Migraines could be a headache of the past

Is there hope for the many millions of migraine sufferers in the United Kingdom and around the world? Researchers at King’s College Hospital certainly believe that this is the case. While they are cautious about the findings of their latest research, the results certainly are one that point towards optimism for migraine sufferers.

It is estimated that the number of migraine attacks everyday in the UK number over 190,000. This figure was estimated by the Migraine Trust, and it was probably obtained by taking a sample size of the population, taking into account the number of migraine attacks experienced within that group and then multiplying it by the general population in the United Kingdom. This of course means two things: firstly, the figure was proposed by a group that has an interest in promoting awareness about migraines and is hence slightly biased, probably over-estimated. Secondly, bearing in mind that the UK population is over 66 million, and it is unlikely that the Trust surveyed 1 million people – or even anywhere near that – any differences could have been amplified by over 66 times.

What is the difference between a migraine and a normal headache? A migraine is a headache which happens frequently. Migraines themselves are classed as two types. Headaches which happen more than 15 days a month are known as chronic migraine, while episodic migraine is a term used to describe headaches which happen less than fifteen times a month.

The research uncovered that a chemical in the brain was involved both in the feeling of pain and sensitivity to sound and light. This chemical is known as calcitonin gene-related peptide, or CGRP. If CGRP is neutralised, or if part of a brain cell which it interacts with is blocked, then pain receptors are dulled and migraines are reduced.

There are currently four drug companies in the race to develop a CGRP neutraliser.

Race is an accurate term, for the company that develops and trials the drug successfully may win the patent for developing and marketing the drug over twenty years. Drug companies or pharmaceuticals are normally granted that period to reward them for the time and cost invested into research.

One such company, Novartis, trialled an antibody, erenumab on episodic migraine sufferers. Those who took part in the trial suffered migraines on an average of eight days a month.

955 patients took part in the trial and half of those who received injections of erenumab successfully halved their number of migraine days per month. 27% of patients also reduced their number of migraine days without treatment. The results suggest that the drug was successful, particularly as it worked for over 450 people, and that if it were used for those with chronic migraine it might be equally successful. Even if the same percentage were maintained (50% vs 27%), the number of working days saved by migraine prevention could have significant savings for the economy.
Another pharmaceuticals company, Teva, produced another antibody, fremanezumab, and trialed it on 1130 patients. Unlike Novartis’s trials, the participants in Teva’s were those with chronic migraine, with over 15 or more attacks each month. In the Teva trial, 41% of patients reportedly halved the number of days that they suffered migraine attacks. 18% reported the same effect, so the confidence interval in the trial is pretty high and suggests a high degree of positive use.

The study is very important and useful because of the understanding it offers in treating migraine, and the medical products can reduce the frequency and severity of headaches. It makes for fewer days lost to the disease and more positive, functioning people.

Besides CGRP antibodies, there are other current treatments for migraine such as epilepsy and heart disease pills. Even botox is sometimes used. However, all three come with side-effects and are not necessarily the best for everyone.

The hope is that CGRP antibodies, which are traditionally more expensive to manufacture, will in the long term be available at a more affordable cost, and would benefit those who currently get no benefit from existing therapies.

If the estimation that one in seven people live with regular migraine is accurate, migraine reduction could have significant life-improvement effects for humans. Chronic migraine is in the top seven disabling conditions and improvements in understanding it and how to manage it would not only improve the quality of life for those who suffer with it, but also in reducing the number of work days lost for the economy. But the benefits do not just remain with migraine sufferers. Having to live with chronic disabling conditions often leads to other symptoms such as depression. Who knows? Perhaps CGRP antibodies may even negate the effect of depression, resulting in a secondary effect. It may be possible that those who suffer from migraine alongside depression may even not require treatment for the latter if the CGRP antibodies prove to be effective.
Can you imagine a world without anti-depressants? At the moment millions live on some pain-relief medication of some sort. It would be great if they could be phased out. Although it might not be so great for the economy!

