Pioneering work that has changed our understanding of migraines(theguardian.com)
theguardian.com
Pioneering work that has changed our understanding of migraines
https://www.theguardian.com/society/2021/oct/09/can-migraines-be-untangled-by-new-medical-thinking
91 comments
Yep! I've been keeping a migraine diary since 1998. For twenty years I averaged 12-15 migraines a month, where I define a "recordable" migraine as one that stops me from doing anything other than taking care of the migraine for more than an hour.
In 2018 I started Aimovig (later switching to Emgality). I now average between 0 and 1 migraine a month.
In 2018 I started Aimovig (later switching to Emgality). I now average between 0 and 1 migraine a month.
A friend's insurance would not continue to cover their preferred 'as needed' migraine medication until they tried Ajovy. Both doctor and patient were unhappy with the requirement, but damn if that shot didn't remove the existence of migraines from their life completely.
Very interesting case of an insurance company also being a healthcare provider.
These types of discoveries are becoming more and more common with the explosion of novel biologics.
What are novel biologics?
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.
This is very interesting. Are there any books you'd recommend on the topic which would explain the directions pharmaceutical science is heading towards to a layman?
I'm not currently aware of a book on the subject, but would also like to read a compilation of the cutting edge. I am relaying what I know from tangentially following advances my peers participate in filtered through my former chemistry+bioinformatics background.
Here is some more info on considerations to be had for near-future breakthroughs in the oral administration route. The key is in preserving the biologic structure long enough for it to reach the intestine where, in contrast to the stomach, it would be able to enter the bloodstream with the aid of agents that enhance permeability. https://otd.harvard.edu/explore-innovation/technologies/oral...
Edit: The field of cheminformatics is currently utilizing machine learning to help discover novel drugs in the various search spaces, such as that of kinase inhibitors. They have the ability to function in a multi-target regime. That is, there exist drugs that can be effective for several pathologies.
Here is some more info on considerations to be had for near-future breakthroughs in the oral administration route. The key is in preserving the biologic structure long enough for it to reach the intestine where, in contrast to the stomach, it would be able to enter the bloodstream with the aid of agents that enhance permeability. https://otd.harvard.edu/explore-innovation/technologies/oral...
Edit: The field of cheminformatics is currently utilizing machine learning to help discover novel drugs in the various search spaces, such as that of kinase inhibitors. They have the ability to function in a multi-target regime. That is, there exist drugs that can be effective for several pathologies.
This almost mirrors my own experience, only difference is I take erenumab instead of fremanezumab - it really has been a godsend!
I suffer from migraines and that article could have been interesting, but I cannot stand those ten page long storytelling articles anymore
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.
Low information density articles are such a drain on all of us.
Some readers consider the human interest part "information" too.
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
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
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.
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I give them about 2-3 paragraphs and if they haven't said anything yet, I assume they never will and close the window.
Totally. Hidden topic sentences. Now I just skip preambles.
The Wadsworth Constant for text.
The Wadsworth Constant for text.
Same, I opened this one up a few days ago when someone linked to it, saw what style it was, tried to scan it to get to the juicy bits, then just closed it and asked for a tl;dr. I don't have the attention span for long form stories like this while I'm on my PC. Maybe when I'm on vacation and have a stack of reading material ready, idk.
If you would rather listen, Peter Goadsby was featured in this BBC Discovery podcast about his pioneering research on migraine:
https://www.bbc.co.uk/programmes/w3ct1m7t
That was a great episode of Jim Al-Khalili's "The Life Scientific" which is worth listening to.
It's an excellent series for anyone interested in science and engineering, he does a great job of showing just how varied science is, and also how varied the routes into science can be. Many of his interviewees end up in their specialisms thoough often very circuitous routes.
It's an excellent series for anyone interested in science and engineering, he does a great job of showing just how varied science is, and also how varied the routes into science can be. Many of his interviewees end up in their specialisms thoough often very circuitous routes.
Yes I agree, these articles give me a headache.
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.
I was also taken aback by that. I think the headline set expectations poorly.
What you are looking for is here:
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.
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.
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!
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!
>"As a result, I had to fight with my neurologist for over a year to let me have it."
This is why everyone should be able to have tax-free health savings accounts and more control over their healthcare rather than having to go through insurance/governments :p
I have a high deductible plan that lets me have a health savings account. Anything I put in is tax free and if I use it for healthcare anything I use it for is tax free. Insurance is there solely for routine care that it covers as well as major medical - if I have to go into the hospital, get cancer, etc. Everything else I negotiate out of my HSA. It's amazing the price differences you can get when you pay cash and insurance is not involved!
