healthcare,health and wellness
A softly spoken frustration relief video clip for you with individual interest. ASMR has actually assisted me directly conquer migraines as well as nausea or vomiting so this video clip is a tribute to those who have helped me:D.
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What is ASMR?
ASMR means Autonomous Sensory Meridian Response and also it is a term that categorises the pleasurable (non-sexual) feeling of ‘goosebumps’ or ‘cools’ that some could feel when they are being set off by an exterior stimulations such as tranquil, individual interest or particular sounds.
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Youtube daily Jul 20 2018
On Thursday, Donald Trump held a signing ceremony for a new job training program that the White House is touting, but during his little speech about this program, he had a moment of realization, and in that moment of realization, he let everyone in this country know that he is an absolute and complete moron. Today, 23 companies and associations are pledging to expand apprenticeships. That’s an interesting word for me to be saying, right, the apprentice. I never actually put that together until just now. That was a good experience, I will tell you that. Ain’t that strange, Ivanka, I never associate it, but here we are. Can’t get away from that word. It’s a great word. So Trump never knew, he never knew what the title of his own reality show actually meant. He didn’t know that he was actually looking for an actual apprentice to help him with his business, and to teach them and to give them skills. He didn’t know that. Now I can go ahead and predict how all of the Trumpbots out there are gonna respond to this. No, no, no. We have seen Donald Trump joke. We know what the average human being sounds like when they’re telling a joke or trying to make a play on words. That wasn’t this. The man was genuinely shocked when he read that word, “apprentice”, on the teleprompter, and something clicked in his brain, and that’s why he immediately started going off the cuff, ’cause you could tell the difference in the way he was speaking, when he said “apprentice”, then, “Oh, hey, by the way, I didn’t even know that. Man, I did a show about this Ivanka, how about that?” The man is an absolute moron. And it also reminds us that he is a reality show host who now happens to be the president of the United States. Now we can’t talk about this story, obviously without talking about the actual jobs, training program that Donald Trump is getting businesses to sign onto because that’s a good thing in theory. Unfortunately, these industries that Donald Trump is touting, “Oh, they’re gonna make these apprenticeships, we’re gonna try to retrain 3.8 million people here in the United States.” Yeah, that’s not the industries where we need people retrained. Where we need people retrained are the miners, the people working in the fossil fuel industry who should be retrained at the government’s expense to work in the renewable energy sector. In fact, Hillary Clinton had a phenomenal plan to do that, which was actually one of her only really great ideas when running for president. But that’s not what we’re doing. We’re sending more people into the defense industry, which could possibly mean that we’re gearing up for another war, it could mean that we just wanna waste all that military money we just had, but none of these are jobs that are actually vital here in the United States. There are people that need to be retrained, but they’re not people that are gonna go design bombs and tanks and planes and guns. We need real American workers who are in dying industries right now to be able to move into other industries. But that’s not what Trump wants to do, but what he did manage to do during that speech was to let us all know just how stupid he truly is. For more infomation >> Trump Basically Admits He’s A Complete Moron During Speech – Duration: 3:45.
I’m Michelle from “Oh My Disney.” And I’m here at Toy Story Land. [MUSIC PLAYING] How did this idea begin? As we imagined new opportunities for Disney’s Hollywood Studios, really wanted to bring a multi generational, family-friendly experience to this park. Who better than the “Toy Story” characters to usher in that kind of experience? It was a no brainer, really, to want to bring the world of “Toy Story” here. Now, how all of that came to be, of course, is its own design journey. But that’s where we started. When I walked in, I almost cried. I did cry. I’ve cried a lot today. It’s very beautiful. RYAN: Woo! Speaking of crying, everyone has emotional connections to these characters, these movies. It’s very dear to so many people. And you can feel that here in the land. How do you go about making that connection? With any new world that we bring to life in our Disney Parks and Resorts, we start with the heart of the story. For me, it was very easy, because I was Andy’s age when the original “Toy Story” film came out. And I’ll never forget that when I came back from seeing that movie, I looked at my toys so differently. – Yes, yes. And things that I loved, I never thought for a moment they might love me back as much as I love them. When everything that we do here in Andy’s backyard is charged with that intent and that feeling, that’s what makes this, not just a land of oversized objects, but a place where real heart lives. Yes. So that’s what we’re so grateful for in terms of working with Pixar and bringing these stories to life. But also, we’re so proud we’ve been able to capture in this really idealistic land. So many details to take in. I’ve just, like, been wandering. Just like, I feel like a little kid just looking around at everything. – Yeah, we love that. – Yeah. So when you’re conceptualizing this, when you’re making this, were there any moments where you had a surprise, where you were like, “Aha!” moment? The big surprise and delight was when we realized we had to make these– especially the toys we invented– feel like real toys. And that takes a little more than just building a box for it, right? Slinky Dog Dash is such a great example where we not only invent this mega coaster play kit in the form of this plastic toy track, we’ve invented instructions that tell you how to put this track together. We’ve actually built the tools that come with the play kit that you use to build the track with. That wrench in the Slinky Dog Dash queue fits on our coaster track out here. That is so cool! So what is it like to watch guests come in and experience this for the first time? There have been a lot of tears. Yeah. So we always say, you know, the heart and the soul of these lands that we make, they’re so much fun to design and build and envision. But it’s when the guests occupy these attractions and they come off of these experiences laughing and hugging each other and they’re so excited, when the heart is really felt. Thank you so much for talking with me. MICHELLE: A pleasure meeting you. RYAN: Yes. Enjoy Andy’s backyard. MICHELLE: Thank you. RYAN: Thank you. RYAN: Bye-bye. MICHELLE: Bye, everyone! [MUSIC PLAYING] Hello and welcome, I’m Disha and I’m here to help you transform your house into a home. With rapid urbanization, we have a lot of people living in very less space and this has led to a rapid decline in greenery and green spaces. We have very less green space not only outdoors but indoors as well. So if space is the constraint, should we stop growing plants. No, go vertical and hang plants on the wall and you can start growing plants indoors as well, you should grow more and more indoor plants in cute little tiny planters such as these. So I got these cute really cute little planters from Elite Earth. Elite Earth makes concrete planters which are not only trendy but sustainable as well. So when I got these from Elite Earth, I thought will be doing a giveaway on my Instagram as well as YouTube. So Instagram giveaway is already over and now it’s time for a giveaway here. First, let me tell you something about these gorgeous planters that first thing that these are quite trendy and contemporary and the second thing is these aren’t made of plastic. The third one, these are sustainable products. Fourth is that you can get them customized. Yes, this is the fun thing that you can get them customized. Whatever you have on your mind or you have dreamed of having such planter. Like if you ever wanted to have a planter in a shape of fish or duck or elephant or a clasping hand or any such planter then you can just tell me and Gurpreet who is the founder of Elite Earth will be gladly making that planter for you. So this giveaway is all about turning your dream into reality. So two of you