| One-Minute Clinician

The Time is Now for Migraine Treatment!

What a person experiences during a migraine, loosely speaking, is a very sensitized brain. Migraine is among the most disabling disorders in the world, and much of the treatment armamentarium to date comes with significant unwanted effects. But new advances in our understanding of neurotransmitters and sensory processing may have led us to the dawn of a new and better era of migraine diagnosis and treatment.

  • Migraine is the most common type of primary headache problem
  • 30 to 40 million Americans experience migraine
  • Of those diagnosed, many have headaches so frequently they should have preventative treatment; but either they’re not recognized as having headaches frequently enough or the preventative medicines are either ineffective or poorly tolerated
  • Side effects among current FDA approved preventative medicines for migraine include
    • Liver toxicity
    • Weight gain
    • Hair loss
    • Tremor
    • Glaucoma
    • Kidney stones
    • Cognitive impairment
    • Blood pressure changes
  • Over the last couple of decades, the idea that there are various neurotransmitters specifically involved in pain and sensory processing in general has emerged; for example
    • Substance P
    • Glutamate
    • Neurokinins
    • Calcitonin gene-related peptide (CGRP)
  • CGRP
    • Is expressed throughout the body and relevant brain areas involved in the migraine experience
    • Can make the nervous system peripherally and centrally more sensitized
    • Armed with CGRP knowledge, efforts are underway to develop targeted treatments to either block the CGRP molecule itself or to block the receptor, the dock that it has to bind to. Incredible work has led to the current availability of an FDA-approved treatment that is a monoclonal, very specific antibody targeted to the CGRP receptor
    • Other medicines are being developed that have not yet been FDA-approved that block the actual molecule

The availability of one and theoretically soon more CGRP monoclonal antibodies is the first time that a treatment has been developed for migraine specifically based upon science demonstrating the role of this molecule in migraine and blocking its effect