Migraine disorder is an elephant in the room of medicine, says Dr. Andrew Charles, professor of neurology and director of the Headache Research and Treatment Program at UCLA. "All physicians — anybody in any kind of medical practice — knows how common headache and migraine are as a presenting complaint, and yet we don't really talk about it that much," he explains.
Though migraine disorder affects 36 million Americans each year and is listed by the World Health Organization as the third most common disorder on the planet, it isn't well represented in medical school curricula. It also receives relatively little research funding, with the National Institutes of Health dedicating only $18 million to migraine research, out of a budget of more than $21 billion. Most medications prescribed for migraine headaches were developed for other conditions, such as high blood pressure and epilepsy, and were serendipitously discovered to treat migraine. And most of them seem to follow the general rule of working for about half the patients half the time.
At the same time, new treatments are on the horizon.
One promising approach targets a peptide called CGRP that is released from nerve cells and is thought to play a role in the pain mechanisms of migraine. Researchers are developing CGRP antibodies that can be injected beneath the skin, where they bind to CGRP and may prevent migraine attacks.
Now that scientists know that migraine is a neurological disorder rather than a vascular one, they are on the hunt for medicines that don't affect the cardiovascular system and are thus safer for people with heart conditions.
Another drug in development is an inhaled version of dihydroergotamine, a medication that's usually delivered intravenously in hospitals to relieve patients suffering from continuous migraine.
Supplements and herbs
The American Academy of Neurology recommends several complementary treatments, including the herb butterbur (Petasites hybridus), as effective for reducing the severity and frequency of migraine headache in some patients, though the report cautions that the safety of long-term butterbur use hasn't been established.
AAN guidelines state that magnesium supplements are "probably effective" at preventing attacks. Side effects can include stomach upset. Riboflavin, known as Vitamin B-2, is also placed in the "probably effective" category.
A new paradigm in migraine treatment involves the search for non-drug, non-invasive therapies. Transcranial magnetic stimulation delivers a magnetic pulse to the brain, essentially hitting "reset" on electrochemical signals that run awry in migraine attacks. Studies show it is effective in patients experiencing migraine with aura, and the first hand-held, single-pulse device has been approved by the Food and Drug Administration.