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.

Health umbrella reviews mask the real issues

You have to wonder why the breakfast tea doesn’t get the same level of attention. Or perhaps whether in France, the humble croissant is elevated to the same status. Or maybe the banana could soon be the star of another media show. But unfortunately it is coffee that headlines tomorrow’s fish and chips papers.

“Drinking three or four cups of coffee a day could have benefits for your health”. As we have seen previously, this kind of headline bears the hallmarks of a media health report:

1) repackaging of common information requiring little or no specialist examination;

2) use of a modal auxiliary verb (could) to conveniently justify or disclaim an

attention-grabbing headline – which, by the way, is point number three.

The health reports in the media also incorporate:

4) a statistically small group of trial participants, whose results are then blown up in proportion as if to be representative of the 7 billion people on the planet.

5) Assumptions. A media report about health could simply include assumptions.

Why dwell on coffee? For starters, it is a commonly consumed drink and so any meaningful research would potentially have bearings on millions of people. It is common media practice to focus on common food and activities because of the relevance to daily life.

But if you examine this carefully, why not tea? Why not write about tea? While conspiracy theories may be slightly far fetched, it is possible that – unless it is a speciality tea – coffees cost more, and any potential health benefits would lead people to spend more, hence generating more for the economy in the forms of tax. Perhaps this is why media writers don’t waste too much ink on researching the potential life-saving benefits of bananas, even though they are widely consumed. The research isn’t going to drive people to buy bananas in bulk, and even so, the extra revenue generated from a low priced item isn’t going to raise much extra tax.

Are there any notable similarities or differences in style across different countries? One wonders whether Parisian newspapers, on a regular basis, churn out headlines such as:

“Eating two or more croissants a day could reduce your chances of heart disease.”

“Pan aux raisins linked with dementia”.

The research done was an umbrella review to potentially examine whether further research should be undertaken into researching the effects of coffee and its role in preventing liver cancer. An umbrella review meant that no actual research was undertaken, but that existing research was examined and analysed to glean insights.

The problem with umbrella reviews is that they are very generalised, no actual research is done, and they are only brief analyses of existing research. This means that first of all, an umbrella review could arrive at a particular conclusion, but in no way should that be taken as the final conclusion.

In fact, the findings of an umbrella review are only the preliminary to more detailed investigation. If an umbrella review suggested that drinking coffee could prevent cancer, then what it is saying is more research needs to be undertaken, and the media needs to be ethically responsible by not reporting “Coffee prevents Cancer”, because there are people that look at newspapers and television as the source of their information and assume just because it has been released in the public domain, it is truth. Who could conceive that newspapers spend time and resources to publish trivial information and that television is pure rubbish?

The second problem with umbrella reviews is that the outcomes are only as good as the original sources. If someone gave you a set of grainy photos, then asked you to make a collage with them, then your collage is going to be as good as the grainy photos will allow. If the original sources were not thorough or exact in their investigation, are any subsequent findings based on these merely just a waste of time?

The third issue with umbrella reviews is that under closer scrutiny, the overall picture is distorted by over focussing on small statistical variances, or sometimes minute errors are magnified and lead one down the wrong path.

If you took a picture on your phone and then blew it up to the size of a mural covering the side of your house, the picture becomes very dotty. You might see big patchy squares. But if you started looking for that big patchy square from the image in your phone… one has to wonder what the purpose of that is.

The fourth is that because umbrella reviews are a prelude to a more thorough investigation, their end results are slightly skewed from the outset. If an umbrella review is bound to provide a few avenues for later time-consuming research then it is fundamentally biased into having to provide one in the first place. Why, in that case, have such reviews in the first place? Some may point out that the flaw in the system is that umbrella reviews are relied on by those in academia and research to warrant the continued longevity of their positions. In other words, if researchers had nothing to research, they might be out of a job, so they best find something to stick their noses in.

Have you ever read the London newspaper Metro and come across some research news such as:

“Going to bed angry can wreck your sleep” (25 Sept 2017)

It is the sort of headline that makes you think “Why bother doing the research in the first place?”

It is likely that you have read a media report of an umbrella review.

What were the findings of the original coffee review?

Drinking coffee was consistently linked with a lower risk of death from all causes and from heart disease. The largest reduction in relative risk of premature death was seen in people consuming three cups a day, compared with non-coffee drinkers.

Now, when an umbrella review mentions drinking coffee is linked with a lower risk of death, it is important to be clear about what it specifically means. And what it is stating is that those who had a lower risk of death all happened to drink coffee. It might have nothing to do with the coffee itself. It might have been that they took a break to slow down a fast-paced lifestyle, and the taking of a break gave them a lower risk of death. By that logic of association, tea could also be linked with a lower risk of death.

Coffee was also associated with a lower risk of several cancers, including prostate, endometrial, skin and liver cancer, as well as type-2 diabetes, gallstones and gout, the researchers said. The greatest benefit was seen for liver conditions such as cirrhosis of the liver.

Again, to be clear, the above link means that those who were at lower risk of those cancers happened to drink coffee. But it is not necessarily stating the coffee had anything to do with it.

And coffee is such a commonly consumed drink, that it is easy to use it to draw links to anything.

If people who died from car accidents happened to drink coffee, an umbrella review might state that drinking coffee is linked with higher incidences of car accidents.

The findings can be summarised by a health analyst:

“Does coffee prevent chronic disease and reduce mortality? We simply do not know. Should doctors recommend drinking coffee to prevent disease? Should people start drinking coffee for health reasons? The answer to both questions is ‘no’.”

We should perhaps add a further third question: Did the umbrella review produce any actionable findings, and should it have been undertaken in the first place?

