Migraine Clinical Trials

Migraine is a complex neurological condition which results in varying intensities of headaches associated with different body responses caused by the presence of sound, smell and light. It often begins during childhood and could persist until one reaches adulthood. It can be inherited throughout generations and is therefore considered a genetic disorder.

Around 18% of women and 6% of men are at the risk of getting a migraine [3]. Women are at higher risk due to the fact that menstruation could trigger migraines in some conditions [4]. Therefore its diagnosis and treatment, as well as proper management, becomes quite important. Migraines may be triggered due to certain factors such as meager sleep, hormonal changes, stressful lifestyle and glints of light, noise, certain fragrances or odors [1].

Since migraines affect the mental lifestyle of an individual, anxiety and depression are commonly associated with them. The mental health issues could be so chronic that could lead to suicidal attempts. Thus, migraines affect the overall lifestyle of an individual.

A migraine attack starts in central areas of the brain, which results in the production of early symptoms (aura). The headache phase begins when meningeal nociceptors are activated due to the aura, which is caused by the hypothalamic and brainstem neurons. Trigeminovascular system plays a great role in the manifestation of headaches. However, the exact mechanism through which nociceptors are activated still remains unknown. Apart from that, deficiency of 5-hydroxytriptamine (5-HT) may also play a significant role in the development of migraines.

The repetitive nature of headaches could result in changes on the functionality as well as in the structure of a normal brain, which could lead to the development of a number of diseases.

Those are classified into two types, based on the presence of pre-headache manifestations such as the aura. Symptoms like depression, food cravings, cranky behavior as well as constipation could be noticed before or during a headache. Migraines without aura are the most common types and account for around 75% of cases whereas migraines with aura account for around 25% of the migraine cases.

Major symptoms include headaches that lasts from a few hours to a few days. Headaches are often associated with nausea, vomiting and other gastrointestinal problems. Since migraines could also have effects on brain functioning, cognitive symptoms associated with them may include difficulty finding words, lack of attention, episodes of memory loss, etc. [1].

It is quite obvious that migraines with aura are easier to detect compared to migraines without it. Major problems associated with the diagnosis of migraines could often be misunderstood as sinusitis, medication overuse or normal headaches. Therefore, proper diagnostic tests should be carried out in order to detect the real issue if one experiences severe headaches. Since migraines affect the structure of the brain, a neuroimaging test could be easily able to detect the presence of those modifications [3]. Studying the pattern and intensity of the headaches along with the symptoms associated with them could be used to detect the type of migraines of an individual.

Migraines could be managed with changes in the lifestyle that include having plenty of sleep, relaxation and a proper diet that includes high fiber intake and low sugary content [3]. Intensity and frequency of symptoms could be lessened by staying away from light and sound. Changes in sleep patterns as well as work routines should be avoided as much as possible, as disruption to routine can exacerbate symptoms.

Medications used for treating the issues associated with migraine focus on modifying brain networks and their functions. There are two types of treatment, as described below:

Medications

Acute treatment: Medications of 5-HT1F receptor agonist could also be used to decrease the number of days that the patient manifests migraine symptoms. Analgesic, triptans and ergots could be used to manage the headaches. Suitable medications could be selected by an expert based on the medical history and nature of the patient, intensity of headache and side effects associated. Paracetamol is a preferable choice by medical experts due to its low cost, high availability, minimal side effects as well as effectiveness in treating headaches.

Preventive treatment: Headache caused due to migraine could be controlled with the help of beta blockers such as atenolol, metoprolol and bisoprolol. It has been reported that propranolol shows the highest efficiency in controlling headaches as compared to other beta blockers. Tricyclic antidepressant could be used to control the mental conditions caused by the presence of migraine [2]. Calcium channel modulators, flunarizine and anticonvulsants could also be used to control migraine symptoms.

CGRP is a type of neuropeptide responsible for controlling peripheral and central pain circuits. Medications that target the CGRP pathway could be used to relieve the pain on individuals affected by migraines. Current researches have also been focusing on calcitonin gene related peptide and calcium channel abnormalities in order to develop progress in the effective treatment of migraines [4]. Neuromodulation by occipital nerve stimulation with implanted tiny wires could be used to treat chronic migraine [2]. Thus, there are a lot of future options available for the relief of symptoms associated with migraines.

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Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty and two to three times more women than men. The risk of migraines usually decreases during pregnancy. The underlying mechanisms are not fully known. They are, however, believed to involve the nerves and blood vessels of the brain.

No treatments stop or reverse its progression, though some may temporarily improve symptoms. Affected people increasingly rely on others for assistance, often placing a burden on the caregiver. The pressures can include social, psychological, physical, and economic elements. Exercise programs may be beneficial with respect to activities of daily living and can potentially improve outcomes. Behavioural problems or psychosis due to dementia are often treated with antipsychotics, but this is not usually recommended, as there is little benefit with an increased risk of early death.

Globally, approximately 15% of people are affected by migraines. It most often starts at puberty and is worst during middle age. In some women, they become less common following menopause. As of 2016, it is one of the most common causes of disability. An early description consistent with migraines is contained in the Ebers papyrus, written around 1500 BCE in ancient Egypt. The word "migraine" is from the Greek ἡμικρανία (hemikrania), "pain on one side of the head", from ἡμι- (hemi-), "half", and κρανίον (kranion), "skull".

Initial recommended treatment is with simple pain medication such as ibuprofen and paracetamol (acetaminophen) for the headache, medication for the nausea, and the avoidance of triggers. Specific medications such as triptans or ergotamines may be used in those for whom simple pain medications are not effective. Caffeine may be added to the above. A number of medications are useful to prevent attacks including metoprolol, valproate, and topiramate.