Migraine treatments

Sasha

Sasha

Senior Member (Voting Rights)
30 Nov 2017 | BBC: Migraine therapy that cut attacks hailed as 'huge deal' [antibody treatment]

Interesting to those of us who get migraines:

BBC said:
A new approach to preventing migraines can cut the number and severity of attacks, two clinical trials show.

About 50% of people on one study halved the number of migraines they had each month, which researchers at King's College Hospital called a "huge deal".

The treatment is the first specifically designed for preventing migraine and uses antibodies to alter the activity of chemicals in the brain.

Further trials will need to assess the long-term effects...
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Read the rest: http://www.bbc.co.uk/news/health-42154668
 
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The study was published in the NEJM but it's paywalled.

Abstract on NEJM said:
A Controlled Trial of Erenumab for Episodic Migraine
Peter J. Goadsby, M.D., Ph.D., Uwe Reuter, M.D., Yngve Hallström, M.D., Gregor Broessner, M.D., Jo H. Bonner, M.D., Feng Zhang, M.S., Sandhya Sapra, Ph.D., Hernan Picard, M.D., Ph.D., Daniel D. Mikol, M.D., Ph.D., and Robert A. Lenz, M.D., Ph.D.

BACKGROUND
We tested erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene–related peptide receptor, for the prevention of episodic migraine.


METHODS
We randomly assigned patients to receive a subcutaneous injection of either erenumab, at a dose of 70 mg or 140 mg, or placebo monthly for 6 months. The primary end point was the change from baseline to months 4 through 6 in the mean number of migraine days per month.

Secondary end points were a 50% or greater reduction in mean migraine days per month, change in the number of days of use of acute migraine–specific medication, and change in scores on the physical-impairment and everyday-activities domains of the Migraine Physical Function Impact Diary (scale transformed to 0 to 100, with higher scores representing greater migraine burden on functioning).


RESULTS
A total of 955 patients underwent randomization: 317 were assigned to the 70-mg erenumab group, 319 to the 140-mg erenumab group, and 319 to the placebo group.

The mean number of migraine days per month at baseline was 8.3 in the overall population; by months 4 through 6, the number of days was reduced by 3.2 in the 70-mg erenumab group and by 3.7 in the 140-mg erenumab group, as compared with 1.8 days in the placebo group (P<0.001 for each dose vs. placebo).

A 50% or greater reduction in the mean number of migraine days per month was achieved for 43.3% of patients in the 70-mg erenumab group and 50.0% of patients in the 140-mg erenumab group, as compared with 26.6% in the placebo group (P<0.001 for each dose vs. placebo), and the number of days of use of acute migraine–specific medication was reduced by 1.1 days in the 70-mg erenumab group and by 1.6 days in the 140-mg erenumab group, as compared with 0.2 days in the placebo group (P<0.001 for each dose vs. placebo).

Physical-impairment scores improved by 4.2 and 4.8 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 2.4 points in the placebo group (P<0.001 for each dose vs. placebo), and everyday-activities scores improved by 5.5 and 5.9 points in the 70-mg and 140-mg erenumab groups, respectively, as compared with 3.3 points in the placebo group (P<0.001 for each dose vs. placebo). The rates of adverse events were similar between erenumab and placebo.


CONCLUSIONS
Erenumab administered subcutaneously at a monthly dose of 70 mg or 140 mg significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine–specific medication over a period of 6 months. The long-term safety and durability of the effect of erenumab require further study.
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Source: http://www.nejm.org/doi/full/10.1056/NEJMoa1705848
 
Merged thread

FDA just approved the first drug to prevent migraines. Here’s the story of its discovery—and its limitations

*Update, 18 May, 10 a.m.: Yesterday, the U.S. Food and Drug Administration approved the first in a new class of drugs designed to prevent migraines. This feature, originally published on 7 January 2016, describes the history of these drugs, the powerful relief they can bring some patients, and the limitations that still exist with them.

As long as she can remember, 53-year-old Rosa Sundquist has tallied the number of days per month when her head explodes with pain. The migraines started in childhood and have gotten worse as she’s grown older. Since 2008, they have incapacitated her at least 15 days per month, year-round.

