New Hope for Migraine Sufferers

Each day, millions of people get a headache. Tension headaches affect over one-third of men and half of women worldwide; one in 20 adults suffers from a headache every day or nearly every day. While uncomfortable, such headaches are typically managed with over-the-counter pain medications or the passage of time.

But for migraine sufferers, the severe pain, sensitivity to light and sound, and, in some cases, vomiting they experience can stand in the way of living a productive life.

Compounding their suffering is the fact that most people who live with this debilitating condition go undiagnosed and never receive treatment, which can dramatically improve their quality of life. One such therapy, Aimovig, recently hit the market. It is the first migraine-specific preventive medication proven to reduce migraine frequency in adults, by up to 50 percent in one six-month study of those with episodic migraines.

How can people know if what they are experiencing is a common headache or a migraine? Dr. Susan W. Broner, medical director of the Weill Cornell Medicine Headaches Program, talked to Health Matters to answer common questions about migraines and provide insight into this new medication.

What’s the difference between a headache and a migraine?
The term headache is used to describe pain anywhere in the head, and there can be many causes of headaches. The most common are primary headaches, though people are often worried they have a secondary headache. Secondary headaches are caused by things like aneurysms, brain tumors, or a sinus infection, and many systemic illnesses or diseases can cause a headache.

The most common primary headache disorder is a tension-type headache, which is typically mild to moderate in pain. It’s usually not associated with sound sensitivity, and it is never associated with nausea. Usually, people just go on about their day and treat it.

Migraines are the second most common primary headache disorder. It is an episodic neurological disorder that involves a complex interplay between neurotransmitters and inflammatory molecules. During an attack, the trigeminal nucleus, a structure deep in the brainstem, becomes activated and sends signals to other areas in and around the brain that ultimately create the pain and symptoms of a migraine.

How can people tell if they have a tension headache or a migraine?
There’s diagnostic criteria for migraines. To be diagnosed with a migraine, a person has to have two out of four pain characteristics: one-sided; throbbing; moderate to severe pain intensity; and pain that worsens with activity, like walking stairs. A migraine may be accompanied by either light or sound sensitivity, nausea, or vomiting. An attack usually lasts four to 72 hours, and the diagnosis is made after a person has experienced at least five attacks and the pain is not thought to be caused by anything else.

How common are migraines?
Migraines are extremely common. They are more common than diabetes and asthma combined, and affect about 12 percent of the U.S. population. Migraines are more common in women than men at a ratio of 3 to 1. Although over 35 million Americans suffer from migraines, there’s a good percentage of people who haven’t been diagnosed or have received the wrong diagnosis.

The World Health Organization notes that migraines rank as the sixth most debilitating condition globally in terms of years lost to disability — and in people under 50 it ranks third. Even though migraines don’t shorten people’s lives, they do greatly affect work and family life in terms of ability to function during attacks, and lost work.

Are there signs you’re about to get a migraine?
A migraine comes either with or without an aura. Most people with a migraine don’t have aura, but those who do may see flashing lights or zig-zag lines, have difficulty speaking, lose sensation in part of their body, or even get weakness of an arm or leg. Auras last five to 60 minutes, and a headache typically follows. About 30 percent of sufferers get an aura with their migraine. Some people will get what is called a prodrome: subtler symptoms before a migraine starts, such as excessive yawning, craving of salty or sugary foods, or a sense of overwhelming fatigue or irritability in the minutes or hours before the headache begins. That’s also part of the migraine attack.

How can you treat a migraine once an attack comes on?
The key is to treat it as early as possible, within 15 to 30 minutes of the onset of pain symptoms. I ask my patients to keep a diary and include what they think are triggers — caffeine, stress, or a combination of things — so we can reduce a person’s vulnerability to migraines.

There are over-the-counter analgesics that can be helpful for people; things like ibuprofen, naproxen, Excedrin, or caffeine may help. Hydration is also helpful.

The goal is to get rid of the headache within two hours and not allow it to recur. There are also prescription-as-needed treatments that were specifically designed to treat migraines. These are called triptans, and they can be very effective in eliminating a migraine attack. These medications cannot be used in folks with risk factors for heart disease or stroke. Some patients may also need anti-nausea pills if they experience nausea during a migraine.

All these as-needed medications should not be used more than twice a week. Those who are experiencing frequent migraines should speak to their doctor, neurologist, or headache specialist about ways to reduce their frequency and reliance on these medications.

What can you tell us about the new drug that claims to prevent migraines?
Aimovig is the first migraine-specific preventive medication developed. It directly treats part of the underlying mechanism of migraines. Prior to this, we have been using medications from other classes, such as blood pressure agents, antidepressants, seizure drugs, and Botox, to reduce migraine frequency.

Given as a recurring monthly injection, Aimovig blocks the inflammatory molecule CGRP, which is elevated during a migraine attack, and keeps it from escalating further, thereby reducing the chances of future attacks. It’s not a cure because no migraine treatment is a cure, but the data suggests that some patients will see about a 50 percent reduction or more in their migraine frequency.

It’s very promising because it is a treatment specific to the mechanism of migraines, has very few reported side effects, and seems to have really dramatically helped people. However, because it’s just come out on the market, we don’t know the long-term side effects. We are hoping they’re going to be minimal.

If someone is suffering from migraines, what’s your key piece of advice?
Basically, if people have moderate to severe headaches that interfere with activities, or if they are getting more frequent headaches, they should speak to their doctor.

This is a great moment for people to understand that there are many treatments available, and if they haven’t responded to prior treatments, we’ve got a new class of drugs coming out, and that’s exciting news.

Learn more about brain health.

Dr. Susan W. Broner is an assistant attending neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. She is also the medical director of the Weill Cornell Medicine Headaches Program and an assistant professor of clinical neurology at Weill Cornell Medicine.