How to keep your teeth young

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How to keep your teeth young

The association between aging and teeth is so well-established that it’s entered popular idiom, “too long in the tooth”, and when it comes to visual representations, false teeth are well-associated with old age.

And yet, avoiding such outcomes does not get anywhere near so much attention as, say, avoiding wrinkles or hair loss.

At 10almonds, we’ve covered general dental health before, in a three-part series:

  1. Toothpastes & Mouthwashes: Which Help And Which Harm?
  2. Flossing, Better (And Easier!)
  3. Less Common Oral Hygiene Options

Today, we’re going to be looking specifically at keeping our teeth young. What if you have lost your teeth already? Well, gum health remains important, and it’s foundational for everyone, so…

Look after your gums first and last

Hollywood’s most “perfect” whites would be nothing without the gums holding them in place. So, set aside the cosmetic whitening products that often harm gums (anything containing bleach / hydrogen peroxide, is generally a bad idea), andinstead focus on your gums.

As for avoiding gum disease (periodontitis)?

❝In conclusion, periodontitis might enhance the association of biological aging with all-cause mortality in middle-aged and older adults.

Hence, maintaining and enhancing periodontal health is expected to become an intervention to slow aging and extend life span.❞

Source: Does Periodontitis Affect the Association of Biological Aging with Mortality?

Ways to look after gum health include the obvious “floss” and “brush often” and “use fluoride toothpaste”, along with other options we covered in our “Less Common Oral Hygiene Options” article above.

Also important: don’t smoke. It is bad for everything, and this is no exception.

We expect we probably don’t have many subscribers who smoke, but if you do, please consider making quitting a priority.

See also: Smoking, Gum Disease, and Tooth Loss

Consider supplementing with collagen

Everyone’s all about the calcium and vitamin D for bones (and teeth), but a large part of the mass of both is actually collagen. And unlike calcium, which most people not living in a food desert get plenty of, or vitamin D, which is one of the most popular supplements around, collagen is something that gets depleted as we get older. We’ve written about its importance for bones:

We Are Such Stuff As Fish Are Made Of—Collagen’s benefits are more than skin deep

And as for its role in combatting gum disease and tooth loss:

Nanoscale Dynamics of Streptococcal Adhesion to AGE-Modified Collagen

By the way, that “AGE” there isn’t about chronological age; it’s about advanced glycation end-products. Those are also something you can and should avoid:

Are You Eating AGEs?

A different kind of “spit and polish”

We imagine you have the “polishing” part in hand; that’s tooth-brushing, of course. But spit?

Saliva is hugely important for our oral health, but it’s not something most of us think about a lot. For example, you might not have known (or might have known but not thought much about) that many common medications affect our saliva, including many blood pressure medications and antidepressants:

Impact of ageing and drug consumption on oral health

Because there are so many possibilities, this is the kind of thing to check with your pharmacist or doctor about. But as a rule, if you take a medication whose side-effects include “dry mouth”, this might be you.

Here’s a really useful (academic) article that covers what drugs cause this, how to diagnose it, and what can be done about it:

Hyposalivation in Elderly Patients

If something’s difficult, find a way to make it easier

Sometimes, as we get older, some things that used to be easy, aren’t. We can lose strength, coordination, manual dexterity, memory, attention, and more. Obviously, we try not to, and do what we can to keep ourselves in good health.

But, if you do have some disability that makes for example brushing and/or flossing difficult to do consistently and/or well, consider talking to your doctor to see if there are assistive devices that can help, or some other kind of support that could allow you to do what you need to.

See also: Improving oral hygiene for better cognitive health: Interrelationships of oral hygiene habits, oral health status, and cognitive function in older adults

There’s never any shame in getting help if we need it.

Take care!

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  • Alpha, beta, theta: what are brain states and brain waves? And can we control them?

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    There’s no shortage of apps and technology that claim to shift the brain into a “theta” state – said to help with relaxation, inward focus and sleep.

    But what exactly does it mean to change one’s “mental state”? And is that even possible? For now, the evidence remains murky. But our understanding of the brain is growing exponentially as our methods of investigation improve.

    Brain-measuring tech is evolving

    Currently, no single approach to imaging or measuring brain activity gives us the whole picture. What we “see” in the brain depends on which tool we use to “look”. There are myriad ways to do this, but each one comes with trade-offs.

    We learnt a lot about brain activity in the 1980s thanks to the advent of magnetic resonance imaging (MRI).