will stand a chance to win this giveaway and for that what you have to do, I’ll share that later in this video. First, lemme quickly show you how I planted my succulents in these gorgeous planters and how I styled them. Now that you’ve already seen how I have styled these gorgeous little planters. Here are the details to enter the giveaway First, you’ve to like this video Second, go through the link that I have added in the description box and choose one planter from there and you can share the link in the comment box below or you can get customized your planter Yes, in your desired shape, your desired color. You just tell me everything in comment box below And Gurpreet will gladly turn that dream of yours into reality. So what you’re waiting for. Come on hurry up and leave me a comment and you stand a chance, two of you stand a chance to win concrete planters. So that’s all and I’ll see you really soon. Till then wish you all Love, Luck & Sunshine!! What happens when Prince Philip dies – and why he’s not getting a fancy funeral – Duration: 3:26. He’s been by the Queen’s side for the last 71 years and, whatever you think of the Royal family , there’s no denying Prince Philip makes it more interesting For the Queen, his presence has been one of steadfast support. For the public, he’s almost as famous for his often off-colour gaffes as he is for a life of duty Since retiring from public duties in August 2017 – and undergoing planned surgery – we’ve obviously seen a lot less of the Duke of Edinburgh, This, along with his age and health problems have, however, got people wondering what happens when Prince Philip passes away While Prince Philip very much remains alive and well, when that does happen, there are five things the British public can expect to take place 1. How the news will break Should the Duke of Edinburgh die overnight, the official announcement is likely to be made at 8am, and the BBC will be the first to have the news confirmed 2. No fancy funeral for him He may be entitled to a full-blown state funeral, but the Duke has expressed a preference for something a little more simple – and he’s been closely involved with the arrangements, which are being co-ordinated by the Lord Chamberlain’s Office at Buckingham Palace Rather than lying in state at Westminster Abbey, it’s thought the Duke’s body will lie at St James’s Palace instead, where Princess Diana lay for several days before her funeral in 1997 The public would not be allowed to view the body. As for the funeral itself, it’s believed the guest list will be comparatively paired back with only family, friends and heads of state from Commonwealth countries attending a service at St George’s Chapel in Windsor Castle, in the style of a military funeral 3. Where he’ll be buried While many of Britain’s monarchs and consorts are buried in Westminster Abbey and St George’s Chapel, Prince Philip’s burial will be at a different, more private location In keeping with his more low-key funeral the Duke of Edinburgh would be buried in Frogmore Gardens, in the grounds of Windsor Castle That said, he’ll be in good company – both Queen Victoria and Prince Albert are buried in a mausoleum there 4. How long the mourning period lasts for If Prince Philip dies before the Queen, she is expected to enter a period of mourning which will last for eight days During this time, laws will not be given the Royal Assent and affairs of state will be put on pause in a sign of respect 5. When the Queen will return to public duties The period of Royal Mourning will then continue for a further 30 days, after which the Queen will make a full return to public life and duties “When life leaves us blind, love keeps us kind.” – Chester Bennington. How can a voice reach so many? How can a man touch thousands of hearts? To move so many people? Change their lives? How can he give sense to pain or to the internal demons? Maybe we will not know how… But Chester Bennington did it. Probably without wanting it or even knowing it. But we can’t talk about pain without talking about Linkin Park. Especially about Chester… …a man able to sing as an angel and also as a demon at the same time. His voice was powerful… …angry, but also so melodious and capable of transmitting different feelings. It was manage to make you vibrate with emotion or move you to the edge of tears… …it was joy and pain, anger and love. All at the same time. It seemed to have no rival. A whole generation was identified whit it. Chester took his own life on July 20, 2017… He was at his best. He was only 41 years old, he had an incredible family… …one of the most important bands and a whole road ahead. Everyone was disconcerted by the news, because his death didn’t make any sense… …it did not seem real. At some point, many of his fans felt us betrayed. He taught us to deal with pain, with difficult burdens… …he told us a thousand times that no matter how complicated the trip was… …you could always raise your head and stand firm. It did not matter the fatigue, it did not matter if you felt lonely… desperate, if you were on the verge of collapse… You just had to keep all that out and continue. After his death this message seemed false… But it wasn’t. Chester fought throughout his life against it. He resisted for many years, always showing himself full of life… …proving to be a great human being, spreading his enthusiasm, laughter, love and energy… …to his friends, family and, of course, his fans. In the end those problems he faced as a child… …his addictions and all the demons that afflicted him ended up taking him away. We can’t reproach it, finally those demons were the ones who took him to Linkin Park. Those demons are the ones we see embodied in their songs… and they are the ones whit we feel reflected in at some point. Those songs have managed to inspire so many… Maybe more than Chester imagined. Personally, Chester was one of the best singers I’ve ever seen live… …one of the greatest talents I’ve ever met. As a person I also admired him Every fan knows what I mean by that, because Chester proved more than once to be an excellent human being. In Mexico we had a clear example of it with his last visit to our country. Linkin Park will never be complete without Chester and many of his fans will never feel the same again… …as his absence left a huge void. His songs will never feel the same way, many of them now look like a farewell letter… …an announcement of what was to come. Words can’t describe the constant pain we feel. A year ago our hearts broke and they will stay that way. Nothing can fill his absence. We can only learn to deal with the pain, we hope that he finally had found peace… …and we’ll be thankful for everything he taught us. As the band said: “A boisterous, funny, ambitious, creative, kind, generous voice in the room is missing”. “While we don’t know what path our future may take, we know that each of our lives was made better by you. Thank you for that gift. We love you, and miss you so much. Until we see you again…” -LP from a mild headache to a head pounding migraine attack headaches can be debilitating if you have ever had one or have seen someone from your family friend suffer you’d agree but some home remedies right out of your kitchen can do wonders in today’s video remedies 1 we’ll discuss the effect of banana peel on your forehead before you watch this video please take a moment to subscribe our YouTube channel by clicking the subscribe button then tap the bell icon so you will be the first to know when we post new videos daily sure I’m not a fan of too many fruits but give me a banana and you will never hear me say no it’s usually what I eat in the morning to get my share of carbs and just before I sleep after my early dinner it keeps you full and also keeps the midnight hunger pangs a day so now when I tell you that the banana peel can magically shoo away your headache will you trust me it might sound absurd but let me tell you this remedy is tried and tested how to use this the idea is to use the banana peel with an ice pack here’s what you need to do 1 before you use the peel you could probably eat it because it is filling and works even faster if the headache is triggered due to hunger place ice cubes on the banana peel and tape it so that it stays intact on your forehead 2 another way of doing this is to put ice cubes on a cloth tie it and then place it on the peel on your forehead there’s not just one way to do it but you get the drill don’t you also have a cloth or a towel handy because the ice will start to melt in no time 3 leave it on for a good 20 to 25 minutes and lie down preferably in a room that is silent and dark this remedy works like magic every single