‘This is a milestone’
Conn. doctors make migraine breakthrough
Migraines have baffled humankind at least as far back as the ancient Egyptians, who blamed the excruciating headaches, and their often-accompanying visual auras and nausea, on the supernatural.
Now, in a development doctors are calling revolutionary, an international group of neurologists has deciphered the mystery of why people get migraines and, in doing so, has determined how to greatly reduce their frequency and severity.
The discovery “has revolutionized our treatment of migraine,” said Dr. P. Christopher H. Gottschalk, a neurologist at Yale Medicine and assistant professor of neurology at the Yale School of Medicine.
“I’m witnessing a change in the landscape,” said Dr. Sandhya Mehla, a headache specialist and vascular neurologist with Hartford HealthCare Medical Group. “I would say this is a milestone.”
The discovery, the fruit of 40 years of research, won four scientists in Sweden, Denmark and the United States the 2021 Brain Prize, the world’s most prestigious award in neurology.
It’s already leading to treatments that can significantly reduce migraine attacks as well as minimize any breakthrough headaches. The new class of drugs has the potential to change the lives of the 1 billion migraine sufferers around the globe.
Linda Kelley-Dodd’s life has already been transformed. The Bristol resident started having headaches as a teenager, although, she said, “It wasn’t until I was in my 20s that I really noticed,
this is a problem for me, this is really, truly a problem.”
Before becoming one of Gottschalk’s patients, KelleyDodd, 49, who’s the costume project coordinator at the David Geffen School of Drama at Yale, experienced all the hallmarks of migraine. In addition to headaches, she had auras, nausea, smell sensitivity and, especially, light sensitivity, which forced her to wear sunglasses when she drove home at night because the headlights of oncoming cars were so painful.
Her headaches varied. “Sometimes they would range from just a low-grade headache to a full-on I-can’tdeal-with-the-world-pleasejust-somebody-make-it-goaway.”
She carried an arsenal to help “at least just tamp down the pain so I could semi-function” and “plowed through Excedrin Migraine” for days at a time, “jacking” herself up on Coca-Cola, aspirin and ibuprofen.
A year and a half ago, however, Kelley-Dodd started monoclonal antibody therapy, injecting herself once a month with a drug called Emgality.
“I can’t talk about how amazing this drug is,” she said. “It has completely changed my life.”
Cause of Migraine
Migraine, the scientists found, is the result of an interaction between the largest nerve in the head, called the trigeminal, and the meninges, the thin membrane surrounding the brain that senses pain.
When fibers in the trigeminal nerve are activated, they emit powerful chemical signals that dilate blood vessels in the meninges. The meninges then becomes inflamed, triggering a migraine.
What activates the trigeminal fibers is highly individualistic. In her essay, “In Bed,” Joan Didion, a lifelong migraineur, wrote, “Almost anything can trigger a specific attack of migraine: stress, allergy, fatigue, an abrupt change in barometric pressure, a contretemps over a parking ticket. A flashing light. A fire drill.”
The researchers found that blocking those chemical signals, which they named calcitonin gene-related peptides (CGRP), can abort a migraine. This is what monoclonal antibodies, or CGRP antagonists, do.
Mehla of the Hartford HealthCare Medical Group called the discovery “a milestone” because it led to “the first medications that were specifically designed and tested only for migraine.” In the past, she said, doctors have had to treat their patients with medications that were developed for other medical conditions.
“Migraine is in our genes, so it really cannot be cured,” she said. But these new medications can greatly reduce their frequency.
Another huge benefit, said Gottschalk, is that their side effects “have been practically zero.”