Discover and read the best of Twitter Threads about #migraine

Most recents (24)





SIGNED: —@jamie_culpon

#migraine #pain #adhd #autist #actuallyAutistic #fuck #fuck #fuck #nsaidx3


Ha ha just serious

ha ha

But the thread ended with the 1E JP MC Joke.


(@creativecommons CC BY-SA-NC / BSD 3 clause (C) @jamie_culpon)


Read 4 tweets
Taken me several days to answer this, because migraines have long been a gap in my knowledge

Can't feel too bad though, because the science of #migraines is WAY more complex and uncertain than most would have thought

Here's what's known

Strap in, this will get complicated

What is the root cause of migraines? Currently 'TBC', unfortunately.

But evidence suggests it involves neurological, vascular, hormonal and genetic factors are working in concert

Applies to pretty much anything in the brain, it never makes it easy

But if there IS one specific 'root cause' of migraines, most fingers point to Cortical Spreading Depression, CSD

What's that?

It's when a neuron, brain cell, experiences a sudden burst of activity (depolarisation), followed by a period of inactivity, as if it's exhausted

Read 34 tweets
What is a spontaneous spinal CSF leak?

It’s so much more than a headache. It’s extremely debilitating.

When I experienced a CSF leak in 2014, I had to lie down all day every day for several months.

#leakweek2022 #csfleak #spinalCSFleak #SIH #headache…
Sometimes people are wrongly diagnosed with postural orthostatic tachycardia syndrome #POTS when it’s actually a spinal CSF leak.

I gave a short talk at the PoTS UK London Masterclass in December 2019

#leakweek2022 #CSFleak #spinalCSFleak #SIH #headache

I was interviewed for the National Migraine Centre HeadsUp Podcast about my experiences with a spontaneous spinal CSF leak (Series 2, Ep 6) to help educate healthcare professionals & patients

Sometimes a #CSFleak is misdiagnosed as chronic #migraine

#headache #SIH #leakweek2022
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What’s going on in the 🧠 that causes motion sickness – and what’s the link with #migraine?

A #tweetorial about motion sickness, the importance of matching, and why serotonin matters

#MedTwitter #NeuroTwitter
First, let’s review some structures of the vestibular system that help us sense body movement:

1⃣ Semicircular canals = angular acceleration
2⃣ Otoliths (utricle & saccule) = linear acceleration & head tilt

The 🧠 combines this vestibular input with visual 👀 & proprioceptive input to assess motion

➡️ This is where the importance of matching comes in

...So what happens when the inputs don't match?
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Let’s talk about #topiramate for #migraine. Love it or hate it, you’re probably gonna prescribe it for your patients. Unfortunately, I see a lot folks prescribe it in a way that it is either not effective or causes side effects, leading to the general disdain for the med. A 🧵1/n
This #tweetorial is more for medical providers but patients can learn from it to. Here are some ways to take topiramate that may lead to decrease in frequency and severity of migraine symptoms with less side effects. #MedTwitter #NeuroTwitter #MedEd 2/n
Topiramate one of the cheapest migraine preventives and it is usually covered by insurance. It also often needs to be trialed due to step therapy before other treatments can be prescribed. It’s also an effective med. But only if prescribed right. 3/n
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How does botulinum neurotoxin (BoNT) work to improve chronic migraine? 🤔

⚡️ Spoiler: it's probably not what you think!

A 🧵 about BoNT & #migraine

#MedTwitter #NeuroTwitter #tweetorial
Let's start with a definition: what makes a migraine "chronic?"

◾️ Headache occurs at least 1⃣5⃣ days per month
◾️ Of which at least 8⃣ have features of migraine headache
◾️ For 3⃣ months or more

From: Int'l Classification of Headache Disorders…
And a bit of history: botulinum neurotoxin (BoNT) came to be studied for chronic migraine after anecdotes suggested that BoNT injections to treat wrinkles also helped with headaches!
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Something I learned recently is there are 3 different types of photophobia associated with #migraine.