time it’s soothing relaxing and most importantly gives great relief here are some more home remedies these that can be tried one lavender oil lavender oil is the first thing that comes to your mind for room fresheners or anything pleasant smelling but did you know that it can cure headaches you can use this in more than one way one put a few drops of lavender oil on a tissue or a towel and inhale it you will start feeling better in no time it helps with nausea too – or just add a few drops of the oil to hot water and inhale the steam 3 another interesting option is to add a few drops of this – lemon or coconut oil and massage your forehead with the blend take a nap once you do this and you will feel so much better – coffee there’s nothing a caffeine shot cannot relieve it can make everything better and it works wonders especially for headaches the first thing I get my hands on when I get a headache at work is a cup of coffee caffeine is known to be an anti-inflammatory supplement and hence it helps a great deal but remember not to get into the addictive zone because it can be just as bad everything should be done in moderation 3 peppermint oil peppermint is an essential part of all our headache balms and it’s no news to most of us menthol which is found in peppermint is strong yet soothing and is known to relax your muscles and release tension thereby helping reduce the headache 1 take a few drops of peppermint oil and massage it on your forehead and around the temples you could also mix this with other oils like coconut almond olive oil or just with water for the massage – another option is to add it to hot water and do the steam treatment 3 as a last resort you could use any bomb that has peppermint menthol and massage it on the forehead but remember to follow up all of this with sleep have you ever suffered with migraine attack let me know in our comment section below if you like this video give it a thumbs up and share with your friends for more daily tips subscribe to our channel below thank you My name is Martin Bertilsson. I was born in Sweden. It’s kind of natural for me to be a fan. It’s quite amazing; the band was offered one billion dollars to reunite. They were supposed to do 100 concerts, but the problem they had was that they weren’t — according to the rumors — the four band members had kind of been together a long time and they were not getting along, and that was probably one of the reasons why they didn’t want to reunite. And one billion dollars is a lot of money; obviously, they had already made their money and thought that “we have enough.” But I think over the years, they’d probably mended some of their conflicts within the group. And I’m sure Björn and Benny had written some songs that they really liked! They’ve written a lot of songs for other people, and I believe that they wrote some songs where they thought, “These are for us!” And somehow, they mended the group together and recorded these songs. And I think the whole world is very excited about them. And as I know Björn and Benny, of everything they do, it’s quality. They will never release something that’s half good. I think it’s great! I think the songs will be awesome, and I think they will be hits. So I think what, if you are an ABBA fan and you go to Stockholm, Sweden, what you have to stop by is the ABBA Museum. ABBA museum was kind of late into the game, and I don’t know if they waited until they felt they had all the material, but they have a fantastic museum in Stockholm. And you have the whole studio there, you have all the songs; they have karaoke, and it’s a very popular place. So if you have the opportunity and have the time, if you’re going to Stockholm, please stop by the ABBA Museum. Björn and Benny, they do everything so perfectly; they spent a lot of time on each thing, and that museum is great. So you really should go. [Speaking in Swedish:] Thank you for listening to what I’ve said about ABBA and their trip throughout time and their successes. Thank you very much. Nice Slightly Rustic Log Cabin Like a Small Hotel Suite for 4 People – Duration: 3:44. Nice Slightly Rustic Log Cabin Like a Small Hotel Suite for 4 People For more infomation >> Create a Lake House Environment with Two & a Half Sisters – Duration: 3:27.
Massage for Headaches
Raleigh Medial Massage
From time to time, we all experience headaches. Some people experience them more than others. They can range from a nagging feeling of discomfort to a more serious pain that can make us lose focus at work and at home, become more irritable, and just simply put us in a bad mood. And for those afflicted with migraine headaches, the pain can be completely debilitating. For many of us, the solution to a headache has been to reach for ibuprofen or other painkillers. This can sometimes relieve the pain, but the underlying problem still exists. Luckily, the number of headaches you experience can be greatly reduced with a few easy stretches, some healthy habits, and a little pampering.
One of the best ways to get to the root of your headaches is to reduce the tension that’s causing them. A build up of tension in the muscles of the neck, shoulders and head often triggers tension headaches. Massage therapy can bring relief by decreasing pain, reducing this tension and increasing circulation.
Massage loosens the trigger points and blockages that are brought on by the muscle tension, cause headaches to occur and to come back again and again. Metabolic waste builds up in our muscle fibers from overuse and strain, which hardens and stiffens them and decreases the healthy flow of fluid from tight and inflamed muscles. A trained massage therapist will access the muscles that may be causing headaches and treat them by breaking down, loosening, and removing this buildup.
That’s the science behind the benefits of massage. But what you care about most is that massage can decrease the pain you feel from headaches, reduce depression and anxiety, decrease the overall tension you feel, and reduce the frequency, intensity, and duration of headaches. But massage alone isn’t the only cure.
Between massage visits it is important to relax. With busy schedules and hectic lives this is easier said than done. But even simply reducing the amount of time you spend in front of a computer or looking at screens can increase relaxation and decrease your stress and tension levels.
Another tip is to heat or cool your head and neck. The choice of heating or cooling is up to you and what your body needs. Improving the ergonomic conditions of your workspace can also be helpful. Wearing a headset if you spend a great deal of time on the phone reduces shoulder strain. Simply repositioning your computer monitor can make you feel better. Many people sit too close to the monitor, or too low in their chairs which causes us to lean our heads forward adding unwanted tension on muscles and joints.
It’s also imperative that we stay hydrated. Many people do not drink enough water on a daily basis, and drinks with caffeine and sugar that give us energy are often dehydrating us and causing our headaches. A good rule of thumb for how much water we need is to divide our body weight in half and drink that number in ounces of water each day. For example, a person who weighs 150 pounds should be drinking at least 75 fluid ounces of water on a daily basis. This can be adjusted depending on exercise and exposure to heat.
And finally, remember to stay mobile. Taking a break from work each hour to stretch reduces tension and increases circulation. You want long, slow stretches, holding for 8-10 seconds. Use this time to get up, fill your water bottle, or walk around and shake it out.
Following some of these easy tips can reduce the frequency of your headaches. If you want to really get relief from the pain and annoyance that headaches cause, or to identify the root of the problem, spending some time with a skilled massage therapist could be the answer. Absolute Body Balance has qualified, trained massage therapists and offers a new client discount for your first massage; $55 one-hour massage. Call 919-841-9344 or visit http://www.absolutebodybalance.com to schedule.
Dr. Blake, your Baltimore area chiropractic doctor, situated in Towson, MD reveals the results of simply 1 treatment for extreme migraine headaches, as well as demonstrates the exact treatments their workplace utilizes to relieve serious migraine headaches. If you are seeking the migraine relief you are entitled to, call our workplace today 410-296-7700.
Dr. Blake Kalkstein, DC, MS, CCSP Board Certified Sports Chiropractic Physician with Adolph & Kalkstein Chiropractic, Team Chiropractors for Baltimore’s expert baseball group.
