N1‑Headache™ in collaboration with patients, clinicians and patient associations has generated findings that deepen understanding of migraine.

Do people who have continuous migraine also have triggers and protectors?

Individuals with chronic migraine have 15 or more headaches per month, often resulting in days of continuous migraine. We are interested in understanding the impact of the most suspected migraine trigger, stress, on chronic migraine.

In a Curelator™ study¹ with 136 participants analyzing more than 8,200 migraine days over three months using the N1-Headache™ App, it was concluded that on average higher perceived stress increased the odds of higher severity of pain. Although stress has been traditionally seen as a trigger (with high levels preceding attack onset), the day-to-day relationship between perceived stress and peak pain severity proved to be more complex, with most participants showing amplified pain severity on days with higher stress. Curelator™ has proposed referring to such factors as Severity Amplifiers™.

However, there was great variation within and between individuals. Some individuals showed no relationship between stress and peak pain severity. In other individuals lower peak severity was associated with days with higher perceived stress. Factors that are associated with lower peak severity (such as stress in those individuals) are referred to as Severity Attenuators™.

Everybody is different! This underscores the need for each individual to understand their own unique experience and to personally tailor treatments. Please follow the following link to read more about this novel study.

In a Curelator™ study¹ with 136 participants analyzing more than 8,200 migraine days over three months using the N1-Headache™ App, it was concluded that on average higher perceived stress increased the odds of higher severity of pain. Although stress has been traditionally seen as a trigger (with high levels preceding attack onset), the day-to-day relationship between perceived stress and peak pain severity proved to be more complex, with most participants showing amplified pain severity on days with higher stress. Curelator™ has proposed referring to such factors as Severity Amplifiers™.

However, there was great variation within and between individuals. Some individuals showed no relationship between stress and peak pain severity. In other individuals lower peak severity was associated with days with higher perceived stress. Factors that are associated with lower peak severity (such as stress in those individuals) are referred to as Severity Attenuators™.

Everybody is different! This underscores the need for each individual to understand their own unique experience and to personally tailor treatments. Please follow the following link to read more about this novel study.

¹ Vives-Mestres, M, Casanova, A, Hershey, AD, Orr, SL. Perceived stress and pain severity in individuals with chronic migraine: A longitudinal cohort study using daily prospective diary data.. Headache. 2021; 61: 1245 – 1254. DOI: 10.1111/head.14199

How accurate are people with migraine at predicting their attacks? Not very.

We classified good predictors as those who predicted both migraine days and migraine-free days with >75% accuracy. Only 5% of migraineurs were able to do so.

Prieto P, Boucher G, Mian A, Rosen N. Individual self-prediction of migraine attacks: longitudinal analysis of cohort of migraine patients using a digital platform.. Cephalalgia 2017; 37 (1S): 275.

Prieto P, Boucher G, Mian A, Rosen N. Individual self-prediction of migraine attacks: longitudinal analysis of cohort of migraine patients using a digital platform.. Journal of Headache and Pain 2017; 18 (S1): P60.

Identifying ‘protectors’ may be a useful addition to the management of migraine, potentially of equal importance to identifying triggers.

N1‑Headache™ data shows for the first time, potential ‘protectors,’ the spectrum of factors associated with reduced incidence of migraine attacks.

Donoghue S, Mian A, Albert M, Boucher G, Peris F, Wöber C. Identification of ‘protectors’ against migraine attacks using Curelator Headache^®.Cephalalgia 2016; Vol. 36(1S) 18–19

N1‑Headache™ could be used to alert patients and their clinicians about potential overuse of acute medications which can lead to medication overuse headache (MOH).

A 2017 N1‑Headache™ study on medication overuse patterns determined that about 20 percent of migraine patients were overusing acute headache medications in the UK, compared to almost 30 percent of migraine patients in the US.

Prieto P, Boucher G and Donoghue S, Goadsby PJ and Silberstein SD. Medication use and overuse patterns in Curelator Headache^® US and UK users..Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303

It is not ununusual for people with migraine to suspect risk factors not associated with their attacks.

