There is nothing earth-shattering that has been published in the last month. I will summarize what I have seen.
- The CGRP antagonist (the so-called “migraine vaccine”) studies are still looking promising. We hope that something would be on the market by the end of next year (2017). We also hope that the cost would not be prohibitive and that the insurances will not reject the treatments, considering that migraine is not a priority.
- We wish that our models of migraine would reach that eureka moment when everything would fall into place. Then we could come up with a concise, yet, universal explanation of migraine. The reason we haven’t reached this conclusion isn’t because the researchers are dumb. They are brilliant and work very hard. It is because the human body is so incredibly complex (we are talking about billions of neurons). A model that was starting to take place a decade ago, is where migraine starts with an electrical disturbance on the surface of the cortex (the outer most layer of the brain), is now being questioned. It could be even more intricate and complex involving faulty circuits between the cortex and the thalamus. The thalamus—as an understatement—is like a relay station between the nerves coming in from the body and the cortex of the brain, where those signals are processed. We understand why some patients op to believe far simpler (but erroneous) explanations for headache such as allergies, toxins, joints out of place or hormonal imbalances. We only dream that headaches could be explained easier and fixed with less efforts.
- As study of cluster headache patients in Europe showed that only 35% were treated with standardized and effective treatments. This was due to a lack of understanding of present protocols by primary care physicians and general neurologists. It also showed that when the standard treatments are followed, there is a much higher quality of life. These numbers are probably the same in the US.
- High altitude headaches in both normal people and migraine sufferers are very similar and it raised the question of low oxygen consumption as a migraine trigger and the possibility of treating high altitude headaches the same way we treat migraines.
- Occipital or four point, implantable electrical stimulators (one type is known as the Omega Procedure®) have been found to be quite effective, although the long term benefit is still unproven. If these procedure are paid for by insurance companies (and rarely are) the insurance companies require that the patient has an external trial device (needles through the skin) first and if that works, the implantable devices would be covered. A study now shows that there is no relationship between the response to the trial device and the real device. In other words, if the needle through the skin does not work, it has no implication on how well the implantable device will work.
Once again I had to type fast between patients and this has not been proof-read.
Mike Jones, MPAS-C