Archives: Summit Talks

Key Questions

• What is the definition of medication overuse headache (MOH)?
• Can pain medication make migraine worse?
• Which migraine drugs are most likely to contribute to MOH?
• Can MOH be caused by non-migraine-related drugs?
• Which non-migraine drugs contribute to MOH?
• Can MOH be caused by over-the-counter medications like NSAIDs or cold medications?
• Can MOH be caused by an overuse of a combination of different drugs?
• Are there any drugs that do not contribute to MOH?
• Can MOH contribute to someone developing chronic migraine?
• Are there risk factors outside of medication that contribute to MOH?
• How might MOH differ from a regular migraine attack, if at all?
• How do you know if you have MOH?
• Does caffeine contribute to MOH?
• Should butalbital be taken off the market?
• Does undertreatment of migraine increase MOH?
• How do you strike a balance between undertreatment and overtreatment?
• What has changed in the past three years in the MOH treatment space?
• How have the new CGRP drugs changed the outlook for MOH?
• How can advocacy help reduce the occurrence of MOH across the population?
• Are there any nonpharmacological ways to break MOH?
• Does proper acute treatment of episodic migraine reduce the probability of having MOH?

Interview Notes

• Dr. Stewart J Tepper
• The International Headache Society
• Opioid Use and Dependence Among Person With Migraine: Results of the AMPP Study
• Adherence to Oral Migraine Preventive Medications Among Patients with Chronic Migraine: Analysis of a Large US Health Insurance Claims Database (S41.009)
• Migraine prevalence, disease burden, and the need for preventive therapy

Key Questions

• How can diet affect migraine and headache disorders?
• What are dietary triggers?
• What are some common dietary triggers?
• What types of diets are safe for people with migraine?
• Why do certain diets work for people with migraine while others do not?
• What is the DASH diet?
• Does intermittent fasting work for people with migraine?
• How do ketogenic diets affect migraine?
• Why choose a plant-based diet?
• How can a low-glycemic-index diet help with migraine?
• How does one choose the best diet for migraine?

Interview Notes

• Vincent Martin, M.D.
• Diet and Headache: Part 1
• Red Wine As a Cause of Migraine
• Neurobehavioral Effects of Aspartame Consumption
• DASH diet: Healthy eating to lower your blood pressure
• Short-term improvement of migraine headaches during ketogenic diet: a prospective observational study in a dietician clinical setting
• Early and long period follow-up results of low glycemic index diet for migraine prophylaxis
• Nutrition intervention for migraine: a randomized crossover trial

Key Questions

• What is yoga?
• How can yoga help someone with migraine?
• What evidence is there that supports yoga for migraine?
• How do postures and breathing combine to create an effective yoga practice?
• How can yoga benefit the hyper-responsive nervous system common in people with migraine?
• Can yoga be practiced during times of high pain?
• Is there a type of yoga that’s best-suited for people with migraine?
• Are there certain types of yoga that are better suited for different body types?
• What type of yoga is most beneficial if the neck is a factor in migraine?
• What type of yoga is appropriate for people who have migraine with vestibular symptoms, such as dizziness and vertigo?
• Can yoga help with insomnia?
• What other conditions can yoga be beneficial for?
• Is there anyone who shouldn’t practice yoga?
• What are some reasons that people might be hesitant to try yoga?
• What is the best way to start a yoga practice for those who are new to it?
• How can you find a certified yoga instructor who can provide personal feedback?

