Pauline Anderson

June 23, 2016

SAN DIEGO — New research suggests some common migraine triggers may actually be protective for some people in some situations.

The study, which used an analytical technology (Curelator Headache, Curelator Inc), showed that common triggers such as red wine or chocolate actually appeared to be protective for some patients when their individual data were analyzed.

The platform "helps patients increase their knowledge of their individual triggers and guides them to modify their behavior, which may enable them to improve their condition," said Stephen Donoghue, PhD, vice president of Clinical Research at Curelator Inc.

It can also facilitate discussions between clinicians and patients about complementary interventions, he said.

The research, funded by the company, was presented here at the American Headache Society (AHS) 58th Annual Scientific Meeting.

For the study, 284 individuals recorded details of their migraine attacks in an electronic diary for 90 days. Researchers used an analytic engine to examine associations between suspected factors and migraine attacks.

"We statistically confirmed only a small proportion: less than 20%," said Dr Donoghue.

This is important because many people with migraine try to avoid things they think are triggers for no good scientific reason, he said.

He added that this can affect enjoyment of life or make patients feel helpless if they think they can't do anything about their triggers. "For example, how do you avoid certain types of weather?" he pointed out.

The company was started in 2013 by founder and Chief Executive Officer Alec Mian, PhD. The impetus, said Dr Donoghue, was the realization that any chronic migraine treatments, pharmaceutical or otherwise, are effective in only a minority of patients.

"Pharmaceuticals, and the therapeutic pathways that drive them, are developed and tested on aggregate populations and target an average patient, who in fact may or may not exist," he said.

The goal of this data platform for migraine is to address the problem of improving individual outcomes in a diverse patient population, he said.

This is being done in two stages. The first stage has involved implementing analytical technology that measures an individual patient's response to a wide spectrum of medical, environmental, dietary, emotional, and other factors.

"We use a smartphone as a data entry interface to gather daily longitudinal data on disease symptoms and exposure, or lack thereof, to an array of factors," explained Dr Donoghue.

From outputs of their statistical analyses, researchers developed for each individual what they call a "trigger map," a "protector map," and a "no association map" of visual associations between dietary, environmental, hormonal, and emotional factors and the occurrence of migraine attacks.

The results of their work showed that so-called "common" trigger profiles, identified in aggregate analysis, are, in fact, not very common in individuals, said Dr Donoghue.

Common "Protectors"

Some of the common protectors the research uncovered (eg, good sleep quality, relaxation, and happiness) were not surprising. That red wine and chocolate, both of which have been "vilified" as migraine triggers for decades, actually appear to be more commonly protectors was surprising, said Dr Donoghue.

In some circumstances, a person's trigger depends on the setting. Dr Donoghue used red wine as an example: "Interviews with patients seem to support the hypothesis that red wine is in fact more closely associated with a social context than the red wine itself. In other words, if alcohol is consumed in a relaxed situation, then it will show up as a protector."

Other unexpected protective factors included physical activity, caffeine, and travel. For example, instead of being stressful, it appears for some individuals, travel is a chance to relax, listen to favorite pieces of music, and not be bothered by cell phones; in any case, travel was associated with fewer headaches.

"So it may be that relaxation is the 'true' protector," said Dr Donoghue. "We are careful to tell people that they need to think about the context in which the 'protector' occurs, as this is the clue to something that may help them avoid attacks."

For one study subject, sparkling wine was a trigger for a migraine, but other forms of alcohol protected against attacks. "We asked her when she drank sparkling wine and she revealed that she only did so in formal occasions, and the crowds made her anxious."

Another surprising finding was that protective factors could be clearly measured, he said. "Historically, we have been so focused on avoiding what makes us sick. Now we've opened a door to enable us to discover things that make us healthy, and to then embrace them."

But what was truly "astonishing" was the degree of interindividual heterogeneity, said Dr Donoghue. "Based on our findings, the vast majority of people with migraine have unique profiles."

To access the system, patients download the app from the Curelator website, which they can then customize. When the system has enough information — after about 90 days of entering data — the statistical analyses are performed and the "trigger," "protector," and "no association" maps are produced and delivered in a Personal Summary Report.

If the patient has been referred by a clinician, a copy of the report is sent to the clinician, provided the patient provides consent.

The company offers clinicians a "coupon referral program," so their patients can use the platform free of charge.

The second stage of development will focus on developing individualized therapeutic pathways, said Dr Donoghue. "This will include using predictive analytics to allow patients to follow optimized individual therapeutic pathways with the goal of better outcomes at lower cost."

For comment on these findings, Medscape Medical News approached Benjamin W. Friedman, MD, associate professor, emergency medicine, Albert Einstein College of Medicine, Bronx, New York.

"I am always intrigued how differently a data-driven reality looks from an experiential sense of the world," Dr Friedman said.

"I encourage my migraine patients to keep detailed diaries to help them understand and contextualize their migraine attacks," he added. "It is true that external triggers vary from patient to patient, and it is very useful for individuals to understand their own unique triggers."

The study was funded by Curelator, Inc. Dr Donoghue is an employee of Curelator Inc. Dr Friedman has disclosed no relevant financial relationships.

American Headache Society (AHS) 58th Annual Scientific Meeting: Abstracts PF42, PF43, PF44. Presented June 10, 2016.

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