Migraines: The ongoing search for an illness that was studied as far back as Ancient Greece

Some 2,500 years ago, Greek physician Hippocrates was already describing patients who were seeing dazzling shapes in their eyes, had sharp pains in the middle of their skulls, and on occasion even ended up vomiting. Toward the 2nd century AD, Galen of Pergamon distinguished common headaches from migraines, and wise men from the Islamic world such as Avicenna also investigated this common form of suffering centuries later. The solution in those days, which included burr-hole surgeries or the use of leeches, would have had the usual efficiency of the medicine of the time. But the arrival of modern medicine also failed to provide a rapid solution for sufferers. Not that long ago, in 1986, JMS Pearce admitted in the Journal of Neurology, Neurosurgery and Psychiatry that it was still “extremely difficult to investigate migraines.”

This recent history and the fact that migraines are often something inherited from our relatives, have led many people to believe that their tools against the illness are the same as those from prior generations: resignation and self-medication. However, specialists point to a number of advances in recent years and say that a good diagnosis is key to reducing the suffering of millions of people who are still experiencing migraines without medical assistance. While the severity varies, more than 10% of the global population suffers from the condition.

An important part of the change began four decades ago with the work of four researchers who, last year, received the prestigious The Brain Prize, worth €1.3 million. Michael Moskowitz, from the United States, proposed that a migraine attack began with the activation of the trigeminal fibers, which transmit feeling from the face to the brain. This activation releases chemical signals that dilate the blood vessels in the meninges (a fine membrane that surrounds the brain), and the resulting inflammation causes the headache.

We are giving some drugs very late and the migraine becomes chronic

Patricia Pozo-Rosich, Hospital Universitario Vall d’Hebron in Barcelona

Another two of the prizewinners, Australian Peter Goadsby and Swede Lars Edvinsson, showed that a molecule known as CGRP (calcitonin gene-related peptide) was released during the attacks and that this molecule had a high capacity to dilate the meninges. During their work at the beginning of the 1990s, they observed that Sumatriptan, a drug discovered in 1998 and that today is among the most-used to calm migraine headaches, limited the release of CGRP. Together with the work of Edvinson and Goadsby and another two researchers, the Brain Prize also highlighted the work of Jes Olesen from Denmark, who showed that injecting CGRP into migraine patients caused an attack, and that drugs which blocked the molecule could avoid this.

Another two of the prizewinners, Australian Peter Goadsby and Swede Lars Edvinsson, showed that a molecule known as CGRP (calcitonin gene-related peptide) was released during the attacks and that this molecule had a high capacity to dilate the meninges. During work at the beginning of the 1990s, they observed that Sumatriptan, a drug discovered in 1998 and that today is among the most-used to calm migraine headaches, limited the release of CGRP. Together with the work of Edvinson and Goadsby and another two researchers, the Brain Prize also highlighted the work of Jes Olesen from Denmark, who showed that injecting CGRP into migraine patients caused an attack, and that drugs which blocked the molecule could avoid this.

Patricia Pozo-Rosich, the head of the Migraine and Craniofacial Unit at the Hospital Universitario Vall d’Hebron in Barcelona, took part in the clinical trials of one of these drugs in Spain, where treatments were first approved in 2019, and he considers that, since their approval, the results have been “as good or better than those of the clinical trials.” However, as happens with many innovative treatments such as monoclonal antibodies, the price is high and they are used in patients who have not responded well to conventional treatments.

“We should be able to offer them to everyone, and not wait for three previous treatments to have failed as we do now,” said Pozo-Rosich. “We are giving some drugs very late and the migraine becomes chronic, when we could have done something good from the start, before these people get very bad,” she adds.

A near-total cure?

These medications work in up to 80% of people with migraines, although the levels of effectivity vary between partial improvements and a near-total cure.

Migraines affect three women for every man, and were once often viewed as a hysterical woman’s illness or a pain that had a psychological origin related to stress. However, scientific studies in recent decades have shown that, despite the fact that stress has a role in the cause of the attacks, the migraine has its origin in biological process that can be identified and manipulated. Now experts point to the need for the many people who suffer these headaches alone or with self-medication to receive an adequate and timely diagnosis, so that they are given the treatment that they need.