Migraine Treatments in 2023: Better Medicine or Stronger Pharma Echo Chamber?
To gain some therapeutic insight, all you have to do is determine how to influence the same receptor—without using drugs—using the nutrition and functional medicine protocol that I’ve outlined in IM4
A recent article (2023 May) posted by the popular medical infomercial/infotainment website Medscape (“which boasts an unrivaled reach of more than 6.5 million physicians worldwide”1) provides more noise than signal but is still worth a read and review, if not a chuckle; the article’s overstated headline “Head-to-Head Comparison of 25 Migraine Meds Reveals Top Options” promises some insight but delivers very little. Nonetheless, if this information reflects the current “standard of care” and “recommendations from clinical treatment guidelines” and is current from the American Academy of Neurology (AAN) 2023 Annual Meeting, then we should at least be aware of their conversation whether or not we agree with the methodology and conclusions; the only way to know if their paradigm is insightful or inane is to actually evaluate it.
What they claim to have done
With regard to the treatment of acute migraine events, the authors are claiming to provide “new real-world analysis of data on more than 3 million migraine attacks” using “the power of big data” based on “large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience.” The authors vacillate between describing the 278,000-person database as being covering either “3 million migraine attacks” or “10 million self-reported migraine attack records.”
Twenty-five medications were evaluated within the seven categories of 1) acetaminophen, 2) nonsteroidal anti-inflammatory drugs [NSAIDs, such as ibuprofen], 3) triptans, 4) combination analgesics [acetaminophen/aspirin/caffeine], 5) ergots, 6) antiemetics, and 7) opioids.
They claim to have applied sophisticated statistical analysis (“two-level nested logistic regression model …adjusting concurrent medications and the covariance within the same user”) to their big but bad dataset.
They used ibuprofen as the arbitrary reference (potency = 1) and thus ranked the effectiveness of intervention as follows:
triptans specific to eletriptan = 6.1
triptans specific to zolmitriptan = 5.7
triptans specific to sumatriptan = 5.2
triptans generally = 4.8
ergots = 3.2
antiemetics = 2.7
opioids = 2.5
NSAIDs generally = 1.9
combination analgesics = 1.7
NSAIDs specific to ibuprofen = 1
acetaminophen = 0.8
They congratulated themselves by calling this “a great study of Big Data”, said that they are “smart researchers” and that this heralds the end of “trial-and-error medicine.”
What they actually did
The data reported above shows us virtually nothing because it is based on relative not absolute efficacy and furthermore their interventions failed to include the newer classes of drugs known as “ditan” and “gepant” let alone any mention of nondrug treatments such as nutrition, functional medicine, chiropractic/osteopathic treatment, etc; they claim that because their data was from 2014-2020, the use of gepant drugs (FDA approved in 2018) and ditan drugs (FDA approved in 2019) was too small to warrant inclusion and evaluation but I suspect that they did not want to show that these new drugs are mostly therapeutic failures, especially for the price-tag of $8,5000 per year.
The loss and expense of migraine in work/income/suffering is estimated to be ~$6,500 per year, so the cost of the new drugs at $8,500 means that patients—most of whom do not receive major benefit from the drugs—are still at negative balance at the end of it all; you can’t expect that level of simple-but-honest analysis from pro-pharma shills and sources.
Thus, their failures are as follows:
Reporting relative (instead of absolute) benefit tells. you. nothing.
You can’t look at the data they presented and discern if a single one of their 278,000 participants received any meaningful benefit.
This is the same technique that they used to push the failed CV vaxxines: they stated a relative risk reduction of 95% when in fact the real-world benefit was less than 1%2
They failed to include any cost-benefit or risk-benefit analysis
They only included drugs, and not even the most recent new drugs
Complete exclusion of any mention of nutrition or other non-drug treatments
By glorifying the relative benefit and ignoring the absolute benefit, they create the illusion that these drugs are actually providing benefit; this is “assumption by selective presentation” because all of these drugs are relative failures for most patients.
What useful and applicable insight can we take away from this article?
Mostly nothing, except that the medical-pharma machine is pretty skilled at presenting data in such a way as to make the reader think that he/she is actually reading something of importance when in fact nothing of meaning is being stated.
If they don’t present information on absolute benefit, then the reader cannot even state whether or not the drugs provide any benefit.
If they don’t present information on risk, then the reader cannot even state whether or not the drugs are worth the risk.
If they don’t present information on comparison against nutrition or nondrug treatments, then the reader cannot even state whether or not the drugs are better or worse than “vitamin therapy.”
Does this article provide any insight into the use of nutrition and functional medicine for the treatment of migraine?
Not really, because the medical approach isn’t based on an understanding of the disease but rather the interception of dysfunctional pathways, or as I have said, “intercepting the inflammatory football, but never stopping the game that is in play.”
7 years after its updating and publication in 2016, the anti-migraine protocol in Inflammation Mastery 4th Edition is still the most comprehensive and precise approach available because it—the protocol—is based on the main factors that perpetuate the disorder of migraine.
Careful readers can gain some legitimate therapeutic insight from the drug-centered data above; notice that treatments 1-5 of the list of 11 all function on the same family of receptors. Then, in order to gain some therapeutic insight, all you have to do is determine how to influence that same receptor—without using drugs—using the nutrition and functional medicine protocol that I’ve outlined.
Dr Alex Kennerly Vasquez (introduction; brief Bio-CV) writes and teaches for an international audience on various topics ranging from leadership to nutrition to functional inflammology. Major books include Inflammation Mastery, 4th Edition (full-color printing, 1182 pages, equivalent to 25 typical books [averaging 60,000 words each]), which was also published in two separate volumes as Textbook of Clinical Nutrition and Functional Medicine (Volume 1: Chapters 1-4; Volume 2: Chapter 5—Clinical Protocols for Diabetes, Hypertension, Migraine, Fibromyalgia, Rheumatoid Arthritis, Psoriasis, Vasculitis, Dermatomyositis and most other major inflammatory/autoimmune disorders); several sections have been excerpted including Antiviral Strategies and Immune Nutrition (ISBN 1502894890) (aka, Antiviral Nutrition [available as PDF download] and Brain Inflammation in Chronic Pain, Migraine, and Fibromyalgia. Dr Vasquez’s books are available internationally via bookstores such as BookDepository, Amazon.com, Barnes and Noble, ThriftBooks, AbeBooks, BetterWorldBooks, WaterStonesBooks and his new Telegram channel is https://t.me/DrAlexVasquez.
"Medscape, which boasts an unrivalled reach of more than 6.5 million physicians worldwide" March 8, 2023 prnewswire.com/news-releases/medscape-expands-global-reach-with-acquisition-of-health-information-platform-grupo-saned-301765227.html