Should we be excited about the results? Well, yes. The combined large sample size of both studies, of over 2000 migraine sufferers showed that there was some weight behind the study compared to if – for example – it had been done only on one hundred participants. Secondly, while the research was undertaken by pharmaceutical companies, the outcome was actionable, meaning that it produced a result that was useful, rather than one that merely formed the prelude to a more extensive study. In previous posts I demonstrated how some – such as the coffee umbrella review – did not produce any significantly useful outcome. But we know from this particular research that it may work to neutralise either CGRP, or lessen its interaction with the particular brain cells in order to lower the effect of migraine.

Did the media have a field day with this? Unsurprisingly, no. You see, good research does not lend itself to sensationalist headlines.

A smart person thought up the mental improvement products

The trail of human evolution is littered with gadgetry that have outlived their usefulness. We can add devices such as the fax machine, walkman, mini-disc and tape recorder to the list of machines which seemed clever at the time but have now before obsolete. Those of us of a certain age will remember newer additions such as the PocketPC, a palm sized screen which was used with a stylus that tapped out letters on screen, and the HP Jornada, a slightly bigger tablet sized keyboard and phone. And who could forget the Nintendo Brain Training programmes for the DS and Fitness Programmes for the Wii?

Launched in 2005, Nintendo’s Brain Training programmes claimed to increase mental functioning. Nintendo’s premise was that the concentration required in solving a variety of puzzles, involving language, mathematical and reasoning, increased blood flow to the frontal cortex of the brain, which at least maintained brain functioning or helped improve it. After all, since the brain is a muscle, exercising it by bombarding it with mental exercises would keep it active and healthy, right?

It is the idea of keeping the brain active that leads many to attempt their daily crossword or Sudoku. The latter in particular has seen an surge in interest over the past decade and is now a feature in newspaper back pages and magazines. There are even publications exclusively filled with Sudoku puzzles, and even more complex versions where each traditional puzzle forms a square in a bigger and complex three by three grid. If you thought doing a Sudoku puzzle was hard, imagine having to work on it in relation to eight others. It would be absolutely mind-boggling!

Is there any truth about the positive enhancements to the human life that these objects or activities bring? Nintendo’s claims about the Brain Training programmes were doubted by leading neuroscientists, who doubted the tenuous links between the increased blood flow to the brain and the vaguely described positive effects to life. It is akin to making a blanket statement saying chess grand masters or academics are the happiest people around. Unfortunately it is yet another case of a company creating a product and then engineering the science around it.

Manufacturers of beauty products do it all the time. Whether it is skin care or facial products being flogged, you will find an aspirational theme within the first five seconds of the advertisement (“Look beautiful! Stay young!”) which is then followed by a pseudo-scientific claim, preferably involving percentages (sounds more authoritative) and a small sample size (easier to corroborate, or disclaim, depending on the need).

“Live young forever. XX skin lotion is carefully formulated to retain your natural moisture, so you look and feel twenty years younger. 86% of 173 women noticed a change in skin density after using it for three months.”

There you have it. The secret of beauty product advertising.

Unfortunately, if there was any display of mental acuity, it was by the marketing team of Nintendo. In pitching a product to adults, using the retention and improvement of mental agility as a plus point, they not only convinced adults to buy what was essentially a toy, but to buy one for their children as well. The DS alone has since sold over 90 million units worldwide, and when you take into account the cost of games and all that, you will have to concede that someone at Nintendo had the smarts to produce a tidy little earner.

(For those who were more concerned with retaining their physical functioning, the Nintendo Wii Fit programmes performed that function and filled in the gap in that market.)

The improvement of mental functioning is always a good basis for marketing any product. You can find a whole plethora of products huddling behind it. Multi vitamins, activity puzzles, recreational activities involving multi-tasking – all supposedly give the brain a workout, but more importantly, tap into the fears of missing out or the loss of mental function in the human psyche, that makes people buy not out of potential gain, but fear of lost opportunity and potential regret.

The loss of mental function can lead to Alzheimer’s disease, for which there is currently no cure. With 30 million people worldwide suffering from it, this presents an endless river of opportunity for people researching the disease, as well as people developing products to improve mental function in the hope that it can stave off the disease. Like the Nintendo Brain Training developers realised, it is not so much about whether these scientific products work that makes people buy them – the evidence that is produced is biased and not independent – but it is the fear of missing out and retrospective guilt that compels people to make the purchase. Buy first, examine the evidence later, is the apparent dogma.

