J. Robinson Group Blog
September 25, 2017

Migraines Part II: With Discovery of Cause, Search Begins for New Treatments

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

Part I of this blog series looked at headaches versus migraines and current treatments. Now, Part II will explore new research and potentially life-changing new approaches for the worst kind of head pain.

migraine

After decades of study, the root cause of migraines was discovered early in the 21st century, opening the door to new treatments.

In 2006, the National Institutes of Health announced that the neuropeptide calcitonin gene-related peptide, also known as CGRP, “plays an integral role in the pathophysiology of migraine.” This discovery essentially means that migraines are not a vascular problem, as long suspected, but rather a neurological one.

The discovery also challenges traditional treatments, including triptans, opioids and certain types of anti-inflammatory drugs.

In a 2012  article on News-Medical.net,  Dr. David Dodick MD, professor of neurology at the Mayo Clinic in Phoenix said, “Today we know that migraine is a largely inherited disorder characterized by physiological changes in the brain, and, if attacks occur with high frequency, structural alterations in the brain.”

How many people could be affected by this discovery? According to the World Health Organization, “Half to three quarters of adults aged 18–65 years in the world have had headache in the last year and, among those individuals, 30 percent or more have reported migraine.”

Several migraine treatments have emerged in the last few years. One method, marketed as the Cefaly device, affects the trigeminal nerve, which ends under the forehead. A headband delivers a low electric current to “calm” the nerve. The American Migraine Foundation, in a review done in December 2016, reported that about half the patients were satisfied with Cefaly, citing a significant reduction in migraine days per month. No serious side effects were reported. The device is to be used preventively for about 20 minutes per day.

A 2015 article in Medical News Today reported on a new treatment involving the application of a light anesthesia to a nerve bundle called the sphenopalatine ganglion, or SPG, at the back of the nose. The well-known pain reliever, lidocaine, is administered via a thin, flexible straw through a nostril.

Nonsystemic treatments are especially welcome for children who suffer from migraines. New research suggests that sphenopalatine ganglion, or SPG, blockade is effective and safe for treating migraines in children and teenagers. With this treatment, a short disruption of the SPG “resets” the headache circuit and breaks the cycle of severe headaches.

An even more revolutionary treatment may be around the corner in the form of drugs that block CGRP release are already in the clinical trial phase.  In February, the American Migraine Foundation reported that an injection of a drug identified as LY2951742 “could completely stop the attacks in about one-third of people with migraine.”

Migraine.com this summer noted that CGRP blockers could be on the market as early as 2018. Four rival companies – Amgen, Eli Lilly, Teva and Alder BioPharmaceuticals – are close to getting FDA approval. The business website Marketwatch said these new drugs could become a $10 billion market since aren’t a lot of options for treating migraine.

September 17, 2017

Migraines Part I: Researchers Focus on Triggers in Search for Cure

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

Part I of this blog series will look at headaches versus migraines and current treatments. Part II will explore new research and potentially life-changing new approaches for the worst kind of head pain.

woman with migraine

As bad as headaches are, a migraine is its own special kind of awful. Usually debilitating, and typified by severe head pain, nausea, dizziness and sensitivity to light, migraines can last several days. It is no wonder sufferers will do almost anything for relief.

But, as with many maladies, no one cure fits all. There is still no cure, per se, for migraines, despite the fact that, in the U.S., migraines affect about 16 percent of adults.  Adult premenopausal women are disproportionately affected, by a ratio of two to one.
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At the same time, recent discoveries about brain physiology and migraines have upended some basic assumptions and have launched a race for a completely new treatment.

Headaches have always been as common as they are mysterious. More often than not, sufferers have no idea why they get headaches or migraines.

However, for both conditions, identifying triggers could make a huge difference. Not only are there numerous and varied causes, there also are different types of headaches.

The Migraine Research Foundation has a lengthy list and a monthly “migraine in the news” column. Some subjects are: ponytail headache; children and migraines; genetic variants for susceptibility; migraine versus cluster headache; avoiding headaches when flying; and food triggers.

Sufferers are urged to keep a journal and track foods, environment, stimuli, alcohol and tobacco intake, medications and emotional state.  A paper published in 2016 in Science Daily notes that in a population of 326 patients who kept a detailed diary for 90 days, it was possible to identify possible migraine triggers in 87 percent of sufferers by performing personalized analyses.

Some common triggers are red wine, dehydration, certain food additives, fluctuations in the hormone estrogen, stress, changes in sleep patterns and even aged cheeses.

There are also differences between migraines and severe headaches, and the correct diagnosis is key to determining treatment. The Mayo Clinic says that, unlike headaches, migraines may be prefaced by visual disturbances called auras or symptoms like mood changes, constipation or frequent yawning.

The Medicinenet article Migraine vs Headache  and the Migraine Trust  are good places for sufferers to start their research.

As far as treatments go, there hadn’t been much new in quite a long time.

Several studies published in 2013 by the National Institutes of Health discuss the prevalence, impact, and treatment of headaches and migraines, defining them as a “major public health problem” since so many are affected. According to data from 2009, the most common treatment involved a class of drugs called Triptans. The study cited that Triptans accounted for almost 80 percent of antimigraine analgesics prescribed at office visits in 2009, nearly half of which were for sumatriptan.

Triptans work by “reversing blood vessel swelling” and come in different formulas and formulations.

The National Headache Foundation said that about half reported considerable pain relief from Triptans. Such drugs are most effective if taken at the earliest onset of a migraine. However, there may be some dangerous drug interactions.  Additionally, the study notes: “Many migraines were misdiagnosed or under diagnosed which can lead to inadequate treatment. When patients were diagnosed with migraine and prescribed a medication, more than half received narcotics and opioid analgesics, which are not approved by the FDA for the treatment of migraines. The consequences of inadequate treatment for disabling migraine may include productivity loss, and adverse events associated with excessive medication use.”

As a preventative, Botox has been found to be fairly successful. (Ironically, according to a 2010 article in The New York Times, the FDA approved Botox for migraines after fining it over a half-billion dollars for off-label marketing of Botox for migraines.)

A Q&A by the Mayo Clinic on Botox describes eligible patients as having migraines at least eight days per month. Shots are injected into the muscles in the back of the head, shoulders, neck and forehead, deactivating pain receptors in the nerves. Results last about three months.

With data concluding that “migraine is the third commonest disorder in the world and ranks sixth among more than 300 diseases when it comes to the burden it represents,” it seems high time to bring some new migraine medications to market. Indeed, research of the last decade is yielding some surprising results.

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