Discover and read the best of Twitter Threads about #migraine

Most recents (23)

2012 column by leading pain expert B Eliot Cole, MD, MPA, warned that "radical changes" proposed by a group calling itself #PROP would deny #opioids "to the majority of patients now receiving them for noncancer pain." / thread hcplive.com/view/just-how-…
In the early 2000s, "buoyed by the success of treating cancer-related pain with #opioids, many physicians rose to the challenge of doing more for their patients suffering with #ChronicPain," Cole wrote.
"This led to an increase in the number of prescriptions for #opioids, which had the unintended consequence of more opioids ending up in medicine cabinets in more homes, ultimately giving more people (🚩not patients) access to these valuable medications for nonmedical purposes."
Read 21 tweets
.@NPR's response to the outcry that they wrongly blamed medical #opioid use as the cause of the OD epidemic? 4 days later they did it again. @BrianMannADK @carriefeibel @vicwj This is LAZY & HARMFUL reporting.

Evidence shows: #ODs & #suicides go UP as # of scripts goes DOWN.
.@NPR @BrianMannADK @carriefeibel @vicwj

🔴 2,887 #vets DIED from #OD or #suicide AFTER their #opioid pain med was stopped in FY 2013.

🔴 1 year of the VA's policy to take #vets off medicine produced just 90 fewer bodies than 9/11. (Link next tweet)
VA study showing people are 4 to 6.8 times MORE LIKELY to die of #overdose or #suicide after discontinuation of a prescription #opioid. THIS IS NOT AN OUTLIER. @NPR, PLEASE contact co-author @StefanKertesz. bmj.com/content/368/bm…
Read 9 tweets
@fightpaindaily @hope411adcock @D321Debbie @painadvocateAR @tal7291 @jillyannjiggs @JillPiggott @Nashkitty66 @Tootwisted40 @MichaelNey19 @NickCarlin6 @esteckler2 @aander1987 @Chronic_FLKeys @ThomasKlineMD @DanLairdMD @JSG_54 @donnelsonguy The problem, Tamera, is that access to other treatments is not being threatened. We get NSAIDs, Bupe, and woo pushed at us all the time.
The people who are suffering are the ones who need #opioids & can’t get them.
I’ve lost count of failed prophylactic & rescue meds over 20 yrs
@fightpaindaily @hope411adcock @D321Debbie @painadvocateAR @tal7291 @jillyannjiggs @JillPiggott @Nashkitty66 @Tootwisted40 @MichaelNey19 @NickCarlin6 @esteckler2 @aander1987 @Chronic_FLKeys @ThomasKlineMD @DanLairdMD @JSG_54 @donnelsonguy There are a few issues here:
1. The inchoate threat of law enforcement, particularly DEA.
2. The conflation of medical and non-medical users
3. The resulting war on #pain patients and physicians.
4. This leaves people with addiction and #drug dealers untouched. /2
@fightpaindaily @hope411adcock @D321Debbie @painadvocateAR @tal7291 @jillyannjiggs @JillPiggott @Nashkitty66 @Tootwisted40 @MichaelNey19 @NickCarlin6 @esteckler2 @aander1987 @Chronic_FLKeys @ThomasKlineMD @DanLairdMD @JSG_54 @donnelsonguy 6. Post 2016, plus state overreach, we see physicians harassed by law enforcement, with medical boards rolling over, or actively assisting.
7. On a parallel track, the VA blithely cuts only opioid Rx by over 1/3 goes {shocked pickachu face} when veteran suicides skyrocket.
/2
Read 7 tweets
.@BrianMannADK At @headsUPmigraine, Dr @NitaGhei & I are trying to understand why medical research about the "very rare" risk of #addiction in medical #opioid use & the rising rate of causalities from rx opioid limits isn't being reported, even by thoughtful outlets like @NPR.
#Addiction expert Maia Szalavitz explained in 2016, "#Opioid addiction is a huge problem, but pain prescriptions are not the cause." The fact that steep rx limits haven't so much as slowed rising ODs proves her right.

How did @NPR get this wrong? blogs.scientificamerican.com/mind-guest-blo…
.@headsUPmigraine has been on the front line of the twin public health crisis caused by widespread discontinuation & dose reduction of rx #opioids: a rise in unnecessary #disability from #ChronicPain & a spike in #suicide.
Read 9 tweets
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Sounds like you're lucky enough to not live with #ChronicPain if you have to read about it. My Harvard #migraine expert said I was permanently disabled in '01. I didn't want to quit. He put me on an #opioid. I kept teaching philosophy & lit until 05 & earned tenure as a result.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz When I retired, the expert who literally wrote the textbook on #migraine said I could increase my long-acting #opioid dose. I worried about a longer taper from a higher dose & went off instead. I spent 8 years in bed w/ continual hemiplegic (stroke-like) migraine.
@docroland @TheDarkGift_ @eileendove910 @StefanKertesz Pain is not my most disabling #migraine symptom. I was diagnosed with breast cancer after 8 years in bed. There was no way I could make more appts in 1 month than I had in the previous 5 years. Because Dilaudid was effective as rescue, my oncologist & neurologist rx'd it daily.
Read 13 tweets
A Google Scholar search for papers about Pain Catastrophizing + #opioids had 2,530 hits since 2018. That's 76.6 times the number of papers in 00-02.