Unfortunately we are at the stage of modern society where it is not just the product that needs scrutiny, but whether the scrutiny itself needs scrutiny for evidence of bias, either in the form of financial ties or expected research outcomes.

Mental improvement is an area that product developers – whether the products be vitamins, books or applications – will continually target because human beings will always seek to improve mental prowess, both in themselves and their children, in the hope that somewhere down the line it offers an advantage, or prevents the mental degeneration associated with the aging process. And the compelling reason to buy lies somewhere in the meeting points of being seduced by the aspirational ideals the product offers, the fear of missing out, and the assumption that the underlying evidence is empirical. The greatest mental sharpness has been displayed by the one who has understood the sales psychology of mental health improvement products and used it to his or her advantage.

Set aside time and space for your own mental health

Work places huge demands on modern living. It goes without saying that over generations work demands have increased. For example, generations ago the concept of a traditional job for most people was a five-day working working week. The song “9 to 5” by Dolly Parton more or less captured the essence of work at the time. (Unfortunately, it is still fairly often played, to the point that people in non-Western societies assume we still only work eight hour days, five times a week, and spend our free time sunning ourselves on the beach.) Nowadays people have to work longer hours, and travel further for work. The total time spent each day traveling and working each day could easily amount to twelve hours, and it is not like the commute is down time – we still have to catch up on emails, admin, and type away busily on the laptop. We could easily spend sixty hours doing work-related things.

And the weekends? Forget the weekends. These days there is no distinction between a weekday and a weekend. Work has steadily grown its talons and where an hourly-rated individual used to get 1.5 or two times the normal rate for working on a weekend, these days it is the same. Employers realise that in an economy with job shortages, they can get away with offering less rates but will not be short of takers.

The problem with all this is that we don’t really have much of a choice when it comes to establishing our work boundaries or exercise or rights when we realise we are being pushed beyond our work boundaries. We’re made to feel that in these times, we are lucky to hold down a job, and if we complain about the increasing demands of it, and how higher managers try to force more work on us without increasing our pay, we might get told to take a hike and end up in a more difficult situation of having no job, commitments to uphold and having to start out again. There are lots of people trapped in jobs where they have to take on more and more as the years go by, and have every ounce of work and free hour extracted from them for little pay. This places increasing mental demands on the individual not just in having to cope with work demands, but the possibility of being made redundant if he or she shows weakness by having to admit an inability to cope any more. It is a no win situation.

Is it a surprising statistic that mental health illness is on the rise? Hardly.

Nowadays people are working more to live and living to work more.

What can you do to preserve some semblance of mental health?

The first thing you can do for yourself is to establish boundaries within the home. Establish a space where work does not intrude. A good idea is often the bedroom, or even have a rule that you will not work on the bed. If you end up working on your laptop in the bed, it will not do you any good – keep at least a certain physical space for yourself.

Also try to set aside a time each day for yourself if possible. It is possibly unrealistic to say an hour each day in the modern life climate, but something like twenty minutes to half an hour would be a good idea. Use this time to wind down in your personal space doing something you enjoy, that is different from work. You may think you cannot really afford that time, but it is important to disassociate yourself from work for the sake of your long-term longevity. Think of it as enforced rest. If it works better for you, take your enforced in the middle part of the working day. You don’t necessarily have to be doing something, use it to rest or catch a power nap.

Every now again, such as on a weekend, do something different from work. Do a yoga class, learn an instrument like the piano, or play a game of tennis. The possibilities for leisure are endless. But don’t bring your work approach to your leisure. Don’t start charting your tennis serve percentage, or do anything that makes your leisure activity appear like work in a different form. The only thing you must do with a businesslike approach is to meet this leisure appointment so that your life does not revolve around a continuous stretch of work.

We can moan about it but the nature of work will never revert back to how it was in the past. Those of us who long for the good old days will only make our own lives miserable with wishful thinking. Those of us who insist on working five-day weeks will find it is insufficient to maintain modern living in the twenty-first century. We will all end up working longer and harder in the current economic climate, and even if times improve, employers will be unlikely to go back to pre-existing forms of remuneration if workers have already been accustomed and conditioned to work at a certain level, because it is more cost effective to hire fewer employees who do more work than have the same work done by more employees. Employees have to recognise that adapting to increasing work loads are a working life skill, and that taking steps to negate increasing pressures will also be an essential part to maintaining our own mental health and well-being.