Type 1 is when light worsens migraine headache pain. This is due to the receptors in the eye then going to the thalamus and being transmitted out to the trigeminal nerves 1/4
which transmit pain receptors in the face and head. Therefore light makes the pain worse.

Type 2 is increased sensitivity to light. Light seems brighter but it doesn’t make the headache worse. This is due to dysfunction in the brain pathways that mediate response to light. 2/4
Type 3 is light causing eye pain which has to do with neural pathways within the eye itself.

This is important for clinicians to ask about these because someone may have photophobia but not realize it. And this may contribute to them not getting a migraine diagnosis. 3/4
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whenever I ask mom to make the lights dimmer she complains being in low light will give her a headache-I ask for low light as light causes headaches/migraines/sensory overload/general asd burnout/eye pain long covid&all this triggers the pain/nausea/fatigue from other conditions
I don't want to cause anybody with any condition pain so I try to compromise. its very difficult I can't have no light [ideal & sometimes necessary for me] but I have empathy so I don't complain about her needs.
it really bothers me how every single time I ask if I can dim the lights mom has to tell me how awful it is & it always makes me feel like a bad person. the hypocrisy also hurts. having some perspective would also be nice. none of my headaches or migraines are treated w/ OTC meds
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If you’re having a migraine prodrome clap your hands! 👏🏽👏🏽 If you are dealing with severe fatigue and irritability and that anxiety knowing a migraine attack is about to happen but you don’t know when and you’re out of your usual rescue so you’re also sad, clap your hands. 👏🏽👏🏽
It’s me. I’m clapping my hands. #migraine #NotJustAHeadache
And the attack is here. I have one charge left on my nerivio and my new one hasn’t come in yet. Praying I caught it early enough that I don’t need much more. 😫
Read 4 tweets
Be sure to join us RIGHT HERE on Monday for the launch of a new accredited #tweetorial on continuity of care in the mgt of #migraine, by expert author Annika Ehrlich, MS, FNP-C, AQH, CNRN (@EhrlichNP). Follow us so you don't miss a tweet on your way to 0.75h CE/#CME credit! Image
1) Welcome to an accredited #tweetorial on #migraine, focusing on continuity of care, education, communication & resources for you & your patients. I am Annika Ehrlich, MS, FNP-C, AQH, CNRN (@EhrlichNP). Follow this thread & earn 0.75h CE/#CME credit! @academiccme @UCSFHospitals Image
2) This series is supported by an educational grant from AbbVie and is intended for healthcare providers. Faculty disclosures are listed at…. Program chair Dr. Tesha Monteith (@headacheMD) and I welcome your participation! #FOAMed #neurotwitter
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Migraine affects over 1 billion people worldwide, is the 2nd leading cause of disability, and a major source of losses to the 🌍 economy—yet professional and political awareness is lacking. Read a new @TheLancet Series on #Migraine by @MessoudAshina et al.
In 2011, migraine cost Europe an estimated €50-€111 billion. Evidence suggests primary care could meet the needs of most #migraine patients, where available. Read an overview of migraine epidemiology, global burden, and migraine care challenges.
Migraine diagnosis is based on clinical criteria—criteria that do not capture migraine’s heterogeneity. Read about recent progress in disease characterisation, biomarkers of #migraine, and precision medicine for affected patients:
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03/12 > Les scientifiques inventent un microscope qui peut regarder directement à travers votre crâne en toute sécurité via @ScienceAlert #LaMethSci
[L’étude à découvrir] 12/11 > Microscopie à matrice de réflexion à balayage laser pour une imagerie sans aberration à travers le crâne de souris intact via @NatureComms #LaMethSci
02/12 > 2020 se classe parmi les 3 années les + chaudes jamais enregistrées via @lemondefr #LaMethSci
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#Migraine is a neurological disorder, not a terrible, disabling #headache," expert @DavidDodick explains. #Pain is "just 1 clinical manifestation deriving from a sensory processing disturbance affecting the nervous system" (Morgan, Lancet 2020). /Thread…
Billie lost her insurance when #migraine disabled her: “There are days I don't see anything except for shapes." Visual warnings are the most commonly recognized auras, but these symptoms are highly variable, both in different patients & on different days for the same patient. 2/
Difficulty speaking or speaking clearly is another common #migraine symptom, either preceding or during an attack.