    Eventually we invented “functional MRI”, which allows us to link brain activity with certain functions or behaviours in real time by measuring the brain’s use of oxygenated blood during a task.

    We can also measure electrical activity using EEG (electroencephalography). This can accurately measure the timing of brain waves as they occur, but isn’t very accurate at identifying which specific areas of the brain they occur in.

    Alternatively, we can measure the brain’s response to magnetic stimulation. This is very accurate in terms of area and timing, but only as long as it’s close to the surface.

    What are brain states?

    All of our simple and complex behaviours, as well as our cognition (thoughts) have a foundation in brain activity, or “neural activity”. Neurons – the brain’s nerve cells – communicate by a sequence of electrical impulses and chemical signals called “neurotransmitters”.

    Neurons are very greedy for fuel from the blood and require a lot of support from companion cells. Hence, a lot of measurement of the site, amount and timing of brain activity is done via measuring electrical activity, neurotransmitter levels or blood flow.

    We can consider this activity at three levels. The first is a single-cell level, wherein individual neurons communicate. But measurement at this level is difficult (laboratory-based) and provides a limited picture.

    As such, we rely more on measurements done on a network level, where a series of neurons or networks are activated. Or, we measure whole-of-brain activity patterns which can incorporate one or more so-called “brain states”.

    According to a recent definition, brain states are “recurring activity patterns distributed across the brain that emerge from physiological or cognitive processes”. These states are functionally relevant, which means they are related to behaviour.

    Brain states involve the synchronisation of different brain regions, something that’s been most readily observed in animal models, usually rodents. Only now are we starting to see some evidence in human studies.

    Various kinds of states

    The most commonly-studied brain states in both rodents and humans are states of “arousal” and “resting”. You can picture these as various levels of alertness.

    Studies show environmental factors and activity influence our brain states. Activities or environments with high cognitive demands drive “attentional” brain states (so-called task-induced brain states) with increased connectivity. Examples of task-induced brain states include complex behaviours such as reward anticipation, mood, hunger and so on.

    In contrast, a brain state such as “mind-wandering” seems to be divorced from one’s environment and tasks. Dropping into daydreaming is, by definition, without connection to the real world.

    We can’t currently disentangle multiple “states” that exist in the brain at any given time and place. As mentioned earlier, this is because of the trade-offs that come with recording spatial (brain region) versus temporal (timing) brain activity.

    Brain states vs brain waves

    Brain state work can be couched in terms such as alpha, delta and so forth. However, this is actually referring to brain waves which specifically come from measuring brain activity using EEG.

    EEG picks up on changing electrical activity in the brain, which can be sorted into different frequencies (based on wavelength). Classically, these frequencies have had specific associations:

    • gamma is linked with states or tasks that require more focused concentration
    • beta is linked with higher anxiety and more active states, with attention often directed externally
    • alpha is linked with being very relaxed, and passive attention (such as listening quietly but not engaging)
    • theta is linked with deep relaxation and inward focus
    • and delta is linked with deep sleep.

    Brain wave patterns are used a lot to monitor sleep stages. When we fall asleep we go from drowsy, light attention that’s easily roused (alpha), to being relaxed and no longer alert (theta), to being deeply asleep (delta).

    Can we control our brain states?

    The question on many people’s minds is: can we judiciously and intentionally influence our brain states?

    For now, it’s likely too simplistic to suggest we can do this, as the actual mechanisms that influence brain states remain hard to detangle. Nonetheless, researchers are investigating everything from the use of drugs, to environmental cues, to practising mindfulness, meditation and sensory manipulation.

    Controversially, brain wave patterns are used in something called “neurofeedback” therapy. In these treatments, people are given feedback (such as visual or auditory) based on their brain wave activity and are then tasked with trying to maintain or change it. To stay in a required state they may be encouraged to control their thoughts, relax, or breathe in certain ways.

    The applications of this work are predominantly around mental health, including for individuals who have experienced trauma, or who have difficulty self-regulating – which may manifest as poor attention or emotional turbulence.

    However, although these techniques have intuitive appeal, they don’t account for the issue of multiple brain states being present at any given time. Overall, clinical studies have been largely inconclusive, and proponents of neurofeedback therapy remain frustrated by a lack of orthodox support.

    Other forms of neurofeedback are delivered by MRI-generated data. Participants engaging in mental tasks are given signals based on their neural activity, which they use to try and “up-regulate” (activate) regions of the brain involved in positive emotions. This could, for instance, be useful for helping people with depression.

