<\/p>
For centuries, scientists have debated whether migraines are caused by blood vessels in the head expanding or by some malfunctioning of our nerves. Over the last few decades, however, a more nuanced picture has emerged. A migraine attack starts when the trigeminal nerve, a big pain-sensing nerve in our heads, is stimulated.<\/p>\n
The source of that stimulation is hard to pin down but some people who get migraines find they are triggered by caffeine, stress or lack of sleep. The trigeminal nerve sends chemical signals to the protective layers that wrap around the brain.<\/p>\n
The signals are vasodilating, meaning they cause blood vessels in some of these layers to expand. Together, the expanding blood vessels and the pathways of nerve fibres connected to the trigeminal nerve, which also reach deeper into the brain, are thought to cause the pain.<\/p>\n
Thanks to King\u2019s College London neurologist Prof Peter Goadbsy<\/a> and colleagues, we now know more about the chemical messengers responsible<\/a>: neuropeptide molecules called calcitonin gene-related peptides (CGRPs), which are now the focus for new treatments.<\/p>\n But Goadsby says that we do currently have enough of an understanding for a coherent explanation of what\u2019s happening and, crucially, to improve treatments.<\/p>\n Read more about migraines:<\/strong><\/p>\n One aspect that we\u2019re just getting to grips with is the genetics \u2013 some people are more susceptible to migraine than others but it\u2019s not clear why. A 2022 study in over 100,000 patients pinpointed 123 different genes associated with migraine<\/a>, 86 of which were previously unknown.<\/p>\n \u201cNot every migraine patient has every gene, so it\u2019s complex,\u201d explains Mikko Kallela<\/a> from the University of Helsinki, who worked on the study. \u201cAnd that also fits very much to the way migraine patients respond to treatment.\u201d<\/p>\n Since the 1990s, we\u2019ve relied on drugs called triptans to treat migraines. These target serotonin receptors in the brain and are thought to work by constricting blood flow and preventing the release of neuropeptides involved in migraine. We are now, though, starting to capitalise on some of the research into the mechanisms that trigger and drive migraines, with the last five years seeing new drugs reaching the market.<\/p>\n Some of them, like erenumab, are human antibodies that bind the receptors for CGRPs, blocking them from triggering the migraine. These are given as monthly injections. Other drugs called gepants bind the same targets but consist of smaller molecules. These are pills that can be taken daily.<\/p>\n The gepants are the first drugs that seem to be beneficial both for an ongoing migraine attack and for preventing future attacks from happening \u2013 previously, drugs have only been prescribed for one or the other. Because there are no side effects from overuse, patients can take more or less depending on their needs.<\/p>\n \u201cSo the idea that you could tailor the therapy on a day-day-day, week-to-week basis with these new therapies is quite revolutionary,\u201d Goadsby says, suggesting a patient could decide to take a tablet in the evening if they knew they needed to do something important the next day.<\/p>\n The difference that CGRP inhibitors have made is \u201cvery, very significant\u201d, according to Kallela, who sees about half of his patients lose half of their migraine days. For the 1 to 2 in 100 people in the general population who experience at least 15 migraine days a month \u2013 chronic migraine sufferers \u2013 the benefits can be life-changing.<\/p>\n Read more about pain:<\/strong><\/p>\n But as it currently stands there is no known cure for migraine. Even if we are seeing a lot of progress in treatments, \u2018curing\u2019 migraines is a very big ask, especially when we don\u2019t have all the answers as to what causes them in the first place. However, according to Goadbsy, we could see more progress in prevention by focusing our efforts to understand migraines on the \u2018premonitory phase\u2019 \u2013 the prelude to the headache, which for many people brings mood changes, yawning, tiredness and other symptoms.<\/p>\n This phase can last a couple of days. \u201cIf we could develop treatments in that phase, then it\u2019s perfectly plausible to think that we could start to eliminate the actual pain phase,\u201d Goadsby explains, adding that it could be a way to \u201chead off attacks before they become troublesome.\u201d<\/p>\n Another approach that may start to make more of an impact in the near future is one of personalised medicine. We\u2019ve known for ages that what works for one person doesn\u2019t necessarily work for the next person, but as our understanding of the genetic components and molecular mechanisms that contribute to migraine expands along with the suite of different drugs targeting them, we may be better able to use this to the patient\u2019s advantage, tailoring treatment regimens to the individual.<\/p>\n Intriguingly, some of the known genes pulled out in Kallela\u2019s 2022 study were targets for existing treatments \u2013 the CGRPs, for example. This suggests we might be able to mine for new migraine targets among the 86 genes whose functions are unknown.<\/p>\n However, because of the way that people who get migraine are genetically predisposed to them, it\u2019s hard to imagine \u201ccuring\u201d them completely. People who get migraines may always go back to having them if they stop taking their medication, according to Kallela, but he remains \u201cvery optimistic\u201d about the prospects for treatment. \u201cYou cannot cure migraine,\u201d he says. \u201cBut in a way, you can take away the attacks.\u201d<\/p>\n By Hayley Bennett Published: Friday, 18 March 2022 at 12:00 am For centuries, scientists have debated whether migraines are caused by blood vessels in the head expanding or by some malfunctioning of our nerves. Over the last few decades, however, a more nuanced picture has emerged. A migraine attack starts when the trigeminal nerve, a […]<\/p>\n","protected":false},"author":24,"featured_media":10987,"template":"","categories":[27],"acf":{"readingTimeMinutes":"5"},"uagb_featured_image_src":{"full":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments.jpg",2091,1433,false],"thumbnail":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-150x150.jpg",150,150,true],"medium":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-300x206.jpg",300,206,true],"medium_large":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-768x526.jpg",768,526,true],"large":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-1024x702.jpg",800,548,true],"1536x1536":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-1536x1053.jpg",1536,1053,true],"2048x2048":["https:\/\/c01.purpledshub.com\/uploads\/sites\/42\/2022\/03\/how-to-get-rid-of-migraines-the-most-promising-new-treatments-2048x1404.jpg",2048,1404,true]},"uagb_author_info":{"display_name":"importmanagerhub@sprylab.com","author_link":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/author\/importmanagerhubsprylab-com\/"},"uagb_comment_info":0,"uagb_excerpt":"By Hayley Bennett Published: Friday, 18 March 2022 at 12:00 am For centuries, scientists have debated whether migraines are caused by blood vessels in the head expanding or by some malfunctioning of our nerves. Over the last few decades, however, a more nuanced picture has emerged. A migraine attack starts when the trigeminal nerve, a…","_links":{"self":[{"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/rss_feed\/10986"}],"collection":[{"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/rss_feed"}],"about":[{"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/types\/rss_feed"}],"author":[{"embeddable":true,"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/users\/24"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/media\/10987"}],"wp:attachment":[{"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/media?parent=10986"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/c01.purpledshub.com\/bbcsciencefocus\/wp-json\/wp\/v2\/categories?post=10986"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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