Dr. Jeff Kalkstein, DC, ART, Team Chiropractor for Baltimore’s expert baseball group and also Chiropractic Physician with Adolph & Kalkstein Chiropractic
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【淘女网】SGLOCALMASSAGE.INFO【快乐】CHIO BU /TEASING MASSAGE/BBBJ/CIM/2X HJ
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BBBJ +CIM + MASSAGE!
*Mint had many years of massage, 100% no bullshit*
*100% REAL PHOTO! 照片保证是她本人!*
Name: Happy ( 快乐 ）
Ht/Wt : 16O/47
Area: North ( Yishun )
SERVICE SHE PERFORM/ALLOW
[If There Is Time Restriction, You May Mix & Match The Following Services Within 60/90 Mins]
[Whole Body Essence Oil Massage] [全身按摩推油]
*She will be sexy lingerie & G-string *
Improved circulation, which nourishes cells and improves waste elimination
-Relief for tight muscles (knots) and other aches and pains
-Release of nerve compression (carpel tunnel, sciatica)
-Greater flexibility and range of motion
-Enhanced energy and vitality
-Help heal scar tissue as well as tendon, ligament, and muscle tears
[Authentic Chinese Mixed Thai Style Massage With Shiatsu] [专业经络推拿穴位按摩和指压]
*Good Strength With Accuracy In Hitting The Right Spot. No Short Cut & Is Hard Working, its better than TCM*
[ Autoroaming] [触摸全身]
*You Will Be Allow To Caress Her WHOLE Body During The Session*
[Head & Abdomen Treatment] [头和腹部按摩]
*She Can Do Great Head Massage To Reduce Migraine & Headaches. Your Shoulder & Neck Will Loosen Up Too!*
*Your manhood therapy. She will massage acupoints around your balls and penis with good hand movement. To Promote Better Sexual Life. *
*This is her killer move! Performing erotic hand movement on your dick and balls. A MUST try!*
[Teasing Massage] [调情按摩]
*Her magic finger will make you shiok shiok & song song*
[BooBs Massage] [性感胸推]
*She will use her boobs and nipples to massage you, shiok!*
*Sucking and swirling her vibrating tongue around the corona, strumming the frenulum and underside of the shaft.
Working her tongue on dicky head and at time some deep throat.*
KILLER MOVE! 杀手招
[CIM] [ 口暴]
* suck till last drop *
[69Hand job] [69打飞机]
*This Is Her ULTIMATE Showdown! Be Taken Aback By How GOOD She Is Able Pump Your Sexual Adrenaline To Da Max!
Her gentle touch and slow body touch will make you surrender in no time*
[Attitude & GFE] [服务态度/女朋友感觉]
*Guarantee good attitude and good massage, not a time watcher & powerful kc feel.
*Services She Doesn’t Perform/Allow
[Service Not Mentioned Above]
OTHERS SERVICE NOT STATED PLEASE NEG WITH HER DIRECT
$100/ FULL Massage Package + Boobs Massage + BBBJ + HDLY With 2x69HJ or 1 x CIM /60 Mins
Happy ☎ 9163 5595 ☎ 快乐
One Step Forward, Two Steps Back – My Health Care Story – The Jolly Runner
The Jolly Runner Health Care , Jolly Runner , Sinus Balloon Dilation , Sinusitis Leave a comment
For the past 1,825+ days, I have had sinus pressure that feels like little slightly obese mice tap dancing across my cheeks accompanied with a sinus headache, congestion, and a runny nose. It’s there every day when I wake up. It gets progressively worse through the day and is there when I go to bed. I have called my various doctors too many times to even count begging for relief, participated in countless web diagnostic sessions, and sat in doctor’s waiting rooms and exams rooms for over 24 hours, if not more, if I added all the 15-30 minute appointments up. I have had at least four CT Scans and gone to four specialists. I have tried nasal sprays, steroids, nasal rinses, anti-reflux medication, and anti-migraine medicine. I have tried a lot of antibiotics – SO MANY ANTIBIOTICS! So many antibiotics that I fear if I were to actually get a serious infection the bacteria would just laugh at me and infection would destroy my entire immune system. With everything I’ve tried nothing has given me any relief.
I haven’t missed any work because of my sinus infections, sinusitis, and sinus pain; I don’t complain about the pain even when it makes me want to curl up and cry (I don’t complain about the pain because it does absolutely no good and I’ve gotten to the point where the doctors have almost convinced me that I am crazy and the pain I am feeling is not real); and I’ve even run a half marathon with a raging sinus infection. Because if I let my sinus issues stop my life I would have even less of a life than I already have!
For the past three years, my health insurance has been through Kaiser Permanente. I have worked with my general doctor, two ENT specialists, and an allergist in attempt to find a solution to my sinus issues. After three years, Kaiser has been absolutely inept at diagnosing or providing any effective treatment options for my sinuses and so when we had open enrollment at work this year I decided to switch health insurance providers and changed to Anthem Blue Cross Blue Shield. I had no idea if it would be better, but I figured at least it would be different and honestly it probably couldn’t get any worse.
On July 2 nd, I thought my sinus story was about to change. My new insurance had kicked in and went to my first appointment at my new ENT doctor. During my appointment with my new doctor he took down my LONG history with sinus issues, did an exam and immediately offered a solution. Balloon Sinus Dilation . The doctor thoroughly explained the procedure, possible benefits and complications, and the benefits far outweighed the complications. I was stoked by the idea of reduced sinus pressure, headaches, congestion…all with a relatively easy procedure and quick recovery. To have the insurance pre-approve the procedure I needed to have another CT Scan and then the doctor would be able to submit my paperwork to the health insurance for pre-authorization. I left the doctor with tears of happiness in my eyes. I thought I was on my way to a solution and for the first time in over five years I was hopeful that there was an end in sight to this sinus pain…I probably should have known better to be so positive when health insurance is involved.
Balloon Sinus Dilation procedures are relatively new and so my new insurance, Anthem Blue Cross Blue Shield, apparently doesn’t usually approve the procedure on the first request. You have to wait to be denied and then the doctor sends in an appeal to see if the insurance will approve the appeal. So, the solution I was so excited about is apparently now a long shot and when I asked my new doctor what my options were if the insurance denies both the original request and the appeal, he said there’s nothing else I can do that I haven’t already tried. NOTHING ELSE ! This is the last resort. If the insurance says no I get to look forward to this sinus pressure and pain for the REST OF MY LIFE ! I don’t mean to be over dramatic but that could be a long fucking time.
So where does that leave me? My fate is in the hand of the person processing my pre-authorization request. I have read the clinical guidelines used to approve the requests for balloon sinus dilation and meet all the requirements but I still have to sit here and wait to see what the insurance company decides. Why do the insurance companies get to hold our fate in their hands?
There are so many battles we have to endure in our current health care system. We jump through hoops to get the right health care coverage and then we continue jumping through hoops, getting lost along the way, until we finally find the right doctor with the right answers and that just seems to be the beginning of the battle. We can have the best doctor, the best solution to the problem, and the insurance company can still say no. They simply say they are not paying for a particular treatment and the road dead ends.
