Can an electronic diary driven by personalized analytics overcome the challenge of identifying and managing individual migraine triggers?
"TODAY I START A DIARY; IT IS AGAINST MY USUAL HABITS, BUT OUT OF A CLEARLY FELT NEED." - Robert Musil
Although determining migraine triggers is believed to be an important step in migraine management, establishing connections between individual triggers and subsequent attacks is difficult. If you have episodic or chronic migraine and have tried to figure out your triggers, you are probably aware that the process can be a frustrating and stressful event.
Perhaps, the challenge we face is best expressed by Dr. Richard Lipton, a professor of Neurology at Albert Einstein College of Medicine and Director, Montefiore Headache Center, in an article, "Migraine: More than Just a Headache", (Reynolds, 2016). Here is an excerpt:
"Trigger management is very important, but the challenge is that there are huge individual differences in which triggers matter, " says Dr. Lipton. He has seen patients come into his clinic with drastic weight loss because they've tried to avoid every food listed as a potential migraine trigger without knowing if any really affect them personally, "and there's nothing left to eat". True trigger identification, he says, requires that people keep a migraine diary and look at multiple attacks over time.
Dr. Lipton is excited about the new generation of online diary tools, such as Curelator Headache, which he recommends to his patients. These tools let migraineurs use a smartphone or tablet to track exposures and symptoms in real time and generate reports of potential triggers they can discuss with their doctor.
"It's one of those areas of medicine where rationalization and individualization is particularly important," says Dr. Lipton, "and the better we get at identifying individual triggers, the better we'll be able to give people individualized advice on trigger avoidance." (p.4/8).
It is important for us to know that in a recent study, "Towards improved migraine management: Determining potential trigger factors in individual patients", (Peris, et al, 2016), published in Cephalalgia and presented with aditional data at the 58th Annual Scientific Meeting of the American Headache Society, the Headache Group, Department of Neurology at Medical University of Vienna, Austria and Curelator Inc. collaborated in an analytical approach to identify potential trigger-factor associations (potential triggers or premonitory symptoms) with migraine attacks in individuals with migraine. The study authors report individual 'potential trigger' profiles were successfully generated for almost all 326 migraine patients (87%) who kept detailed diaries for 90 days. An average of four trigger factors per patient were associated with an increased risk of attack and in 85% of patients, trigger profiles were highly individual and unique. In an adapted press release, "Triggers for migraine attacks determined for individual patients", (MNT, June 8, 2016), Dr. Christian Wober, one of the study authors and head of the section specializing in headaches at MedUni Vienna's Department of Neurology, is quoted as saying, "For the very first time, this new analysis therefore provides information about the correlation between migraine attacks and a broad spectrum of possible trigger factors for each individual patient and is therefore a step towards personalized migraine management."
This brings us to a discussion about Curelator Headache and this new analytical approach to the identification and management of migraine triggers. Curelator Headache is a digital tool that guides individuals with migraine to track and discover factors associated with increasing and decreasing the risk of having a migraine attack and dismiss factors that have no effect on attacks. Along with Dr. Richard B. Lipton and Dr. Christian Wober, members of the clinical advisory board are other leading international headache and migraine experts, including Dr. Peter Goadsby, Dr. Anne MacGregor, Dr. Paul R. Martin, Dr. Noah L. Rosen, and Dr. Stephen D. Silberstein.
People can get Curelator at no cost through a coupon referral program that Curelator runs through any participating neurologist (alternatively, a premium version can be purchased on their website). Either way, when a person downloads an app from the Curelator website (premium version*), after approximately 90 days of accumulating daily data a subsequent statistical analysis provides the individual three visual maps:
- Trigger Map (factors showing increased risk of an attack, including high association and low association).
- Protector Map ( factors associated with a decreased risk of an attack). For example, if poor quality sleep is a trigger for you, good quality sleep may be protective for you; and, if stress is a trigger for you, relaxation may be protective for you.
- No association Map (factors that do not appear to be associated with an attack). For example, if foods with tryramine show no association with your attacks, there may be no need for you to avoid some of the foods you enjoy.