Poor St. Husband. He watched this clip & said, "Yup, that's you." I spent a lotta years in school to talk like this. 3/
Read 7 tweets
A Yale study of 10 patients found 1 dose of #psilocybin can cut #migraine frequency in half for 2 weeks. Each patient did 1 session with placebo, 1 with the drug. People who felt most high got the least migraine relief. /thread…
The Yale researchers who conducted the small, but 1st of its kind study suggest #migraine patients might benefit from microdoses or sub-hallucinogenic doses of #psilocybin. Understanding how psilocybin prevents migraine might open new pathways for drug development, as well.
I did 2 #migraine clinical trials. I'm glad someone else took this one for the team. I hated Methysergide (Sansert), now discontinued, which was synthesized from lysergic #acid. A 1965 study said Sansert users experienced a "confused feeling of unreality." Tell me about it.
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“[W]idespread & variable dysfunction of the nervous system…comprises the aberrant brain state of a #migraine attack” (Charles 2017).

Daily/near-daily migraine is continuous migraine. Imaging shows our brains *always* look like brains during an "attack" (Brennan 2018). >thread
Recurrent #migraine & #pain aren't benign. “Long-lasting &/or repetitive pain over years leads to profound functional as well as structural changes in the brain networks" (Brennan).

Ineffective treatment is a leading risk of progression to continuous migraine. #MedicalTwitter
Brennan & Pietrobon's paper "A Systems Neuroscience Approach to #Migraine" (Neuron 2018) is @headsUPmigraine's favorite. I excerpted it for others like me who aren't fluent in #neurochemistry:…
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Late in CDC's 2016 Guideline, a table reveals the Agency had no solid evidence for its claim that reducing rx #opioids would reduce ODs without harming people in #pain. In fact, ODs & suicides have spiked in their wake.

Thread: What did CDC know & when did they know it?
In a spring 2016 research paper, the Guideline's authors report that no "rigorous" studies had been conducted on whether dose reductions lower ODs, tho "preliminary results" suggested that high doses are less risky than low doses.

(All references at end of thread.)
CDC conducted its own study using VHA data about vets taking rx opioids. They matched 221 vets who died of OD (some of whom "likely" committed suicide) with 221 vets still living.

They found "dosage was a moderately good ‘predictor’ of opioid overdose death."
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#Migraine is the most common & disabling brain disease, but @SocialSecurity still doesn't recognize it as potentially disabling, making it much harder for people to qualify for earned benefits.

🔵Bookmarkable Thread! Info about #SSDI & #disability for migraine.
Globally, #migraine is the #1 cause of disease-related #disability for people 10-24 & the 4th cause for people 25-49. Yet @SocialSecurity still doesn't treat it as a potentially disabling disease.… Image
Severe #migraine is profoundly disabling. The World Health Organization uses objective metrics to determine disease burden & ranks severe migraine in the highest category of disability alongside terminal-stage cancer.

