
First drug to prevent chronic migraines approved by EU - al_ramich
https://www.theguardian.com/science/2018/jul/31/first-ever-pill-to-prevent-chronic-migraines-approved-by-eu
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epmaybe
The title is misleading, as other medications have been used for migraine
prophylaxis. This is the first drug, per the article, that has been
specifically approved for migraine prophylaxis. Medications such as beta
blockers and valproic acid are other medications used for migraine prophylaxis
but were originally approved for other conditions.

Additionally, please note that this drug has already been approved in the US,
since May.

Now, onto the meat of this. If I'm not mistaken, erenumab is a cgrp inhibitor
that made much fanfare a few months ago in New England Journal of Medicine
when two studies found a clinical benefit in cgrp.

Basically healthcare providers are prescribing this if you failed the
aforementioned therapies for migraine prophylaxis (since those are way
cheaper).

On a funnier note, medical students such as myself have started referring to
all of these new biologic drugs as "what-the-f __*-umabs " since they all have
weird names and we can't keep up with the rapid development of them.

~~~
jensvdh
As someone suffering from multiple auto-immune diseases, I love the "biologic
era".

I'm currently taking Cosentyx and it's been life-changing.

More and more the treatment goal of my condition is becoming sustained drug-
induced remission.

~~~
smnplk
Would Cosentyx also help bring Hashimoto thyroid disease into remission ?

~~~
epmaybe
Potentially, as there is some evidence that Hashimoto's has some increased
interleukin 17a (what cosentyx targets). However, it was my understanding that
Hashimoto's is something that could be treated long term with thyroid hormone
supplementation (synthroid, etc).

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orthecreedence
I've been taking Feverfew extract daily (the brand is Mygrafew, I think) and
it has reduced my migraines by about 80%. For the rest of the time there's
sumatriptan, which works about 70% of the time. Between the two, I've got my
migraines under control (maybe one a month).

I used to get at least one a week, and I know there are people who get them
much more often. I'm glad there are advances being made in this area because I
feel like for all the pain migraines have caused me, I'm mostly a dabbler and
others have it much worse.

It's really one of the worst pains I've ever experienced. They are kind of
evil. With some pain, you know "at least it's for a reason" (like your body
self-healing something). With migraines, it's devoid of any purpose. The pain
only exists to torture you. Nasty things.

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SloopJon
I know two people who suffer from chronic, debilitating migraines. As someone
who gets episodic clusters, I am sympathetic / empathetic to their plight. My
attacks (which only happen every two years or so) can be treated pretty
effectively with oxygen and/or sumatriptan injections, so it's tempting to
think that sumatriptan (primarily a migraine drug in the first place) should
just work.

Everyone is different, and there is so much we don't understand about
migraines (and clusters, which often benefit from migraine research). If you
think that ginger, cannabis, or just avoiding your triggers is all it takes,
that's not always (nor probably often) the case.

I hesitate to subject a friend's personal blog to the HN effect, but if you
want to learn about chronic migraine from one firsthand account, read through
some of the archives at thedailyheadache.com. She has been trying desperately
and relentlessly to find peace for a long time.

~~~
waynecochran
Interesting you mention oxygen -- this means you breath from an oxygen tank? I
notice I yawn a lot when a migraine is about to occur -- I always thought this
had something do with lack of oxygen.

I always have a supply of MaxAlt (rizatriptan benzoate) with me which short
circuits my migraines if I take it in the correct window of time. 1 MaxAlt
usually works, 2 or 3 in the worse case.

~~~
SloopJon
For cluster headaches, a high rate of oxygen (like 10-12 liters per minute)
acts as a vasoconstrictor, which can relieve pressure on the nerve.

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bodhibyte
I've found a quarter teaspoon of powdered ginger surprisingly effective for
migraines. Don't take my word for it:
[https://www.ncbi.nlm.nih.gov/pubmed/23657930](https://www.ncbi.nlm.nih.gov/pubmed/23657930)

~~~
raverbashing
I can't imagine how it is to eat powdered ginger given how a piece of solid
ginger tastes like

~~~
saiya-jin
You can make (rather strong) tea from it, i saw it even being sold in
supermarkets straight in tea bags. Add some lemon and honey and it is
delicious and great for those long winter evenings

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cgh
There is growing evidence that hyperinsulemia is related to migraines.
Insulin-resistant individuals and/or people with metabolic syndrome who suffer
migraines could try lowering their insulin levels by removing fast-digesting
carbohydrates (refined sugars, starches, junk food in general) and seeing if
that helps.

~~~
bonesss
Along the same lines: chronic migraine sufferers can sometimes have good
results at reducing frequency by lowering the blood pressure.

A low carb diet, or ketogenic diet, can cause lowered blood pressure. The only
downside with diet instead of medication is that eating carbohydrates will
reverse the effect.

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kodablah
A couple of naive (and admittedly political) questions I didn't see addressed
in the article...

