Daily talks with top migraine docs going on now through March 24. Each is available free for one day. I’ve found them to be quite informative. Upcoming interviews on women’s hormones, treatment burnout, diet, and sleep.
(Sorry if this was already mentioned this year, I didn’t see anything when I searched).
I have not listened to it but I imagine there’s some overlap.
The reason I liked his talk this year was that he focused on clear-cut reasons WHY each treatment may be helpful to an individual. I will certainly butcher the explanation of that so just a brief outline of the treatments he talked about:
-Topiramate and sodium channel blockers
-Calcium channel blockers
-Propranolol and beta blockers
-CGRPs (antibodies and gepants)
-Amitriptyline and Nortriptyline
-Clonazepam (the only benzo he noted as being “uniquely” beneficial to VM)
He has heard from a lot of patients that VRT just isn’t the ticket but he does not discount it. Just recommends finding a good therapist that will individualize your program. Maybe 10 minutes per day or less is the best “dosage”. Or broken up throughout the day.
Dr. Teixido also stressed that, in terms of vestibular migraine, the problem is in the brain – not the inner ear. It’s a problem with how the brain is interpreting information from the inner ear and integrating it with vision/proprioception etc. (Although he does acknowledge inner ear problems like BPPV can cause a domino trigger effect that may cascade into vestibular migraine symptoms).
He feels that because the problem is stemming from the brain, traditional inner ear suppressants like meclizine are often not helpful. This is where a drug like Clonazepam, which acts on the brain stem if I recall correctly, can give the brain a “rest” in the short term. Over the long term, preventative meds like topiramate, ami, and nort help with vertigo because they tamp down the whole migraine mechanism.
I too found the nutrition one - from Margaret Slavin - to be helpful. My overall outtake though is that there didn’t seem to be too much evidence to prove particular foods can help with migraines. Alcohol and caffeine were the only two that could be linked.
Also that the effects of foods can take hours or days to show meaning it’s incredibly difficult to correlate.
They didn’t seem convinced re identifying your food sensitivities, as the tests aren’t standardized and so you will get different results from different companies.
The most exciting learning was from a recent study that had proved that increasing your intake of Omega 3 could reduce incidence of migraines.Omega 3 can be found in fatty cold water fish like salmon, mackerel and sardines & walnuts, The study also found that if you simultaneously reduce your omega 6 then it can be even more beneficial - I believe this is harder to do since omega 6 is in lots of everyday foods.
Ketogenic diet - some promising studies but much more research needed to prove link with migraine.
Gluten- if you are celiac then higher chance of being a migraineur but still no evidence to prove gluten causes migraine in non- celiacs.
Dairy - again no real research linking to migraine, no evidence to show dairy can lead to inflammation
Vegan - no evidence that it can help
Intermittent fasting - evidence that skipping meals can lead to migraine however it’s also been seen that intermittent fasting can help with weight loss, oxidative stress and stabilises insulin levels so could work for some
Some studies have found migraineurs are at greater risk of dementia but more research needed.
For me I was surprised but pleased to hear him mention clonazepam as I have found that on the occasion I have needed to take it has helped not only my anxiety but also helped calm my brain a little. However to date I have mostly avoided due to the strong negativity towards benzos, including Dr Surenthiran who has never indicated it could help with the migraines themselves.
This is how it all started with me. He stressed the importance of treating the crystals, and any trigger EARLY before the dominoes all crash down.
Was impressed by his explanations of drugs that’s for sure. It really helps to understand why some drugs work for someways not others. And it gives hope to those struggling with trialling drugs.
Also really interesting how he described the vestibular nuclei as the main structure affected here. The explanation about motion sensitivity really struck a chord with me.
He uploaded his 2019 talk to you tube here which was very good. Audio only
Also, someone shared this with me - a clip with Dr Teixido and a patient explaining her success with the CGRP meds after many many drug drugs previously. I felt he didn’t touch on this a great deal in this 2022 talk.