It was just a few years ago, after some major breakthroughs in our understanding of headache, that there seemed to be a flurry of new headache research. We were optimistic that we were on the threshold of a whole new world of effective and safe treatments. Unfortunately, there has been a real slump in potential earth-shattering research in the past two years.
The scientific journal on headache, simple titled Headache, was published yesterday and one article looked back at the research of 2012 and ahead to 2013. It was quite disappointing. One new medication, the first in its class (calcitonin gene related peptide antagonist), was scheduled to be launched this past year. However, during their last trials there was a subtle rise in liver enzymes with patients taking it daily (and few ever would). This sent shock waves through the company. Pharmaceutical companies are terrified of bringing a medication to the market and then one person out of a thousand having liver problems. They would be sued for, potentially, hundreds of millions of dollars. So this promising medication was quickly abandoned.
There were two delivery systems of old medications in the pipeline last year, a transdermal sumatriptan (which was finally approved just this week) and an inhaled dihydroergotamine. The inhaled dihydroergotamine was delayed because of the mechanics of the inhaler needed improvements. In Europe they are studying a delivery system of nasal CO2 as a treatment for migraine.
People who don’t work in evidence-based medicine sometimes make the claim that we are not interested in so-called “natural” treatments. Nothing could be further from the truth. At the research meetings every year I see abstract after abstract (summaries of studies) regarding supplements, acupuncture, special diets and a variety of non-drug treatments. Unfortunately most show no benefit (except for acupuncture) and therefore never make the news. We are committed to telling the truth about treatments and if they don’t work, we don’t promote them. It would be our dream that some plant product would cure headache problems . . . but that is just a fantasy at this point.
Research into the complexities of migraine and other headaches do continue. Part of the reason that there are no major breakthroughs is the fact that headaches, while one of the most common symptoms, is one of the most complex. It is far more complex than heart disease, stroke and even epilepsy. It is similar to complex, multi-organ disorders as MS or other autoimmune diseases (but headache is not an autoimmune disease). It is certainly understandable why patients love the simple explanations and “cures” touted for headaches (but with no scientific proof of safety or efficacy).
Most of our treatments for headache at this point are through a serendipitous process, or simply by accident. For example, hundreds of years ago people noticed that when they accidently ate a fungus that grows on wet wheat and rye, that one of the things happened to them was that their headaches got better. Through a long process the fungal extract, ergot derivatives, were discovered. When we learned how they worked (by mimicking two types of serotonin that the brain uses to shut down headaches) then products, which we now know as the triptans, were created. Most of our preventative medications were discovered when they prescribed for non-headache related problems and the headaches got better. The same can be said for Botox.
So, our greatest hope at this time that some new accidental discovery would come to light. Meanwhile, back in the lab, progress is being made in the full understanding of headache disorders and their eventual cure, but that progress is at a glacier rate because of the complexities.
However, with that said, most patients continue to suffer because they have never had specialty care. Everyday I have new patients who feel hopeless because they think they have tried everything for treatment. I’ve never met a patient whom I didn’t have ideas that they had never considered. Most of them have only tried about 25% of the possible treatments so there is always, and I will say ALWAYS, hope.