Thursday, June 28, 2018

It's Not a Headache

Why Did It Take So Long to Figure Out Migraines?

Under-researched and highly dismissed, migraines have made sufferers a resourceful bunch. Though a new promising drug might finally offer them relief.
 
The Cut via 3 Quarks Daily by
To be clear: A migraine is not a headache, and people with migraines don’t like their condition being called one. It’s not that headaches aren’t part of a migraine: They are. But a headache is a single symptom of a multifaceted neurological disease — one that includes loss of vision, intense nausea, and sensitivity to light and sound. And those are just the common side effects. Some sufferers find themselves yawning compulsively, slurring their speech, and losing sensation on one side of the body. Some migraineurs (yes, that is the technically accurate moniker for migraine sufferers) start seeing big things as small — a side effect dubbed “Alice in Wonderland syndrome” by doctors.

Nonetheless, for as long as they have existed, migraines have been trivialized as headaches or dismissed altogether. Which is clear when you look at the treatments available: Almost every drug used between 1550 B.C. and today has been a repurposed one. Poultices of opium and honey, botox, anti-convulsant drugs, antidepressants, beta blockers — drugs whose efficacy was not intended but stumbled upon. Triptan, a class of vessel constrictors created to abort and lessen the effects of (not prevent) attacks at their onset was released in 1991. It was the only class of drug created specifically for migraines — that is, until now. On May 17, a preventative drug called Aimovig, 30 years in the making, gained FDA approval; it’s a monthly shot that modulates patients’ levels of CGRP, a neurotransmitter whose levels rise during migraine attacks. This means that it is days away from getting in the hands (or arms — it’s an injectable) of migraineurs. At at least for those who are able to pay full price: The drug costs $6,900 a year, or $575 per treatment.
That it took until 2018 to produce a drug that could help up to 39 million people in the U.S. alone — 18 percent of all American women, 6 percent of men, and 10 percent of children — is mostly due to a long-standing misunderstanding of what happens in a person’s body during a migraine attack, says neurologist Dr. Peter Goadsby, the director of the UCSF Headache Center. Until the advancement of imaging technology in the 1990s, migraines were entirely invisible. But it also has to do with the fact that women most commonly inherit the disease. One out of four women will experience migraine in their lives, three times as many as men—likely because hormonal fluctuations are a major migraine trigger.

 “The lack of research throughout the 20th century,” says Dr. Alexander Mauskop, the director of the New York Headache Center, “is because people, then and now, underestimated migraines. They thought it was a disease of hysterical, neurotic women.” Only three hours are spent on headaches during four years of medical school. Less than a one percent of the NIH’s annual budget is dedicated to migraine research — $14 million, some 36 cents per sufferer.

That the medical community has (finally) effectively responded with a preventative, targeted treatment is incredibly good news to migraineurs everywhere. Still, there’s work to be done. “Many doctors — doctors! — still believe it’s a stress-related problem,” says Mauskop. “It’s a brain disorder. Period. And it’s important people think of it that way.”

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