Why don’t we have a say in our own medical futures? We pay for our health insurance but a stranger who has never met us gets to decide what is best for us. I know they have to base their decisions on facts, and facts alone, but I wish there was part of the process where we could include a personal statement about how whatever our medical issue is affecting our daily lives and how being approved for the procedure or treatment we are requesting could change our entire lives. I feel I could write a pretty compelling statement on how this sinus procedure could change my life. But, instead, I wait…and wait…and wait…and hopefully, after all the waiting I will be closer to a solution. And if not, there is no going back to the drawing board for me, there’s just accepting that this is what life will be, me and my little slightly obese tap dancing mice. Advertisements
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Is Aimovig A Breakthrough Drug For Migraines? Here’s the Lowdown.
The Migraine Miracle Facebook Group EPISODE TRANSCRIPT
Howdy fellow beast slayers. So, today’s episode is one that I know some of you have been waiting for. As some of you may know, the first drug, and a new class of migraine medications recently hit the market. This one goes by the name Aimovig. That’s the brand name for the drug Erunemab. And many of you have asked if I would share my thoughts about it.
There’s been a fair amount written about it in the news lately and some excitement and buzz around it. Folks are wondering, if any, role it should have in sort of their overall treatment plan. In this episode I’m gonna be reviewing what I consider to be the pros and cons of this new treatment, and I’ll conclude with how I see this new drug fitting into my own approach as a neurologist and the type of patient I would consider it for.
First, a small bit of housekeeping before we launch into the topic. We just started our latest jump start challenge, which means that our next 30 day challenge is going to be a keto blast, which is our 30 day keto challenge. So, if you want to learn more about that and register, you can go to ketoformigraine.com . And if you start up now, you’ll get the early bird discount.
As a reminder, members of Migraine Neverland have unlimited access to all of our challenges so they can participate in as many of the keto and jump start challenges as they like along with the other challenges that we have just for our Migraine Neverland members. And to learn more about Migraine Neverland, go to mymigrainemiracle.com/endofmigraine .
All right, so, on today’s episode, I’m going to be talking about a new drug that just came out for migraine, which is a part of new class of drugs that are being developed and that have been in development for over a decade now.
And all of these drugs target the calcitonin gene related peptide in some way, and that’s abbreviated CGRP. That’s how I’ll be referring to it in the rest of this episode. There are four drugs that I’m aware of that are being developed or have been developed that target CGRP in some way. One of which is Aimovig, which I believe is the correct pronunciation, although I’m sure there will be many different versions of that.
But Aimovig was just recently approved by the FDA and is now out and available in the market, so you can get it. When it received it’s approval, there was a lot written about it in the news. Most of which was very favorable. Some of which even presented it as a possible miracle drug. This is not that unusual when new drugs hit the market.
You are usually going to get more eyeballs on your news story if it’s sensationalized a little bit. But that being said, there are some reasons for celebration when it comes to this drug, and I’ll be talking about that in a minute.
Before we dig into the topic in depth though, I wanted to read a comment that someone made in our Facebook Migraine Miracle group, which I think really frames this discussion well. So, I’d announced that I was going to be covering this topic and discussing my thoughts about Aimovig, and this was a comment made from of our members, Amy.
She says, “Funny that this drug coming out is what finally spurred me to get on the no drug migraine miracle path. I went to my doctor for a prescription of Aimovig and got one. Send it in, it was incorrect. Called to correct it. Waited for it in the mail. By the time it came, I had finished your book and decided not to fill the prescription. I’m curious to hear your thoughts, but I have decided it is kin to firing my brain’s firefighters. I’m done with any drug manipulating my brain. I no longer want the miracle pill or injection, I’ve found the miracle cure.”
So that was a great post from Amy and I think is a good frame for starting this conversation about Aimovig. So, I’m gonna begin by just giving a little bit of background on the story of this class of drugs and CGRP in particular. CGRP, Calcitonin Gene Related Peptide is, as it says, a peptide, which means it’s shorter in length than a protein. It’s only 37 amino acids long and we know that there are receptors for it that are found throughout the body. Now, we’ve only known that it exists for a little more than 30 years.
And we still don’t know very much about what all it does. Like I said, we know that it’s wide spread, in particular we know that there are receptors for it throughout the body including in these central and peripheral system. But because it’s newly discovered and because it’s so wide spread, that means it probably does a lot and we still don’t know a lot about all those functions.
We do know that it is involved both in increasing the size of blood vessels or what’s known as vasodilation, and in pain signaling during a migraine. In particular, in pain signaling within the trigeminovascular system, which is what’s activated during a migraine and is a source of much of the pain, so this molecule CGRP is involved in that pain signaling.
We know that that peptide is elevated during a migraine, which was kind of the initial impotence for folks looking into this for a possible target for migraine relief or prevention. Since this was discovered that it was part of migraine pathophysiology, there’s been a lot of effort over a decade now towards trying to create a drug that targets the CGRP system in signaling in some way that either leads to fewer migraines or helps relieve migraines.
There’s been a race between several drug companies to be the first ones to bring a drug to market, which is often a big advantage. The first kind of drugs that were developed for this were what is known as CGRP antagonists. These are molecules that work by blocking the receptor for CGRP. The idea is there if during a migraine the CGRP is released to signal pain, if it can’t bind to its receptors, then it can’t ultimately result in the perception of pain.
So blocking a receptor essentially neutralizes it. There were trials done over a decade ago for using this as an abortive, these CGRP antagonists, and while the results were somewhat favorable, the drug resulted in liver toxicity and so, it’s never made it to market because it didn’t pass the safety trials.
So the next approach was to try something different. Either to try antibodies against these CGRP molecule itself, or antibodies against the CGRP receptor.
And Aimovig, which, as I said, is the first in this category of CGRP acting drugs to be approved and the one that recently made headlines because of this, it works in this capacity. It is an antibody against the CGRP receptors. So, instead of blocking receptor, Aimovig is an antibody against the receptor. So the antibody will attach to it, which then provokes the immune system to destroy the receptor, just as the immune system would destroy an invading bacteria that’s been tagged with an antibody.
So now, since the receptor or at least some of the receptors have been destroyed by the immune system, the CGRP doesn’t have anything to bind to, and so you can’t generate as great of a pain signal. The other CGRP drugs that are still in development are antibodies to the CGRP molecule itself. In that case, you’re provoking an immune system to attack the molecule, rather than the receptor for the molecule, but with the hope that the end result is the same.
Now, these type of antibody approaches aren’t well suited to working as an abortive. They’re not well suited to relieving an existing migraine, because it takes time to work. You have to have the antibody attached, the immune system has to remove the receptor, and so on. This new class of drugs has been investigated primarily as a preventative treatment.
And they are all either given subcutaneously, so under the skin by injection, or intravenously, and usually at some type of regular interval around monthly. So, given that this is a novel approach and a new targe for migraines, it’s generated a lot of excitement, and anticipation, and perhaps a bit of hype as well.
