Duke Medicine HealthLine
Published: Nov. 26, 2007
Updated: June 7, 2010
You might as well have been hit with a sledgehammer and eaten bad eggs at the same time.
Migraines have long confounded researchers and clinicians, but in the last few years what we know about the causes of migraines has changed -- and it’s opened up possibilities for new treatments.
The source of these savage headaches is now believed to be the brain’s cellular activity. When activity in part of the brain’s cortex becomes depressed, certain inflammatory chemicals are released. These chemicals irritate nerves in the head, triggering the headache pain and its henchmen, light and sound sensitivity. Once a migraine starts, the stomach slows down its emptying process, which causes nausea.
Duke neurologist Timothy Collins, MD, says that researchers at Duke are targeting this process with an experimental treatment, in which a device sends electrical impulses through the occipital nerve to the brain stem. “While the device doesn’t actually block pain,” says Collins, “it sends additional signals down the nerve that change the activity and signals of other nerves in the brain.”
While studies of this and other new therapies continue, most sufferers will find relief from one of the current medications on the market. Each mode of treatment works to throw a wrench in a particular part of the migraine process:
Soothing the sting: Drugs called triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig), treat migraines as they occur by blocking the release of the brain chemicals that contribute to the nerve-irritating inflammation.
Preventing the problem: Propranolol (Inderal), divalproex sodium (Depakote), and topiramate (Topamax) prevent migraines from happening, but researchers aren’t sure why. It’s thought that these drugs may “calm down” the parts of the brain in which migraines begin. Collins says that clinical trials show best results between four to eight weeks after the medication is started.
The new kid on the block: Pregabalin (Lyrica) is a medication that’s currently FDA-approved for pain associated with fibromyalgia, shingles, and nerve damage from diabetes. It’s now being studied as a potential therapy for treating migraines. “The trick isn’t finding a treatment,” says Collins. “It’s finding the right one. We know that all of these medicines work, but people respond differently to each medication, so it takes time to find the drug that works best for each individual.”
Thinking outside the box: Vitamin B12 (riboflavin) has been shown to help prevent migraines, though it takes three months of regular use to become effective. Acupuncture is also considered by some to be a good preventive measure, though this treatment has not been well-assessed in clinical trials, so Collins says it’s harder to speak definitively about its effectiveness.
Neurologist and sleep medicine expert Paul Peterson, MD, notes that healthy, restful sleep is also a potent deterrent and sometimes a cure for migraines. “We know that there is a relationship between sleep disorders and increased migraines,” says Peterson. “And recent studies have shown that in people with both sleep disturbance and chronic pain, we can’t just treat one or the other. Treating both conditions is essential in order to improve either one.”