    Another potential method claimed to purportedly change brain states involves different sensory inputs. Binaural beats are perhaps the most popular example, wherein two different wavelengths of sound are played in each ear. But the evidence for such techniques is similarly mixed.

    Treatments such as neurofeedback therapy are often very costly, and their success likely relies as much on the therapeutic relationship than the actual therapy.

    On the bright side, there’s no evidence these treatment do any harm – other than potentially delaying treatments which have been proven to be beneficial.The Conversation

    Susan Hillier, Professor: Neuroscience and Rehabilitation, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Green Tea Allergies and Capsules

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Hey Sheila – As always, your articles are superb !! So, I have a topic that I’d love you guys to discuss: green tea. I used to try + drink it years ago but I always got an allergic reaction to it. So the question I’d like answered is: Will I still get the same allergic reaction if I take the capsules ? Also, because it’s caffeinated, will taking it interfere with iron pills, other vitamins + meds ? I read that the health benefits of the decaffeinated tea/capsules are not as great as the caffeinated. Any info would be greatly appreciated !! Thanks much !!❞

    Hi! I’m not Sheila, but I’ll answer this one in the first person as I’ve had a similar issue:

    I found long ago that taking any kind of tea (not herbal infusions, but true teas, e.g. green tea, black tea, red tea, etc) on an empty stomach made me want to throw up. The feeling would subside within about half an hour, but I learned it was far better to circumvent it by just not taking tea on an empty stomach.

    However! I take an l-theanine supplement when I wake up, to complement my morning coffee, and have never had a problem with that. Of course, my physiology is not your physiology, and this “shouldn’t” be happening to either of us in the first place, so it’s not something there’s a lot of scientific literature about, and we just have to figure out what works for us.

    This last Monday I wrote (inspired in part by your query) about l-theanine supplementation, and how it doesn’t require caffeine to unlock its benefits after all, by the way. So that’s that part in order.

    I can’t speak for interactions with your other supplements or medications without knowing what they are, but I’m not aware of any known issue, beyond that l-theanine will tend to give a gentler curve to the expression of some neurotransmitters. So, if for example you’re talking anything that affects that (e.g. antidepressants, antipsychotics, ADHD meds, sleepy/wakefulness meds, etc) then checking with your doctor is best.

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  • Neurotransmitter Cheatsheet

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    Which Neurotransmitter?

    There are a lot of neurotransmitters that are important for good mental health (and, by way of knock-on effects, physical health).

    However, when pop-science headlines refer to them as “feel-good chemicals” (yes but which one?!) or “the love molecule” (yes but which one?!) or other such vague names when referring to a specific neurotransmitter, it’s easy to get them mixed up.

    So today we’re going to do a little disambiguation of some of the main mood-related neurotransmitters (there are many more, but we only have so much room), and what things we can do to help manage them.

    Dopamine

    This one predominantly regulates reward responses, though it’s also necessary for critical path analysis (e.g. planning), language faculties, and motor functions. It makes us feel happy, motivated, and awake.

    To have more:

    • eat foods that are rich in dopamine or its precursors such as tyrosine (bananas and almonds are great)
    • do things that you find rewarding

    Downsides: is instrumental in most addictions, and also too much can result in psychosis. For most people, that level of “too much” isn’t obtainable due to the homeostatic system, however.

    See also: Rebalancing Dopamine (Without “Dopamine Fasting”)

    Serotonin

    This one predominantly helps regulate our circadian rhythm. It also makes us feel happy, calm, and awake.

    To have more:

    • get more sunlight, or if the light must be artificial, then (ideally) full-spectrum light, or (if it’s what’s available) blue light
    • spend time in nature; we are hardwired to feel happy in the environments in which we evolved, which for most of human history was large open grassy expanses with occasional trees (however, for modern purposes, a park or appropriate garden will suffice).

    Downsides: this is what keeps us awake at night if we had too much light before bed, and also too much serotonin can result in (potentially fatal) serotonin syndrome. Most people can’t get that much serotonin due to our homeostatic system, but some drugs can force it upon us.

    See also: Seasonal Affective Disorder Strategies

    Oxytocin

    This one predominantly helps us connect to others on an emotional level. It also makes us feel happy, calm, and relaxed.