What are we as migrainers to make of all of this? Is this a miracle treatment? Should we jump on board? Should we be cautious? To help answer that, I’m gonna divide up the pros and cons as I see it. And I’ll begin with the pros, so the things that I see as favorable aspects of this new drug, this new class of drugs in general, and Aimovig in particular.
So, the first pro is that it does seem to help. Understanding whether or not, or knowing whether or not a drug helps is actually a harder question to answer than you might at first think. That’s largely because the placebo response is significant typically in migraine trials and many pain trials. And so, the typical way to try to eliminate the placebo response is to conduct a study where you have half of the subjects given the actual active drug and half the subjects given a placebo drug. One that’s delivered in the same way, but has no active ingredient in it.
Usually both the subjects in the trial and the people who are administering the trial do not know who’s getting the drug and who’s getting a placebo. And then you look and see if the people getting the active drug do better than people getting the placebo.
The main study for Aimovig was published in November of 2017 in the New England Journal of Medicine. One of the primary metrics that are usually used to evaluate a new migraine drug, a new preventative, is in seeing how many subjects achieve a greater than 50 percent reduction in migraine frequency. If their number of migraines per unit time, usually per month, goes down by more than half.
So, in this study, there are actually one set of subjects who were given a 70 milligram dose of Aimovig and one group who were given 140 milligram dose, and 43 percent of the people who were given the 70 milligram dose had a greater than 50 percent reduction in their migraine frequency, and 50 percent who were given double that, the 140 milligram dose, achieved greater than a 50 percent reduction in migraine frequency.
That sounds pretty good. However, the placebo group response was 26 percent. So 26 percent of the folks in the placebo group achieved greater than 50 percent reduction in their migraine frequency. All in all, the patients who were in this study did improve and a little over half of that improvement was from placebo alone, and just under half of that improvement was from the drug itself, with the higher dose drug achieving a little bit more improvement than the lower dose.
Now, you may wonder how does that stack up against prior preventative treatments? We know that there are several FDA approved medications on the market for migraine prevention. One of the most recently approved is Topamax and very commonly used. In a similar trial of Topamax in 2005 where they looked at the same exact end point, so how many people achieved 50 percent reduction or more in their migraine frequency, 46 percent of people in that trial achieved greater than 50 percent reduction with 23 percent doing so in the placebo arm.
The numbers from the Aimovig trial, and the numbers from Topamax are almost identical. Now, you do have to take any comparison like that that’s not done head to head as part of the same trial with a grain of salt, but we can at least say that it looks to be in the same ball park as the existing treatments in terms of its effectiveness.
Now, I know there are probably some of you listening who may say, “Well, wait a minute. Topamax, I took Topamax and it didn’t work at all for me.” And, this is often a thing that happens, is that we see results that come in a clinical trial that don’t match what actually happens in the real world and there may be several reasons why that is, I could speculate, but I’ll leave that for another day.
But, just taking the data on face value, it does appear the effect of this drug is real and that it can lower migraine frequency to some extent in some people. Now, as the drug is used over the next several years, we will learn more about just how effective it is.
Typically, when a new drug hits the market, there’s often a honeymoon phase, so there’s lots of good press. We get a good placebo response, everybody’s excited about it. Then, over time after about a year or so, that phase wears off and we get a little bit more accurate picture of what the drug really does. We also hope that at some point we will get some independent trials of the drug that are not funded by the company that’s making it.
So usually, it takes a few years after a drug hits the market, for us to really understand its impact in the clinic. The second pro of Aimovig is the tolerability seems to very good so far. One of the issues with the preventative medications are the side effects, as some of you probably know, Topamax, which I mentioned earlier can have some unpleasant side effects, most commonly some cognitive effects where people have difficulty finding words, they may have numbness and tingling, it can predispose to kidney stones and things like that.
In most of the migraine preventatives that are available, do have side effects that are experienced by a reasonable number of people who take them and so that limits their use to some degree. While we don’t have any head to head trials that compare the Aimovig to the existing treatments, which is what you really like to make these kind of comparisons, it does seem that it’s better tolerated at least so far than most of the other preventatives that are available.
All in all, the effectiveness seems to be at least as good as the other available preventatives and it may be the fact that its side effect profile is better. We don’t have a lot of information to go on. We’re really talking about side effects in the short term. The trial that I mentioned before of Aimovig lasted for six months.
The third pro is that the drug is long lasting. This could see as both a pro and a potential con, which I’ll discuss in a minute. But the good part about it being long lasting is that it doesn’t have to be taken every day, which typically helps with compliance. You don’t have to remember to take a medicine every day and for preventative medications, if you don’t take them, they’re not gonna do their job. You can’t wait til you have a migraine to take one.
The reason it lasts a while is because it’s an antibody, as I mentioned. So it’s not a drug. It’s not metabolized like a drug typically would be, but rather, it’s a function of how long the antibody lasts in our system. Aimovig is given once a month by injection and another benefit of this being a longer lasting medication is that since it is only delivered only by either injection or IV as with the other drugs in this class, that means fewer pokes with the needle.
Our fourth pro, which I think is the most significant pro of all is that this is the first migraine specific preventative medication that has ever come out. The other drugs that are used for migraine prevention and that are approved were not originally developed for that. They were either developed as anti seizure medications, anti hypertension medications, or antidepressants and then were tested for use for migraine prevention and then found to be of some benefit.
That’s the history of a lot of drugs is that somebody finds or creates a new molecule and then they just throw it at a bunch of things to see what it might help for. In this case, as I mentioned earlier, this began with the identification of CGRP as molecule that was involved in migraine pathophysiology which then led to the search for a drug that could modify its action in a way that would reduce the frequency of migraines.
The fact that we’ve gone from that scientific observation years ago to now having a drug available that actually does that, now, this is more of a scientific achievement. In other words, this is an important milestone in science and in particular in migraine research, even if it’s not a breakthrough in terms of migraine therapy.
But this is the first in a new and entirely new class of molecules that were designed specifically for treatment of migraine and it’s possible that our approach will get more sophisticated and that years down the line we’ll have something that’s even more effective or closer to a real therapeutic breakthrough.
All right, so those are four of the most significant pros in my mind. Now we’ll discuss what I kind of consider as the cons or the drawbacks at this point in time. The first con for Aimovig and any other drugs in its class, at least initially is that our information on them is still very limited. So probably the biggest negative right now is that this is brand new.
We don’t have all the information we’d like to have to make an informed decision, so things like side effects, both in the short and long term, as well as any other long term risks and overall long term effectiveness. As I mentioned earlier, we still don’t know very much about CGRP, what it does, except the fact that it’s wide spread, meaning it’s found throughout the body and throughout the nervous system, which means that it’s like to be important in a wide range of physiological processes.
So, that means we have really no idea how to predict all of the possible consequences of blocking the receptor of this molecule. Clearly our body is making it for a reason, meaning it probably does some very important things and what we’re doing with this drug is blocking its ability to do so, at least to some degree.
