The Mindful Migraine

OK, so today is another deep dive into the science of migraines, from the Migraine World Summit 2024, covering an interview with Dr Peter Goadsby, a professor of neurology at Kings College, London.

This is another example of a science-discussion that pushed my art-brain to the max, which makes it a good place to put my disclaimer up front:

Disclaimer – I’m not a doctor, so please do your own research when it comes to medical information and always speak to a qualified practitioner before making any medical decisions.

The bulk of the discussion was about CPRG which I looked up online and found this disturbing description (who volunteered for this trial??):

“CGRP stands for calcitonin gene-related peptide, and it is a protein that is released around the brain. When CGRP is released, it causes intense inflammation in the coverings of the brain (the meninges), and for most migraine patients, causes the pain of a migraine attack. In fact, if you give CGRP by an intravenous method to a person with migraine, within four hours, most of them will get a migraine. That’s the basis of all the new treatments.”

(Source: Anti CGRP Migraine Treatment | American Migraine Foundation)

According to Dr Goadsby, CGRP is a neurotransmitter found in the brain, and is used to transmit signals between nerves, and blood vessels / other nerves.  Apparently, they have many roles and are found distributed in the brain in the dura (the covering), but also in hair follicles and the gut.  In a migraine person they are ‘over expressed’. 

Triptans, which are used as abortive medications in migraine attacks, change how blood circulates in the brain and how the brain processes pain signals.  They influence the release of CGRP from nerves.  Now we can block CGRP with monoclonal antibodies (which are biologically engineered with proteins that modulate our physiology), or with ‘gepants’ (which are medications which block the pathway between CGRP and its receptors = a ‘roadblock’).

I looked up ‘gepants’ online too and it said:

“Gepants are a class of drugs specifically designed to treat migraine attacks when they occur by targeting the calcitonin gene-related peptide (CGRP) pathway. CGRP is a protein found in the nervous system that plays a crucial role in inflammation, the transmission of pain and the dilation of blood vessels in the brain.”

(Source: Gepants: A New Class of Migraine Treatments – Headache Australia)

Dr Goadsby said there was still a long way to go with CGRP research, but so far research seems promising, in particular because the associated medications seem to have low or no side effects – or no ‘penalty’ as the doctor phrased it.

That said, up to 30% of migraine patients found CGRP treatment “useless”. The probability is that for these patients, CGRP is NOT the biological factor creating their migraines.  These ‘non-responders’ are often bitterly disappointed, but they also motivate researchers to ‘double down’ on their efforts. 

He reiterated that migraine differs between people, and between attacks for the same person.  He also noted that the ways of treating migraine attacks might differ for the same person, with over the counter medications working one time, but not the next.  He reminded patients that taking medication on day two is too late [in other words, when you feel sick, take your meds before the migraine ‘leaves the station’ / ‘gets carried away’.]

Dr Goadsby reiterated that migraine is a condition which is incredibly complex.  On the downside, the level of research funding being directed towards migraine is “atrociously minimal”.  On the upside, he suggested that modern migraine research is only 40 years old, and that they have come a long way in that time, and already medicine is getting better and better, and doctors are increasingly being able to find the right treatment matched to each person.  He believes that one day there will be a “smorgasbord” of treatment options to choose from that are reliable and tolerable.  He hopes to be able to see it in his life time.

Lastly, PACAP [pituitary adenylate cyclase-activating polypeptide – phew!] was mentioned, which is similar to CGRP, and is released from nerves in the brain. Initial studies suggest blocking PACAP can reduce the frequency of migraines, and this might be another target moving forward.  Apparently, there is also a glutamate neurotransmitter that they are using to try to ‘turn down the volume’ on migraine. Whilst these are still in its early days of research, he reminded patients that this means you haven’t ‘tried everything’ because they are still inventing the next thing for you to try!

Dr Goadsby finished with some really important advice: don’t compare yourself to others, just do the best you can do for you. 

Remember your brain – your pain – your journey: you are you-nique.

Take care, Linda x