly press release.

Emgality and Nurtec both inhibit calcitonin gene-related peptides (CGRP), a protein that causes migraine pain, but their delivery systems are very different. Emgality is injected once a month, while Nurtec is taken in a pill every other day.

Emgality was one of the first CGRP inhibitors to be approved by the FDA in 2018, while Nurtec is a relative newcomer, first approved in 2020. Nurtec’s label was recently expanded to include both migraine prevention and treatment.

The primary goal of the Lilly study is to see which drug gives patients a greater reduction in monthly headache days, with a secondary goal of measuring quality of life improvements.

“We believe patients should expect more and get more from medications that can help prevent migraine. Therefore, we look forward to sharing the findings from our Emgality versus Nurtec ODT head-to-head trial,” said Anne White, senior vice president of Eli Lilly and president of Lilly Neuroscience.

Biohaven’s CEO welcomes the study and sees it as an affirmation of Nurtec’s growing share of the market. Since it was introduced last year, Nurtec has generated about $200 million in revenue for Biohaven, with over 750,000 prescriptions filled.

“This new head-to-head trial affirms that Nurtec ODT is perceived as the new standard of care. The dual-therapy action of Nurtec ODT is unique and provides clear advantages to both treat and prevent migraine attacks. Since the launch of oral acute CGRP agents, the performance of injectable CGRP (inhibitors) is now negligible to flat,” Vlad Coric, MD, CEO of Biohaven Pharmaceuticals, said in a statement to PNN.

“Regardless of this Emgality study outcome, the Nurtec ODT value proposition will not be matched. And Nurtec ODT will have an impressive and entrenched market penetration by the completion of the proposed head-to-head study. We continue to hear from patients, who want oral over needle-based therapies.”

Regardless of whether it’s a pill or injection, both drugs are expensive. A supply of eight Nurtec tablets costs about $941, depending on insurance coverage. The listed price for Emgality is $627 for a single injection or about $7,524 annually.

If you’d like to know more about the study or possibly enroll in it, call the Lilly Answers Center at 1-800-545-5979.

Pat Anson

FDA Approves Another Expensive Migraine Drug

By Pat Anson, PNN Editor

The highly competitive and lucrative market for migraine drugs will grow more crowded this month when AbbVie introduces Qulipta (atogepant), an oral CGRP medication developed for the prevention of episodic migraines.

The Food and Drug Administration approved Qulipta after seeing the results of a Phase 3 clinical trial that found the drug was 50 to 100% effective in preventing migraines.

“During the trial while taking Qulipta, I had many fewer migraine days. For the first time ever, I don’t have difficulty doing my daily activities and I don’t have to worry as much that a migraine attack will cause me to miss important events with family and friends,” said Kelsi Owens, a trial participant who has lived with migraine for nearly three decades.

Like other CGRP inhibitors, Qulipta blocks proteins called calcitonin gene-related peptides from binding to nerve receptors in the brain and causing migraine pain. Since 2018, the FDA has approved over half a dozen CGRP medications, most of which are injected monthly.

Qulipta is a pill meant to be taken daily that comes in three different doses. Like other CGRP inhibitors, Qulipta is expensive. The wholesale price for a patient without insurance is $991 for 30 pills, according to Abbvie. Insured patients or those enrolled in an AbbVie patient support program will pay less.

“Qulipta provides a simple oral treatment option specifically developed to prevent migraine attacks and target CGRP, which is believed to be crucially involved in migraine in many patients,” said study investigator Peter Goadsby, MD, a neurologist and professor at University of California, Los Angeles. “I’m particularly encouraged by the convenience of the oral daily use of Qulipta, its rapid onset of significant efficacy, and its safety and tolerability as well as its high patient response rates.”

Qulipta is expected to compete directly with Nurtec, an oral CGRP inhibitor made by Biohaven Pharmaceuticals that is approved for both migraine prevention and treatment. A supply of eight Nurtec tablets costs about $941, depending on insurance coverage. Since it was introduced in 2020, Nurtec has generated about $200 million in revenue for Biohaven, with over 750,000 prescriptions filled.

AbbVie says Qulipta will be available in early October. Wall Street analysts project Qulipta sales will reach $1 billion by 2030.

Side effects from Qulipta include nausea, constipation, fatigue and loss of appetite. AbbVie is currently conducting a clinical trial to seek if Qulipta should also be approved for the prevention of chronic migraine – patients who have 15 or more headaches per month.

