Category Archives: Migraine

Easing the pain of migraine attacks

Dr Chad Beyer

Welcome to Part Three of this series on migraine attacks. Today, I am stepping into the world of guest blogging and am delighted to host Inside The Brain’s first guest blogger – Dr Chad Beyer, who explains how the race is on to discover better and safer drugs to diminish migraine pain and prevent future attacks.  

If you belong to the 1 in 4 households in theUnited States or the 11% of the world who suffer from acute migraines, you have about a 50/50 chance of being prescribed a “triptan” or a non-steroidal anti-inflammatory drug (NSAID) such as aspirin.  Unfortunately for patients, both treatment options are routinely accompanied by severe safety liabilities.  Most people are probably aware of the gastrointestinal and cardiovascular side-effects associated with NSAIDs and selective COX-2 inhibitors – if you are not, just Google Vioxx or Celebrex!

Collectively, the triptans (exemplified by sumatriptan) are not a squeaky clean class of molecules either and bring with them potential cardiovascular liabilities that make them contraindicated in roughly 20% of migraineurs who are also diagnosed with high blood pressure, angina and several other cardiovascular-related events.  This is due to the non-specific vasoconstriction induced by triptans – which is great in the middle cerebral and meningeal arteries where migraines are suspected to occur but notsomuch in other arteries within the cardiovascular, pulmonary and renal systems.

Therefore, despite the marked advances in our understanding of the complex biology of migraines (i.e., the vasoconstriction and neuropeptide (CGRP) hypotheses) and the discovery of a variety of prescription medicines used to manage the clinical symptoms (the triptans), there remain considerable unmet needs requiring a focused eye towards improving both the efficacy and safety profile of future migraine treatments.

Although commercially-available triptans only work in about 40% of migraine patients, they continue to be the market leader used to combat migraine.  My opinion is that not all migraines are created equal and if you have found a treatment strategy (e.g., a triptan) that works well for you and one that you can tolerate – then by all means, keep doing what you are doing!

However, there is clear evidence that exists to support the discovery and development of therapies designed to work by a novel mechanism to treat migraine.  We (and other companies focused on this problem) are excited about the possibility to bring to the world a novel medication that demonstrates superior safety and possibly efficacy for the millions of patients suffering from acute migraine.  To find out more about our treatment approach for migraine and our company, please visit arielpharma.com to learn more.

For additional information on the prevalence of migraine, current treatment options or to read patient testimonials, the following websites are an excellent starting point:

www.migraineresearchfoundation.org

www.headaches.org

 

Read the first two parts of this series:

The Anatomy Of A Migraine Attack (Part One)

What Happens During A Migraine Attack (Part Two)

 

 


What happens during a migraine attack?

The figure above shows our understanding of what happens during a migraine attack.  It is now thought that a migraine is triggered when a wave of electricity which starts in the trigeminal nerve on the side of the face stimulates the release of peptides such as CGRP and other substances that cause inflammation and makes other nerves more sensitive to pain. The wave of electricity then enters the brain and ripples across the surface of the brain – and together with CGRP causes blood vessels to dilate, as shown in Inset A above. In this way sensitization of the nerves often progresses from peripheral nerve cells on the skin to central neurons in the brain.

(Adapted from the American Society for Neuroscience).

Related Post:

The Anatomy of a Migraine Attack


The anatomy of a migraine attack

Scientists have learned a lot in recent years about what happens in the brain to explain the throbbing pain, nausea, heightened sensitivity to light or sound felt during a migraine headache, and the mysterious ‘aura’ that both doctors and scientists use to describe the telltale period, starting up to an hour before a migraine attack, when a person sees dots, wavy lines, flashing lights, blind spots or difficulty with speech, sensation, or movement.

What triggers a migraine attack? 

Although researchers don’t understand exactly what triggers migraine attacks, they do know that certain foods, lack of sleep, changes in weather, and even stress can trigger a migraine attack in 1 in 200 people.

The anatomy of a migraine attack

Neuroscientists now see migraine as firstly a disturbance in nerve function rather than a disorder of the brain’s blood vessels. It is believed that in most patients, a wave of electrical activity passing through a major nerve that collects and transmits signals to the face – the trigeminal nerve – and stimulates the release of chemicals such as CGRP and other substances that cause inflammation, makes the nerves more sensitive to pain, and causes blood vessels near the brain to expand (dilate). This nerve irritation often progresses as an electrical wave from the skin to nerves located centrally in the brain.

The first 20mins are crucial for treatment

The key to treatment is to act quickly to stop the irritation spreading.  In fact anti-migraine drugs can offer relief only in the earlier stages of the attack, but not later, when the pain neurons in the brain have become sensitized. For this reason patients are advised to take medication within 20 minutes of an attack and while migraine pain is still mild.

The wave that turns into a flood

A migraine attack is triggered when a wave of electrical activity which starts in the trigeminal nerve on the side of the face enters the brain and ripples across the surface of the brain. In fact, researchers have been able to demonstrate a possible link between this wave and the experience of ‘aura’ particularly as it spreads across the visual part of the brain. Several drugs used to prevent migraine attacks work by preventing this wave from spreading.

Click on the National Headache Foundation website (www.headaches.org) for additional information.

In an upcoming post, prominent migraine research scientist  Dr. Chad Beyer will explain how the race is on to discover better and safer drugs to diminish migraine pain and prevent future attacks.

Read Part Two – What happens during a migraine attack

 


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