Migraine: new treatments, new hopes

Do you feel like you can feel the hammer hitting part of your head? Do you feel nauseous and the light attacks you to such an extent that you have to retire to a dark place? It could be a migraine, a condition that should not be taken lightly.

This disease, which affects 10% to 12% of the population, is the third leading cause of disability among those under 50 years of age. Depression and anxiety are common among sufferers, as are loss of productivity and frequent absences from work or school.

More and more treatments are available to physicians that specifically target the biological mechanisms of migraine. For example, since 2018 in Canada, most migraine sufferers have been able to prevent half of their attacks with an antibody-based drug called CRRP inhibitor monoclonal antibodies. Another class of drugs, the molecules dubbed hepants, are also due for approval next year in Canada.

“This is good news because there are now several treatment options for migraine,” says the doctor.D Heather Pym, migraine neurologist and president of Migraine Québec. The head of the CHUM Headache Clinic also sees the spread of treatments as an opportunity to better inform the public and medical staff about the various treatments for migraine.

Genetics and hormones

Like type 1 diabetics, migraine sufferers have a genetic predisposition associated with triggers such as severe stress, excessive drinking, or even hormonal changes. Neurologists also believe that hormones play an important role, since migraines mostly affect people in their 20s and 50s. In addition, women suffer more than men. “Before puberty, migraines affect boys to the same extent as girls, but after this age, women are three times more likely to have migraines,” says the doctor.D Heather Pim.

The frequency of seizures usually decreases with age as hormone levels decrease, especially in post-menopausal women.

Break the crisis

Often the disease begins with infrequent and spaced episodes. For some, seizures will remain episodic; in others, the disease will become chronic. “Eight percent of Canadians experience 7 or fewer episodes per month, and 2% experience 8 to 14 episodes per month. And then, from 1% to 2% of Canadians have a chronic form of the disease, i.e. 15 or more days of migraine per month,” notes D.D pim.

The specialist adds that every year from 2% to 3% of migraine sufferers move from an episodic form of the disease to a chronic one. Hence the importance of rapid diagnosis of migraine for the implementation of targeted treatment.

Doctor-recommended first-line weapons: Pain relievers like Tylenol and anti-inflammatory drugs like Advil. When the last two don’t work, triptans come into play. “These are real anticonvulsants, specifically designed to treat migraines, to be taken at the first sign of an attack,” explains the neurologist. These molecules reduce the dilation and inflammation of the blood vessels that cause pain. » Caution, triptans are contraindicated in people with a vascular history.

Avoid migraines?

But to improve the quality of life of those who have frequent or very severe migraines, it is necessary to have time to prevent attacks. Doctors have used antidepressants, antihypertensives, and anti-epileptic drugs with some success. This problem? They cause side effects such as memory loss, drowsiness or significant weight gain.

However, 40 years ago, neuroscientists who had just received the prestigious Brain Prize discovered the key role of CGRP in migraine. In 2018, prophylactic drugs based on antibodies that block the action of this protein finally entered the market. Several studies have shown that these injectables (under the skin or intravenously) given once a month can halve the frequency and intensity of seizures in about 50-60% of people with episodic disease. For the chronic form, this improvement is noted by 25% to 40% of migraine sufferers.

“These drugs are effective in reducing the frequency of migraine attacks, but they do not cure the disease,” says the doctor.D pim. The neurologist especially appreciates a few side effects. But be careful, antibodies don’t work on everyone. Why ? In some people, it is suspected that the biology of migraine is not based solely on the CGRP protein, the specialist explains. “A study of the complexity of this disease remains to be done. In the meantime, you need to try the treatment to see if it works or not. »

This new weapon is added to Botox, which has been used for several years to treat chronic migraines. “This topical treatment with few side effects reduces the frequency of seizures by at least 50% in 70% of patients after two to three injections,” the doctor notes.

Please note that due to their high cost, antibody-based drugs and Botox are only available in Canada after you have tried at least two oral preventative treatments such as antidepressants and anticonvulsants.

Other hopes on the horizon

The neurologist is also delighted with the imminent arrival of hepants. This new treatment is primarily intended for prevention by blocking the action of the protein. KGRP. But unlike antibodies, will instead be administered orally, making treatment easier!

The drug can also be used as an anticonvulsant. Since it does not affect the blood vessels, it represents an alternative for patients at risk of cardiovascular complications who are contraindicated in triptans.

The Importance of a Healthy Lifestyle

Despite the growing number of pharmacological options, DD Pym emphasizes the importance of managing migraines primarily through good lifestyle habits. She mentions, in particular, seven to eight hours of sleep in a cool room, sleep without screens, frequent exercise, a healthy diet, adequate fluids, and good daily stress management.

He also recommends, on the advice of a physician, the use of some natural therapies, such as vitamin B2 and magnesium supplements, which have been shown to be effective in reducing the frequency of migraines.

“I suggest that all my patients keep a migraine diary to record the time and circumstances of their attacks. Among other things, this allows the attending physician to measure the extent of the disease and identify triggers; red wine is a typical example,” she notes.

Headache or migraine?

“You must first understand that a headache or headache is a symptom of another health problem, such as a cold, flu or sinusitis,” the doctor explains.D pim. It is also often associated with our lifestyle; for example, the day after a drunken night, a bad night’s sleep, or a poor diet. » The headache is usually temporary and resolves quickly after taking an analgesic such as acetaminophen (Tylenol).

Migraines are much more painful and last from 4 to 72 hours. This often recurs as it is a disease caused by electrical disturbance and inflammation in the brain. In addition to throbbing pain in the head, migraines are accompanied by nausea and even vomiting, sensitivity to light and sound, and even temporary vision problems. People who suffer from it often have to stop their activities in order to lie down in a quiet, dark place.

To be diagnosed with migraine, a person must have at least five episodes for which a doctor has ruled out other causes, such as an infection, brain tumor, or venous thrombosis, that can cause migraine headaches.

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