This is why everyone should be able to have tax-free health savings accounts and more control over their healthcare rather than having to go through insurance/governments :p
I have a high deductible plan that lets me have a health savings account. Anything I put in is tax free and if I use it for healthcare anything I use it for is tax free. Insurance is there solely for routine care that it covers as well as major medical - if I have to go into the hospital, get cancer, etc. Everything else I negotiate out of my HSA. It's amazing the price differences you can get when you pay cash and insurance is not involved!
Well, the way I understood, the parent had to negotiate but succeeded, so he got it for "free" (i.e. paid by taxpayers) - without any fund, tax-free or otherwise. This is an excellent alternative to the option you described as you don't have to worry whether the funds you gathered are enough for the treatment you need. Generally, in Europe, things like cancer etc. are treated for free, i.e. included in your general social security payments that are relatively low.
What I’m looking at here 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.
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.
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.
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.
to the people in this thread saying that applying Aimovig hurts - yes it does, but it hurts less than when they're drawing your blood. also, in my opinion these 15 seconds of mild pain a lot better than the constant pain I was in due to migraines..
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.
I would lose the right half of my vision, except not like anyone here (without similar experiences) is probably imagining it right now: it was not like my right eye stopped working, no, the part of my brain that processes visual information would deny the existence of the right half of my vision and replace it with a reaction-diffusion lookalike aura. Split precisely down the middle, doesn't matter which eye. Even freakier, if I were to look at someone's face, my eyes would refuse to turn and show me the missing half of said face on the "left" side of my remaining vision. Similarly I could no longer read words or sentences because they were cut off and my eyes refused to do the normal reading saccades.
It was then that I first learned that my conscious is only a small part of my mind, and not in direct control of everything.
If I would have been stuck with that mode of perception permanently I would have gone crazy.
It was then that I first learned that my conscious is only a small part of my mind, and not in direct control of everything.
If I would have been stuck with that mode of perception permanently I would have gone crazy.
> It was then that I first learned that my conscious is only a small part of my mind, and not in direct control of everything.
That's probably the craziest takeaway from these. In my experience, losing half the vision + the middle part was the most often one. However, the craziest attack was when I temporarily lost the control of speech. The mind and thoughts were there, but nothing verbally said made sense when listening to myself. I'm so glad that taking a nap was enough to resolve that...
That's probably the craziest takeaway from these. In my experience, losing half the vision + the middle part was the most often one. However, the craziest attack was when I temporarily lost the control of speech. The mind and thoughts were there, but nothing verbally said made sense when listening to myself. I'm so glad that taking a nap was enough to resolve that...
> the part of my brain that processes visual information would deny the existence of the right half of my vision
YES. I get the scintillating scatoma but also a new thing, that I call "the folded magazine page": it looks as if someone folded out the middle of a magazine page and I have to turn my head left & right rapidly to construct the rest of the image.
My brain is like: nope, not gonna show you the middle strip, just gonna cut-and-paste the left and right thirds together in the middle.
YES. I get the scintillating scatoma but also a new thing, that I call "the folded magazine page": it looks as if someone folded out the middle of a magazine page and I have to turn my head left & right rapidly to construct the rest of the image.
My brain is like: nope, not gonna show you the middle strip, just gonna cut-and-paste the left and right thirds together in the middle.
This exactly describes an experience I had recently. I ended up in ER thinking it was a stroke. Nobody ever mentioned migraines or auras.
> If I would have been stuck with that mode of perception permanently I would have gone crazy.
I get some sort of hearing perception change and vertigo to the point of vomiting. However the devastating pain makes any examination of the strange hearing changes near impossible.
Anyone who has these last any significant duration has my sympathy.
I get some sort of hearing perception change and vertigo to the point of vomiting. However the devastating pain makes any examination of the strange hearing changes near impossible.
Anyone who has these last any significant duration has my sympathy.
> It was then that I first learned that my conscious is only a small part of my mind, and not in direct control of everything.
We're made up of disparate systems that our conscience pilots essentially, even our mental faculties are disparate systems. This can sometimes make it hard to recognize when one of these systems is under-performing or worse-yet failing.
We're made up of disparate systems that our conscience pilots essentially, even our mental faculties are disparate systems. This can sometimes make it hard to recognize when one of these systems is under-performing or worse-yet failing.
I know exactly what you describe, I had migraines for many decades; oddly enough now that I am older I still get the aura, but the headache itself is barely a Tylenol.
I also had cluster headaches one summer in college; now those are truly the worst pain in the world. Imagine an electric drill going through your head for 15 minutes once a day, then vanishing.
I also had cluster headaches one summer in college; now those are truly the worst pain in the world. Imagine an electric drill going through your head for 15 minutes once a day, then vanishing.
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)
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)
Mine started with a very weird feeling that something was off in my vision (usually triggered while working on a screen). I would notice after a while that a tiny portion of my vision was going missing and then the shimmering would begin and spread out.
I've also not had auras for several years though I do get headaches still. I had extremely low vitamin b-12 levels and I think the auras disappeared after I took shots for b-12.
