Migraines are better understood today than in the past – patients also benefit from this. What can you do about migraines?
The pain comes up as suddenly as thunderclouds and overwhelms the patient with force: sometimes as hammering and drilling, sometimes as stabbing and pulling. Many people also suffer from nausea, vomiting, and sensitivity to light and noise during such migraine attacks. Anyone who has to endure such attacks often has a tremendous level of suffering. After all, scientists have made significant advances in the study of migraines in recent years. “The key is that we understand the disease better today,” says neurologist Dr. Lars Neeb from the Charité Headache Center in Berlin. “We could soon benefit from this in therapy too.”
What helps against migraines?
Successes are particularly evident in the prevention of attacks. This is important in order to improve the quality of life of permanently afflicted patients. In addition, the frequent use of painkillers is dangerous: Overuse can lead to new headaches.
When headaches arise, the body’s own neurotransmitter “Calcitonin Gene-related Peptide” (CGRP) plays an important role. It has been found that the concentration of the substance is increased during a migraine attack, as Dr. Charly Gaul, spokesman for the German Migraine and Headache Society, explains. Pharmaceutical manufacturers are currently relying on antibodies that block the effect of this messenger substance and thereby prevent migraine attacks. The preparations must be injected under the skin or given as an infusion every few weeks. “Such monoclonal antibodies are currently being investigated in clinical studies by four manufacturers,” reports Gaul.
The side effects are apparently rather minor. “Most often, there seems to be a slightly increased risk of upper respiratory infections,” says the expert at the Koenigstein Migraine and Headache Clinic. However, no data are yet available on long-term use. In addition, patients respond differently to the drugs. It was shown that the medication had hardly any effect on some test subjects, while others experienced almost no attacks at all. Neeb says, “Antibody therapy is not for everyone. But there are signs that it will be a good treatment option. This is especially true for patients with frequent migraine attacks for whom other preventive therapies have not been effective.” The first drug of this type could possibly be approved in the coming year.
Remedies for migraines: Doctors also use botox
But doctors can already help people with chronic migraines, i.e. those who suffer from headache attacks for at least 15 days a month, better than they did a few years ago. An important step was the approval of botulinum toxin A (“Botox”) for migraine prevention in 2011. This highly toxic substance is produced by bacteria and blocks the transmission of nerve signals in the muscles.
It is therefore injected into the muscle during cramps, for example. Far better known is “Botox” as an anti-aging agent that is injected under the skin to smooth out wrinkles. In fact, it was this application that first gave researchers the idea of using the poison against migraines: Some people had reported that their headache attacks improved as part of their anti-wrinkle treatment.
“Botox” is an option for patients with chronic migraines for whom other preventive drugs are not effective, explains Gaul. Beta blockers, which are actually used to treat high blood pressure, certain antidepressants, or topiramate, originally developed to treat epilepsy, can also help some people. “The selection is based on the patient profile,” explains Gaul. “Comorbidities such as obesity, sleep disorders, depression and asthma must be taken into account.”
In any case, neurologist Neeb has had positive experience with Botox therapy: “The treatment helps about 60 percent of patients with chronic migraines to reduce the frequency of headaches.” The side effects are minor. “In some patients, however, the eyelid may hang for several weeks after the injection. Some also have a heaviness in the neck.” Botox is not a miracle cure either. As experts emphasize, such a miracle cure is still a long time coming.
What can you do about migraines? Prevention through neurostimulation
There are other promising approaches for this: For example, migraine attacks can apparently be prevented by neurostimulation. Cranial nerves are stimulated with electrical impulses so that the transmission of pain is prevented. There are various devices on the market for this purpose: One has an electrode stuck to the forehead to stimulate the terminal branches of the so-called trigeminal nerve. Another uses an ear electrode to activate the vagus nerve. “Something like that can definitely bring something,” says Neeb. “But it is still too early to be able to really judge the proceedings.”
But neither neurostimulation nor medication alone can cure severely affected patients. Instead, according to Gaul, they need a “multimodal therapy approach” that doctors, psychologists and physiotherapists work out together. The best way to prevent seizures is to combine relaxation methods, psychotherapy, endurance sports and medication.
You can find more helpful information here in our health guide.