A Patient Perspective of the 2022 Migraine Symposium
Yuri Cárdenas, Patient Advocate, shares their takeaways from the Association of Migraine Disorders’ 2022 Migraine Symposium.
The Migraine Symposium hosted by the Association of Migraine Disorders, was a hybrid event held virtually and in-person in Providence, Rhode Island. The symposium was divided into two tracks, one tailored to medical professionals and the other to patients and the general public; however, both programs were open to all attendees.
This year there were presentations on new and pipeline treatments including oxytocin and psilocybin, migraine symptoms such as brain fog and mood changes along with migraine comorbidities such as sleep and migraine and more. Below are my perspectives and key takeaways from the Migraine Symposium.
Key Takeaways: Migraine Symptoms
Managing life with chronic migraine can be frustrating and focusing on triggers can increase anxiety as well as self-blame. It was hopeful to hear that Dr. Gottschalk encouraged people to move away from focusing on migraine triggers and instead to look at the relationship with our environment at any given moment. “Most trigger studies lead us nowhere.. you don’t work yourself into a headache by getting stressed or angry or what have you, but your brain is changing as migraine develops and it’s your relationship to your environment that changes as a function of migraine.”
Dr. White reviewed the history of brain fog, definitions, and a review of research; including imaging studies that show brain fog symptoms are related to changes in the brain during and between migraine attacks.
Brain fog occurs as frequently as other symptoms that are included in diagnostic criteria of migraine. Cognitive tests have identified objective impairments on processing speed, attention, verbal and nonverbal memory, verbal skills, executive function and visual-motor skills. Imaging studies have associated three key areas in the brain that are affected more than others during ‘brain fog’:
- Frontal lobe – involved in paying attention, making decisions and higher order function
- Thalamus and hypothalamus – involved in processing speed as well as wakefulness and arousal
- Temporal lobe – involved in memory and language
Key Takeaways: Migraine Treatments
For some people, like myself, numerous preventative medications and other treatment options do not offer relief. I have gone from one medication to the next, for nine years. I manage to endure medical burnout but still try to maintain hope, thanks in large part to events like the annual Migraine Symposium.
While we have seen a boom in new treatments, there are still several options potentially on the horizon: from psychedelics, to the ‘love drug’ oxytocin or liquid celecoxib.
Dr. Emmanuelle Schindler presented research on psilocybin and migraine. She included definitions of psychedelics and comparisons of the chemical structure of psilocybin, which looks ‘almost identical’ to sumatriptan and melatonin. Psilocybin shows promise for cluster headache and is rapidly metabolized and out of the bloodstream in 24 hours; “There’s nothing else in headache medicine that you can take by mouth that’s metabolized out of your body that has such a profound effect.” Dr. Schindler’s research on psilocybin and migraine included a small sample size of 10 people but the effects were profound. A single dose of psilocybin reduced the number of migraine days per week by half. More research is needed in this area though.
Dr. Stephanie Nahas’ presentation on oxytocin for migraine prevention was incredibly comprehensive. Oxytocin is naturally produced in the hypothalamus and can inhibit the activity of pain sensing fibers. It has many functions including relaxing muscles and decreasing sensitivity to outside stimuli as well as decreasing sensitivity to and awareness of pain. We learned that oxytocin plays an important role in social bonding, reducing fear, anxiety, depression and pain through mechanisms possibly linked to CGRP. Oxytocin shows promise as a preventative treatment for migraine.
Dr. Nada Hindiyeh’s comparative analysis of new migraine treatments over the last three years and Dr. Cynthia Armand’s review of atogepant was fantastic. Their reviews of the research on medications, and profile comparisons to other medications, are extremely helpful for patients that are determining which medication to try next. Visualizing comparisons of reported side effects is also helpful for patients who have side effects from a specific class of medication.
Key Takeaways: Migraine and Sleep
Jessica Mong, PhD reviewed estrogen, sleep and migraine. She noted there is a big jump in insomnia around perimenopause/menopause, and sleep disruption in women is highly associated with changes in ovarian profiles. “Particularly when estrogen levels are low, we tend to see the majority of disrupted sleep such as insomnia.” Dr. Mong also noted decreased levels of estrogen are highly associated with migraine attacks.
Interestingly, Dr. Kyle Bills shared that localized hypoglycemia is a known trigger of cortical spreading depression, and reviewed studies showing people with migraine don’t have the glucose spike expected after eating a meal.
The Migraine Symposium offered patients a way to better understand the multitude of migraine experiences, and communicate them with doctors, coworkers, friends and family. Even if you have stayed on top of all-things-migraine, it is likely you learned about new treatment ideas, advances and areas of research.