EXPERT OPINION
Meet the Expert : Migraine Messoud Ashina
Messoud Ashina MD PhD DMsc is Professor of Neurology , Danish Headache Center and Department of Neurology , University of Copenhagen , and has been involved into headache research since 1995 . He completed his PhD in headache science focusing on tension-type headaches . Since 2006 , he has been working on migraine and , in particular , experimental models of migraine .
We had the pleasure of speaking with Professor Ashina about his work , some of the innovations in patient management and his hopes for the future for helping sufferers of this debilitating condition .
Q Please tell us about your research on migraines ?
A Professor Ashina ’ s research focuses on experimental models of migraine in humans . This work involves provoking a migraine attack in patients and then trying to ascertain the specific biomarkers involved in induction with a view to developing drugs that can target these markers . In addition to his basic scientific research , he is also a lead investigator on clinical trials yet still manages to practice as a neurologist seeing headache patients .
Q How would you define migraine and what are the main symptoms ?
A Professor Ashina described migraine as ‘ quite a complicated neurological disease characterised by attacks , and which are paroxysmal in nature and self-limiting ’. He explained how typically the disease first presents during the teenage years and then gradually evolves over the following decades but then gradually becomes less severe and less frequent with advancing age . He sees migraine as a ‘ fascinating disease to study ’ because it is not just a headache but also associated with a sensitivity to light , sound , smell and nausea or vomiting . As a result , he felt that it was important for clinicians to recognise that migraine can be a debilitating disease . In many instances , during an attack , patients tend to either stay in bed or remain sat at home since the slightest movement ‘ aggravates the pain ’. Both the headache and sensitivities have contributed to the archetypal depiction of a migraine sufferer as someone who remains in a darkened room during their attack , for anywhere between two to three days .
Despite much research time and effort spent trying to understand the condition , Professor Ashina concedes that we are still very much in the dark as to why a migraine
The ultimate goal in migraine research is not to provide a cure but to be able to control an attack so that ‘ patients can return to an almost normal life ’
starts . He believes that the underlying cause most likely involves some form of complex communication between area swithin and outside of the brain that which will ultimately ignite a migraine attack . Furthermore , because attacks naturally abate after a few days , either the same , or another communication pathway , transpires to somehow extinguish the migraine flame . Thus , exactly how a migraine starts and stops remain some of the biggest unanswered questions in migraine research .
Q How is migraine classified ?
A Professor Ashina said there are only two subtypes of migraine : ‘ migraine with aura and migraine without aura ’ with the latter accounting for around two-thirds of all cases . Those who have migraines with aura experience symptoms that normally persist up until the development of the headache . He explained how patients often experience ‘ transient neurological symptoms usually occurring before the headache starts and which are usually visual symptoms ( known as fortification spectra ) of different colours or sometimes black and white that move around the visual field ’.
In terms of the clinical presentation , patients report both uni- and bilateral headaches and to consider a headache as a migraine , it requires the presence of at least two of four main pain characteristics : localisation ; throbbing ; intensity ; and aggravation by physical activity . Professor Ashina described how where a patient had a ‘ bilateral headache and with intense throbbing , this would fulfil two of the four criteria ’ [ for migraine ]. In other words , although in the past , migraine was classically defined by hemicrania ( one-sided headache ), the definition has evolved to include a headache which ‘ migrates ’ to cover a larger area of the head . If patients display at least two of the four headache pain characteristics , if this occurs in conjunction with associated symptoms such as photo- or phonophobia or nausea / vomiting , it is possible to diagnose migraine .
16 | Issue 102 | hospitalpharmacyeurope . com