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Migraines: in search of a solution for a disease of a billion people

2022-03-06T04:05:26.374Z


The condition, which affects more than 10% of the population, is underdiagnosed and many patients do not receive available treatments


2,500 years ago, the Greek physician Hippocrates already described patients who began to see little chiribites in nothingness, continued with severe pain in the middle of the skull and, sometimes, ended up vomiting.

Around the second century, the Roman Galen distinguished common headaches from migraines (hemicrania, he called them) and sages from the Islamic world such as Avicenna also worried about this common suffering centuries later.

The solutions in those times, which included trepanation or the use of leeches, would have the usual efficacy of the medicine of the time, but the arrival of modern science did not provide a quick solution to the mourners either.

As recently as 1986, in the Journal of Neurology, Neurosurgery and Psychiatry, JMS Pearce acknowledged that it was still "extremely difficult to research migraine."

This recent history and the fact that migraine is often a family inheritance, makes many people believe that their tools against the disease are the same as those of previous generations: resignation and self-medication.

However, specialists highlight the many advances in recent years and ensure that a good diagnosis is key to reducing the suffering of millions of people who still have migraines without medical help.

Although with variable severity, migraineurs are more than 10% of humans.

An important part of the change began four decades ago with the work of four researchers who last year received the prestigious The Brain Prize, endowed with 1.3 million euros.

The American Michael Moskowitz proposed that the migraine attack begins with an activation of the trigeminal fibers, which transmit sensations from the face to the brain.

This activation releases chemical signals that dilate blood vessels in the meninges (a thin membrane that surrounds the brain) and the resulting inflammation causes the headache.

Two other winners, the Australian Peter Goadsby and the Swedish Lars Edvinsson, showed that a molecule known as CGRP (calcitonin gene-related peptide) was released by the trigeminal muscle during seizures and that this molecule had a great capacity to dilate the meninges.

In their work at the beginning of the 1990s, they observed that sumpatriptan, a drug discovered in 1988 and that today is among the most used to calm migraine attacks, limited the release of CGRP.

Along with the work of Edvinson and Goadsby and other researchers, the Brain Prize highlighted the work of Dane Jes Olesen, who showed that injecting CGRP into migraine patients triggered an attack and that drugs that blocked the molecule could prevent it.

With all this accumulated knowledge, the first drugs to block CGRP, known as

gepants

, were created, and the door was opened to the use of other treatments with great potential to prevent migraines.

In recent times, monoclonal antibodies, a type of biological medication capable of fitting together like puzzle pieces in different types of molecules, which have been used to block the development of tumors or covid, have also shown their usefulness in blocking the CGRP and avoid migraines.

These treatments were approved in Spain for the first time in 2019.

Patricia Pozo-Rosich, head of the Headache and Craniofacial Pain Unit at the Vall d'Hebron University Hospital in Barcelona, ​​participated in the clinical trials of one of these drugs in Spain and believes that, since their approval, the results of applying them to patients in their usual practice “they have been as good or better than those of the clinical trials”.

However, as with many innovative drugs such as monoclonal antibodies, the price is expensive and it is used in patients who have not responded well to conventional treatments.

"We should be able to offer it to everyone, and not wait until three previous treatments have failed like now," says Pozo-Rosich.

"We give some drugs very late and the migraine becomes chronic, when we could have given something good from the beginning, before people are very bad," she adds.

The president of the Spanish Society of Neurology and head of the Neurology Service at the University Clinical Hospital of Valencia, José Miguel Laínez, agrees that these types of drugs "have helped rescue a percentage of patients who were previously resistant to other treatments" .

“Patients with chronic migraine, who had pain almost every day, have gone to have very few days.

For these people, not being in bed for so many days is spectacular, and this is another step towards complete migraine control, ”he concludes.

Pablo Irimia, a neurologist at the University Clinic of Navarra in Pamplona, ​​agrees on the usefulness of the drugs and on the importance of patients who meet the access requirements set by social security receiving them as soon as possible.

"Many who should be receiving it are not accessing the drug, and others are not receiving it as quickly as they would like," he says.

In addition, Irimia, like the other experts consulted, emphasizes the importance of basic research to have an understanding of how the biology of migraines works in order to combat them.

As a result of this research, for example, alternatives to triptans will reach the market, effective in stopping migraines when they occur, but which had limitations for people with cardiovascular problems.

However, research funding for this condition is very low.

Data from the US show that while diseases such as asthma or diabetes receive an annual investment of about 150 dollars a year, the figure for migraine does not reach 50 cents.

Irimia recalls that "there are no specific lines to finance migraine projects."

"Neurological diseases are very complex and migraine competes with Alzheimer's or Parkinson's, which have a very important weight due to population aging, have a great awareness of people and take a lot of funding," he says.

In this line, Laínez emphasizes that "migraine is between the first and second place for days of disability caused, but since it does not cause mortality, it does not receive the attention it deserves."

"This disease is relevant enough that there is a national plan dedicated to it," he demands.

Migraine, which affects three women for every man, was often dismissed as a disease of hysterical women or a pain of psychological origin related to stress.

However, scientific studies over the past few decades have shown that while stress plays a role in triggering attacks, migraine is caused by biological processes that can be identified and manipulated.

Experts now stress the importance of many people who suffer from these headaches alone or with self-medication receiving a proper diagnosis and in time to be treated as needed.

Irimia finally points to a visibility problem.

"In other diseases there are famous people who come out and tell their case, but with migraine it doesn't happen," she says.

“It is not reasonable for someone to hide this problem for fear of not being hired and there are already some strategies to improve the visibility of migraine in the work environment, to train people so that they know their headache well and that those people who have a disability can benefit from available treatments.

That also benefits companies”, summarizes the neurologist.

Pozo-Rosich insists that although migraines do not kill, they cause a lot of pain in the most productive years of many people.

“We have to realize how important it is to address these issues so that people not only live but live happier and more capable and productive.

You have to invest in surviving, but also in living better”, he emphasizes.

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Source: elparis

All news articles on 2022-03-06

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