What we’re essentially doing is creating an autoimmune condition on purpose. Autoimmune illnesses like multiple sclerosis and lupus and rheumatoid arthritis occur when our body’s immune system attacks and destroys part of itself. As I mentioned earlier, this is exactly how this drug works and the other drugs in this class are going to work.
We’re essentially creating an autoimmune condition, in this case where we’re attacking our own receptors for CGRP or the CGRP molecule itself. Now, we’re assuming at this point in time that because people who are on it on this short term trial didn’t have any major adverse reactions that there aren’t any real significant downsides to doing this. To me, that would be fairly surprising if that turned out to be true.
It’s not at all unlikely that we may find certain issues or negative consequences that arise with longer term therapy. One of the problems is, when we don’t have a lot of information on something, we don’t really understand how it works completely, we really don’t know what to look for in a clinical trial. I know from experience being an investigator in clinical trials that it’s really challenging to detect problems if you don’t know what you’re looking for.
It’s possible even that there are short term issues associated with the drug that weren’t picked up in the trial simply because we didn’t know what to look for. Of course, we’ve seen over history, this sort of thing happen time and again where a drug comes out and only over time do we learn of risks and negative consequences that we didn’t initially know about but that emerged several years later, either because they just weren’t detected, or in some cases because they were detected but hidden.
One of the more high profile cases of this was the drug Vioxx, which was approved in 1999 and quickly became one of the best selling drugs, it’s an antiinflammatory drug that doesn’t bother the stomach like some of the others, yet it increased the risk of heart attacks and strokes, a company Merck that manufactured it hadn’t disclosed some of the heart attacks that had occurred.
Ultimately, it was pulled from the market, though there was still risks that remained after taking the drug, so it didn’t immediately stop after someone stopped taking it. And, one study concluded that there were 88 thousand heart attacks, 38 thousand of which were fatal simply from the prescription, from the prescribing of Vioxx.
Again, part of this is because it hadn’t been disclosed by the company that some of the heart attacks that had occurred … Again, this is a really challenging problem whenever you have billions of dollars on the line. It’s pretty crazy to think that you can get unbiased information, it’s just sort of a byproduct of the system that we have.
Another issue of not having all the information that we want because this is a new drug, is also that the information that we do have is mainly coming from those that have a vested interest in over emphasizing the positive aspects of the drug and downplaying any negative aspects and we’ve talked in our Facebook group before about the challenge of getting unbiased information about pharmaceuticals. It’s really difficult and a significant problem in this day in age, even for doctors to get unbiased information.
That’s largely because of the increasingly close relationship between the drug industry and healthcare providers, which wasn’t always the case but has become much more significant in the past couple of decades.
So, with so much money at stake, there’s a lot of money changing hands in an effort to try to influence doctor’s prescribing behaviors and you’ll often find that many of the most vocal advocates of a particular drug are receiving money from the company that makes it. Within the past decade, there was legislation passed that forced drug companies to disclose what payments had been paid to doctors and now there’s even a website you can go and look up any doctor and find how much money he or she receives every year from the various drug companies.
Some people might be surprised by what they find. Needless to say, there are big time conflicts of interest which compromise our ability to get unbiased information. With a brand new drug, this is even more challenging because literally all the information we’re getting on its safety and effectiveness is coming from the trials that are sponsored by the company.
All in all, there’s really just not the kind of information that we’d like to have to make an informed decision at this point of time right after a drug has come out. It’s just not possible at this stage in the game. That’s why I generally, regardless of what drug it is, I generally don’t recommend being an early adopter of a medication unless a drug has incredible benefits or is potentially life saving.
I think it’s best to think of the first several years of a drug as still an experimental phase. It takes at least a good five or 10 years for it to be used in the real world, in the clinic, before we have decent enough amount of information to make at least somewhat of an informed decision.
Now, the second con is that it’s expensive. What I saw is the estimated cost is about seven thousand dollars per year for the monthly injections. Now, compared to all of the available drugs our there, especially new drugs, that’s not as steep as it might be, and most folks who are receiving it won’t be paying that entire amount out of pocket.
More than likely you’ll be paying some sort of copay and that copay will probably be on the higher side. Most new drugs are going to be lower tier in an insurance company’s formulary meaning they’ll play less of the cost than ones that are on a higher tier. There’s likely to be a decent expense for you the patient, though you won’t probably foot the entire seven thousand dollar a year bill and there may be some assistance programs that folks may qualify for.
The third con is that the benefits of the drug, at least from the trial that has been done are somewhat modest. Like I said, they’re about on par with the results that came from the trials of Topamax and in a scenario like this where there’s still a lot of uncertainty where we don’t really know the long term risks and where there’s some reason to believe that there could be such a thing, we’d want the treatment to work really, really well before we accepted that risk, at least I would personally.
If every person in the trial never had a migraine again, then that would be certainly more motivation to take one the risks that come with adopting a drug like this right off the bat. The fourth con is that this type of treatment kind of represents the best available thing within all the constraints that our current system for finding medical therapies imposes.
This is an issue that almost never gets discussed or talked about, but is relevant to anyone who’s trying to make an informed decision in the confines of the traditional healthcare system, particularly in the US and most western influenced system. And that is, that the treatments that are delivered that are available inside of these systems have to fit within all of the constraints that are imposed as part of that system.
What I mean by that is there’s a huge set of hoops that are both formal and informal that any treatment has to clear or jump through before it can be offered in a conventional medical clinic. Number one, it almost always will have to be something that can be patented so that it can be produced on a large enough scale and that somebody can make money from it.
It also has to be testable within the confines of a randomized clinical trial like I discussed above. That almost means some single treatment that can be randomized where one groups gets the treatment and one group doesn’t. It also has to be something that can be delivered or administered in a very short timeframe, so within the span of a typical office visit.
Right there with those criteria, we’ve essentially excluded anything in the realm of diet and lifestyle treatments or really any type of holistic systems based treatment. None of those treatments would be able to fit within those constraints. Another one is that the treatment has to be something that’s going to be accepted by the typical patient.
Right now, the typical patient, not surprisingly, comes into a clinic expecting to receive a drug treatment and aren’t usually willing to make significant lifestyle and behavioral changes. All in all, this means that the reason that we have drug therapies as our main treatments, isn’t because they’re the best available treatment, it’s because they fit within the constraints of that system so that the available drugs are simply the best ones that fit within those constraints.
As an analogy, imagine that you were trying to build the very best house that you could, but you only had styrofoam, glue, and rubber bands as your materials. You might go through many different house designs and ways of putting those things together, and you’d certainly find certain designs and certain ways of building the house from those materials that were better than another one, but, of course, compared to a house that used all of the available materials we have for building, you’re house made of styrofoam, glue, and rubber bands wouldn’t be nearly as sturdy or as suitable for inhabiting.
The available treatments that we have inside of the medical clinic aren’t there because they’re the best of all possible solutions, it’s just that they’re the ones that are the best within the constraints that we’ve imposed from that system. But the problem is, most of us don’t appreciate that in this system, we’re not trying to find the very best house design, but rather we’re trying to build the best house made of styrofoam, glue, and rubber bands.
