New therapies offer hope to migraine sufferers
Dear Doctor: I hate having migraines. The pain is brutal, they knock me down for days and everyone thinks I’m just having a bad headache. Why do they happen? Can you tell me about any new therapies?
Dear Reader: For anyone lucky enough to never have had a migraine, it’s much more than just a bad headache. Migraine is an extended, often debilitating full-body experience. Severe throbbing head pain is typically accompanied by nausea and sometimes vomiting. Other symptoms are extreme sensitivity to light, motion and sound. A migraine can last for several hours or several days.
Many people also have a range of symptoms before an attack. Known as a migraine aura, it’s a cluster of visual, sensory and cognitive disturbances such as flashes of light, prickling sensations on the skin and lapses in speech or reasoning. Migraines often conclude with a phase known as postdrome, sometimes known as a migraine hangover. Postdrome can include nausea, continued sensitivity to external stimuli, body aches, exhaustion and problems concentrating. In addition, studies show that individuals with chronic migraine are at higher risk of anxiety and depression.
Despite having been studied for at least 3,000 years, we still don’t have a definitive answer for what causes migraines in an estimated 3 billion people worldwide. It is known to be a complex neurological disorder, likely with a genetic component. Women are three times more likely to suffer from migraines than men.
Behaviors known as “triggers” can launch a migraine. These include a skipped meal, irregular sleep, changes to caffeine intake and emotional or physical stress. Foods associated with migraine include chocolate, fermented foods, aged cheeses, alcohol in general and red wine in particular. Birth control pills and antidepressants are also believed to have an effect on migraine frequency. Unfortunately over-the-counter pain medications, which can provide relief, can also result in a “rebound” headache.
In the past, migraine patients relied on a variety of medications for relief, the majority of them created to treat other conditions. These include antidepressants, hypertension medicines, Botox injections, opioids and a class of drugs called triptans. Vitamins and supplements such as vitamin B2, magnesium, Coenzyme Q10 and melatonin have proven helpful. And although aerobic exercise is known to reduce the frequency and severity of attacks, people who have regular migraines often feel too poorly to exercise regularly.
Most recently, a new class of drugs known as monoclonal antibodies, the first medications developed specifically for migraine sufferers, are offering hope. The FDA approved three such treatments earlier this year. Delivered via a monthly injection, they have been shown to reduce the number of migraine days in some patients by half. They’re costly and don’t work for everyone, but it’s worth checking with your doctor to see if they might be right for you.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.