A study of 390 people who used N1‑Headache™ for 90 days showed that only 16% of suspected triggers were shown to be statistically associated with attack occurrence.

Donoghue S, Martin PR, Boucher G, Peris F, Mian A.Migraineurs suspected triggers vs associations statistically determined using a digital platform.Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303

To validate our novel statistical approach, N1‑Headache™ applied a N=1 statistical algorithm to a 326 migraine patient database from the benchmark PAMINA study.

The results show an unexpectedly high degree of variability in individual risk profiles: 85% of the study patients had unique trigger profiles and no one had the aggregate average profile.

Donoghue S, Peris F, Torres F, Mian A, Wöber C.Statistical methodology for determining potential migraine trigger factors in individuals..Headache: The Journal of Head and Face Pain 2016; 56 (S1): 36-37.

It is widely believed that chocolate can trigger migraine attacks, but our data suggests its true impact may be far less than suspected.

Chocolate increased the risk of migraine attacks in less than 2% of N1‑Headache™ users.

Donoghue, S, Vives-Mestres, M, Silberstein, SD. Chocolate as a risk factor for migraine attacks: an exploration..Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 109-110.

Alcohol and tyramine are widely suspected as migraine triggers - but are they really?

In these prospective studies neither alcohol nor tyramine was found to be commonly associated with migraine attacks.

Prieto P, Boucher G, Donoghue S, Mian A, Rosen N. Alcohol as a risk factor for migraine attacks: an exploration. Cephalalgia 2017; 37 (1S): 198.

Prieto P, Boucher G, Donoghue S, Mian A, Rosen N. Alcohol as a risk factor for migraine attacks: an exploration. Journal of Headache and Pain 2017; 18 (S1): P58

Donoghue S, Boucher G, Peris F, Mian A, MacGregor A. Tyramine as a risk factor for migraine attacks: an exploration. Headache: The Journal of Head and Face Pain 2017; 57 (S3): 194–195 / Cephalalgia 2017; 37 (1S): 282-283.

In a group of 254 users, N1‑Headache™ identified a number of “protectors,” which are commonly thought to be “triggers.”

Surprisingly, the following factors were associated with decreasing the risk of migraine attack in the specified number of users: alcohol (15); travel (14); stress (12); bright lights (8); odors (6); and neck pain (5).

Donoghue S, Mian A, Albert M, Boucher G, Peris F. Identification of ‘protectors’ – factors associated with reduced risk of migraine attacks: some surprising observations and interpretations.. Headache: The Journal of Head and Face Pain 2016; 56 (S1): 36.

Previous studies at the population level define the risk of migraine increasing 2 days before until 3 days after the onset of menstruation.

By contrast, N1‑Headache™’s collection of daily data suggests that a ‘one size fits all’ window for analysis of the impact of menstruation on migraine is likely not valid for many individuals.

McGinley JS, Wirth RJ, Boucher G, Buse DC, Donoghue S, Pavlovic J, MacGregor A, Lipton RB. Redefining the Time Window of Perimenstrual Migraine Days Reveals Additional Inter- and Intra-Individual Differences.Cephalalgia 2017; Vol. 37(1S) 172–208 (* Poster selected as the top submission for a special presentation)

Determining a statistical association between stress and migraine attacks in individuals with chronic migraine is often not possible because attacks are not distinct.

Using an alternative approach, N1‑Headache™ detected an association between stress and “high” pain days (i.e., headache pain intensity) in more than one-quarter of individuals with chronic migraine.

Donoghue S, Shulman KJ, Vives-Mestres M. Is stress associated with pain severity in chronic migraine? Headache: The Journal of Head and Face Pain. 2019; 59 (S1): 165-166

In some individuals with migraine, excessive yawning is a sensitive predictor of an attack that may provide an opportunity for early intervention.

Out of 285 individuals with migraine registered to use N1‑Headache™ and tracking for 90 days or more, excessive yawning was associated with increased risk of migraine attack in 72 (25.3%), with decreased risk in 4 (1.4%).

Donoghue S, Vives-Mestres M, MacGregor A. Correlation of migraine attacks with neck pain and tension. The Journal of Headache and Pain 2018, 19 (S1): S27