Head-splitting pain isn’t the worst of Sundquist’s symptoms. Nausea, vomiting, and an intense sensitivity to light, sound, and smell make it impossible for her to work—she used to be an office manager—or often even to leave her light-proofed home in Dumfries, Virginia. On the rare occasions when she does go out to dinner or a movie with her husband and two college-aged children, she wears sunglasses and noise-canceling headphones. A short trip to the grocery store can turn into a full-blown attack “on a dime,” she says.

....

Millions of others similarly dread the onset of a migraine, although many are not afflicted as severely as Sundquist. Worldwide, migraines strike roughly 12% of people at least once per year, with women roughly three times as likely as men to have an attack. The Migraine Research Foundation estimates that U.S. employees take 113 million sick days per year because of migraines, creating an annual loss of $13 billion. The toll underscores how little current treatments—not just drugs, but nerve-numbing injections, behavioral therapies, and special diets—can help many people.

On the horizon, however, is a new class of drugs that many scientists believe can stop migraines at their root. The drugs block the activity of a molecule called calcitonin gene-related peptide, or CGRP, which spikes during migraine attacks. CGRP is “the best validated target for migraine, ever,” says David Dodick, a neurologist at the Mayo Clinic in Phoenix. It may also help finally solve the centuries-old puzzle of what triggers the complex events of a migraine attack, which can cause brain activity to be “completely disregulated” for several days, similar to epilepsy and other recurrent, seizurelike disorders, says Michel Ferrari, a neurologist at Leiden University in the Netherlands.
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http://www.sciencemag.org/news/2018/05/will-antibodies-finally-put-end-migraines?utm
 
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I'm very pissed off with these hyped up announcements. The competing companies have massaged their findings and share "facts" which are underwhelming to me as a chronic migraine sufferer. Their "success rates" are barely above placebo!

The stories of complete remission trumpeted in the press are singularities.

There are no long term studies. Nothing past 6 months. I'm concerned about the long term effect of blocking CGRP.

This from the article above:

"DESPITE SUCH ANECDOTAL SUCCESSES, some migraine researchers don’t think it’s time to celebrate yet. If CGRP “really is a fundamental mechanism, you would expect a much higher proportion of patients to be completely free of attacks,” Ferrari says. Safety also concerns him because of CGRP’s natural role in dilating arteries and maintaining blood supply to the heart and brain. “Theoretically, if you block CGRP you could translate a minor stroke or cardiac ischemia … into a full blown stroke or heart attack,” he says. So far, the companies say they haven’t seen that or other significant side effects in the several thousand people who have completed phase I and II trials, but the drugs have only been administered for up to 6 months—not long enough to judge long-term effects, Bigal says."

From neurologist Robert P. Cowan, MD, FAAN
"CGRP is found throughout the body, and in addition to modulating pain, it has anti-inflammatory action and a role in energy metabolism, among other functions, and the risks compound. The list of drugs found to be unsafe following release is long and includes medications such as Vioxx, Accutane, Cylert, Permax, and Propulsid, to name a few. The risks associated with these drugs did not come to light until a wider distribution revealed them. Without a major restructuring of drug trial design or wider and more sophisticated use of computer modeling, it is impossible to predict these unforeseen outcomes. However, the effect of circulating antibodies in patients with unanticipated breakdown of the blood–brain barrier due to injury or stroke and the effect on healing in patients with circulating antibodies and cardiac events or inflammatory disease remains unknown."

http://practicalneurology.com/2018/...raine-landscape-look-like-post-cgrp&center=39

EDIT: I put energy metabolism in bold. Yeah, not gonna risk it.
 
I imagine those who have VERY chronic treatment resistant migraines will be more than willing to take the risk of the unknown long-term risks, and will jump at the chance to try this medication.

There are ME patients who are willing to try treatments for which the risks are not completely known.

I choose to take medications that may cause me serious health issues in the future because as this point I care about quality not quantity.
 
TrixieStix said:
I choose to take medications that may cause me serious health issues in the future because as this point I care about quality not quantity.
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Yes definitely. Me too. If my migraines were treatment resistant I'd jump at it. The pain is excruciating. I'd rather have bamboo pushed under my nails than have another 3 day torture migraine. Not joking.