Migraine affects more than 37 million people in the United States, according to the American Migraine Foundation. In addition to headache pain, migraine can cause nausea, visual disturbances, and sensitivity to light and sound. Women are three times more likely to suffer from migraines than men.

Pat Anson

UK Migraine Sufferers Face ‘Broken Healthcare System’

By Pat Anson, PNN Editor

The United Kingdom has a “broken healthcare system” that leaves millions of migraine sufferers without treatment or a proper diagnosis, according to a new study.

The report by The Migraine Trust estimates that one in every seven people in the UK – about ten million — suffer from migraine attacks. Most say they haven’t been officially diagnosed by a doctor and have never seen a headache specialist.

Those who have been diagnosed often have trouble getting a new class of drugs to prevent migraine — calcitonin gene-related peptide (CGRP) inhibitors – even though the medications have been approved for use by the UK’s National Health Service (NHS).

“My migraine has never been managed properly by the NHS. I’ve suffered for 13 years and they’ve increasingly become worse each year. I’m bed bound at least once a week,” a migraine sufferer told the charity. “I visit my GP regularly and they send me away with a different drug to try for another year before I can be considered for another. I asked for a referral to the migraine clinic and was refused by my doctor.”

The Migraine Trust filed Freedom of Information requests with nearly a hundred NHS healthcare systems in England, Northern Ireland, Scotland and Wales and found that only a few were giving eligible patients access to CGRP treatment.

“There is clearly a postcode lottery of care where only the lucky few can access a treatment which has proven transformational for many migraine patients,” Rob Music, CEO of The Migraine Trust, said in a statement. “This should be such an exciting and positive time for those needing migraine care, but right now this lack of access is leading to continued poor health and deep frustration.”

CGRP inhibitors have been available in the United States since 2018, including a drug recently approved for both migraine prevention and treatment. The medications – which block a protein released during migraine attacks from binding to nerve receptors in the brain – are not cheap. Eight tablets of Nurtec, for example, cost nearly $1,000.

Not treating migraines can be costly as well. The Migraine Trust estimates that lack of adequate migraine treatment in the UK results in 16,500 emergency admissions and 43 million lost workdays every year.

The charity says migraine attacks also have a negative impact on the lives of migraine sufferers. In surveys, nearly a third said migraines negatively affect their mental and physical health. About one in four said migraines disrupt their family and social life.

The pandemic has also taken a toll on migraine patients, with 68% saying their symptoms have worsened. Some reported it was because of stress, some because their lifestyle was harder to manage, and others because they couldn’t access the treatment they had been receiving. An increase in computer screen time during the pandemic also contributed to worsening migraine attacks.

The Migraine Trust recommends that everyone seeing a doctor for head pain should be assessed for migraine and receive an individualized care plan. More headache specialists and neurologists should also be recruited to bring the UK in line with other European nations. The Trust called for public awareness campaigns to improve understanding of migraine symptoms and reduce the stigma associated with migraine.

About a billion people worldwide suffer from migraine headaches, which affect three times as many women as men. In addition to headache pain, migraine can cause nausea, blurriness or visual disturbances, and sensitivity to light and sound.

Pat Anson

My Migraine Journey: From Electrodes to Cannabis

By Gabriella Kelly-Davies, PNN Columnist

The room swirled as my eyes fluttered open, and I could feel something tight around my neck. It felt like a vice, making it difficult to swallow. The antiseptic smell was familiar, but I couldn’t quite place it. Struggling to focus my eyes, I heard a voice I knew well — it was Ben, a doctor at the hospital where I worked as a physiotherapist.

“How do you feel?” Ben said, shining a bright torch into my eyes.

“You’re in emergency. An ambulance brought you here. You were lying on the side of the road, unconscious.”

Ben told me the ambulance officers had received reports of cyclists being pushed off their bikes at the quieter end of the beach. They assumed that’s what had happened to me.

That day, my twenty-fourth birthday, heralded the onset of a life of migraine attacks.

Gabriella Kelly-Davies

During the 1990s, I regularly traveled around Australia for work while studying business at night. In the plane as I read my textbooks, a pain like an electric shock would shoot up the back of my neck and head.

It lasted for several minutes, then a deep ache started in the base of my skull. The pain eventually spread upwards, fanning out until it covered the entire back of my head and temples.

All too soon, the pain I experienced while flying became more regular and was most severe after sailing and playing my piano or cello. Cycling and tennis also triggered it.

