The Latest Research on Migraine and Headaches (2009)
New approaches to migraine relief
Research continues on the mechanisms behind migraine headaches and effective treatment. While migraines continue to lag behind other health issues in terms of available research dollars, there are some promising developments on the horizon.
The specific biochemical neurologic mechanisms behind migraine headaches continue to elude researchers. Recent evidence suggests that pain results from a complex cascade of changes within the brain originating in the area of the trigeminal nerve. A phenomenon called cortical spreading depression (CSD) is thought to be at least partially responsible for the experience of aura and for triggering pain. CSD depends on a specific type of chemical communication between different types of brain cells. Very early studies of a new compound, tonabersat , indicate that it inhibits the type of communication between cells resulting in CSD. This suggests that tonabersat should have some ability to prevent migraine attacks. Further research over the next 3 to 5 years should confirm these findings.
Another mechanism behind migraine headaches involves calcitonin gene-related peptide (CGRP). CGRP is a blood vessel-dilating brain chemical released from stimulated trigeminal nerves. Another type of medication being developed blocks the effect of CGRP. The first oral form of this medication is known as telcagepant, and preliminary studies have shown that it's highly effective in treating migraine headaches. However, much more research is needed to confirm its effectiveness before it will be widely available.
These are the only two types of medications currently being developed specifically to treat migraines. Medications developed to treat other conditions are also being applied to migraine treatment with some success. In addition to the anti-seizure drugs topiramate (Topamax®) and gabapentin (Neurontin®), whose use for migraine prevention is supported by a fair amount of evidence, these include the beta blocker candesartan (Atacand®) which is used to treat hypertension. Evidence supporting the use of candesartan is more limited, but beta blockers have historically been the mainstay of migraine prevention strategies, and its use is gaining in popularity.
Of all new therapeutic approaches to migraine headaches, botulinum toxin type A has been studied most extensively. Eight high quality trials involving more than 1600 patients were analyzed in an article published in 2009. At 30, 60, and 90 days after injection of botulinum toxin, no significant effect of reducing migraine frequency was apparent. The authors concluded that botulinum toxin type A is no more effective than a placebo for treating migraine headaches.
Research into an established treatment, triptans, found that providing three times as many doses of rizatriptan (Maxalt®) over three months did not change the number of headaches experienced by study participants. The purpose of the study was to evaluate the assumptions behind pharmacy benefits plans that limit the number of triptans patients can receive: namely, that too frequent use of triptans can lead to medication overuse headaches. In short, the study found that patients who had more access to triptans did not develop chronic migraines.
Surgical intervention has also been studied, although its use is only appropriate for migraine sufferers for whom no other treatment has provided relief from symptoms. In a very small study of surgical deactivation of three common migraine headache trigger sites, more than half of patients reported complete elimination of migraine headaches, compared to 4% of patients who received a different surgical procedure. Further research is also needed to confirm the effectiveness of this procedure, but it may hold promise for migraine sufferers for whom standard treatments are ineffective.
The immediate future for migraine treatment involves refining the use of types of medications that have long been used, for the most part, effectively. Over the next several years, new medications may become available that will significantly improve migraine treatment and provide relief for millions of people.