I've also not had auras for several years though I do get headaches still. I had extremely low vitamin b-12 levels and I think the auras disappeared after I took shots for b-12.
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.
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.
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
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
Thank god for the internet. I too would (infrequently still do) lose my periphery. (I called it tunnel-vision when I was a teenager ... close enough.) No one I talked to knew what I was talking about.
Woah is sun exposure a trigger all by itself? I almost always get a headache if I've been outside all day, but I always assumed it was a second order effect like being outside makes it harder to get enough liquids so I was dehydrated. Or heat stroke.
I think it’s just like what you described. I love the sun and I love being outside, but after a long day out at the beach or racetrack I feel drained and I always have a headache that can end up in migraine easily if I don’t cool off and over hydrate
Bright light of the sun can trigger a migraine, at least in me and some other people I know. It's not dehydration, it's the bright light itself.
I found shade 5 sunglasses that are essentially lightweight welding glasses they have been amazing. Unlike most sunglasses they are actually dark.
I found shade 5 sunglasses that are essentially lightweight welding glasses they have been amazing. Unlike most sunglasses they are actually dark.
Yes, I had no idea that was possible! I have had a total of 5 silent migraines (aura but no headache) in my life, and each time was terrifying.
What's worse is that my current doctor says there's no way to know if my last one was a TIA or migraine (all my research shows otherwise) and now wants me to start on baby aspirin. So yeah, every time I have an aura I'm convinced it's a stroke.
What's worse is that my current doctor says there's no way to know if my last one was a TIA or migraine (all my research shows otherwise) and now wants me to start on baby aspirin. So yeah, every time I have an aura I'm convinced it's a stroke.
I also get auras but thankfully it's the worst part of my migraine cycle (actual headache is a 3/10). Probably get one a month. I occasionally get pre-drome symptoms a couple days to a week out. It's a minor inconvenience for 30-45 minutes but they seem pretty benign (also verified by a neurologist).
Some interesting work on the visionary writings of the 12th century Abbess Hildegard of Bingham. Her visions are now being understood as manifestations of migraines. I believe Oliver Saks was the first to understand them in this way.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103393/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103393/
I also suffer these though I've learnt to pick up on them before they happen so I can pull over or step away from the computer. This started when I was a teenager and has gotten better since my mid twenties (30 now). I've only had 2 attacks this year, though they have both been in August.
I find taking a nap helps. I don't get a headache but I do eventually lose 99% of my vision.
Heya, me too. A few times a year, 30-40 minutes. More frequently as I get older. Are you on anything for them?
Hi, no, right now I'm not on any medication for them. At the time I had them frequently (a few years ago) I was diagnosed with very low vitamin b-12 and given shots for it which seemed to help a lot with the frequency.
I also gave up alcohol gradually around the same time and the episodes gradually subsided after that (I had noticed that the migraines were pretty bad after drinking). I do not know if the two were related or not.
Hope you get better.
I also gave up alcohol gradually around the same time and the episodes gradually subsided after that (I had noticed that the migraines were pretty bad after drinking). I do not know if the two were related or not.
Hope you get better.
That whole article could have been just two sentences.
I recommend the 6th paragraph (4 sentences) in this article: https://newsroom.ucla.edu/dept/faculty/peter-goadsby-migrain...
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.
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.
My SO had that problem with word limits at school. She would write 5 pages for a 300 word assignment, it was almost like a brain dump.
At college I helped her with her assignments after she was done writing. I didn't know her topic but just reordering sentences, deleting redundant ones and shortening others.
I started doing this after she failed an assignment and she asked for help. After we were done "post-processing" it, she got a B on it. We hadn't touched any of her technical points, just improved the language.
I now help my sister through something similar. She has the opposite. She'll write 300 words for a 1000 word assignment. Again I know nothing of her subject, but I'll do a similar post-processing. In the process I'll notice there are some gaps in her arguments perhaps, or things that aren't as fleshed out.
So I ask her about it and almost always she can tell me lots about the subject from the books and articles she's read as part of the curriculum. So I tell her to write it down, and after going through the assignment we're suddenly in the position where we have to trim some stuff.
I used to think word limits were somewhat silly, but now I see how they can help focus the unfocused or help tease out the knowledge. Both my SO and my sister improved over time, requiring much less help after a while.
Of course left to their own devices, it would likely be very difficult for them. So there's that.
Incidentally, language was never my favorite subject and I didn't do particularly well. However studying math helped me a lot with writing non-fiction, where things like consistent logical arguments matter.
At college I helped her with her assignments after she was done writing. I didn't know her topic but just reordering sentences, deleting redundant ones and shortening others.
I started doing this after she failed an assignment and she asked for help. After we were done "post-processing" it, she got a B on it. We hadn't touched any of her technical points, just improved the language.
