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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