What's "pain catastrophizing"? / thread
The Pain Catastrophizing scale assesses whether people in #chronicpain engage in rumination on &/or magnification of their pain &/or how many feel hopeless.

They claim that "catastrophizing has been associated w/ #opioid craving, long-term opioid use," & misuse.
"Pain catastrophizing has been identified as a risk factor for prescription #opioid misuse in patients with chronic pain generally." Sharifzadeh, Kao, Sturgeon, Rico, Mackey, Darnall (2017). #cpp anesthesiology.pubs.asahq.org/article.aspx?a…
Read 11 tweets
.@BethDarnall designed the questionnaire widely used to diagnose Pain Catastrophizing (PC). She pinned a survey to her twitter pg, asking people in #ChronicPain what they think of the term. Research on PC & rx #opioids is +75 times higher now than in '00-02.

What's PC? / thread
The Pain Catastrophizing Scale measures "rumination (eg, 'I can't stop thinking about how much it hurts'), magnification (eg, 'I worry that something serious may happen'), and helplessness (eg, There is nothing I can do to reduce the intensity of the pain')." [Darnall note 1]
"Psycho-pathology is both an antecedent & a consequence of persistent pain." [note 2]

Pain catastrophizing is "a mental set related to pain that is characterized by feelings of helplessness and persistent and unrealistic beliefs about pain and its consequences." [note 3]
Read 12 tweets
.@VoteVets You're wrong to make rx #opioids the focus of your anti-Collins ad. #Vets taken off rx #opioids are up to 6.8 times MORE likely to die by OD or #suicide than those who stay on, per 2020 VA study. (thread) bmj.com/content/368/bm…
#Vets whose rx #opioid was stopped after 3 months overdosed or killed themselves at nearly 4 times the rate of those who continued to be treated. Those whose med was stopped after 1+ year ODed or killed themselves at 6.8 times the rate of those still treated (Oliva 2020).
2020 VA study: “Studies have identified a rise in adverse events (death from overdose, suicidal thoughts, self-harm, & hospital admissions or emergency department visits
for substance related events) after stopping treatment with #opioids in patients treated long term” (Oliva).
Read 15 tweets
2006! #Psychologists "predicted" #anxiety & "catastrophizing" would "predict the presence & intensity of persistent #headache, as well as other non-pain physical symptoms of headache." HA+nonpain=#migraine. If headache has non-pain symptoms, it's #migraine webmd.com/migraines-head…
✔️ FACT "Researchers believe that #migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain." New models help scientists study "the biological cascade, genetic components & mechanisms of migraine." ninds.nih.gov/Disorders/All-…
Participants in the 2006 study got 1 #anxiety or #castrophizing point per #migraine symptom: light/sound sensitivity; nausea; visual disturbance; speech difficulty; 1-sided weakness, numbness, tingling.

✔️ These are all standard migraine symptoms (& just the START of the fun).
Read 12 tweets
Brain imaging confirms what your grandmother told you: overworrying makes you feel worse. Treating #anxiety can often ease the burden of #ChronicPain.

Thread: comparing tests that screen for anxiety with & without physical symptoms threadreaderapp.com/thread/1270853…
The Hospital Anxiety & Depression Scale (HADS) doesn't include specific physical symptoms. HADS assesses #anxiety by asking how often a person feels tense, restless, worried, vaguely frightened, or panicked. svri.org/sites/default/…
By contrast, 40% of the items on the 4 Dimensional Symptoms Questionnaire ask about specific physical symptoms, every 1 of which can be indicate #migraine. semanticscholar.org/paper/The-Four…
Read 19 tweets
My #migraine was wrongly diagnosed as a mental disorder by a questionnaire widely used in primary care. Migraine is a progressive brain disease. Accurate diagnosis & effective treatment are essential.