Is there any way to find out how much of the R&D money for the medicine came
from public funding? I can understand if the information is simply not
available because it comes from a larger pool of R&D monies.

> Erenumab is now expected to be considered by English and Scottish health
> agencies to assess whether it is appropriate for NHS use.

Curious whether it has to be approved by the EU first before its use by NHS is
allowed (or if its assessment is even worth it until EU approval occurs). Also
curious whether "appropriate for NHS use" means at no cost to migraine
sufferers.

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xchaotic
Side effects include chronic migraines and death.

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okmokmz
Some people have been able to successfully treat migraines, as well as cluster
headaches, with hallucinogens such as psilocybin and LSD:

"These patients are in a desperate and vulnerable situation, and illicit
psychoactive substances are often considered a last resort. There appeared to
be little or no interest in psychoactive effects per se as these were rather
tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin,
lysergic acid diethylamide, and related psychedelic tryptamines were
reportedly effective for both prophylactic and acute treatment of cluster
headache and migraines. Treatment results with cannabis were more
unpredictable. No severe adverse events were reported, but it was observed how
desperation sometimes spurred risky behavior when obtaining and testing
various treatment alternatives." [1]

"The authors interviewed 53 cluster headache patients who had used psilocybin
or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26
psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin
users and 7 of 8 LSD users reported cluster period termination; 18 of 19
psilocybin users and 4 of 5 LSD users reported remission period extension.
Research on the effects of psilocybin and LSD on cluster headache may be
warranted."[2]

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584001/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584001/)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/16801660](https://www.ncbi.nlm.nih.gov/pubmed/16801660)

[https://clinicaltrials.gov/ct2/show/NCT03341689](https://clinicaltrials.gov/ct2/show/NCT03341689)

~~~
heyyyouu
Yes, it's been found to work well on certain types of "cluster" type migranes.
However, it hasn't been found to work for chronic migranes, which is what this
new drug is focused on. Prevention of chronic migranes is horribly elusive,
and while there's a number of "preventatives," for many people they don't work
well or for very long.

~~~
Uberphallus
I have chronic migraines, the frequency isn't too bad (2-3 times a month).
Personally I've spent 2 years migraine free doing LSD and psilocybe mushrooms
(and other related drugs) every couple of months during a year and a half.
Sometimes in the range of microdosing: ~25µg LSD monthly for the last 3
months). I know, n=1, but still.

~~~
heyyyouu
Chronic migranes is defined as 15 days or more per month. Many people have it
24 hours a day.

Frequency is what chronic migranes are about.

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jlebrech
you could also just avoid your migraine trigger, I have and get around 3
migraines a year max rather than having one every month or 2 or 3 a week as a
teen.

~~~
driverdan
You state that as if it's simple and anyone can do it.

What if something common like changes in atmospheric pressure trigger it? What
if you have multiple common triggers? What if you don't know all your
triggers?

~~~
orthecreedence
Just keep a food log, mood log, sleep log, stress log, barometric pressure
log, air quality log, oxygen level log, altitude log, brightness log, screen-
time log, eye strain log, face-shoulder-neck tension log, spine pain log, head
trauma log, and a blood pressure log.

Then you can hook up all the data into a recurrent neural network that finds
the patterns in the data and lets you know what combination of conditions will
give you migraines.

It's really easy to find all your migraine triggers if you follow these very
basic steps.

~~~
ianai
Should also probably log stool weight/color, mineral/vitamin intake across all
foods, etc etc - just to make it even more clear that a person has no time to
“just log everything” that could possibly play a role. And at the end, it
would probably not explain a majority of the headaches - at least in my
experience.

~~~
orthecreedence
> it would probably not explain a majority of the headaches - at least in my
> experience

This is my experience too. I know a good number of my migraine triggers, but
some days I do _everything_ right: I eat good food (regularly), plenty of
sleep, no over-exertion, lots of water, breaks from screen time, no eye
strain, etc etc...still get a fucking migraine!

Sometimes there's just not a reason for it.

~~~
ianai
Yep and that list of things you did correct could go on for pages. It’s
similar for how I treat my headaches. I don’t just take a triptan. I do the
yoga stretch, maybe a cup of tea (full cup of coffee if I’m in 9/10 zone),
some Gatorade, ginger powder, tumeric powder, heat on the traps, TENS unit on
the traps/neck/temples, ice, etc and nothing. I’ve even fallen asleep while
doing half of those in the crocodile position before. It worked that time,
too.

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merinowool
For a lot of people cannabis works great for their migraines, but I guess it
is difficult for pharma to make money off of it so it is still a gray area in
the EU. I am only pointing this out because the hype coming from the article
makes the situation grotesque.

~~~
soperj
My sister in law lived in the netherlands, and they actually prescribed her
mushrooms (the magical kind) for her migraines.

~~~
heyyyouu
It is known to work for specific types of cluster migraines. But unfortunately
only those kinds.

