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.

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