    To have more:

    • hug a loved one (or even just think about doing so, if they’re not available)
    • look at pictures/videos of cute puppies, kittens, and the like—this triggers a similar response

    Downsides: negligible. Socially speaking, it can cause us to drop our guard, most for most people most of the time, this is not a problem. It can also reduce sexual desire—it’s in large part responsible for the peaceful lulled state post-orgasm. It’s not responsible for the sleepiness in men though; that’s mostly prolactin.

    See also: Only One Kind Of Relationship Promotes Longevity This Much!

    Adrenaline

    This one predominantly affects our sympathetic nervous system; it elevates heart rate, blood pressure, and other similar functions. It makes us feel alert, ready for action, and energized.

    To have more:

    • listen to a “power anthem” piece of music. What it is can depend on your musical tastes; whatever gets you riled up in an empowering way.
    • engage in something competitive that you feel strongly about while doing it—or by the same mechanism, a solitary activity where the stakes feel high even if it’s actually quite safe (e.g. watching a thriller or a horror movie, if that’s your thing).

    Downsides: its effects are not sustainable, and (in cases of chronic stress) the body will try to sustain them anyway, which has a deleterious effect. Because adrenaline and cortisol are closely linked, chronically high adrenal action will tend to mean chronically high cortisol also.

    See also: Lower Your Cortisol! (Here’s Why & How)

    Some final words

    You’ll notice that in none of the “how to have more” did we mention drugs. That’s because:

    • a drug-free approach is generally the best thing to try first, at the very least
    • there are simply a lot of drugs to affect each one (or more), and talking about them would require talking about each drug in some detail.

    However, the following may be of interest for some readers:

    Antidepressants: Personalization Is Key!

    Take care!

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  • What Weston Price Got Right (And Wrong)

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    Weston Price: What Stood The Test of Time?

    This is Dr. Weston Price, a dentist. You may guess from the photo, or perhaps already knew, his work is not new in 2023. We usually feature current health experts here, but we’re taking a day to do a blast from the past, because his ideas endure today, and inform a lot of people’s health views. So, he’s a good one to at least know about.

    What was his deal?

    Dr. Price (1870–1948) wanted to study focal infection theory—the idea that repairing root canals allowed bacterial infections that caused everything from heart disease to arthritis. His solution was that the teeth should be extracted instead.

    This theory was popular in the 1920s, was challenged in the 1930s, ignored in the 1940s (the world was a bit busy), and by broad medical consensus anyway, rejected in the 1950s. But, while it was being challenged in the 1930s, Dr. Price decided to find more evidence for its support.

    The result was his famous world tour of peoples living traditional lifestyles without the influence of “modern” diet. His findings, and the conclusions he drew from them, extended to far more than just dental health.

    What did he find?

    Dr. Price found that people living traditional lifestyles, with their traditional diets based on locally-sourced foods, had much better overall health. Of course, he was a dentist and not a general practitioner, so aside from examining their teeth, he largely relied on self-reported diagnoses of illness, or lack thereof.

    In short: he found that people in places without modern medical institutions had fewer diagnoses of disease. From this, he concluded that incidence of disease was much lower.

    There was also an unexamined element of survivorship bias—an undiagnosed disease is more likely to be fatal, and he questioned only living people, which skewed the stats rather. Nor did he examine infant mortality rate nor adult life expectancy, both of which were not great.

    Was it all useless, then?

    Actually no! He did hit upon some observations that have stood the test of time:

    • He correctly concluded that modern diets with sugar and white flour were ruinous to the health.
    • He correctly concluded that locally-sourced food, and grass-fed in the case of pastoral farming, tended to have much more nutritional value than the mass-produced results of intensive farming.
    • He correctly concluded that many modern preservation methods robbed foods of their nutrients.
    • He correctly concluded that many grains and seeds are more nutritions when fermented/soaked/sprouted.

    About that “locally-sourced food”: the reason locally-sourced food tends to be more nutritious is that it has required less in the way of preservation for a long trip around the world, and will also tend to be fresher.

    On the other hand, this does mean a lot of the foods that Dr. Price recommends are very much subject to availability. It may well be true that the Inuit people do not eat a lot of fruit and veg (which mostly do not grow there), but if you live in Nevada, maybe locally-sourced whale fat is just as difficult to find.

    One person’s “this fatty organ meat contains the vitamin C we need” may be another person’s “that’s great; I have an apple tree in my garden though”.

    Want to learn more?

    Dr. Price’s most influential work is his magnum opus, “Nutrition and Physical Degeneration”. It’s a fascinating book, but do be warned, it was written by a rich white man in 1939 and the writing is as racist as you might expect. Even when making favourable comparisons, the tone is very much “and here is what these savages are doing well”.

