Haims: Migraine – headway in pain management
According to Duke University School of Medicine, “More than 1 billion people worldwide suffer from migraines, making it the most common neurological disease and third most common illness” Here in the U.S., it is estimated that there are about 37 million people who suffer the impact of migraines.
Migraines are not the same as a headache. Although many people may say that they have a migraine, in actuality, they may only have a headache. While a headache may hurt, often for a short while, a migraine is neurological and involves nerve pathways and chemicals within the brain. Often, migraines can cause indescribable pain and frequently be incapacitating.
Of the many different types of headaches, the most common are sinus, tension, medication overuse (from painkillers), caffeine-related, menstrual, head injury, and of course – the hangover. Most of the time, such headaches are short in duration and do not cause pulsing/throbbing pain, nausea, visual symptoms, and neck pain that is common with migraines.
For those who suffer from migraines, the recent announcement from the FDA of two newly approved drugs that may offer relief is exciting. Unfortunately, there are no generic versions and they come with a big price tag. Zavzpret, produced by the biopharmaceutical company Pfizer, is available at a cost of about $1,000 for 6 nasal sprays of 10mg. Qulipta, produced by AbbVie, is an oral tablet also costing about $1,000. However, for this cost, Qulipa is supplied for 30 tablets (depending on the pharmacy). Both have insurance and Medicare coverage.
These medications are lab-created and designed to block certain proteins believed to play a part in the cause of migraines. Similar to the antibodies our immune system makes to attack viruses and other intruders, these lab-produced antibodies have been specifically designed to attach onto receptors in our body that interact with a protein called CGRP-R.
In order to understand what the medicines do and how they work, we need to understand a few terms.
• Antibody: An antibody is a protein produced by the body’s immune system. They protect us from harmful invaders such as bacteria, fungi, parasites, and viruses.
• Peptide: Peptides are a short chain of amino acids – usually between 2 and 50 amino acids – whereas proteins are made up of 50 or more amino acids.
• Trigeminal nerve: The trigeminal nerve is a nerve responsible for sensation in the face and motor functions such as biting and chewing.
Many people incorrectly believe that the cause and pain of migraines results from the dilatation of blood vessels. The pain of a migraine occurs because CGRP is released and binds to the trigeminal nerve. As our brain does not have the ability to feel pain, the trigeminal nerve passes the sensation of pain on the brain’s behalf. So, while blood vessel dilation does occur with migraines, the dilation is not the cause of pain.
The success of these medications is based on the belief that they will block CGRP from its receptors and thereby keep pain at bay. This is exciting as further research may find that CGRP-blocking antibodies can prevent other pain-related issues. According to Michael Moskowitz, a migraine researcher at Harvard University, “If CGRP fulfills its promise as a blockbuster pain target, that success could signal to drug developers that effective treatments for other complex and seemingly intractable pain disorders, such as fibromyalgia, are also within reach.”
These medicines do not claim to eliminate migraines but have proven effective in reducing the frequency and duration of the symptoms. At this time, the pros seem to outweigh the cons. However, there is concern about the side effects of blocking CGRP receptors. Possible side effects include pulmonary, cardiological, and wound healing.
Other migraine treatments currently available also have side effects. So, currently, there are no silver bullets for those afflicted with migraines. Education and a willingness to try a variety of treatment options may prove beneficial for many people.
Some known therapeutic treatments include; acupuncture, massage therapy, biofeedback, and dietary changes. Herbs and vitamins have also been shown to be helpful and often have few if any side effects. Feverfew, buckwheat, flaxseed, magnesium mallet, CoQ10, and melatonin have been found beneficial in reducing headache pain.
While some people are predisposed to headaches and migraines, having some knowledge of common triggers could be beneficial. Below is a short list of common triggers:
• Diet -aged cheeses, salty foods, MSG, aspartame, nitrates, nitrites
• Alcohol – especially wine, and highly caffeinated beverages
• Skipping meals
• Hormonal changes, menstrual cycle
• Changes in the weather
• Inadequate sleep
If you suffer from frequent headaches and/or migraines, and think you may be a candidate for these new migraine medications, you should talk with your doctor, neurologist, or headache specialist. They can assist and educate you about the options that are best suited for your personal needs.
Judson Haims is the owner of Visiting Angels Home Care in Eagle County. He is an advocate for our elderly and is available to answer questions.