A new ap­proach to treat­ing mi­graines


Good Health Choices - - Content -

Mi­graine has plagued suf­fer­ers and puz­zled doc­tors for cen­turies. And it’s the third most com­mon con­di­tion in the world. For one in five women – and one in 15 men – the thun­der­ing headache in­ten­si­fied by the slight­est move­ment, the crip­pling nausea and some­times vom­it­ing, the acute sen­si­tiv­ity to light, sound, smells and/or touch, are all too fa­mil­iar. But mi­graine isn’t just a headache. Doc­tors now recog­nise it’s a com­plex neu­ro­log­i­cal con­di­tion with sev­eral stages.

“New re­search tech­niques, plus the ad­vent of sen­si­tive MRI scans, are lead­ing to a greater un­der­stand­ing of un­der­ly­ing mech­a­nisms,” says lead­ing mi­graine ex­pert Pro­fes­sor Pe­ter Goadsby.

And the good news is, this is lead­ing to new treat­ments.

What causes mi­graine?

Un­til re­cently, mi­graine was at­trib­uted to widen­ing of blood ves­sels. But ex­perts now be­lieve it re­sults from brain re­gions be­com­ing over-sen­si­tive to in­ter­nal or ex­ter­nal changes such as de­hy­dra­tion, sleep de­pri­va­tion, skip­ping a meal, sun­light, changes in weather, or cer­tain foods. This causes cells in the trigem­i­nal nerve – the brain’s largest nerve serv­ing the face – to re­lease pain-pro­duc­ing chem­i­cals, mak­ing the nerves around blood ves­sels acutely sen­si­tive. This leads to the nor­mal pul­sat­ing of blood in those ves­sels be­ing felt as ex­cru­ci­at­ing, throb­bing pain. Be­fore the pain sets in, one in five peo­ple ex­pe­ri­ence auras – un­nerv­ing neu­ro­log­i­cal dis­tur­bances such as dark or coloured spots, sparkles, ‘stars’ and zigzag lines, numb­ness or tin­gling, tin­ni­tus or touch dis­tur­bances, dizzi­ness and ver­tigo.

Are genes to blame?

Many mi­graine suf­fer­ers have a par­ent or sib­ling with the con­di­tion, and it’s thought genes could be the bul­lets that load the gun. Three po­ten­tial ge­netic cul­prits that in­crease ex­citabil­ity in the brain have been iden­ti­fied, but other genes are likely in­volved too, which in­ter­act with the en­vi­ron­ment to cause mi­graine.

Hor­mone headache?

Men­strual mi­graines, which oc­cur only around men­stru­a­tion, af­fect two in five women. Thought to be trig­gered by the fall in oe­stro­gen lev­els pre­men­stru­a­tion, they may be ex­ac­er­bated by prostaglandins, fatty acids in­volved in pain. Un­for­tu­nately, menopause doesn’t al­ways bring re­lief, with around 45 per cent re­port­ing mi­graine wors­en­ing, of­ten after a pe­riod of rel­a­tive sta­bil­ity. HRT helps some peo­ple but ex­ac­er­bates the con­di­tion for oth­ers. Cloni­dine (dixarit), a high blood pres­sure drug, also li­censed for hot flushes, may help too. But, says Dr Bren­dan Davies, “mi­graine is a bit of a chameleon. Post-menopause, it can lose in­ten­sity or morph into other symp­toms, such as dizzi­ness, light or noise sen­si­tiv­ity, fa­tigue, sleep dis­tur­bances, sen­si­tive skin and mood changes.”

Treat­ment tac­tics

Var­i­ous treat­ments can help. The most pop­u­lar are over-the-counter painkillers or anti-in­flam­ma­to­ries, anti-nausea medicines, low-dose aspirin or trip­tans (drugs that in­ter­fere with cer­tain brain chem­i­cals), ei­ther alone or in com­bi­na­tion. If symp­toms are se­verely dis­rupt­ing life, anti-seizure med­i­ca­tions, blood pres­sure drugs, cer­tain an­tide­pres­sants and/or bo­tulinum in­jec­tions may be pre­scribed to try to pre­vent at­tacks. None is per­fect, but un­der­stand­ing the pat­tern of at­tacks can help your doc­tor tai­lor treat­ment.

In­jec­tion of hope

Four in­jectable drugs, the first ever to specif­i­cally tar­get mi­graines, are show­ing promis­ing re­sults. Known as CGRP mon­o­clonal an­ti­bod­ies, they re­duce the ef­fects of a key cul­prit in mi­graine pain, a com­pound called cal­ci­tonin gene-re­lated pep­tide (CGRP). “It’s a very ex­cit­ing time as at last we have the po­ten­tial of gen­uinely ground­break­ing new treat­ments ca­pa­ble of stop­ping mi­graine be­fore it starts,” says Davies, chief UK in­ves­ti­ga­tor for two of the new drugs, which would be ad­min­is­tered via monthly in­jec­tion.

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