Interview Notes

• Effect of yoga as add-on therapy in migraine (CONTAIN)
• Yoga for Migraine
• Yoga for Migraine Facebook group
• On Instagram:  Adriane Dellorco (@yogamigraine)
• Yoga Alliance

Key Questions

• How can migraine result from concussions?
• Is it possible for a person to have no personal or family history of migraine, get a concussion, and then develop migraine?
• Can imaging help with identifying concussion?
• Does having migraine increase the risk for concussion?
• What is your advice for someone who has sustained a concussion?
• What strategies should someone try to promote brain healing after a concussion?
• What is a post-traumatic headache (PTH)?
• What are the differences between persistent PTH and migraine?
• How does a diagnosis of migraine versus PTH change the treatment strategy?
• How can a person determine whether their condition is persistent PTH or true migraine triggered by physical trauma?
• Is it possible for a person to have no history of migraine, and still have a concussion trigger migraine, or would that always be PTH?
• In the last 5-10 years, our understanding of TBIs and potential treatments has grown significantly. We obviously still have a long way to go, but what would you say are a few of the most important findings?

Interview Notes

• Headache Cooperative of The Pacific: Headache Education
• Headache Center | UCSF Health
• Facts about TBI | Concussion | Traumatic Brain Injury | CDC Injury
• Concussion.org | by the International Concussion Society
• Understanding Your Migraines: A Guide for Patients and Families

Key Questions

• What are the most common headache disorders in people over the age of 50?
• How does migraine typically change in middle and older age?
• Is it true that migraine improves with age?
• Are triptans still safe for the older population with migraine?
• How common is it for an older person to get a new diagnosis of migraine?
• In someone with a history of migraine, what are some factors that might lead to increased frequency of attacks in middle age?
• What are some alternatives if triptans either stop working for someone, or become unsafe to use?
• How safe are some of the typical migraine medications for people older than 50?
• Why do some people with migraine become more or less responsive to their usual medications as they age?
• What are the risks of a long-term migraine history and the long-term medication use that may accompany it?
• Are the newer medications safe for older people with migraine?
• What nonmedicinal options exist for migraine after 50 years of age?

Interview Notes

• • Management of headache in the elderly
  • Dr. Robbins on Twitter: @mrobbinsmd
  • Matthew Robbins, MD

Viewer note: If the audio/video sync issues that occur at some points in this video are distracting, you might opt to listen to the audio-only so as not to miss valuable information.

Key Questions

• Why can it be difficult to find doctors who think outside the box when it comes to migraine treatment?
• How long do you recommend sticking with an integrative therapy before moving on?
• Is alternative medicine as effective as mainstream therapies?
• How can patients distinguish between safe, evidence-based alternative therapies and those that are bogus or misleading?
• Which integrative therapy approaches have shown the most promise in treating migraine?
• What sort of training or education are providers receiving to open up the conversation about alternative treatments with patients?
• What is the best way to navigate the search for providers who can incorporate integrative medicine into their patients’ treatment plans?
• Are chiropractic maneuvers safe for treating migraine?
• Is there enough evidence to suggest that psilocybin is an effective migraine treatment?
• Why is alternative medicine being taken more seriously now than before?

Interview Notes

• American Headache Society
• Headache: The Journal of Head and Face Pain
• Headache toolbox: evidence-based integrative treatments for headache
• Systematic review: Acupuncture vs. standard pharmacological therapy for migraine prevention
• Westport Headache Institute
• Instagram: @westportheadache
• National Center for Complementary and Integrative Health

Key Questions

• What effect does barometric pressure have on migraine?
• How does weather influence migraine and headache disorders?
• How does one manage weather-related triggers?
• What is weather’s effect on the brain?
• How does the environment of where you live affect migraine and headache disorders?
• Is there a certain numerical change in pressure that triggers an attack?
• How do seasonal changes influence migraine and headache disorders?
• Why is weather not always a consistent trigger?
• What medications can be used to treat weather-related migraine and headache attacks specifically?
• Is it possible to prevent a headache or migraine attack triggered by weather?

Interview Notes

• Dr. Jan Hoffman
• International Headache Society
• American Headache Society
• The Migraine Trust
• The influence of weather on migraine – are migraine attacks predictable?
• Increases in Neuronal Activity in Rat Spinal Trigeminal Nucleus Following Changes in Barometric Pressure—Relevance for Weather‐Associated Headaches?

