News From the World of Headache Research

I read several journals and listen to many lectures each month on the cutting edge of headache research. I try to provide brief summaries of the most pertinent findings here.

1) Will Chronic Migraine Last Forever? A look at remission  from chronic migraine (15 days per month or more of migraine or other headaches) found that only 34% still had persistent chronic migraine and another 26% had intermittent chronic migraine two years later. So it is no hype to suggest to patients that have chronic migraine that most likely they will be better within two years.  Of the 383 patients studied, those on preventative medications in the beginning were most likely not to have chronic migraine in the end.

2) Does Migraine Make You More Prone to Dementia? This question has been raised a lot, most likely because headache sufferers have a higher incidence of spots on their brains in MRIs.  A study published this week showed no association between having migraines and later developing dementia. So this is good news for those who worry about such things.

3) Zecuity® is Will Be Available Soon. A electrically driven patch that delivers sumatriptan (what’s in Imitrex®) will be available in the next few weeks. The greatest advantage of the patch is that it will bypass the stomach for those patients who have early onset of nausea or even the typical migraine patient who doesn’t absorb medications well during an attack.  The patch is slower than the nasal spray and the injection and I’m a bit concerned that it will not be covered by some or most insurances.

4) Can Dihydroergotamine (DHE 45®)Cause Rebound Headache? It has long been believed by most of us that dihydroergotamine is not only the most effective migraine abortive, but the one with no risk of rebound headaches. Indeed, the gold standard for getting people off of rebounding medications is putting them on dihydroergotamine.  A couple of top Eruopean headache specialists presented a report that dihydroergotamine can cause rebound and should not be used more than two days per week.  I’m still doubtful but time will tell. I bet that other headache specialists will write articles in the near future trying to disprove this theory.

5) More Migraine Genes? A couple of new genes have been found (more than five others have been found) that may be related to forms of migraine. One is called KCNK18 and the other MTHFD1 (a coding polymorphism of that gene). Some day the precise diagnoses of  headaches will be done by genetic testing and even further down the road, the real cure will come through gene therapy (fixing the broke gene that leads to migraine headaches).

Genetic flaws are the real “root causes” of headaches.  We in evidence-based medicine are often accused by those who don’t know a lot about headache research that if we prescribe medications we are “only treating symptoms and not the cause.” Nothing is further from the truth. The only medicines that “only treat the symptoms” are pain pills. Pain pills have only a limited, compassionate use in headache treatment. Our prescription medications are targeting and compensating for the effects of broken genes, which cannot not be “fixed” at this present time by any therapy.