To raise life expectancy, ignore the television and newspapers

With increasing good health, the average human being in the developed world can expect to live a longer life, well into the eighties. This is in contrast to a century ago, where reaching the age of sixty was regarded to be a milestone. And what about the 1800s? Being 50 was an achievement, so much so that people married young and being in their twenties was considered middle aged! Life has certainly changed a lot to enable the average life expectancy to increase.

How has the average life expectancy almost doubled over the last two centuries? This can be said to be due to a few significant reasons.

The first is of course improvements in the medical world. The world of medicine has advanced significantly into the modern area, that it is undeniable that this has been the greatest single factor in the lengthening of human life expectancy. Take a look at the average supermarket medical shelf. On it you will see a mind-boggling range of medical products for a variety of symptoms, a range so wide that you may even start to examine how product A differs from product B. Two products to treat one symptom! Bear in mind that a hundred years ago, this might not have even existed! Feeling under the weather? Got a fever? Take a paracetamol or ibuprofen and sleep it off. Centuries ago the only method might have been to get plenty of rest, dabbing your forehead with a wet flannel. Or to visit the apothecary to get a mixture of powders to mix and grind according to some secret formula. And if you are adverse to medication, that makes you hesitant about taking counter medication, there are herbal remedies to explore.

Certainly the range of available medication has contributed in some way to humans living longer lives. But the range of products that you can see are not just the ones available to humans of course; these are the only ones that be purchased without prescription. For medication to treat more serious ailments such as blood pressure for example, these can be obtained via a doctor’s prescription and a subsequent visit to the pharmacist.

The medical process differs getting country to country. In the United Kingdom, you make an appointment to visit a general practitioner but depending on your practice, this could be a week later. Why make an  appointment if you need help later? It is almost as is you are having to anticipate your illness. More likely though, is the explanation that for minor ailments, you are almost expected to self medicate.

In other countries like Singapore for instance, the availability of appointments in what is termed polyclinics means if people are unwell, they merely turn up on the day to be seen. They can also turn up at any polyclinic rather than the one they normally go to, if they happen to be in another area, because medical records are readily shared – as they have been for over three decades. Ill patients are not expected to self medicate; they also go to a doctor despite illness because as doctor’s note is the only accepted evidence for absence from work.

Pharmacists do not exist in Singapore in the same context as in the United Kingdom. In the UK, patients visit the pharmacist after the doctor, and have to make trips to two separate places. In Singapore, the pharmacist is housed in the polyclinic; a separate unit called the Dispensary handles the prescription so after you see the doctor it is ready for collection within the same building.

Better medication is a reason for longer life expectancy. But improvements in medical surgery and practice have played a role in this too. We know about how to treat patients better because medical practices are shared and what used to be exclusive medical information is now widely available to all. In the previous century, for example, the practice of blood letting, removing blood from a patient, was acceptable despite its unproven results. Patients did not necessary survive when this practice was resorted to. When patients survived, surgeons would proclaim “It worked!” But when blood letting failed, surgeons would say that the patient was so weak to begin with that the process could not even save him. Advances in medical surgery have shown that blood letting, presumed to be a cure, actually weakened a patient at his most vulnerable state. But it is only improvements in medical surgery that have meant that this dangerous practice is no longer used or necessary in many cases.

Advancements in the medical world have been backed by improvements in the world of technology. In the past, when information was written down and filed in large binders and filing cabinets, the sharing was done either by executives travelling from hospital to hospital, in a top-level only way of information dissemination. But now information can be stored electronically, and shared seamlessly and knowledge is no longer the preserve of the privileged few. The advances in medical technology have been accelerated by the ability to share this information, resulting in a knowledge boost within the medical community which benefits those within its umbrella.

The availability of knowledge to the average citizen has also played a part in extending human life expectancy. Knowledge about how our bodies work, and the help and care available have helped individuals take better care of themselves. Continual research about diet, exercise and lifestyle influence how individuals live their life, hopefully positively.