Probably not.

Is there any truth about the benefits of Classical music?

Is there any truth to the commonly accepted notion that listening to classical music improves mental capacity? Somehow it has been accepted in modern society that classical musicians have larger frontal cortices, better mental reasoning powers and perhaps intelligence quotients. Over the last two decades or so this idea has fuelled a rise in the number of pregnant mothers listening to classical music – whether or not they like it – and parents enrolling their children into music classes. The music of Mozart, in particular, has enjoyed a resurgence as its classical form is deemed to be more logical and organised, compared to music of other periods, assisting in triggering patterns of organisation in the brain amongst its listeners.

How did this idea about Classical music come about? In the 1990s scientists conducted a series of experiments where one group of students were played one of Mozart’s piano sonatas before a spatial reasoning test, while another group sat in silence. The group that was played the music beforehand performed better on that task than the control group. The effect on the control group was temporary and only lasted fifteen minutes, meaning that after the fifteen minute mark the disparities between the results were minimal and statistically the same. The results of the group found also that while music primed the individual particularly for mathematical tasks, after an hour of listening to Classical music, the effect on the brain was lost.

That piece of research was pounced on by the media and other individuals and seemingly perpetuated to promote the listening of Classical music. One governor of the state of Georgia even decreed that newborn babies be given a copy of a CD of Mozart’s works upon leaving the hospital. The Mozart Effect, to give it its common name, was written about in newspapers and magazines, and this began the spur of Mozart-related sales of music as well as the trend of mothers playing such music to their children in and out of the womb.

The most important question we need to ask is whether there is any truth in such research, and whether it can be corroborated.

We know that some forms of music has a soothing, calming effect on individuals. Playing the music to the students may have calmed that so they were not nervous, allowing them to perform better on the task. However, relaxation need not take them the form of Classical music. Any activity that promotes calm before a task – reading a light magazine, playing computer games, talking with a friend – can also hence be said to have the same effect as the classical music that was played.

What if the students in the group had read a joke book or comic beforehand, been less worried about the test and scored better? It might have prompted a deluge of articles claiming “Reading Archie (or The Beano – insert your own title here) improves your IQ”.

Or if the students had been offered a protein drink beforehand, it would not be inconceivable that someone would latch to that piece of research and declare that “Protein Drinks not just good for your body, but for your brain too”.

Mozart’s music has been said to embody the elements of classical music as we know it. Organised formal structures, chords and harmonies through related keys, use of contrasting tunes, contrasts in volume all feature in his music. But the music of other composers have such features too. Imagine if the composer Josef Haydn had been the lucky beneficiary of the experiment and his music had been played instead. The sales of his music catalogue would have hit the roof!

Subsequent scientists all found that listening to music of any form caused improvements, and the genre of music – whether rock or Classical – was irrelevant. But studies today still quote Mozart.

Is it ethical that the media promotes unsubstantiated research by reporting without closer scrutiny? As we have seen in previous blogs posts, the media reports on things without necessarily scrutinising the evidence, and entrusts so-called experts to corroborate the evidence, while it fills column inches and air time with modal auxiliary verbs? Huh? In simple terms, it means that if there is a sniff of a link between A and B, the media reports that “A could cause B”. Never mind whether it does or not, there is always the disclaimer of the word “could”.

In this instance, students performed better on a spatial reasoning task after listening to Mozart; hence the headline “Mozart could improve mental powers”. Diluted over several recounts, you could get “According to XXX newspaper, Mozart improves brain power” before arriving at “Mozart improves brain power”. Unfortunately, this is when the headline is then pounced on by anyone who would stand to profit from espousing this theme.

Who would profit from this? The Classical music world – performers, writers, musicians – can use this “research” to entice people into taking up lessons and buying CDs and magazines. If you read any music teacher’s website you may find them espousing the benefits of learning music; it is rare if you find one that advises it is a lot of effort.

The media will profit from such “research” because it means there is an untapped well of news to report and bleed dry in the quest for filling column inches and air time. News exclusives will be brought out, and so-called experts will also profit for appearing on the news and programmes, either monetarily or in the form of public exposure.

One must question the ethics of incorrect reporting. Unfortunately unsubstantiated research leads to more diluted misreporting, which can then form the basis of new research – research that uses these claims as the groundwork for investigation.

It is scary to think that all the medical research that has been done into effect of music and health could be biased because of the so-called effect of classical music. Could musical activities such as learning the piano help reduce Parkinson’s disease? Could listening to the music of Beethoven reduce the incidence of higher cases of Alzheimer’s disease? Could it all be wrong – have we all been sent down the wrong tunnel by an avalance of hype reporting?

It may be fair to say the human impulse is to buy first and consider later, because we are prone to regret. If we have missed an opportunity to improve the lives and abilities of our children, then we will be kicking ourselves silly forever with guilt.

So if you are still not convinced either way about whether classical music – either in the listening or the practice – really does have any effect, you could at least mitigate your guilt by exposing your child to piano music, for example that has predictable patterns in the left hand. Sometimes, listening to structurally-organised music such as from the Baroque may be useful, but it is also good to listen to Romantic music because the greater range of expression arguably develops a child that has more emotionally subtlety and intelligence.

You may find that ultimately, any truth in the research about Classical music and its mental benefits is not due to the blind passive listening, sitting there while the music goes on around your children. It is in the child’s inner drive to mentally organise the sounds that are heard, the trying and attempts to organise background sounds that really triggers the mental activity in the brain. It is more the practised ability in the inner mind to organise musical sounds that causes better performance in related mental tasks.

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.