ALL IN THE HEAD
THE MIGRAINE REVOLUTION HAS BEGUN – WHY IT MATTERS TO YOU AND YOUR PATIENTS
AUTHOR Brian M . Plato , DO , FAHS time to be involved in this field .
12 LOUISVILLE MEDICINE
From time to time , I will be asked by a colleague why I would choose to pursue a career as a headache specialist . My reply is always the same , “ Why not ?” It ’ s especially true now , with how much has changed in the landscape of headache medicine within the past several years . It ’ s an amazing
Worldwide , migraine is the second leading cause of total years lived with disability . It ’ s such a significant degree of disability that our patients cannot live the life that they want without impairment . Many people with migraine will live with the disorder for many years before they choose to receive medical attention . Sadly , others have previously sought care and not responded to the then-available treatments . They understandably felt there was no value in continuing to make appointments and see specialists when “ there isn ’ t anything to do .” I would encourage them , and us , to begin thinking of migraine differently .
The first shift in our thinking about migraine needs to be a change in the way that we think of migraine as a disease . Many of us might have been taught in medical school that migraine was a vascular disorder of blood vessels constricting and dilating producing the primary symptom of head pain . We must shift our thinking away from this outdated theory – migraine is a neurological disease that involves numerous central nervous system structures as well as activation of the peripheral nervous system . Explaining better to our patients - we know now that migraine is a disorder that involves both our brains and peripheral nerves - helps them to understand why they experience many of their symptoms . With migraine attacks , they may suffer balance problems ( cerebellum ), difficulty thinking and forming complete thoughts ( cerebral cortex ), neck pain ( upper cervical nerves ) and so on . As we better understand the many physiological responses that occur during migraine , we have improved treatments which now align with the pathophysiology of this disease .
The recent development of treatments aimed at calcitonin gene related peptide ( CGRP ) has revolutionized the management of migraine . These have furthered our understanding of the disease itself . CGRP is a protein that is released primarily by the trigeminal nerves during a migraine attack . This results in the release of inflammatory substances and transmits nociceptive signals through the nervous system . For many years , CGRP had been identified as a key substrate in the pathophysiology of migraine . It was potentially linked to the development of chronic migraine in some individuals . There were several initial roadblocks to targeting it directly , which made pharmacological development challenging . But now , we have