The N1-Headache App: Figuring Out Migraine Triggers!
Neuroscience is challenging because we can’t always provide a disease cure or resolution to some patients. But, we can always work with them by listening and never giving up. That makes a real and tangible difference! - Kenneth Shulman, DO
It’s a fascinating app, and I was recently privileged to have the opportunity to sit down and chat with Kenneth Shulman, DO, VP of Medical Affairs at Curelator and the N1-Headache app. Dr. Shulman is a clinical neurologist and neuroscientist with over two decades of experience working with the migraine community both in clinical practice and also in the pharmaceutical industry. While he does not live with migraine himself, he loves being involved in this field.
Here are some of the questions I wanted to ask Dr. Shulman which may help you decide if N-1 Headache is a good option for you!
Can you tell us a bit about Curelator?
Curelator is a digital healthcare company that has produced a platform called N1-Headache. This is an app with a clinician dashboard that is focused solely on helping people with headache disorders as well as their healthcare providers.
How does N1-Headache help?
The app allows users to easily collect daily information about factors that are associated with risk of migraine attacks. Those factors include mood, diet, physical activity, weather, environment, scents, and more. It also collects important information about their actual migraine attacks.
N1-Headache takes the data and performs individualized analyses to help identify the factors that can increase (Trigger), decrease (Protector), or have no association (NA) with migraine attacks. This gives the user personalized information that helps show how the disease is expressed for them individually.
Can you explain more about why we need such a personalized approach?
Migraine is a very complex disease and all people are different. Obviously this is one of the things makes managing it a big challenge. After the first 90 days of use, N1-Headache is able to create 3 personalized maps. Triggers, Protectors, and NA (for factors that appear to not impact migraine attacks either way). People can then use this information to take action which can potentially help them manage migraine attacks as well as see patterns.
How easy is it to use N1-Headache?
Every day, the patient uses the app’s simple interface to enter information about factors that can influence the occurrence and severity of migraine attacks. In addition, on headache days there are specific questions about the pain and other associated symptoms, as well as treatment options used.
Patients are able to download or print a personal analytic report in PDF format to share with their doctor or even to provide documentation to their insurance company if needed. It’s a simple process with easy-to-answer questions that only takes a couple of minutes each day!
Tracking for 90 days sounds a bit intimidating! What happens if we miss a few days?
It’s definitely true that daily tracking for the first 90 days produces the best results and the most accurate personalized “maps.” However, missing a few days shouldn’t be a problem as long as there are enough attacks recorded and enough exposure to the factors/potential triggers in question.
Let’s talk about accuracy! Can N1-Headache really figure out what are triggers and what are not?
It’s important to bear in mind that the analysis reports risks but not necessarily direct causes. People often suspect they have many more triggers than they actually do, and the analysis can help narrow things down! However, if something looks “off” to you then you may need to enter more data or test it individually.
How do we get hold of the N1-Headache app?
A lifetime membership is available through the app store, both Android and iOS, for $50. The app is also available from many headache specialists for free as long as your doctor is enrolled in the N1-Headache program. Bear in mind that when you receive it for free your migraine information is shared with your doctor through the clinician dashboard. This helps them better understand and see the factors involved in your migraine. The paid version, however, is private, and you can choose to share as much or as little as you want with your doctor!
What are a couple of the more surprising things you’ve learned about migraine through this app?
It’s always interesting to see that everybody doesn’t have the same triggers. In addition, what could be a Trigger for one person could actually be a Protector for another! For example, we have found that chocolate is associated with migraine in only 5% of those studied, and in half of those, it is a protector! That’s going to be great news for some chocolate lovers! While MSG, artificial sweeteners, and red wine are triggers for some, these are not as common as previously suspected.
There are a variety of reasons that we may incorrectly suspect something is a trigger:
- We tend to look back at factors after the migraine attack
- There is an expectation that something is or should be a trigger.
- We may be exposed to a potential trigger during the prodrome phase of the migraine. That then leads us to conclude that it is causative when in fact it may not be!
What is the good news that you’ve learned from N1-Headache?
There are plenty of triggers that people cannot control. Those include weather, hormones, and certain environmental exposures. However, we have learned that there are other somewhat controllable factors that help fairly consistently. Those include good sleep hygiene, regular eating, staying hydrated, and reducing stress. All of those have a positive impact on migraine attacks and may even help reduce the impact of uncontrollable factors!
Any final thoughts?
Migraine is such an individualized disease! It simply doesn’t make sense that all of the migraine triggers people read about, and have historically been advised to avoid, should affect everyone all the time. We think that many people are unnecessarily avoiding things which may not actually be triggers for them. The concern with this is that it adds unnecessary pressure in trying to manage an already difficult disease.
In short, using N1-Headache can help people with migraine explore their own personal factors to discover what really may be their own Triggers, Protectors, or non-associated items. And that is good news!
Have you tried N1-Headache? If so, did the personalized maps help you manage migraine better? If not, are you interested in trying it?
When was your last migraine check-up?