Can a Protein Prevent Migraine?
By RHONDA MANN, Tufts Medical Center Staff
For twenty days each month, Shaynah Barnes was in pain. It would start behind her left eye and migrate down her neck into her back.
"I was so beaten down by my migraine. I need to attend social events for my job and could not function well at them," said the 41 year old who works in politics. "Now, I feel more like a normal person: I haven't had a migraine headache in months!"
The difference for Shaynah came after enrolling in a clinical trial, looking at one of a new class of four drugs to treat migraine headaches preventively, known as biologics.
"Think of a migraine headache as a snowball, starting to roll down a hill. It picks up speed and gains momentum as it rolls down the hill, until it can't be easily stopped," explained Egilius L.H. Spierings, MD, PhD, a neurologist and fellowship-trained headache specialist and Director of the Headache and Face Pain Program at Tufts MC. "These biologics stop the snowball before it starts rolling down the hill and gaining momentum by blocking the activity of a protein involved in causing migraine headaches."
Research has shown that this protein, known as calcitonin gene-related peptide (CGRP), spikes during a migraine headache. CGRP is released from nerve endings in the head, opening up blood vessels and causing the pain of the migraine headache.
"These biologics are potent in terms of blocking the effects of CGRP on the blood vessels in the head. I've been working in this field for 40 years and have never seen anything as effective in preventing migraine headaches," said Dr. Spierings.
About 12 percent of adults get migraine headaches at least once per year, according to the National Institutes of Health. Women are roughly three times as likely as men to have migraine and also tend to have them more often. Unlike a regular headache, migraine comes with a host of symptoms, often including severe pain on one side of the head, sensitivity to light and sound, vision changes ranging from blurred vision to scintillations, and nausea or vomiting. Without treatment, migraine headaches can last for three or five days and sometimes even longer. Currently, while a number of preventive medications are available, Dr. Spierings says many have side effects like fatigue, difficulty thinking, and weight gain.
Nearly a dozen studies conducted to date suggest these new biologics - three of which are given monthly by injection and one that is given every three months intravenously – decrease the number of headaches as well as the intensity of the pain. Overall, the studies showed a 50 percent reduction in migraine headache days in 60 to 70 percent of patients and a 75 percent reduction in as much as one-third to one-half.
"There were virtually no side effects," noted Spierings. Some patients saw relief after just one treatment, he said.
Larger confirmatory trials are ongoing on these biologics with possible consideration for approval by the Food and Drug administration by the end of 2018. Because the treatment is antibody based, it is likely to be expensive, according to reports. Because the presentations of migraine differ, no single type of therapy is likely to work in everyone. However, for many, the result may well be life changing.
"I'm in disbelief. I don't ever remember going this long without having a migraine headache," said another patient of Dr. Spierings, who requested to not be named. The mother of three had tried everything to put an end to her headaches – from herbal medicine to acupuncture and massage and many preventive medications. "I was constantly waking up with a migraine headache and going to bed with one."
Then, she saw a segment about the clinical trials on the local news.
"I was having 15 migraine headaches a month. After just a few treatments, I feel like a new person – I notice an 80 percent reduction in my headaches and those I do get can be treated easily."
These biologic studies are still enrolling patients with frequent or chronic migraine. As with clinical trials in general, not every patient is eligible however. For more information about the studies and to inquire about eligibility, call 617-744-1310.
The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use. For information about your own health, contact your physician.
Posted March 2017