I now help my sister through something similar. She has the opposite. She'll write 300 words for a 1000 word assignment. Again I know nothing of her subject, but I'll do a similar post-processing. In the process I'll notice there are some gaps in her arguments perhaps, or things that aren't as fleshed out.
So I ask her about it and almost always she can tell me lots about the subject from the books and articles she's read as part of the curriculum. So I tell her to write it down, and after going through the assignment we're suddenly in the position where we have to trim some stuff.
I used to think word limits were somewhat silly, but now I see how they can help focus the unfocused or help tease out the knowledge. Both my SO and my sister improved over time, requiring much less help after a while.
Of course left to their own devices, it would likely be very difficult for them. So there's that.
Incidentally, language was never my favorite subject and I didn't do particularly well. However studying math helped me a lot with writing non-fiction, where things like consistent logical arguments matter.
The ability to tell an engaging and concise story without gaps is a difficult skill. I imagine it can be required through practice and attention. I have noticed a certain deficit in this regard with my own family and I would love to hear what techniques or exercises might help.
>I used to think word limits were somewhat silly, but now I see how they can help focus the unfocused or help tease out the knowledge.
Favorite quote (because I tend to be wordy): “I apologize for such a long letter - I didn't have time to write a short one.” ― Mark Twain
So much nuance in that simple sentence!
Favorite quote (because I tend to be wordy): “I apologize for such a long letter - I didn't have time to write a short one.” ― Mark Twain
So much nuance in that simple sentence!
Do you think there is any problem with teachers setting word limits appropriately?
I could imagine novice teachers who haven't attempted the exercise themselves being off considerably -- over or under -- on the number of words needed to complete an assignment.
I could imagine novice teachers who haven't attempted the exercise themselves being off considerably -- over or under -- on the number of words needed to complete an assignment.
So far I haven't seen much of that. There has been a few times were I told them to ask the teacher about clarification of the word count, like how bad would it be if we had 1300 instead of 1000. Sometimes the teacher would say OK if it was relevant stuff.
I can't recall any instance where either of them got a low grade for not fulfilling the assignment due to very limited word count. If you have 200 words it's impossible to go into deep details, that's just how it is.
Of course in those cases we often would have to do multiple passes to cut fluff, focus the arguments by cutting out details, find a word which might replace three others etc. We'd typically start with maybe 4-600 the words and work our way down to 200.
Of course as a teacher, if you just failed your entire class, maybe you need to look at yourself and the assignment you gave rather than the students.
I had one instance of that at high school. When handing back the assignments he loudly proclaimed "Well done, you did by far the best in class" as he handed me my assignment. I looked down and saw a D- on the paper.
The following class the teacher explained what he was looking for, and we would explain what we had learned earlier and he then filled in the gaps.
I can't recall any instance where either of them got a low grade for not fulfilling the assignment due to very limited word count. If you have 200 words it's impossible to go into deep details, that's just how it is.
Of course in those cases we often would have to do multiple passes to cut fluff, focus the arguments by cutting out details, find a word which might replace three others etc. We'd typically start with maybe 4-600 the words and work our way down to 200.
Of course as a teacher, if you just failed your entire class, maybe you need to look at yourself and the assignment you gave rather than the students.
I had one instance of that at high school. When handing back the assignments he loudly proclaimed "Well done, you did by far the best in class" as he handed me my assignment. I looked down and saw a D- on the paper.
The following class the teacher explained what he was looking for, and we would explain what we had learned earlier and he then filled in the gaps.
> 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)
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)
They can also fit more ads into a longer article. That's arguably the most important thing.
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.
> schools [...] subscription
None of that. Journalists simply want to feel like they are novelists, because, deep down, that's what most of them really wanted to be.
None of that. Journalists simply want to feel like they are novelists, because, deep down, that's what most of them really wanted to be.
Wish we could use one of those “social highlighting/annotation” apps so people identify key highlights to make it easier for others to find the key points.
Come on, it wouldn't be an article then.
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.
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.
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.
Now I’m curious about this, thank you for posting this.
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.
Article gives me an attack.
List of commercial anti-GCRP meds. https://www.drugs.com/drug-class/cgrp-inhibitors.html
List of commercial anti-GCRP meds. https://www.drugs.com/drug-class/cgrp-inhibitors.html
If you don’t want to wade through the preamble in the article, search for “calcitonin” and start at that paragraph.
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.
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.
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.
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.
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!
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!
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.
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.
What a meandering read.
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
- 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
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.
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.
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.
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.
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.
> 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.
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.
> 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/b...
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.
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/b...
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.
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.
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.
> 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.
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.
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.
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.
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...
They are the most effective family physicians I have ever had. I go out of my way to find them.
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.
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.
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.
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/) - its expensive. But after it was shown to work managed to get it on the NHS via a referral to a specialist.