Thread: psychologizing #illness & #pain
PHQ assesses 15 symptoms: pain in head, chest, stomach, back, limbs/joints; pain with menstruation or sex; dizziness; heart pounding; fainting; shortness of breath; upper & lower GI distress; low energy; insomnia. qxmd.com/calculate/calc…
.
The Patient Heath Questionnaire-15 & the Somatic Symptom Scale (SSS-8, pictured) are used to diagnose people with a newly conceived mental illness known as "somatic symptom disorder": the "expression of mental phenomena as physical (somatic) symptoms" (Merck).
Read 17 tweets
@CContrarus @hope411adcock @painadvocateAR @tal7291 @fightpaindaily @speakingabtpain @jillyannjiggs @JoeFalzone8 @JSG_54 @LadyAg72 @brent_kellogg @dr4liberty @Irishbrat1966 @ThomasKlineMD @DanLairdMD @D321Debbie @Angelsgal02 @esteckler2 I've been housebound w/ continuous #migraine for 15 yrs, direct @headsUPmigraine, & disagree profoundly w/ overpsychologizing pain.

#Psychologists are wrong to diagnose "catastrophizing" w/ this test w/o telling patients that doctors may use results to taper/deny #opioids.
@CContrarus @hope411adcock @painadvocateAR @tal7291 @fightpaindaily @speakingabtpain @jillyannjiggs @JoeFalzone8 @JSG_54 @LadyAg72 @brent_kellogg @dr4liberty @Irishbrat1966 @ThomasKlineMD @DanLairdMD @D321Debbie @Angelsgal02 @esteckler2 @headsUPmigraine Thread below: @headsUPmigraine's response to "catastrophizing" survey & diagnosis, as well as its "possible predictive value for #opioid prescription" (sec 4: Discussion, Sharifzadeh, Darnall, et al., 2017). ncbi.nlm.nih.gov/pmc/articles/P…
People should be informed if a questionnaire they're given to diagnose a #psychological disorder might potentially be used by a physician to deny them treatment for a physical disease.
Read 18 tweets
As a public service, @headsUPmigraine is field-testing an @NHF article on #hemiplegic migraine!

❌ "Individuals with hemiplegic #migraine may have attacks frequently (once a week) or very infrequently (once a year)."

✔️ You can have this kind of fun ALL WEEK LONG!
✔️ "Notably, some...w/ hemiplegic migraine have unsteadiness or imbalance that isn’t just limited to their attacks of #migraine. In these individuals, incoordination/ imbalance progresses slowly over time and can be a permanent symptom."

❌ "fully reversible" HM @ihs_official
.@ihs_official I wish you were right that HM has "fully reversible motor weakness." I'm a 42-yr HM vet (50 yr daily CM). I've been homebound 15 yrs.

Tip to other rural HMers: a wheelbarrow is an excellent wheelchair replacement on grass but you need a St. Husband to drive you.
Read 11 tweets
#AlbertCamus's 1947 novel "The Plague" is now a bestseller. Penguin is reprinting it to meet demand. But YOU can #StayHome & read the 1957 Nobel laureate's masterpiece for free online! / thread #Covid19 #quarantine antilogicalism.com/wp-content/upl…
Algerian-born #AlbertCamus sets his novel in Oran, Algeria, which had 95 cases of the bubonic plague in 1944. He ends "The Plague" by reminding readers the bacillus never dies. He might've been surprised to learn it reemerged only 50 years later, in 2003. ncbi.nlm.nih.gov/pmc/articles/P…
#AlbertCamus was editor-in-chief of the French-resistance newspaper, "Combat," from 1944-47, and his 1947 novel "The Plague" reads simultaneously as an exploration of #quarantine & of the Nazi occupation of France. openculture.com/2017/01/albert…
Read 10 tweets
#Migraine patients were excluded from Eli Lilly's trial of #Emgality 300 in which 71.4% of people got +50% reduction in #headache days. Only 28% of people taking 120 mg hit this benchmark. Trial exclusion means FDA did NOT approve 2.5x more effective 300 for CM. @LillyPad thread
Trial exclusions determine FDA "labeled" usage. Insurers routinely cover off-label use of inexpensive meds & deny off-label use of expensive meds. Eli Lilly priced #Emgality high: $6,900/year. investor.lilly.com/news-releases/…
Both #cluster & #migraine are profoundly disabling diseases w/ overlapping symptoms. #Emgality treats both. People fully disabled by 1 are no more/less disabled than people fully disabled by the other, so why did Lilly assume #cluster required nearly 3x more med?
Read 11 tweets
.@MedPageToday Your 3/1 illustration about #opioid tapering is so offensive I won't retweet it. #ChronicPain, not the medicine that relieves it, is the ball & chain millions drag behind us. I direct @headsUPmigraine. I know people who died after being forced off safe med. /thread
Shame on you for perpetuating the stigma & misinformation that's ruining & even ending people's lives. "When #pain meds are taken the right way, #addiction is very rare." #opioids #cpp #spoonie cancer.org/content/dam/ca…
#CDC's Guidelines put the rate of non-problematic use of rx #opioids at average 96.97% w/ 3.03% including non-addictive "dependence." Brat 2018 reviewed 1+ million post-op patients & found rate of 99.4% unremarkable use; 0.6% included patients who refilled, @MedPageToday.
Read 9 tweets
.@BridgeMichigan You gave positive press to BC/BS Michigan's decision to pay doctors 35% more if they don't prescribe #opioids post-op. This thread is a #factcheck.