Shame on @SocialSecurity. Image
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@ravensspirit68 @funchefchick @NitaGhei @StefanKertesz @AllysonVarley @PainPtFightBack @LelenaPeacock @tal7291 @urbanfatbiker I'm working on a big annotated bibliography of #cpp/rx #opioid research that I'll put online for activists to use. Here are studies I've got on #CPP-associated #suicide. Send me titles & authors for papers I'm missing & I'll add them. I'll link them below.
Tang et al 2006 review: Risk of death by #suicide at least doubled in #ChronicPain patients. Ideation is 3 times more common; lifetime prevalence of about 20%. 8 risks for suicidality in chronic pain were identified, half are physical.…
Tang et al: 8 risks for #suicide in #ChronicPain patients: 4 are physical, including type, intensity & duration of pain & sleep-onset insomnia co-occuring with #pain; 4 are psychological. CP is a neurological suicide risk AND a psychological risk.
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Med Schools offer almost no instruction in the world's #1 cause of working-age disability. It'd be like Dental Schools not covering cavities.

7 words diagnose most #migraine: Recurrent #pain w/ hypersensitivity &/or nausea. 60% of patients go undiagnosed. #MedicalTwitter #PCP
#Migraine is PROGRESSIVE. A 40% diagnostic rate condemns some to lifelong #disability: Late diagnosis & ineffective treatment of acute #migraine are leading risks for continuous migraine. #PCP #MedicalTwitter…
🔴HOW DOES THIS CHILD GO 8 YEARS WITHOUT A DIAGNOSIS? She has textbook ICHD-3 #migraine! 1>sudden hypersensitivity (smell) 2>throbbing #pain 3>nausea 4>need for bedrest

She might've avoided #disability w/ early diagnosis & treatment. #PCP…
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.@mareasachs The good news is that you're at the peak of #migraine prevalence! Preventive treatment is always important, but especially so in people with childhood onset & women within a decade +/- of peak.… Image
@mareasachs Thanks for your message! I'm rushing off now, but will check back in soon. If you're just starting to learn about #migraine, try @amfmigraine and ....
And check out this great interview by Angie Glaser (@winedarkme), who, like us, also started #migraine very young. She talks with another talented member of the #migraine sisterhood, @AbiStevens_Art.…
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BOTOX: A PRINCIPLE OF MEDICAL DIAGNOSIS & THERAPY? Several insidious medical disorders encompass similar pathophysiology seeming amenable to #Botox therapy: #Migraine, #TMJ, chronic neck pain (#cervicalgia), & Thoracic Outlet Syndrome (#TOS).
The pathophysiology found within all these disorders is the phenomenon of “crossed muscle” syndromes. Dr. Victor Janda is possibly first to describe this curious syndrome, which is easily discovered by simple physical examinations.
When the body musculoskeletal tower is asymmetric (tilted) within the ambient gravitational field, muscle pairs symmetric from side to side or which oppose in individual body part functions, become dissimilar in dynamic action; one muscle stronger & hypertrophic. The other weak.
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0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
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#Opioid tapering is "extremely difficult" for people w/ #ChronicPain, "not only in those w/ problematic opioid use."

Kurita: Worsened pain &/or function led more than half of those studied to stop scheduled dose reduction of 10% or 20% per week. /thread…
1b/ Kurita: Altho 40 of 75 didn't complete the taper, researchers found "improvements after opioid treatment stabilization was achieved," suggesting stabilization (whether at a dose or at 0 dose) is a preferable goal to forcing everyone off rx #opioids.

Stopping can be fatal.
2/ Glanz: "Attempts to adhere to prescribing guidelines may lead patients to be exposed to variability in #opioid dosing." Dose variability of 30% or more increases the risk of overdose more than 300%.

Glanz et al. JAMA Network Open. 2019;2(4):e192613.…
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1) Migraine Premonitory(Prodromal) Phase::
Presences of non-painful Symptoms, which can start hours to days before the onset of migraine pain and can be predictive of an impending headache.
2) Three Separate Groups of Symptoms::
1::Fatigue & Cognitive changes...
Concentration difficulty, Irritability, depression, fatigue, memory impairment.
2::Homeostatic Changes...
Food craving, Thirst, Yawning, Increased Urination, Sleep disturbance.
3) 3::Sensory Changes...
Photo, phono, osmo, Phobia, nause, neckstiffness.
Read 7 tweets

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