    If you don’t fancy reading all that, here are two other sources about Weston Price’s work and conclusions, presented for balance:

    Enjoy!

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  • Kiwi Fruit vs Pineapple – Which is Healthier?

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    Our Verdict

    When comparing kiwi fruit to pineapple, we picked the kiwi.

    Why?

    In terms of macros, they’re mostly quite comparable, being fruits made of mostly water, and a similar carb count (slightly different proportions of sugar types, but nothing that throws out the end result, and the GI is low for both). Technically kiwi has twice the protein, but they are fruits and “twice the protein” means “0.5g difference per 100g”. Aside from that, and more meaningfully, kiwi also has twice the fiber.

    When it comes to vitamins, kiwi has more of vitamins A, B9, C, E, K, and choline, while pineapple has more of vitamins B1, B2, B3, B5, and B6. This would be a marginal (6:5) win for kiwi, but kiwi’s margins of difference are greater per vitamin, including 72x more vitamin E (with a cupful giving 29% of the RDA, vs a cupful of pineapple giving 0.4% of the RDA) and 57x more vitamin K (with a cupful giving a day’s RDA, vs a cupful of pineapple giving a little under 2% of the RDA). So, this is a fair win for kiwi.

    In the category of minerals, things are clear: kiwi has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while pineapple has more manganese. An overwhelming win for kiwi.

    Looking at their respective anti-inflammatory powers, pineapple has its special bromelain enzymes, which is a point in its favour, but when it comes to actual polyphenols, the two fruits are quite balanced, with kiwi’s flavonoids vs pineapple’s lignans.

    Adding up the sections, it’s a clear win for kiwi—but pineapple is a very respectable fruit too (especially because of its bromelain content), so do enjoy both!

    Want to learn more?

    You might like to read:

    Bromelain vs Inflammation & Much More

    Take care!

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  • What happens in my brain when I get a migraine? And what medications can I use to treat it?

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    Migraine is many things, but one thing it’s not is “just a headache”.

    “Migraine” comes from the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided.

    Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function.

    Migraine is a disease with a huge personal and societal impact. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health.

    Francisco Gonzelez/Unsplash

    What’s happening in my brain?

    The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply:

    The earliest phase is called the prodrome. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision.

    The hypothalamus is shown here in red. Blamb/Shutterstock

    Next is the aura phase, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands.

    In the headache phase, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache.

    Finally, the postdromal phase occurs after the headache resolves and commonly involves changes in mood and energy.

    What can you do about the acute attack?

    A useful way to conceive of migraine treatment is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect.

    https://datawrapper.dwcdn.net/Pj1sC

    Aspirin

    For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication.

    Triptans

    For moderate to severe attacks, the mainstay of treatment is a class of medications called “triptans”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals.

    Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action.

    The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action).

    As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke.

    Nurse takes blood pressure
    Triptans should be used cautiously in patients with heart disease. CDC/Unsplash

    Gepants

    Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”.

    Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them.

    They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke.

    Ditans

    Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack.

    However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a cost of approximately A$300 for eight wafers.

    What about preventing migraines?

    The first step is to see if lifestyle changes can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol.

    Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month benefit the most from starting preventives.

    Pharmacy assistant serves customer
    Some people will take medicines to prevent migraines. Tbel Abuseridze/Unsplash

    Almost all migraine preventives have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include:

    • tablets that lower blood pressure (candesartan, metoprolol, propranolol)
    • antidepressants (amitriptyline, venlafaxine)
    • anticonvulsants (sodium valproate, topiramate).

    Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone.

    For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached.

    It is rare for noticeable benefits to be seen immediately, but with time these drugs typically reduce migraine frequency by 50% or more.


    https://datawrapper.dwcdn.net/jxajY

    ‘Nothing works for me!’

    In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications block the action of CGRP.

    The most common PBS-listed anti-CGRP medications are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections.

    These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also effective and PBS-listed for chronic migraine) which must be administered by a trained specialist.

    Up to half of adolescents and one-third of young adults are needle-phobic. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away.

    Data over the past five years suggest anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives.

    Nonetheless, these are used only after a number of cheaper and more readily available first-line treatments (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.

    Mark Slee, Associate Professor, Clinical Academic Neurologist, Flinders University and Anthony Khoo, Lecturer, Flinders University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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