The government hope is that the filtering of health information down to the citizens will incentivise them to manage their own health better. This is one of the aims as it moves towards a sustainable healthcare model. How can a sustainable healthcare help? It would focus diminishing resources on those who need it most, so those who cannot afford healthcare or those whose treatments are more costly, and who would normally not be able to qualify for treatments based on quality adjusted life years, would be in a better position. Theoretically, this would slowly raise life expectancy even further by targeting the more life threatening illnesses.

In a previous post I have mentioned that sustainable health is not as clear cut as it seems, but nothing ever is. But if managed right, it could be another contributing factor towards the extension of average life expectancy.

The average citizen has access to more medical information than ever before. There is so much health advice alone on the internet that if it were all only published in books, you could line them to end to end to circle the planet many times over. There are also helplines available to call for advice. Some of these are government sponsored while others are manned by volunteers. There is of course, everyone’s general practitioner to go with. There are many avenues for health information. For those who are interested to medical issues, periodicals such as the British Medical Journal after available.

Then there is also the media.

I have discussed previously that the news on television and newspapers regularly report on health issues, but as I highlighted also in another earlier post, you should take in these pieces of information cautiously, because the research that is done is often linked to a report with a dramatic headline. The lower the quality of journalism, the more outlandish the headline, and the fancier the font too, it would appear. You should not see the health section of the newspaper as the font of your health information, because what might be a fairly tenuous link, or bordering on common knowledge becomes sensationalised into the something new.

Take for instance, cats. They wander about in all hours and sometimes don’t come back, or get lost. Some have collars, some don’t. What would you feel if your cat went missing? Stressed. Sooner or later some newspaper would report Cat Collars Can Minimise Stress Levels, because if  your cat had one, and went missing, you might feel slightly better knowing someone might find it and call you, than if it had no collar and had no means of being returned to you. When this headline would be resorted to, no one can say; but it would be on a day there is nothing to report and not much going on in the world.

You see, the news and newspapers don’t exist to give you information, they exist to pad out the ads and advertising space. In a fifteen minute time slot in television, twelve and a half is filled with listed programmes, while the remaining two and a half are made from advertising that is linked to the programme. We often think of ads as the things that break up the television programme, but a better perspective is to think of the programmes as binding agents for the advertisements – unfortunately, that is how poor television has become. You can similarly think of the news in the newspaper as bits which hold the advertisements together.

The advertising is where media makes its money. But if the newspapers were little more than an Argos catalogue, they wouldn’t survive. If the ads on television were strung together, no one would watch it.

You can look at it using this similar analogy. A library loans books out. But loaning books out does not allow it to make money. A library makes money by selling advertising space on its noticeboards, renting out DVDs for cash, charging for the hire of rooms and delay in book returns. It tries to attract a user base so that it can sell these numbers to event organisers hoping to hold events on its premises.

News on the television and print media work the same way. So you could probably save a few years of your life by ignoring the headlines you encounter, such as those that say “Pet owners live XX% longer live than non pet owners”. The supposed research is the common knowledge that pets  provide companionship and relieve stress, which lead to owners having less pressures and living longer. The percentage is to lull you into thinking research was done when it was not. It may have been the group of pet owners sampled were already older than the average life expectancy and that the animals had no bearing.

What if the pets were unwanted ones, inherited, or ones that had grown to big or become to cumbersome to look after?

“XX% of pets cause stress to their owners.”

The media periodically comes up with headlines such as “Having a pet may help you live longer” – with a catch. The pet must be a dog, and you must be the one that takes it for walks. It is a way of generating column inches on the basic premise that having to walk to walk a dog means you are having to be more active and likely to live longer. There was no mention of whether active individuals who already went out for a walk got a dog for company, or if a dog encouraged individuals to go out walking.

Another headline that surfaced this year was that Grandparents who babysat tended to live longer. This was again based on the tenuous link that having grandchildren around made individuals more likely to go out more often; for those that sat in chairs watching TV most of the time, any evidence to the contrary was explained away by the “tended” in the headline.

So it would not be unfair to state that there is not anything significantly meaningful you can learn from the media to improve your health. If you wanted to live longer, there are more specialised avenues you can seek information from. The thing with health articles is that they are not time-specific, they can be written or filed away, then brought out on a day where news is fallow, in contrast to current events, where – if not reported today – the opportunity is lost. So if you wanted to learn more about living longer, forget the media; simply keep active, keep an open mind, maintain a healthy diet … and what will be, will be.