In 1996, I started a job in Parliament House, Canberra as a policy adviser to a senior politician. Mid-morning, I would feel shooting pains running up the back of my head, accompanied by waves of intense nausea. Soon afterwards, a deep ache in the base of my skull started, quickly spreading up over my head and into my temples. My eyes felt gritty, as if they were full of sand, and I yearned for them to explode to release the mounting pressure inside them.

Often when the pain was at its worst, I couldn’t think of the words I wanted to say, infuriating some colleagues. Sometimes I couldn’t string two words together coherently. My mouth refused to form the words I wanted to say, as if the messages weren’t getting through from my brain to the muscles in my face.

The Merry-Go-Round

Returning to Sydney in 1999, I despaired of ever being free of pain and nausea. I consulted an endless round of specialists and health professionals, but none of them helped much. I felt overwhelmed by head and neck pain and a general sense of ever-increasing pressure inside my head and eyes. I fantasized about boring a hole through the base of my skull with an electric drill to release the tension.

Between 2000 and 2005, I progressively stopped doing all the things I most loved because they triggered migraine attacks. My goal became getting through a day of work, returning home and lying in a dark room with a series of ice packs under my neck.

Anxiety about being stigmatized and the intolerance I perceived in some colleagues at work prevented me from admitting I was in pain. Instead, I worked like a Trojan to ensure I maintained a high level of performance and no one could accuse me of using pain as an excuse to under-perform.

While on the endless merry-go-round of seeking solutions, I ended up at the Michael J. Cousins Pain Management and Research Centre in Sydney. Dr. Cousins and a team of health professionals assessed me. They diagnosed occipital neuralgia, a form of headache that can activate migraine attacks. I had chronic pain, a malfunction in the way the nervous system processes pain signals.

The team suggested an experimental treatment. It involved implanting tiny electrodes into the back of my head and neck to block the pain signals from traveling along the nerves in my head. I agreed to the surgery and afterwards; I had fewer migraine attacks than previously. I even had a few completely pain-free days.

One year later, I felt something sharp sticking out from the base of my skull. My pain specialist discovered an electrode wire protruding through the skin. Tests revealed the electrodes were infected, so they were removed. Afterwards, migraine attacks returned in full force.

Three months later, new electrodes were implanted, but they didn’t work as well, possibly because scar tissue blocked transmission of the electric current. Still, overall I was better than before the initial surgery. I worked full time and sang in a choir at Sydney Opera House.

Disappointingly, disaster struck in 2008. A superbug infected the electrodes, forcing my doctor to remove them. Once the infection cleared and the electrodes were re-implanted, they were only partially successful, and my life returned to its pre-electrode state.

Multidisciplinary Pain Management

A significant turning point occurred in 2009 when I participated in a three-week multidisciplinary pain management program. Each day, a team of pain specialists gave lectures on topics such as chronic pain and how it differs from acute pain. The physiotherapists started us on a carefully graded exercise program, and a psychologist taught us cognitive behavioural therapy techniques to help us change the way we thought about and dealt with pain. Surprisingly, the exercises didn’t cause a flare-up and at last I felt as if I was making progress.

The pain management program taught me to stop catastrophizing and to believe I had the power to change how I reacted to pain. For years, I practiced the stretches and strengthening exercises every night after work. I also applied the psychological techniques, and they became central to my daily routine.

Twelve years later, I continue to live with migraine. I’ve tried several migraine preventatives, but none helped. Eight months ago, I started taking medicinal cannabis and it has significantly reduced the frequency and severity of migraine attacks.

Over the years I’ve learned to reduce the impact of migraine on my life by using techniques such as mindfulness meditation and carefully paced exercise that turn down the volume of pain signals racing through my malfunctioning nervous system.

Chronic pain is complex and difficult to treat but it is possible to live well with pain. I encourage you to do a multidisciplinary pain management program and continue your search for approaches that reduce the impact of pain on your life.

Gabriella Kelly-Davies is a biographer and studied biography writing at the University of Oxford, Australian National University and Sydney University. She recently authored “Breaking Through the Pain Barrier,” a biography of trailblazing Australian pain specialist Dr. Michael Cousins. Gabriella is President of Life Stories Australia Association and founder of Share your life story.

Pat Anson

A New Option for Young Migraine Sufferers

By Pat Anson, PNN Editor

Migraines can have a devastating impact on children and adolescents. In addition to causing head pain, upset stomachs and visual disturbances, migraine attacks can disrupt school and social activities at a sensitive time in a young person’s life.

