A new approach to treating migraines
A REVOLUTION IN OUR UNDERSTANDING OF MIGRAINE IS LEADING TO NEW APPROACHES TO ONE OF THE MOST COMMON CAUSES OF PAIN. PATSY WESTCOTT INVESTIGATES
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.
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.”
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.