New hope for migraine

A preventative treatment is not far away

When telltale flashing lights, facial numbness or tingling signals that a migraine is on its way, most people pop painkillers and other medications such as anti-nausea tablets to reduce their symptoms and discomfort. They have an arsenal of tools to help them ride out a migraine episode but when it comes to prevention, solutions have been elusive – until now.

NOVEL APPROACH

For many migraine sufferers, even the thought of an impending attack can be incredibly stressful. So the idea of a new breed of drugs that may head them off at the pass is very welcome. Scientists have developed a type of medication specifically aimed at preventing migraine. An immunotherapy treatment, these drugs counteract a molecule that’s released during a migraine and they have been found successful in reducing the number of days that chronic migraine sufferers experience headaches. The treatment works by blocking CGRP – a protein involved in the transmission of pain. During a migraine episode, this protein normally binds to receptors located in the sensory nerves of the face and brain. Inflammation occurs and the blood vessels expand, worsening the migraine pain, which becomes excruciating. After years of clinical trials, doctors and scientists expect this type of medication to be most helpful for people with severely debilitating migraine.

“CGRP medications are one of the most exciting developments in treating migraine in 20 years,” says Richard Stark, adjunct clinical associate professor at the Monash University

Van Cleef Centre for Nervous Diseases.

One version of the new CGRP drug was approved in the US recently. Called Aimovig (also known as erenumab) it involves once-a-month injections. Although the drug has been approved by the Therapeutic Goods Administration (TGA) here in Australia, allowing doctors to prescribe it, there are no supplies yet in this country. It is hoped the migraine treatment will be available by November but as it isn’t on the Pharmaceutical Benefits Scheme (PBS), the cost will be quite prohibitive at about US$6,900 annually. The committee that advises the Federal Government about items that should go on the PBS has collected submissions about the level of need but they are yet to make a decision on this drug.

NEW FRONTIERS

In the meantime, a selection of other treatments have emerged in recent years and proved effective in reducing the frequency and intensity of migraines:

Botox injections

Better known as a cosmetic treatment, Botox was approved several years ago by the TGA specifically for use in the treatment of migraines. “Around every three months, Botox is injected by a medical doctor such as a neurologist, into the muscles at approximately 31 different points of the face, head and neck to reduce inflammation and encourage relaxation in some muscles,” explains neurologist Dr Karl Ng, an associate professor at the University of Sydney School of Medicine. Unfortunately, not all insurance companies cover the cost of these injections and some migraine sufferers say the effects can wear off between treatments. Yet some do find Botox provides enormous relief from chronic migraine episodes.

Trigger exposure

Often the advice is to avoid triggers but that’s not always possible, so one approach is to try to desensitise or increase tolerance for the triggers by gradual exposure to them. This idea was explored by scientists at Monash University with their MaTCH (Mastery of Triggers to Conquer Headaches) research. “Regular exposure to triggers such as hot weather or perfume can lower some people’s extreme sensitivity, helping reduce their number of migraine episodes,” says Professor Paul Martin, director of research in the School of Psychology at the Australian National University, who was involved in the MaTCH trials.

Folic acid

When women who suffer from migraine eat foods fortified with folic acid they experience a 14 per cent reduction in migraine severity, research from Queensland’s Griffith University shows. So give your diet a green makeover. “Eat more leafy greens (such as spinach, kale, broccoli and Asian greens) and add more legumes (such as lentils, chickpeas and a variety of beans) to salads, soups and stews,” suggests dietitian Brooke Longfield.

“Wholegrain breads and breakfast cereals are also good choices, preferably those fortified with folic acid. Foods high in these nutrients are also good for bowel health, fibre intake and weight maintenance, so they also have many other health benefits,” Longfield adds.

Electrical stimulation devices

These use electrical signals to stimulate nerves on the head and the back of the neck and this can sometimes help to reduce the pain and intensity of a migraine. They include machines like the Cefaly device. This headband is a type of TENS (transcutaneous electrical nerve stimulation) machine that migraine sufferers can use for 20 minutes a day to prevent headaches. “The most accepted theory about how it works is that it stimulates the trigeminal nerve which supplies sensations to the face and head,

altering pain messages and possibly stimulating endorphins, our natural painkillers, but more research is needed to confirm this,” Edmunds says.

Magnesium supplementation

Magnesium acts as a muscle relaxant. Research also shows that migraine sufferers are more likely to be deficient in magnesium. Studies suggest tablets that combine magnesium with vitamin B2 and coenzyme Q10 can help reduce episodes of migraine in some people.

Green light therapy

Harvard research has shown that exposing migraine sufferers who are light sensitive to a particular wavelength of green light can help reduce sensitivity and also reduce the severity of their migraines.

Temperature changes

Gently applying cooling or warming currents inside the ear canal for 20 minutes can provide migraine relief for some, according to research conducted in the UK. The volunteers wore special padded headphones that delivered the thermal currents via special earpieces. The temperature change appears to alter activity in an area called the brain stem, which is linked to the onset of migraines.

Surgery

Special surgery that decompresses the nerves that trigger migraines or removes a portion of them can, in the right candidates, cause an 80 per cent reduction in migraine symptoms, US research shows.

THE FUTURE

Prevention is what sufferers really need and they are looking to science to find solutions, such as the CGRP medications. “They are a novel approach, and preliminary results are promising,” Stark explains of these new drugs. “They are not just an improvement on an older class of drugs. They are a completely new treatment approach that works on different pathways in the brain.” With new drugs like this, hope is definitely there for an accessible and affordable treatment that will keep the pain away.