But from the info above, I think these CGRP drugs might pose more than a future health risk. For those who have health problems they could be a very present danger. The manufactures just don't know. Or care. Which is alarming. It's just been a race between the pharmaceutical companies to get their product out first.

I'd like these, and other new medications, to have to be prescribed with BIG warnings that they've only been tested in people who are healthy aside from that single condition. That they only know the effects on the body of this med for a term of 6 months. And have no idea how it will affect those with auto immune diseases, heart conditions, asthma...

CGRP receptors are also found in your kidneys, pancreas, adrenal glands, and bones, and it’s not clear how the drugs will affect them after long-term use.
 
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@Skycloud I'm sorry that your daughter is cursed with these bloody things too. Have we talked about what she's tried? My memory is rubbish. I don't know if it's the Topomax - miracle daily migraine preventer for me, but AKA Dopomax. I'm dopey to da max. Or if it's the ME. :emoji_shrug:
 
Many doctors believed it was a psychosomatic condition related to stress. And pain disorders are difficult to research, as pain is subjective. Plus, there’s the gender thing. Goadsby sighs. “Go back 40 years. You don’t have to be a rocket scientist to work out that, if three out of every four people with migraine are women, and there’s a comorbidity, a biological problem of anxiety and depression, and there are periods involved, what is that going to produce? Some stupid interpretations from doctors, who say they’re crazy.” He seems really quite cross.

“But there’s such profound biology going on, with circulating oestrogen levels, I’ve never understood why they would think it was anything other than biological. You don’t need a craziness explanation, because you’ve got biology sitting in front of you. I think there was a protective mechanism for a long time, where physicians hate to say they don’t know, hate to accept that they’re impotent in something. So the alternative to ‘I don’t know,’ is, ‘The person in front of me is crazy.’ So it’s a disorder of women. So what? Get a grip and move on!”
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Their discovery that a biological mechanism triggers an attack, where blood vessels surrounding the brain open up causing pain, led to a new group of drugs that stop CGRP getting to its receptor, either by blocking the receptor or binding to CGRP itself. Goadsby had long suggested that there were “nerve-based mechanisms that might be important. But this was resisted by the mainstream for some time, because it didn’t fit with the narrative.”

Migraine had long been considered to be a vascular disease, linked to the regulation of blood flow in the brain, rather than neurological in origin. “We turned out to be correct. And fortunately, in science, correct still wins.” Previous treatments had debilitating side-effects and only relieved the symptoms, never actually preventing the migraine, but these new drugs – they’re called Gepants – have been shown to improve the quality of life of many sufferers.
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Interesting 2016 article in National Geographic with Hubert Airy’s original sketches:

https://www.nationalgeographic.com/...-century-doctor-who-mapped-his-hallucinations

The 19th Century Doctor Who Mapped His Hallucinations
BYGREG MILLER
PUBLISHED JUNE 13, 2016
• 7 MIN READ

Hubert Airy first became aware of his affliction in the fall of 1854, when he noticed a small blind spot interfering with his ability to read. “At first it looked just like the spot which you see after having looked at the sun or some bright object,” he later wrote. But the blind spot was growing, its edges taking on a zigzag shape that reminded Airy of the bastions of a fortified medieval town. Only, they were gorgeously colored. And they were moving...


Also:

https://journals.lww.com/jneuro-oph...s__Morbid_Affection_of_the_Eyesight__.24.aspx

2014 Sep;34(3):311-4.
Dr. Airy's "morbid affection of the eyesight": lessons from Teichopsia Circa 1870
Frederick E Lepore 1
Affiliations PMID: 2484002
DOI: 10.1097/WNO.0000000000000133
 
Dx Revision Watch said:
Interesting 2016 article in National Geographic with Hubert Airy’s original sketches:

https://www.nationalgeographic.com/...-century-doctor-who-mapped-his-hallucinations

The 19th Century Doctor Who Mapped His Hallucinations
BYGREG MILLER
PUBLISHED JUNE 13, 2016
• 7 MIN READ

Hubert Airy first became aware of his affliction in the fall of 1854, when he noticed a small blind spot interfering with his ability to read. “At first it looked just like the spot which you see after having looked at the sun or some bright object,” he later wrote. But the blind spot was growing, its edges taking on a zigzag shape that reminded Airy of the bastions of a fortified medieval town. Only, they were gorgeously colored. And they were moving...


