Research reveals possible migraine treatment methods

It’s not «just» a headache. Migraine is a complex neurological disorder accompanied by a severe, pulsating headache. Those affected are often enormously restricted in their quality of life and suffer greatly from the discomfort. During a migraine attack, certain brain regions are activated, accompanied by changes in blood flow and neurotransmitter activity. Scientists believe that both genetic and environmental factors play a role in migraine. While there are a variety of ways to alleviate discomfort, a remedy that reliably helps everyone has yet to be found. A new study on ketamine in acute migraine attacks looks promising.

What happens during a migraine attack?

During a migraine attack, certain regions in the brain, such as the trigeminal nerve, become overactive and send out pain signals. At the same time, blood vessels in the brain dilate, followed by an inflammatory response. Often, an acute migraine attack is accompanied by severe headache and nausea as well as sensitivity to light, noise, and smell. One to two out of ten people also experience migraine with aura, in which case neurological symptoms such as visual disturbances and difficulty speaking may also occur.

What triggers migraine?

Why exactly certain people suffer from migraine isn’t yet known. There seems to be a genetic component at play, as it often affects generation after generation.

The triggers of migraine can vary, but there are some common factors that play a role. Lack of sleep or stress, for example, can lead to an attack; the metabolism of certain brain cells is disturbed by altered genetic factors. Migraine triggers can be hormonal, but they can further include a lack of fluids, the consumption of certain foods and beverages, or medications. Sensory stimuli, such as bright lights or loud noises, can also lead to an attack.

And the weather also has an impact on migraine patients. Recently, researchers presented their findings at the annual congress of the European Academy of Neurology. With that, the science supports what sufferers have been experiencing for a long time, namely that in around half of all people who suffer from migraines, changes in weather conditions can trigger attacks or intensify existing headaches.

Recent research also suggests that migraines may be related to changes in gut health, which has resulted in increased attention to diet in migraine patients.

However, migraine not only has physical effects, but can also result in considerable psychological stress. The constant worry of a migraine attack and the limitations in daily life can lead to anxiety, depression and social isolation. In addition, for many people with migraine, the condition presents a challenge in their working lives. Regular absenteeism and decreased productivity can cause difficulties in the workplace. Flexible working hours, ergonomics in the workplace, and raising awareness of migraine can ease the situation for sufferers.

Who is affected?

In Switzerland, one in ten people are affected by migraine. In Germany, the figure is as high as about 18 per cent of adults and 10 to 12 per cent of children. Migraine occurs in all age groups. However, women suffer from migraines about twice as often as men. This could indicate a relationship with female sex hormones. Often, migraine in women is related to the menstrual cycle and occurs at the same time as menstruation.

What helps with migraine?

There are two approaches to the treatment of migraine. First, acute treatment, that is, the treatment of symptoms during an attack. Second, prophylactic treatment, that is, the prevention of migraines.

In acute treatment, pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and triptans are commonly used. In some cases, it may also be necessary to take antiemetics for nausea to get through the attack. Because sensory stimuli such as bright lights or loud noises make pain worse, staying in a dark, quiet place is also helpful during an acute attack.

A study by Harvard Medical School on the influence of different colour spectra showed that not every colour of light produces the same effect. In the study, green light with a wavelength of 530 nanometres was able to reduce the pain of a migraine attack in some of the test subjects. However, the use of green light as an effective therapy against migraine requires further (clinical) studies in significantly more patients.

Ketamine – promising results in clinical trial

The anaesthetic ketamine may be another promising target for the treatment of migraine, according to a study recently published in the journal Regional Anesthesia and Pain Medicine. Ketamine is an analgaesic that has been used for several decades to successfully treat chronic pain, although the exact mechanisms of action are not yet known. The hope, however, is that it can also loosen the pain-reinforcing circuitry in the brain during a migraine attack.

In the study, patients were treated whose migraine attacks couldn’t be prevented with prophylactic methods and who didn’t respond to common medications for acute attacks. The results are promising – almost half of the subjects rated the ketamine spray they used during migraine attacks as very effective. Another 39 per cent felt it was somewhat effective, and nearly three quarters attested to a better effect compared to other migraine medications. But there were also temporary side effects: fatigue and blurred vision were most common. Other side effects included cognitive disturbances such as confusion, vivid dreaming, and hallucinations. Another problem is the potential risk for addiction. Therefore, ketamine should be used sparingly and not too regularly, or long-term consequences (bladder infection) may occur.

People with frequent or severe migraine attacks would be better helped with prophylactic treatment. Here, too, there are various options, but so far there’s no one-size-fits-all remedy. Certain medications, such as beta blockers, antidepressants, or anticonvulsants, show effects in some migraine patients. In addition, non-drug approaches such as relaxation techniques, stress management, and lifestyle changes can play an important role. It’s important that each individual affected finds the remedies that work for them.