Although pediatric migraines are common, affecting about 10% of school-age children and one in five teenagers, treatment options are very limited compared to adults. There are no FDA approved pharmaceutical migraine treatments for kids under the age of 12. That leaves doctors to prescribe migraine medication to children off-label, including a new class of migraine drugs called CGRP inhibitors, which have not yet been approved or studied in young children.

A small new study suggests there may be a safer and more effective option for young migraineurs: neuromodulation. Research recently published in the journal of Pain Medicine found that Nerivio, a neuromodulation device worn on the upper arm, was more effective in treating acute migraine in adolescents than triptans and over-the-counter pain relievers. Nerivio uses smartphone-controlled electrical pulses to stimulate nerves and disrupt pain signals.

“To my knowledge, this is the first study that directly compared remote electrical neuromodulation and standard-care treatment options in adolescents,” says lead author Andrew Hershey, MD, co-director of the Headache Center at Cincinnati Children’s Hospital Medical Center.

“Migraine in adolescents is associated with poorer performance and absence from school and social activities during a particularly formative time in life. Providing teens with more effective and engaging treatments for migraine can have far-reaching positive effects over the course of their lives.”

Nerivio was developed by Theranica, an Israeli medical technology company that sponsored the study. The FDA approved the device as a treatment for acute migraine in adults in 2019 and recently expanded the label to include children over the age of 12 with episodic or chronic migraine.

THERANICA IMAGE

Thirty-five adolescent migraine patients aged 12 to 17 took part in the two-month comparison study. Over-the-counter drugs and oral triptans were used by patients during the medication month, and Nerivio during the Remote Electrical Neuromodulation (REN) month.

Two hours after treatment, over a third (37%) of patients achieved complete pain freedom during the REN phase of the study, compared to just 8.6% in the medication phase. Some degree of pain relief was reported by 80% of patients in the REN phase, as opposed to 57% in the medication phase.

“This study provides evidence that Nerivio may be considered as a first-line acute treatment, especially for adolescents with medication restricting comorbidities or a preference for a non-medication-based treatment,” said co-author Samantha Irwin, MD, a pediatric neurologist at the UCSF Benioff Children Hospital in San Francisco. “The importance of having a non-pharmacologic, discrete, easy-to-use and effective acute treatment in the adolescent armamentarium cannot be overstated.”

Long-Term Effects of Childhood Migraine

Early treatment of childhood migraine is important because there is emerging evidence that repeated headache attacks in children reduce the formation of “gray matter” in parts of the brain that process pain signals, leading to more frequent and severe migraines in adults.

“We’ve done studies here independent of any pharmaceutical company where we’ve show that the earlier we can intervene with effective therapy and education of patients, the better their long-term outcome,” Hershey told PNN. “So we really have this opportunity to intervene with a child or adolescent that can affect them for their life.

“A device can be as effective as a drug. What I tell patients is that it gives them their own locus of control. Instead of taking a medication and hoping it works, they’re actually controlling the device with their smartphone, and so they can really take control of their headaches, which is ultimately what we want them to do.”

Nerivio is only available by prescription and is eligible for insurance. When purchased wholesale, the listed price is $599 for a twelve-treatment unit, although buyers can save money by enrolling in a patient savings program, depending on their insurance coverage.

Theranica is currently recruiting patients for a placebo-controlled study to see if Nerivio may be effective in preventing migraines. The company is also investigating whether the device may help treat other chronic pain conditions besides migraine.

Migraine affects more than 37 million people in the United States, according to the American Migraine Foundation. In addition to headache pain, migraine can cause nausea, blurriness or visual disturbances, and sensitivity to light and sound. Women are three times more likely to suffer from migraines than men.

Pat Anson

Diet Changes Reduce Migraine Headaches

By Pat Anson, PNN Editor

There are many new treatments available for migraine sufferers; everything from CGRP inhibitors to neuromodulation to green light therapy. But there may be a simpler and less expensive way to reduce the frequency and severity of migraine headaches: changing your diet.

A new study funded by the National Institutes of Health found that migraine sufferers who ate more fatty fish and reduced their consumption of polyunsaturated vegetable oils had fewer headaches.

The findings are similar to another recent study that found foods containing healthy omega-3 fats – such as fish, flaxseed and walnuts – can reduce inflammation and neuropathic pain. Researchers say the two studies suggest that dietary changes can affect pain levels for other types of chronic pain.

“It may ultimately be possible to integrate targeted dietary changes alongside medications to improve the lives of patients with chronic pain,” said Chris Ramsden, MD, a clinical investigator and adjunct faculty member at the University of North Carolina at Chapel Hill.

