1st thing the medical committee needs to do is educate Dr on how severe migraines can be I for one will NEVER goto a hospital emergency room again, you get treated like crap , intentionally.

Excellent explanations of these 2 new treatments. Thank you.

On keto diet my migraine rate dropped off the charts. 2 in a year.. hard lifestyle though.

Thank you for an amazing explanation! I am taking my first Aimovig today.

Many patients with migraine have chronic PTSD.

I wish that the medical community would start focusing on bilateral choroid plexus cysts, especially larger ones, and the simple increased/decreased amounts of cerebral spinal fluid as the culprit in all of this. We're seeing this all of the time on MRI these days, clearly those with these anomalies are going to suffer when the barometric pressure changes, when they're dehydrated (wine dehydrates a body quickly), when they eat chocolate, which can cause inflammation around already too much CSF causing things to get squeezed and that causes pain (it's like a balloon that's either too full or underfilled except with pain either way). Mainline medicines that alter blood pressure\flow have shown to be ineffective, simply because the volume of CSF is dependent on daily, changing circumstances and it's a different system than BP, although higher BP can cause issues with off normal CSF levels, treating it by treating BP is like trying to get a car that's out of gas to start by adding oil to the engine, the oil helps, but the car still won't start without gasoline. Triptans clearly won't work 100% of the time because if a patient takes them when their CSF is too low already, the vasoconstrictive effect would obviously exacerbate pain (this is why they only work about 50% of the time and only in some). CGRP is a dangerous answer, because our bodies need to be able to regulate blood pressure, and going against that just isn't a good bet in those with chronic conditions because the BP generally rises when a person is in pain. And, increasing or decreasing serotonin flow is the cookie cutter approach for so many meds these days (seriously new pharma people, stop copying what somebody else did last time around and think outside the box). Think along the lines of hydrocephalus, however caused by the cysts being in the way and causing off normal CSF fluid level symptoms on a daily, varying basis. Treat the fluctuations in CSF, keeping it as consistent as possible, and treat the pain itself on days when the stimulus (barometric pressure increases, inflamed eyes from too much time on a computer, etc.) is uncontrollable. One day MDs will get this, but for now it seems that the lay people who suffer are leagues ahead of the medical community. I'm hopeful MDs will catch up soon!

Can you give the link for part 2 the q and a discussion as I'm not finding it.

Every complex migtain I get is a bit different. I'm worried TIA ot Stroke can be involved. Numbness lasting longer,one with vision loss but no aur!a etc. So my concern has prompted my neurologist to have a neck and head angiogram. I'm 66 . Been getting them since age 44. My daughter started getting them at age 34. The stroke worry always looms on my mind.

Thanks for this. Any update on the efficacy of Engality as associated to Chronic cluster migraines?

By any chance, would there be possibility of Fremanezumab also working "off-label" for chronic pain disorders? Because that would be amazing.

Dr. Dodick...can you tell me how long it should take to get some reduction in headaches. I have taken 2 doses of the Amovig..Im at 45 days and have had a total of 14 migraine days...10 in Oct. and 4 so far- Nov....I am a borderline chronic...averaging 10-15 migraine days per mo. I keep a monthly log. I am so hoping to cut them in half so I can reduce taking a Triptan at onset of headache. I had no luck w/ Topiramate except for terrible sides..when I got Tinnitis in my ears..that was the final straw and I went off of it. ..thankfully after a couple of days getting off that drug the ringing stopped. I was really worried my ears were damaged.

Janelepauw My upper arms are swollen and I am bruising easily. I am in my 4th month of Ajovy...thoughts?

How about for vestibular migraines? i’ve always understood that benzos are what helps with dizziness. My doctor believes aimovig will help my lightheadedness/dizziness. Ive been on it for 3 months now. i still feel dizzy. and neck pain is at it’s worse the first 2 weeks after dose. how long should i continue taking aimovig ?

Sorry for my simple understanding. So is a migrain theorized to be a sustained pain signal in the trigeminal nerve? I like the lock and key description.

Happy to be able to hear Dr Dodick ...so migraine is not vascular related at all? Are triptans safe or unsafe for migraine with aura?

Doctor I just started taking aimovig in December. Recently I have developed pretty severe lower back pain. However I didn't do anything different over the last few months there is absolutely no reason for me to have this back pain. So it then occurred to me that the only thing that I've done different is aimovig shots. So I went online to see if anybody else has been experiencing similar side effects and it turns out that there are a number of people that have experienced the same thing. Do you have any insight into this?

Did any of the patients that were in the trials have systemic lupus? If so did it work well?

Since Aimovig has been on the market for a while, it seems to be getting some rather bad reviews especially since some of the horrible side effects seem to persist even when the medication has been discontinued. I remember when Imitrex came on the market and was praised as a wonder drug in the beginning. Now so many people are claiming that they had very little luck with that medication which is probably why the pharmaceutical corporations keep pushing out new medications that don’t seem to be very effective.