This is one of the primary reasons why there’s been almost no progress in the world of medical treatments over the past couple of decades. Even as we’ve had incredible technological advancements and transformations of our daily life, and other areas, including in medical diagnostic tools, but what we’ve done is created a system that makes it virtually impossible to find solutions that work for the conditions that we now face.
This is a big reason why, once I realized that I couldn’t offer my patients the very thing that would solve the problem I was supposed to help them solve, I had to find another way to do so. I wanted access to all of the available tools and materials, not just a tiny little subset.
Even worse was the fact that many of those treatments ultimately made their problem worse and especially in the case of migraines as I’ve discussed. So, this is the main reason why I advocate primarily for a drug free strategy. Not because there’s anything inherently wrong with drugs, but it’s because I want the thing that works the best because I realize how limited that approach is.
The problem with not recognizing that these drugs are the best thing we have within the constraints that we’ve imposed is that we end up seeing drugs as the only tool. And if we were to break down all of the things that we could do to protect ourselves from migraines and rank them in order of their effectiveness, drugs, any drug, would be way down on the list.
If you consider that they also come with potential harms and side effects, which drug free approaches don’t have, on the contrary, they often have health promoting effects, then you’d bump that down even further on your priority list. That being said, there are still situations where it may make sense to use them, at least in the short term, and I’ll discuss that in just a second.
The fifth con, which is somewhat individual is that there is needles involved. For some people, needles are a no go, they won’t consider any treatment that involves poking. But as I said, most of these are fairly infrequently delivered treatments, maybe about once a month, so you get poked about once a month. But most people tend to prefer swallowing a pill to being poked by a needle.
And the sixth and final con is that this treatment doesn’t address the root cause of migraines. As I mentioned Aimovig and the other drugs in this category target CGRP or the CGRP receptors, which is a part of migraine physiology. It’s part of the pain signaling, it happens after the migraine process has been initiated.
It’s definitely not treating migraines at their source or at their root cause and there are a few reasons why I’d consider this to be a con or a drawback. One is that, root cause treatments are almost always going to be the most effective and oftentimes treatments that don’t address root causes and just treat symptoms keep us from looking into or finding the root causes and in some instances may end up making the underlying condition worse.
This has become an even bigger problem in the last half century or so as more and more of the conditions that we see in the healthcare clinic are systemic and multifactorial like migraines, so they’re not well suited for a drug approach that can only target a single thing, but are sort of single minded focused on drugs as the only real tool, means that all we can ever really do in these instances is reduce symptoms.
That’s essentially stopped us collectively from looking toward root cause approaches. Nowadays, the typical approach to finding treatments is to kind of throw the available molecules and drugs that we have at a condition and see what works both in the research lab and in the medical clinic.
So take the example of type two diabetes. We know that it’s primarily an issue of diet and lifestyle, or at least it requires that environmental component. Yet, the treatments for diabetes basically allow you to engage in the very behaviors that brought the condition on in the first place.
Many people can get their sugar under reasonably good control with a pill or drug, which allows people to continue to eat the foods and lead lifestyles that led to that problem developing to begin with rather than addressing those root causes of diet and lifestyle that were a big part of it to begin with and were part of the root cause.
Another reason why this not being a root cause treatment is a downside is, I’ve talked before about there being a silver lining with migraines, which is they can be seen as kind of a canary in the coal mine alerting us when there are disturbances in the body that are harmful that are stressing or overburdening our brain and our body’s homeostatic capacities and if we listen to that signal, and we adjust our behavior accordingly, then not only will we have fewer migraines, but we will also enjoy much better long term health and wellbeing.
For example, with Amy’s comments that I read earlier, it was not being able to get the drug immediately that led her to took for other possible solutions and stumble on the Migraine Miracle Plan and now she’s fully on board with that and is not interested in drugs anymore.
Oftentimes that’s the issue, is that the drugs keep us from looking into those most transformative root cause treatments. Really, that’s the central message here, which is not that drugs are bad, but there are so many other effective treatments that are being completely ignored because we just have single mindedly focused on that as the only tool, so they only get a disproportionate amount of attention. It’s as if we’ve forgotten that you can build houses out of something other than styrofoam, rubber bands, and glue, which leads people to miss out on therapies and treatments that could be much more powerful and effective.
So with all of those pros and cons in mind, where do I as a neurologist see the role of Aimovig and the other drugs in this class that may follow? One scenario I can see it being used, is for those who are unwilling or unable to make holistic diet and lifestyle changes that address root causes. I think it’s a reasonable option in that scenario.
At the end of the day, my main concern is reducing suffering and in a perfect world everybody would adopt the best course of treatment. But I’m a realist being in the health care clinic for over a decade has taught me that. I know that not everyone is ready to do those sorts of things. This is a reasonable option in those situations.
Now, as I said, I’m apprehensive about being an early adopter for things like this and I think that history tells us that there is plenty of reason to be apprehensive. So, I won’t strongly advocate for it until it’s been proven in the real world. So, right now, I’m most apt to prescribe it for those who ask for it and who are comfortable with the risks.
Then for those who are willing to adopt a holistic approach like the Migraine Miracle Plan, but who are in dyer straights, particularly in the very depths of rebound headaches and really need any extra boost they can get, I think it’s a reasonable consideration in that scenario as well. In this instance, I’d favor using it as a short term treatment as a kind of temporary aid until rebound had been broken and the other changes had had enough time to take effect.
As you probably know, my primary objective is to get people to migraine freedom without pills mainly because the pills, the drugs, make it harder to get to migraine freedom. But there are certainly scenarios where the drugs can actually act as an aid to getting you to that point. Ultimately, all that matters to me is trying to find the fastest and most effective approach to ending suffering from the beast, and I’m fine with using every available tool I have to do that.
Just as a final summation, on the plus side, Aimovig and the other drugs in this class I think are a significant scientific milestone, even if they’re not a therapeutic breakthrough. And while this isn’t a panacea, it can certainly improve the quality of life for some people, especially if it’s used thoughtfully.
On the other hand, if we were to divide all of the things that we can do to strengthen our protection against the beast, a topic I covered in the last episode, this would be pretty far down on the list.
Okay, so that concludes this discussion on Aimovig and the new class of CGRP drugs. Hopefully you found this helpful. Clearly these things aren’t black and white. I think this discussion illustrates why medicine is referred to as an art, because it’s messy and there are a lot of different considerations and seldom are things as cut and dry as we’d like them to be, so we are almost always operating without all the information we’d like and trying to deal primarily with probabilities in a very imperfect system.
If you have any questions or comments about this episode, please feel free to leave them inside of our Facebook group and if you are wanting to adopt a root cause approach to migraines to slay the beast once and for all, head over to mymigrainemiracle.com and click on our resources link to see all the things that we have available to help you get there.
Okay, thanks so much for listening. Now it’s time to go out and slay the beast.