Also:

https://journals.lww.com/jneuro-oph...s__Morbid_Affection_of_the_Eyesight__.24.aspx

2014 Sep;34(3):311-4.
Dr. Airy's "morbid affection of the eyesight": lessons from Teichopsia Circa 1870
Frederick E Lepore 1
Affiliations PMID: 2484002
DOI: 10.1097/WNO.0000000000000133
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Wow Airy's picture is exactly like my migraine aura! That spreading out from a spot in the centre into a crescent.... eventually over about 30mins it opens up & then gets so wide it eventually disappears... which is when the vomiting starts.
 
JemPD said:
Wow Airy's picture is exactly like my migraine aura! That spreading out from a spot in the centre into a crescent.... eventually over about 30mins it opens up & then gets so wide it eventually disappears... which is when the vomiting starts.
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Yes, just like mine, too, though I have had them very rarely, and having worked out what triggers mine, it's been several years, now, since I've had another.
 
JemPD said:
Wow Airy's picture is exactly like my migraine aura! That spreading out from a spot in the centre into a crescent.... eventually over about 30mins it opens up & then gets so wide it eventually disappears... which is when the vomiting starts.
Click to expand...

That sounds like hell. I remember a couple of female classmates having migraines too, my school at the time luckily just sent them home to recover. None of that pull yourself up by the bootstraps bullshit luckily. But still sounds awful to have, sorry you and others have to go through that.
 
Merged thread

New York Times article 2022 about migraine: For Decades, He Had Strange Episodes of Utter Exhaustion

If not exercising could affect the frequency of these spells, so could exercising too hard. After a really long run, there was a good chance he would end up in bed the next day. Because of that, he thought for a while that he might have chronic fatigue syndrome, which is also known as systemic exertion intolerance disease (S.E.I.D.). But he usually recovered within 24 hours, and that wasn’t true for those with S.E.I.D.

Part of a Bigger Picture

The patient was able to have his first video visit with a headache specialist two weeks later. He described his symptoms and the timeline. It starts off with a feeling of malaise, he said — as if he were coming down with something. Then after half an hour, stiffness arrives in his neck and shoulders, sometimes even his jaw. Another half-hour later, the weakness kicks in and he has trouble even sitting up. But he didn’t get headaches and hadn’t for decades.

The specialist had been seeing migraine patients for more than 30 years and knew that migraines came in many shapes and sizes. What the patient described wasn’t an aura: It lasted far too long. It was as if he had a long episode of the preliminary symptoms but never quite got the headache. Moreover, he had a history of migraine headaches and, over time, a patient’s migraines can change so that they have many of the symptoms but not the headache. Indeed, experts in the field no longer call the disorder migraine headaches but rather migraine disease, because the headache is only a part of the bigger picture. And the way these debilitating symptoms came out of nowhere and then resolved completely was consistent with migraine disease.

There are no tests for migraine — it is a diagnosis made based on the patient’s story. The story this patient was telling didn’t make the diagnosis certain, but it was possible. To test the diagnosis, the headache specialist suggested that they try treating the episodes with medications that can stop a migraine from progressing. A new medication, approved by the F.D.A. just over a year earlier, called ubrogepant or Ubrelvy, had been effective for many. The drug blocks a protein that promotes the inflammation in the brain that is thought to initiate the process that produces migraines. When taken at the very start of the symptoms, it can stop the episode in its tracks. The patient needed no persuading. Anything that might free him from the unpredictable tyranny of these spells was worth trying.

The medication was life changing, the patient told the specialist at their next appointment. He took it when the stiffness was first starting to set in, and within a couple of hours, it was gone completely.

For decades the presence of the typical headache was the defining quality of migraines. Experts like the one who saw this patient now recognize that migraines can change over time so that sometimes they aren’t even headaches anymore.

https://www.nytimes.com/2022/03/31/...aine-diagnosis.html?smtyp=cur&smid=tw-nytimes
 
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