4 TRIGGERS TO AGONY

Chemicals in red wine, yoghurt, and cheese trigger migraines in some patients. Hormonal swings and chronic stress can also make the brain release the CGRP protein that causes a migraine attack.

FOOD/DRINK: Red wine contains migraine substance 1 Chocolate and red wine include phenylethylamine, which can trigger an attack in many migraine patients. Tyramine, that is found in yoghurt, cheese, pickled herring, and other fermented food, could have the same effect, but not all migraine patients are equally sensitive, and some are not affected by the substances. HORMONES: Pregnant women are vulnerable 2 Right before and during your period, when the oestrogen level is the lowest, many women are particularly subjected to migraines. The same is the case during pregnancy and menopause, when the hormone level also changes markedly. STRESS: Nerve paths change 3 Many people experience that they have more migraines, when they are under stress at work or at home, but the theory is not supported by much scientific evidence. Chronic stress could affect the brain’s network of nerve paths, perhaps influencing migraine development. ANOXIA: Brain wave makes nerves sensitive 4 When oxygen levels drop, a wave flows through the brain. Behind the wave front, the brain cells are depressed, whereas the cells in front are activated. It's called CSD (Cortical Spreading Depression), and is sometimes observed before migraine attacks. But the link is uncertain.

The one side of the woman's head hurts intensely. Sunlight flows in through the open window, and she senses how the light enters her brain, making the pain worse. Outside, birds are singing, but the sound hits her brain like small hammer blows, causing nausea. She would like to close the window and draw the curtains, but at the least motion, the pain intensifies, so she has to lie still in her bed.

Like some one billion other people in the world, the woman suffers from migraine. The severe headache costs the world population 30+ million active years, because the pain prevents people from going to work and carrying out daily activities. Most migraine attacks last for a few hours, but migraine can go on for up to three days. How often the attacks occur varies from individual to individual. Some get migraines a few days apart, whereas others only have attacks a few times a year, but 2-4 attacks a month is common. Particulaly middle-aged people in the Western World suffer from migraines, and women are affected 23 times as often as men.

Although so many people have the disease, doctors and scientists have still not fully understood why the pain develops, and many patients have had difficulties finding an efficient treatment. But in May 2018, the American health authorities approved a new drug that can halve the number of migraine attacks in patients. The clinical testing prior to the approvement showed that 26 % of the patients reacted to the maximum extent to the treatment and were completely cured of their migraines. Erenumab, the new drug, is now also on its way to being approved in the EU, and it could be the first of a series of groundbreaking treatments for migraine patients throughout the world.

Erenumab is an antibody that works by neutralizing the effect of a small protein, CGRP, which in recent years has been named the main cause of migraine. In the vast majority of people, it is completely harmless, but in migraine patients, it makes the sensory nerves of the head extremely sensitive, and scientists are now trying to find the answer to what goes wrong.

Drilled holes to ease the pain

In the Middle Ages, migraine was considered to be evil spirits in the head, and some patients had holes drilled in their skulls to chase the spirits out and be relieved of their sufferings. Not until 1918, doctors developed a drug against the severe headache in the shape of ergotamine, which was extracted from the Claviceps purpurea fungus.

Ergotamine is still used, and just like the more recent group of drugs, triptans, it makes the blood vessels around the brain contract. In 1982, scientists discovered the natural CGRP protein and subsequently revealed that it existed in extra large quantities during a migraine attack and had a marked ability to expand the blood vessels. So, the causal connection seems clear, and for many years, it was the general belief that migraines developed, when the CGRP protein made the blood vessels expand, so the blood supply to the brain was larger than what it normally is.

In 2008, neurologist Guus Schoonman from the Leiden University Medical Center in the Netherlands however used a special type of MRI brain scans to study the blood flow of 27 migraine patients’ brains. The scientist took advantage of the fact that small quantities of nitroglycerine are known to both expand the blood vessels and cause migraine attacks. The scan results surprisingly showed that the blood vessels did only expand during the first minutes after the injection of nitroglycerine, and that the blood flow was back to the normal level, when the migraine attract began after 1.5-5 hours.

So, the painful headache could not be due to the fact that major quantities of blood flowed through the brain. Scientists had to search for a new explanation.

Hypersensitive nerves

Recent research indicates that the CGRP protein causes the pain during a migraine attack, but in a very different way than scientists used to believe. The protein’s effect on the blood vessels around the brain is not part of the explanation. Instead, the migraine attack is caused by another function of the CGRP protein. It affects the sensory nerves of the face, the scalp, and the membranes that protect the brain, so the nerves become extra sensitive and sharpen the senses as much as