New hope for mi­graine

A pre­ven­ta­tive treat­ment is not far away

Prevention (Australia) - - In This Issue - BY STEPHANIE OSFIELD

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.

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