For Migraine Sufferers, a Light at the End of the Tunnel

There’s never a good time to have a migraine. The intense, throbbing pain can last for hours or even days, crippling people by leaving them too distracted and ill to function well at work or at home. Unlike a more typical headache, migraine is a complex neurologic disorder with associated symptoms such as nausea, visual disturbances, mood changes, and sensitivity to odor, light and movement.

Though there’s never a good time to have a migraine, there’s also never been a better time in terms of treatment.

Effective therapies are being further developed each day, with more hope for relief on the horizon than ever before.

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“It’s a really exciting time for us in terms of experimental drugs,” Dr. Juliette Preston, a neurologist, professor, and director of Oregon Health and Science University’s Headache Center, told LifeZette. “It’s a very fruitful time for headache doctors and patients because we’ll be able to offer more options.”

Developed in the 1990s, triptans (including Imitrix) were the last new migraine medications on the market. Two decades later, new, experimental drugs finally show as much promise, if not more.

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“Recently there have been multiple clinical trials on the calcitonin gene-related neuropeptide [CGRP], which are very different from triptans,” Dr. Preston added. “CGRP is a biomarker in migraine physiology. The initial data look beautiful, and the experimental Teva drug, TEV-4812, is a first of its kind for chronic migraine. The pharmaceutical company is applying to the FDA to get the drug approved in 2018.”

Four pharmaceutical companies, Lily, Amgen, Alder and Teva, are working together on new migraine medications, including personal injectables and an IV formulation to be administered at hospitals. Clinical trials prove promising for each, and the drugs are expected to be available within the next two years.

Beyond medication, however, Dr. Preston emphasizes the treatment possibilities of neuromodulation, or the process of regulating neural activity by controlling the brain’s levels of neurotransmitters such as norepinephrine, serotonin, and dopamine. It’s a unique method that addresses nerves through electrical impulses and magnets, not chemicals, stimulating systems such as the occipital nerves, the trigeminal nerves and the vagus nerve, all of which are affected by migraine.

“One of the goals of the American Headache Society is to increase the number of hours being taught in medical school and through residency and training.”

“For someone who cannot tolerate medication, now other things are in the pipeline as well: neurostimulation,” Preston said. “Since 1997 we’ve had a device called a vagus nerve stimulator, or VNS, which causes epilepsy patients to suffer fewer seizures. And patients who suffer epilepsy and migraine, using that machine, have had fewer migraines as well. New studies were done on only migraine patients with a VNS that they could hold in their hand and place on the right side of their neck. Again, great results. Migraine patients who used it for three months got fewer migraines. And it doesn’t have any downside to it. Right now, one of the companies is applying for FDA approval for that device as well.”

Such devices are already widely available in Europe and Australia, but will soon be more common in the United States.

Dr. Andrew Charles, a neurologist at the Goldberg Migraine Program at UCLA Medical School, told Migraineagain.com that, in his experience, neuromodulation treatments are expensive, so he hesitates to recommend them enthusiastically.

Still, he said, “As a non-invasive approach, I’m open to the possibility that it may help some people. As long as it doesn’t harm them, and people have the resources, then I’m OK with patients trying it.” He added that several neuromodulation device companies are still developing their products and have no definite evidence of the devices’ abilities. Yet he believes they should be further explored because of the possibilities and patients who have already been helped.

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Considering the fact that migraine is the sixth-leading cause of disability worldwide, and that 25 percent of women ages 30 to 39 and 6 percent of men in general suffer migraine, finding effective treatment — and maybe even a cure — is vital.

“We have a big job to improve migraine education,” said Dr. Preston. “Right now, headaches receive one or two hours, total, of coverage during a medical student’s four years of medical school training. Residency will add a few more hours. But only specialists such as neurologists receive comprehensive headache training. One of the goals of the American Headache Society is to increase the number of hours being taught in medical school and throughout residency and training. We need to train doctors, and they will in turn train their nurse practitioners and physician assistants, and then it will trickle down to the patients.”

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And patients are desperate for treatment.

There is no one-size-fits-all remedy, and there probably never will be, but researchers continue to seek innovative and effective ways to stop the pain.