Key Questions

• Is migraine the only headache disorder that has light sensitivity as a symptom?
• Is light sensitivity a premonitory symptom or is it a trigger of migraine?
• Is light sensitivity a chronic condition?
• Is light sensitivity something that can develop from another condition, such as concussion?
• What causes light sensitivity?
• Should people with light sensitivity completely avoid the light, or is it better to learn to adapt to it?
• What protections are there for people with light sensitivity?
• Should people with light sensitivity keep their home environments dark at all times?
• How can you tell the difference between photophobia as a trigger and as a premonitory symptom?
• Are tinted lenses helpful?
• When should someone with photophobia see a specialist?
• What kind of specialist should they see?
• Are the CGRP medications helpful to those with light sensitivity?
• Is our modern world of excessive screen time and “Zoom fatigue” causing more photophobia?
• How can someone tell that their photophobia might be chronic

Interview Notes

• Rami Burstein

Key Questions

• Can significant weight gain trigger the onset of migraine?
• Is there a definitive causative relationship between weight and migraine, or is it simply middle age in which both weight and migraine increase?
• Is the risk of migraine any different for people who are overweight or underweight?
• Is there a correlation with being overweight or underweight and having chronic migraine?
• What does the research say about why many migraine symptoms are related to digestion?
• Does inflammation play a role in migraine?
• What are some practical ways to reduce weight safely for someone with migraine?
• Are there any weight loss tactics that can actually make migraine worse?
• Does research indicate that behavioral weight loss intervention or migraine education can reduce migraine frequency or severity?
• Do researchers know how reducing inflammation might affect migraine, and are anti-inflammatory supplements like turmeric, omega-3, or capsaicin considered effective for people with migraine?
• Are there any important considerations for how someone with migraine approaches exercise for weight loss?

Interview Notes

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739951/
• https://pubmed.ncbi.nlm.nih.gov/21444898/
• https://vivo.brown.edu/display/dsbond

Key Questions

• When is preventive therapy for migraine recommended?
• Why is frequent use of acute migraine medications a problem?
• What are the major classes of medications for migraine prevention?
• How can an ineffective acute treatment lead to migraine chronification?
• What can we expect when our doctor puts us on preventive therapy?
• Why are migraine diaries important for migraine prevention?
• Are the CGRP medications effective in patients who haven’t responded to other therapies?
• What is polytherapy?
• When acute migraine medications don’t seem to be working, what can we do?
• Why would it be helpful for your provider to have your complete medical history, going back to childhood?
• Why are some patients labeled difficult to treat?
• Can adverse childhood experiences have an effect of migraine?

Interview Notes

• National Headache Foundation
• The Migraine Trust

Key Questions

• What are the difficulties of exercise for those who have frequent migraine attacks?
• Can exercise be both a trigger and preventive for migraine?
• How can exercise cause a headache or migraine attack?
• How can dehydration during exercise be avoided by those with migraine?
• Why should people with migraine not give up on exercise as a preventive?
• How does exercise affect the brain?
• How does exercise affect some common migraine comorbidities?
• How can you safely begin exercising with migraine?
• Is it safe or beneficial to push through a headache or migraine attack to exercise?
• What is a let-down headache?

Interview Notes

• Dr. Richard B. Lipton
• Do people with migraine get enough exercise?
• Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes
• The association between migraine and physical exercise
• Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial

Key Questions

• What causes migraine?
• If someone in your family has migraine, does that make you more likely to have it?
• Are there other risk factors, such as underlying conditions, that could also predetermine your susceptibility to migraine?
• What is the difference between a cause of migraine and a trigger?
• What does the concept  “migraine threshold” mean?
• What are the different phases of migraine?
• Is tension-type headache the same as migraine?
• When would emergency medical treatment for migraine be necessary?
• What is the correlation between mood disorders and migraine?
• How does sleep affect migraine?

Interview Notes

• Sleep and Chronic Daily Headache