RESEARCHERS EXAMINE AGENTS RESPONSIBLE FOR MIGRAINE
It ’ s an ever-frustrating issue : Migraine researchers have never been able to pin down the true cause of migraine . Yet year after year , researchers continue to look into the agents responsible for the condition . Two possible triggers , a migraine gene and a brain chemical , have received added attention in recent months as researchers focus on their contributions to migraine pain .
Researchers once thought the restriction of blood vessels triggered migraine , leading many to believe migraine was a vascular disorder . Today , many believe that migraine has far more to do with the brain than the blood vessels , pointing to the dysfunction of pain signals or to cortical spreading depression ( see page 32 ). Two neurotransmitters — substance P and calcitonin generelated peptide neurotransmitter ( CGRP )— could also be responsible for activating pain signals in the brain . 1 CGRP made headlines recently when The Wall Street Journal covered its contributions to migraine . According to the newspaper , several companies are conducting studies to develop drugs that could prevent CGRP from triggering pain . 2
In addition to this chemical , a potential “ migraine gene ” has also made headlines in recent months . In June 2012 , Finnish researchers at the Institute for Molecular Medicine Finland and Wellcome Trust Sanger Institute reported they had discovered four new genes that predispose people to migraine without aura and had confirmed the implication of two other genes previously thought to play a role . The study , published in the June issue of the journal Nature Genetics , compared the genetic data of 4,800 migraineurs to 7,000 non-migraineurs . 3 The gene identification could bring researchers one step closer to understanding the basis for migraine .
1 . Nicolodi et al . “ Sensory Neuropeptides ( Substance P , Calcitonin Gene-related Peptide ) and Vasoactive Intestinal Polypeptide in
Human Saliva : Their Pattern in Migraine and Cluster Headache .” Cephalalgia . 1990 ; 10 ( 1 ): 39-50 . 2 . Wang . “ Fresh Target in Hunt for a Migraine Cure .” The Wall Street Journal . Aug . 7 , 2012 . 3 . Isaude . net . “ Researchers Found Four Gene Loci Predisposing People to the Most Common Migraine .” Nov . 6 , 2012 .
Switch Triptans to Relieve Headaches ?
Maybe your insurance company only allows you to use a specific triptan , or your physician wants to try supplementing your triptan prescription with a nonsteroidal anti-inflammatory drug ( NSAID ) to see if you improve . Whatever the reason , many migraineurs switch from one triptan to the next or take a combination of medications to treat their head pain . But does it help ?
Richard B . Lipton , MD , and Dawn C . Buse , PhD , of the Albert Einstein College of Medicine in New York recently explored this question . They reviewed data from the American Migraine Prevalence and Prevention study , which was sponsored by the National Headache Foundation . The researchers discovered :
• Switching from one triptan to another triptan did not improve headache disability .
• Switching from a triptan to an NSAID , opioid or barbiturate worsened headache disability for people with high-frequency episodic migraine or chronic migraine .
• Adding an NSAID to a triptan worsened headache disability for people with high-frequency episodic migraine or chronic migraine .
• Switching medication regimens had less of an impact on people with low-frequency episodic migraine or moderate-frequency episodic migraine . 1 This may sound discouraging to people with high-frequency episodic migraine , for whom triptans are not working . However , physicians who attended the annual American Headache Society meeting where the results were released noted that all triptans are not created equal and some patients may find headache relief by switching medications .
1 . London . “ Studies Examine Scenarios of Changing Triptan Regimens .” Family Practice News . July 3 , 2012 .
www . headaches . org | National Headache Foundation 11