Migraine can often be described as a ‘curse’. An extremely painful condition, yes, but it’s more than that, having over 200 associated symptoms such as brain fog, dizziness, aura and muscular pain to name just a few. It can hit you in the prime of your life and, worst of all (the ‘curse’ bit): it’s an invisible condition. As a migraine sufferer myself, I often describe as it as a ‘dark’ condition, not only due to its severe impact on quality of life but because, physically, sufferers are left lying in the dark. Perhaps, symbolically, too.
If you combine an invisible illness with silent sufferers then, naturally, an awareness campaign is required. But this condition is so common that an entire awareness month is required. In fact, migraine affects around 1 in 7 people globally and is the world’s second-leading cause of years lived with disability. Sufferers are grateful for the National Headache Foundation (USA) for coordinating National Migraine & Headache Awareness Month (#MHAM) every June.
In honour of this event, we thought we’d recap some key insights from our Director and internal Migraine Consultant, Lucy Saunders (read more about her story here) and some key findings from the annual Migraine World Summit which took place earlier this year:
In the past, specific treatments for migraine prevention have been almost non-existent. Treatments for patients have historically been treatments from other areas that sort-of work in migraine, sometimes: propanalol, amitriptyline, topiramate. Acute migraine treatment has been a bit more successful: triptans were game-changers. But with side effects and at limited doses per month.
Then a breakthrough happens: scientists identify the role of CGRP as a key player in the pathogenesis of migraine. There is a clear correlation between the presence of CGRP levels and migraine attacks; what if we can develop drugs to decrease levels of this neuropeptide? By mid-2020, four different CGRP monocolonal antibodies for migraine prevention had been approved by the FDA.
From our learnings at the annual Migraine World Summit, it’s clear that it continues to be a time of great change in the migraine treatment space. A condition that previously had limited treatment options now has more investment and focus from pharmaceutical companies, charities and governments.
It was noted that HCP familiarisation with the four CGRP monoclonal antibodies is increasing and that, on the whole, real-world experience is reflective of clinical trials. Meanwhile, the gepant class in particular is an evolving landscape: some treatments can be used for acute migraine, some for prevention, some both. There are more in development including one with a nasal spray administration.
And there are even more treatments being investigated: the Ditan class and other molecules involved in completely different migraine pathways (eg PACAP, adenosine, amylin).
Another area of interest is in neuromodulation devices. The American Migraine Foundation describes neuromodulation as: “conducted with a device that uses electrical currents or magnets to adjust or change activity that occurs in the brain”. Many patients report success with these, with minimal side effects, especially in combination with pharmacological treatment and at the first sign of an attack. There are a few currently available with more in development.
However, despite all the positive progress, this is still an area of high unmet need. Access to medications is a huge concern (even with insurance) and side effects are also still being understood. There’s also much work to be done in treating the cognitive side effects of migraine such as difficulty concentrating.
So, with this in mind, what does the future hold?
Overall, it was clear that in an ideal world where treatments are more widely available, a mix of drugs are likely to be used with the options tailored to the patient. And HCPs are excited to finally have more options, that are actually designed for migraine as a disease in its own right, rather than having to resort to using treatments from other conditions.
When it comes to the cognitive symptoms, there might even be opportunity for the dual approach of psychological and medical intervention simultaneously. In fact, studies show that medication plus CBT works better than medication alone for the preventive treatment of migraine.
Here at HRW, we have a dedicated neuroscience team, Synapse and have been working in this space for years, with this type of work representing about 15% of the projects we do. We are continually expanding our team’s capabilities in neuroscience, through input and consultancy on research projects; external activities such as conference attendance, webinars, and podcasts; and interviewing expert physicians and researchers within the neuroscience field.
When it comes to migraine, we are so excited that a light is finally being shone on this space. Finally, the future is bright for those sufferers in the dark.
We have extensive experience in the migraine space so do reach out to discuss your research needs!
By Lucy Saunders