In addition, you receive a Personal Analytical Report, including the amount of acute medication you have taken (can help identify medication overuse), missed daily medication (preventives), and missed other medications. This report can be shared by you with your physician, or, with your permission, sent to your physician by Curelator Headache, with the goal of increasing your knowledge of your individual triggers and improving your clinical outcomes.
"PEOPLE DON'T CHANGE THEIR BEHAVIOR UNLESS IT MAKES A DIFFERENCE FOR THEM TO DO SO." - Sharon Stone
I was introduced to Curelator Headache in the fall of 2014 and began to use the tool January, 2015. Before starting to use the tool, I, like other users, was asked to list my suspected triggers. It is interesting to note, in a study conducted by Curelator Headache of hundreds of individuals analyzed who firmly believed they knew their triggers, the accuracy was surprisingly low. On average, accuracy was less than 20%. Factors accurately identified more frequently than others included stress and sleep quality. Dietary factors did poorly. Two individuals, myself and a person from Northern Europe, had above a 70% accuracy. Both of us had meticulously kept diaries for more than 5 years.
After receiving my first set of trigger maps, I had an interview with Alec Mian, PhD, CEO, Curelator Headache. We talked about the method I used to track and successfully manage my triggers, how I use Curelator Headache, and my early results. Since that time (almost a year ago), in addition to the information I shared during the interview, I continue to use Curelator Headache because:
- Comorbidities may increase the frequency of migraine attacks and/or headache days. For example, in my situation, I have had comorbid hypothyroidism for decades. About 6 months ago, I noticed an increase in headaches, along with a sluggish digestive system and a general feeling of malaise. My daily diary helped me distinguish between these headache days and migraine (headache phase). After a discussion with my doctor, the dose of my thyroid supplement was increased and the related headaches have diminished.
- Following a neck injury in my forties, cervicogenic headache has been, for me, increasingly troublesome. Again, through the data I input, my daily diary helps me distinguish between neck pain associated with cervicogenic headache and neck pain as a premonitory symptom related to migraine.
- As I proceed on this journey with trigger management, I find I am able to experiment a bit more with my known triggers. For example, small doses of sun and heat are now tolerable, in particular, if I am relaxed.
- Perhaps, most importantly, the few minutes I spend each day punching in my data have become a "mindfulness moment". A brief time for me to reflect on the challenges of my day, acknowledge emotions like sadness, anger and happiness and let go of what doesn't serve me well. If I feel particularly stressed, I realize I need a session of meditation at bedtime to promote relaxation and help induce sleep. As well, I think about exercise; and, what and how much, I had to eat and drink, not in a stressful way, but one that facilitates learning and reinforces healthy lifestyle habits.
*NOTE: You can choose your plan, free or premium, when you download the tool and customize your app at this time.
Mian, A. (2015). "Q&A with Sharron Muray and Alec Mian." Curelator Headache. December 3, 2015.
Mian, A. & Martin, P.R. (2016). "Confabulation, card tricks and confirming your migraine triggers (part 1)." Curelator Headache. April 7, 2016.
MNT. (2016). "Triggers for migraine determined for individual patients." Adapted Media Release . Tuesday 7 June, 2016.
Peris, F., Donoghue, S., et al. (2016). "Towards improved migraine management: Determining potential trigger factors in individual patients". Cephalalgia. May 14. pii: 0333102416649761
Reynolds, S. (2016). "Migraine: More than Just a Headache". A Woman's Health- Women Magazine. April 25, 2016. pp 3-8.
Sharron is a health and wellness author. A person with migraine herself, her most recent book, "Migraine: Identify Your Triggers, Break Your Dependence on Medication, Take Back Your Life-an Integrative Self-Care Plan for Wellness", (2013), is a Conari Press publication.
This article is not intended as a substitute for medical advice. If you have any specific concerns about your health or nutrition, please consult a qualified professional.
Copyright, August 4, 2016: Sharron E. Murray