“Biochemical findings from both studies support the biological plausibility for this type of approach and could open the door to new approaches for managing many types of chronic pain. What is needed now is more evidence from randomized controlled trials in other populations with chronic pain.”

Ramsden is lead author of a study, published in the British Medical Journal, in which 182 adults with frequent migraines were broken into three groups and put on special diets for 16 weeks.

One group received meals that had high levels of fatty fish and low amounts of linoleic acid, a polyunsaturated fatty acid commonly found in American diets of corn, soybean and other vegetable oils. A second group received meals that had high levels of fatty fish and higher linoleic acid. The third control group received meals with high linoleic acid and low levels of fatty fish to mimic what an average American consumes.

“Our ancestors ate very different amounts and types of fats compared to our modern diets,” said co-first author Daisy Zamora, PhD, an assistant psychiatry professor in the UNC School of Medicine. “Polyunsaturated fatty acids, which our bodies do not produce, have increased substantially in our diet due to the addition of oils such as corn, soybean and cottonseed to many processed foods like chips, crackers and granola.”

When the study began, participants averaged over 16 headache days per month and over five hours of migraine pain each headache day — despite taking multiple headache medications.

Those who consumed a diet low in vegetable oil and high in fatty fish had 30% to 40% reductions in total headache hours per day, severe headache hours per day, and overall headache days per month compared to the control group.

Blood samples from this group also had lower levels of pain-related omega-6 fatty acids found in processed foods.

“Our trial is the first moderate sized controlled trial showing that targeted changes in diet can decrease physical pain in humans,” Ramsden told PNN, noting that fatty acids appear to regulate the production of calcitonin gene-related peptides, the same protein targeted by CGRP medications.

“Diets alter the amounts of omega-3 and omega-6 fatty acids in the nervous system and other tissues linked to chronic pain. These fatty acids are converted by the body into biochemical mediators of pain. Several of these biochemical mediators act on receptor channels to regulate CGRP release,” he said in an email.

“I think this modification in diet could be impactful,” Zamora added. “The effect we saw for the reduction of headaches is similar to what we see with some medications.”

Zamora, Ramsden and their colleagues are currently working on a new study to test diet modification for other chronic pain syndromes.

Pat Anson

FDA Approves First Drug for Both Migraine Treatment and Prevention

By Pat Anson, PNN Editor

Migraine sufferers have a new medication that not only treats migraines, but can also be used to help prevent them. Biohaven Pharmaceuticals announced this week that Nurtec (rimegepant) — a drug already being used to treat migraine pain – has been approved by the FDA as a migraine preventative, making it the first migraine medication that can be used for both treatment and prevention.

Nurtec is a calcitonin gene-related peptide (CGRP) inhibitor, a relatively new class of medication that blocks a protein released during migraine attacks from binding to nerve receptors in the brain. Since 2018, the FDA has approved a handful of CGRP medications, most which are taken by injection.

Nurtec is a quick-dissolving tablet that is taken orally. A single dose can treat migraine pain for up to 48 hours. The expanded FDA approval means Nurtec can now also be taken daily or every other day to help reduce the frequency of migraines.

“The FDA approval of Nurtec ODT for the preventive treatment of migraine — along with its acute treatment indication — is one of the most groundbreaking things to happen to migraine treatment in my 40 years of practicing headache medicine. To have one medication patients can use to treat and prevent migraine will likely change the treatment paradigm for many of the millions of people who live with migraine,” said Peter Goadsby, MD, a Professor of Neurology at the University of California, Los Angeles.

Goadsby was one of the investigators in a Phase 3 study that helped prove Nurtec can be used as a migraine preventive. In findings recently published in The Lancet, Nurtec reduced the number of migraine days per month by 30% after one week of treatment. After three months of treatment, about half of the patients taking Nurtec had at least a 50% reduction in the number of moderate-to-severe migraine days per month.

Nurtec was well-tolerated by most patients during the clinical trial. Some reported nausea, stomach pain and indigestion.

“This FDA approval marks the beginning of a new era for migraine treatments, allowing the potential for healthcare professionals to prescribe, and patients to have, a single medication to treat and prevent migraine attacks,” Biohaven CEO Vlad Coric, MD, said in a statement. “This groundbreaking approach to treating the full spectrum of migraine disease, from acute therapy to prevention, can have a significant impact in a patient’s life by helping to decrease treatment plan complexity and reduce challenges with adherence and polypharmacy.”