1) You never mentioned that restricting rx access has failed to curb ODs, which are fueled by illegal drug use.
Jnl of AMA study: Efforts to curb ODs focused on "restricting the supply of prescription #opioids...have failed to demonstrate consistent benefit." Continuing these policies "may have a modest effect, at best."

This is widely known. Your writer didn't know it.
2) A 2017 study looked specifically at rx post-op & found 99.4+% safe use. The 0.6% included people who refilled their rx. You just gave great press to @BCBSM who's paying doctors to leave patients in pain to avoid meds w/ +99.4% safe use. (Citations in report below.)
Read 12 tweets
Let's get started on our first @realbrainbook CBD.
A 49 year old woman presents to the emergency department with an acute onset headache, vomiting, neck stiffness and photophobia. On examination she is conscious and alert with a GCS of 15. She has no neurological deficits #BBSAH
Based on the history what are your thoughts on differential diagnoses? #BBSAH
Indeed, some great differentials mentioned. Here are some important ones to consider:
Vascular: Ruptured #aneurysm, Ruptured arterio-venous malformation #AVM
Infectious: #Meningitis ,Ruptured mycotic aneurysm
Other: #Migraine, Traumatic haemorrhage #BBSAH
Read 50 tweets
Always appeal insurance denials: they deny things knowing % won't appeal. I know this because whistleblower @WendellPotter is 1 of my #Healthcare Heroes. content.time.com/time/politics/…
I'm badly battered by multiple insurance appeals, but "won" them all. Tips: 1) Partner up, esp if you're sick. You can hand the phone to anyone you want. But if you want someone to be able to call in your place, ask company to send you form so you can designate a spokesperson.
2) Tweet or Fb-post your complaint to your insurer: "I get @Aetna insurance thru work & they just denied coverage of the med that lets me work," for ex. The customer service reps who respond to social media are BETTER than the ones who answer the phone, & you're not on hold.
Read 10 tweets
Here's my latest* update to my vetted collection of Twitter Disability and Chronic Illness hashtags. Please share it!

Thank you :-) Graffiti background. Foreground in black letters on a  white background to the left reads “Twitter Disability and Chronic Illness Hashtags”<br />
This collection is current as of 01.30.20, previous Twitter update 09.11.19.

There's a PDF version coming up this weekend, to be posted to my Kofi profile. I'll add the link toward the end when it goes up, after the questions, where you can also sign up for email updates.
This version has added

- community suggestions,
- mental health hashtags,
- Medical crowdfunding hashtags,
- and a section for cancer-related hashtags.
Read 84 tweets
Time for "What's My #ChronicPain Personality Disorder?"

Does continual #pain make you suspect others aren't on your side? Does severe pain make you detach from relationships or restrict your emotions? You have a CLUSTER A Disorder! / thread
When you're in #pain, do you feel excessively emotional & seek attention? ... Congratulations! You're histrionic! (Cluster B)
Does having continual #pain give you an "excessive need to be taken care of"? Join the 17.4% of #CPPs in Cluster C Personality Disorders!

(17.4 strikes me as a little low, peeps. Who's not having enough pain? We should be in the 20s, if not the 30s on this baby.)
Read 12 tweets
Happy Saturday! Ready for some #headache management tips from #AIHS19 / @aihsHeadache ?

1/
First, from @123Migraine: Medication overuse headache.
5% of the population has a chronic daily headache - HALF of these are due to MOH; 8 million people!

Criteria:
15+ days per month of a headache medication if over-the-counter, 10+ if Rx or combo
>3 months of regular use

2/
Medication overuse #headache:

Treatment is removing the overused drug!

Sometimes this requires inpatient treatment and tweaking of the current regimen. Butalbital/#fiorcet withdrawal can be dangerous. Sometimes it gets worse before it gets better. Help with coping skills!

3/
Read 25 tweets
When I was 20 I had a dream of being a park ranger, living in the woods, and spending as much time outside as possible. I *truly* believed I could outwork, outsmart, and out-stubborn #migraine and build whatever life I wanted.
When I was 24, I started a job in the high country of Yosemite and moved to 8500 ft. Three weeks later I woke up with a visual aura that turned into intractable Migraine. That was 6 years ago - I have had symptoms every day since. (My cabin didn’t fare well, either)
There’s a lot in between now and then - a romance, a betrayal, a heart break, a resurrection, many doubts, many meds, and many moves. It hit me like a ton of bricks that this summer is the first in 10 years I haven’t been to the Yosemite.
Read 6 tweets

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