What is a Migraine?
Migraines affect more than 10 percent of people worldwide with women being affected three times more than men. The American Academy of Neurology defines a migraine as “a neurological condition defined by intense head pain, often only on one side, that may occur with other symptoms such as nausea, vomiting, or sensitivity to light, sound, and smells.” Sometimes migraines can also be retriggered by stress, hormonal changes, bright or flashing lights, lack of sleep and certain foods. Additionally, the website Brain & Life website defines a migraine as “a biological disorder of the brain that causes recurring moderate to severe headaches.” While this disorder can affect anyone at any time it is a different experience for many people. Research is currently being undertaken worldwide to better understand the causes and potential treatments for migraines.
There is not a lot known about what causes migraines but according to experimental evidence, migraines may be associated with the activation and sensitisation of parts of the brain known as the trigeminovascular system which consists of connections between nerve cells and cerebral blood vessels. Furthermore, for women, migraine can also be related to hormones during their menstrual cycle. Genetic and environmental factors also play a role in migraine.
Potential symptoms vary greatly among people with migraine, but can include: moderate to severe headache that lasts 4 to 72 hours, if untreated, throbbing pain, often on one side of the head, increased pain after exercise or movement; sensitivity to bright light, sound, and/or odours, and nausea and/or vomiting with the headache.” Additionally, some people may experience other symptoms before the onset of a migraine such as a migraine aura.
A migraine aura manifests in three different ways,
- Vision Disturbances - seeing spots, flashes, zig zags, stars, or even losing sight for short periods of time.
- Sensory Changes - feeling tingling or numbness in the face, body, hands, and fingers.
- Speech and Language Problems - unable to produce the right words, slurring, or mumbling words.
Although these symptoms differ from person to person, with the proper medical care and self-management migraines are treatable. A key thing to keep in mind is finding the trigger that causes migraines. Once the trigger is identified medication and steps can be taken to avoid that trigger.
Potential triggers include variation in diet, sleep, stress, hormones and environmental factors such as weather changes or high altitude.
Lifestyle interventions are important. Many people find they can reduce the number of migraines by keeping fit, managing their stress and making sure they get the right amount of sleep. Different types of medication also play a role in treating migraines. Acute medication, preventative, and pre-emptive medications are all potential treatments for migraines.
Professor Debbie Hay Head of Biological Sciences at the University of Auckland says that “in New Zealand, migraine places a substantial burden on individuals, families, and society.” Her lab is currently researching specific proteins that are important to the development of treatments for migraines and other known conditions.
Migraine Matters: A totally new approach to preventing and treating migraine by Professor Debbie Hay FBPhS
Migraine - a prevalent and debilitating neurological disorder
Migraine is one of the most prevalent neurological disorders, affecting 10-20% of adults. Classified as a disability, the World Health Organisation cites migraine as a priority for finding more effective treatments. In New Zealand, migraine places a substantial burden on individuals, families and society. Migraine matters.
Some patients are able to manage their migraines by avoiding their triggers, using the “triptan” class of medication to blunt their attacks once they have started, or they can use regular pain treatments, such as paracetamol and ibuprofen. Unfortunately, these drugs do not work for all patients and many patients, especially those who suffer from chronic migraine, typified by 15 migraine days per month, have no effective treatment. New hope has come from research into the underlying mechanisms of migraine. Through decades of research we now understand that naturally occurring substances called “neuropeptides” are released from the nerves that control sensation in the face and head, promoting pain transmission.
Calcitonin Gene-Related Peptide (CGRP) is a key player in migraine
One of these neuropeptides, CGRP, seems to play a particularly important role in migraine. Migraine sufferers have higher amounts of CGRP than others, and if CGRP is given to them via an intravenous infusion, CGRP triggers migraine-like headache but not those who don’t usually suffer from migraine. This suggests that people with migraine are more sensitive to CGRP, although we don’t yet know why this is. Based on this and other research into migraine, the quest to find ways to block CGRP signals in nerves began.
New treatments for migraine stop CGRP in its tracks, relieving migraine symptoms
Antibodies that “mop-up” CGRP in the blood or prevent it binding to its matched protein target on nerve cells (called CGRP receptors) are currently the subject of much excitement to neurologists and to patients. Four of these drugs have successfully completed global clinical trials and three of them are now available to patients in other countries. They are erenumab (Aimovig®, Amgen/Novartis), galcanezumab (Emgality®, Lily), fremanezumab (Ajovy®, Teva) and eptinezumab (Alder; awaiting decision). These drugs are given by injection monthly or every three months, and they are used to prevent migraine attacks from occurring. Galcanezumab has also recently received approval by the United States Food and Drug Administration for episodic cluster headache, which is a major advance for cluster headache patients.
Mysteries remain – how does the future look?
The main question is when will these new treatments be available to patients in New Zealand? Keep looking out for them and talk to your neurologist. Also look out for another new class of treatment that is on the horizon that also stops CGRP from working. If given the green light, these will be available as tablets, rather than injections and they will either be available for prevention or as acute treatments. It looks like these might work for people who can’t take or don’t respond well to triptans, which will mean that there are more options for patients. The future is certainly looking much brighter for migraine patients, but we can still do better. When examining the clinical trial data for all the CGRP blocking drugs it is clear that some patients respond much better than others. Why is this? It seems that we don’t have all the answers yet and we will be busy working with others around the world to find those answers.