One obstacle to using Nurtec is its cost. Currently, a single 75mg tablet is priced at about $117. A supply of eight tablets is around $941, depending on your insurance coverage and pharmacy. Biohaven has a patient assistance program that can help some patients who lack insurance or can’t afford the drug.

A recent survey of nearly 4,700 migraine patients by Health Union found that about one in four (26%) are currently using a preventive CGRP medication. About 11 percent said they were using a CGRP to treat migraine pain. Patients who did not try the drugs said they were concerned about side effects, long-term safety and their cost.

Migraine affects more than 37 million people in the United States, according to the American Migraine Foundation. In addition to headache pain, migraine can cause nausea, blurriness or visual disturbances, and sensitivity to light and sound. Women are three times more likely to suffer from migraines than men.

Pat Anson

A Virtual Headache on the Hill

By Mia Maysack, PNN Columnist

Last week I was fortunate to attend the 14th annual “Headache on the Hill,” a lobbying event held by the Alliance for Headache Disorders Advocacy (AHDA). We had the largest turnout ever in participants and number of meetings, although it was a far different affair than previous ones.

Due to the pandemic and Covid precautions, visits to congressional offices that normally would’ve taken place in person on Capitol Hill were conducted online via Zoom — which was an adjustment I was grateful to make.

As a result of doing things virtually, it gave people who ordinarily may not be well enough to attend an opportunity to do so. I feel this is a more inclusive approach and should perhaps remain an option even after this pandemic settles.

Traveling is extraordinarily strenuous on my health and always requires an extensive amount of recovery time. So the opportunity to lie down in between meetings and have the comforts of home around me — such as soft lighting and blackout curtains — made all the difference and helped make getting through the day possible. It also ensures I won’t be confronted by weeks on end of flare ups and pain cycles.

I am proud to represent the state of Wisconsin as a volunteer patient advocate, human rights activist and someone who has lived with intractable head pain to some extent each and every day for almost 21 years as a direct result of a traumatic brain injury.

Given that there are around 40 million people in the U.S. alone who live with migraine disease, the odds are that you either experience it yourself or know of someone who does. For those who are privileged not to have migraine, Covid-19 has given you a small taste of how we often exist: shut in and unable to see loved ones, go to work or do things we enjoy.

I live with both migraine disease and cluster headaches, which are called “suicide headaches” for good reason. There’s no limit to the chaos, interruption, inconvenience and discomfort these conditions have caused in my life, requiring my full time attention just to manage the symptoms.

The difficult experiences I and countless others have faced in seeking, finding and attempting different forms of treatment is why I continue to advocate — even when I don’t feel up to it. Migraine and other forms of head pain are at the top of the list regarding burden and disability, yet we’ve been severely limited with treatment options that usually mask the symptoms temporarily, as opposed to addressing the root cause.

We’ve seen progress in recent years with more injectable treatment options, after being limited for decades to oral triptans. But insurance for the shots can be a nightmare (if you’re fortunate enough to have insurance) and I received what was labeled as a “bad batch” of shots that gave me side effects I am still living with today.

What We Asked For

Our medical system is set up in such a way that we’re able to receive a prescription relatively easily, but alternative tools such as water therapy, massage, oxygen and mindfulness meditation aren’t seriously considered, let alone covered. This is a very real problem.

It also makes no sense that migraine conditions are some of the least funded research areas for the National Institutes of Health. Our “asks” during Headache on the Hill were to devote more funding toward the research and treatment of migraine. Currently there’s only $20 million or so being spent. We’re requesting $50 Million designated specifically for NIH research on migraine and headache disorders.

Additional funding could also help incentivize more providers to obtain neurology-related medical degrees, as there is a severe shortage and need for more headache specialists. More funding is needed to develop new treatments, help cultivate data on the benefits of more holistic approaches, and assist in providing more dignity to those of us who feel invisible and shunned by a system that’s supposed to be on our side.

Furthermore, and perhaps even more disgracefully, hundreds of thousands of our military veterans suffer from traumatic brain injuries as a result of being exposed to explosions and toxic open burn pits. We asked for another $25 million to double the number of specialized treatment sites that the VA has for veterans with headache disorders.

These are the individuals who ensure that we possess and maintain the liberties of this country and they deserve the absolute best we have to offer. I know that we can do better on all of these issues and we must. It’s time to urge our representatives to follow through and do the right thing.

You can help by visiting the AHDA website and following the prompts for sending an email to your representatives and senators. Urge them to fully fund the VA’s Headache Disorders Centers.

Mia Maysack lives with chronic migraine, cluster headache and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill.