The most recent issue of Cephalalgia (the journal of the International Headache Society) had a focus on genetics and migraine. I often tell my patients that I foresee a day when, on the first visit, a patient is genetically tested and based on their genetic profile, we can pick the best treatment plan. As I just finished reading the journal from cover to cover, I will have to say that day is not here yet.
Some of the things that we have learned, as revealed in the studies published in this issue, are the following:
- The genetics of migraine—while very real—are quite complex.
- There is early genetic evidence that migraine with aura and migraine without aura are the same thing. In the 1980s we considered them very different.
- A large trial, looking at the association between genetics and treatment, shows no significant predictors. There were only minimal predictive properties from genetics to which abortive treatments might work (but not worth doing the tests because of reliability) and no predictive properties regarding what preventative medications might work.
- (My Commentary): We hope with a better understanding of the genetics, this will all change. In ten years, genetic testing will have value. There are companies and even providers now claiming that they can do genetic testing to better figure out the patient’s headaches and to find better treatments. However, these advocates appear to be opportunists, looking for an edge on making money, not helping patients. There are no such tests available at this juncture anywhere in the world and the patient should be leery of anyone making those claims now.
- We have known that there is an association between migraine and depression. Some of that is causal. This means that if you have migraines often enough, anyone would become depressed. However, there is a genetic connection too. It appears that 20% of the tendency for migraine sufferers to be depressed can be directed related to shared genetics.