The Mystery of Migraines
- manuelladanso
- Aug 6
- 3 min read
Migraines! A socially debilitating condition that affects approximately 1 billion people world wide (1). What is it? Why do so many people get it? Is there any hope in finding a cure? This article discusses the current knowledge surrounding this area and the current generic and FDA approved drugs that can be used to treatment. Here, we hope to spread some awareness about migraines.
Migraines are intense pulsing headaches that are usually associated with symptoms as nausea, vomiting, sensitivity to: light, sound, touch or smell. For patients to be diagnosed as having migraines they must have experienced at least 5 migraine attacks. with attacks lasting for four or more hours without any treatment, and two or more of the following: pain that is one sided, throbbing, moderate or severe, or triggered by physical activity such as bending over. Additionally, these symptoms should be accompanied by the presence of nausea or vomiting, light or noise sensitivity. (2)
There are two main types of migraines characterised by the their duration and whether there is aura or not.(2) Aura is a set of neurological symptoms that accompany the headaches experienced during a migraines e.g. flashing lights, numbness, aphasia, trouble speaking, etc. The two main types are episodic (14 episodes or fewer in a month) or chronic (15 episodes or more a month). Episodic migraines can transition into chronic(2). Currently, there is no known cause of migraines. However, patterns have shown that there may be a hereditary aspect to this condition as well as environmental triggers such as: chocolate, caffeine, stress, onset of periods, anxiety, depression, to name a few.
Treatments and remedies vary from individual to individual and is dependent on factors such as co-morbidities, in order to provide personalised options. Home remedies include regular exercise, staying hydrated, maintaining optimal sleep patterns and practicing relaxing techniques such as yoga. These remedies may be effective for those with low to mild migraine symptoms. However patients with more severe effects will require pharmacological intervention. First line treatments are non-steroidal pain killers i.e. Ibuprofen, especially for milder migraines with "antiemetic/neuroleptics Dopamine D2 receptor antagonists being used for patients with nausea and vomiting," but may have associated side effects. For patients with more severe symptoms can be prescribed Triptans such as Sumatriptan, Frivatriptan, Rizatriptan, etc. However, these have been shown to have side effects i.e. heart palpitations and vasoconstriction of the blood vesels. As such, the FDA has approved a new drug named Lasmiditan, which belongs to a class f drugs known as Ditans and works by blocking pain pathways to the brain. Lasmiditan has been shown to have less side effects than Triptan's and does not cause vasoconstriction. It is currently approved for use in US and Europe.
However, a significant unmet need remains in fully understanding the complex mechanisms underlying migraines. Advancing research into their root causes will pave the way for more effective, personalized, and potentially permanent treatments for individuals affected by this condition.
Bibliography
Migraine: epidemiology and systems of care Ashina, Messoud et al. The Lancet, Volume 397, Issue 10283, 1485 - 1495
Antonio L. Aguilar-Shea, Javier A. Membrilla MD, Javier Diaz-de-Teran, Migraine review for general practice, Atención Primaria, Volume 54, Issue 2, 2022, 102208, ISSN 0212-6567, https://doi.org/10.1016/j.aprim.2021.102208 (https://www.sciencedirect.com/science/article/pii/S0212656721002420)
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