“I’ve tried every treatment, and none of them work for me!” The long search for a solution to migraine continues.
Writer: Viktorija Vaitkeviciute and Eugenia Wong
Editor: Javier Bautista
Artist: Cveta Gotovats
Most of us have had a headache and know that merely functioning with a pulsating pain in your head can be a challenge. Now imagine that headache intensifying to the point of feeling nauseous and becoming acutely sensitive to light and noise, for at least 15 days per month – quite debilitating, isn’t it?
That was a short description of chronic migraine, an incredibly common disorder that affects not only the person who experiences it but their family too, who must adjust their day-to-day lives around the condition and provide support. It is a genetic neurovascular disorder that affects around 15% of the population, most commonly between the ages of 22 and 55. It is much more prevalent in women, with a 3:1 female to male ratio. It often begins in childhood and the frequency of attacks increases during adulthood. Some migraine headaches start without warning signs (prodromes), while others have a prodromal phase whose symptoms include irritability, fatigue, and increased sensitivity to sound, smell and light. There could also be an induced aura, which is a group of neurological symptoms including visual disturbances (flashing lights, white spots) and sensory disturbances (numbness and tingling) that begin right before the migraine attack.
Despite the prevalence of migraines and the abundance of existing treatments, there is an increasing number of patients who say that they have tried every medication and that none of them have worked. So, why is that?
Current treatments: not a definitive solution
The leading abortive treatments, which stop a migraine episode once it has begun, are anti-inflammatory drugs and triptans. Triptans inhibit the release of neurotransmitters that transmit pain signals to the brain. Anti-inflammatory drugs, such as ibuprofen, inhibit pain development and inflammation. Since triptans are significantly more expensive, they are used when other therapies fail to provide relief from a migraine attack or if the acute migraine is severe.
Despite the abortive drugs’ relative success in diminishing the pain, the relief they offer is short-lived. This leads to an endless cycle of pain and further drug consumption. Excessive use of these drugs can even worsen the headache.
“I’ve tried so many treatments – none of them work”
There are many patients who think that they have exhausted every possible migraine treatment when they see a doctor. In many cases, treatment failure is a result of the patient having an incomplete or incorrect diagnosis. They could be treating the wrong brain disorder or only targeting one of several comorbid conditions that they may have. It is therefore essential to have a complete diagnosis before commencing treatment.
There may also be some specific, unidentified headache triggers. The most common trigger is the overuse of medications. For example, someone who is taking over-the-counter drugs for pain relief that contain caffeine might be unaware that caffeine can also trigger future headaches once the effect of the drugs wears off.
It is also essential that preventive medications are used correctly. Patients are often quick to say that a drug is not effective after just a few days of use, which might not be enough time for it to work. Unfortunately, the misconception that preventative drugs will stop headaches completely is wrong since migraine is a chronic disease with no cure; a migraine treatment is considered successful if it reduces headache frequency by 50%.
New therapies: a step closer to an effective treatment
Erenumab is one of the newest drugs for migraine prevention. It is an injection that a patient can self-administer every month. Erenumab inhibits CGRP, a migraine-inducing transmitter that mediates pain perception and relaxes blood vessels in the brain. It seems to be effective in patients for whom other treatments have proved unsuccessful. However, this drug only reduces headache frequency and severity rather than ceasing them entirely. It is also incredibly expensive, costing around £5,000 a year, which limits its availability to patients.
Non-invasive neurostimulation is emerging as a safer alternative in the abortive and preventative treatment of migraine compared to conventional pharmacological approaches. This brings significant help for sensitive patient populations such as pregnant women, as well as those who do not respond to treatment or have overused medications. These therapies work by altering the neural activity of pain pathways in the brain.
As migraine is such a common disorder that affects people in their most productive years, there is a pressing need for new and better treatments. Unfortunately, there is no cure in sight that can solve the condition once and for all, but only drugs that provide symptomatic relief. While some new therapeutics seem promising, the cost and side effects often reduce their availability to the general population. Hopefully, increasing migraine research will offer more solutions to this exhausting condition which affects the lives of many families.