Treatments for migraines are more promising than ever

Treatments for migraines are more promising than ever

Migraine headaches are troubling health events that can affect people's ability to work and live productive lives. It is the second-most debilitating neurological disease (after stroke), according to nurse practitioner Maria Tereza Dias, MSN, FNP-C, at Neurologists of Cape Cod in Hyannis. Dias not only treats migraine patients; she is one herself.

"I have migraines, so I think it's easy for me to empathize with my patients because I know what it is like to have them. I understand how debilitating these events can be and how they can impact your quality of life" she said. "Back when I was a teenager, there were not a lot of treatments, but nowadays there are many treatment options with fewer effects".

Typically, a migraine is a throbbing, pulsing headache of moderate to severe intensity that lasts from four to 72 hours. Studies estimate that up to 60 percent of migraines can be attributed to genetic factors, Dias said. They affect more women than men and often peak during childbearing years. If caused by hormonal factors, they can get better after menopause, she continued.

There are many environmental factors that can cause migraines, like stress, sleep disturbances, dietary factors and hormonal changes, she said.

Migraines are very common but Dias believes the number of people who suffer from them is underestimated because some people think they are just an average headache. Anyone with throbbing, pulsating headaches with a sensitivity to light and noise and sometimes nausea is most likely suffering from a migraine. There are many different treatments, from stopping them while in progress to preventing them from occurring.

Treating or Preventing

To stop or relieve a mild-to-moderate migraine, acetaminophen or NSAIDs, like ibuprofen, can be effective. For more severe headaches, there is a class of medications called triptans. There are seven FDA-approved triptans, but they might not be safe for patients with a significant cardiovascular history, Dias said, because they narrow blood vessels. Those patients are better off taking a class of medications called gepants.

"In addition to pharmacological therapies, it is imperative to consider lifestyle behavioral modifications. Ensuring adequate sleep, maintaining hydration, and utilizing stress reduction techniques which can be very effective," she said.

Some of the dietary triggers that can cause a migraine include alcohol, too much caffeine, food additives, highly processed foods and aged cheese. Avoiding these things can help. Some patients also find relief with supplements like magnesium, feverfew, vitamin B2 and CoQ10.

For those interested in non-medication options, there are different neuromodulator devices, such as Nerivio, which is a proven treatment. It is an armband that patients wear and helps to deliver remote electrical neuromodulation that interrupts the pain signal. It can be very effective for patients who don't want to take any medications, she said.

If patients are having six or more headache days per month, or if they have four or more with impairment, or as few as three with severe impairment, that's when preventive therapy is recommended, Dias said. Preventive treatment includes some older medications like beta blockers, antidepressants and anti-seizure medications. Newer medications, called the Calcitonic Gene-Related Peptide (CGRP) monoclonal antibodies, can prevent migraines by binding to either CGRP receptor or peptide.

And then there's Botox. If patients have chronic migraines with more than 15 headache days a month or at least eight migraine days, Botox is a very effective treatment, she said. Treatment involves 31 injections in the head and shoulder region.

"It's done over 12 weeks and most patients respond really well to Botox," Dias said. "That's for the chronic patients and it's also a good option for patients with a lot of comorbidities, because it's a safer treatment with risk of fewer side effects compared to the other ones."

Another option, especially for patients experiencing a severe migraine is nerve block. There are several different ones depending on the source of the pain.

More Options Coming

The good news is that there are more treatments in the pipeline. Dias is a member of the American Headache Society and the American Academy of Neurology, so she's watching the pituitary adenylate cyclase-activating polypeptide (PACAP) studies closely. Researchers are already in stage two of clinical trials for this promising treatment focused on migraine prevention.

"It is so rewarding to see patients that don't have any quality of life and they cannot work because of these migraines and when we treat them, either with Botox or with the CGRPs, they come back and they are so happy. They have their life back again and it's very rewarding for me as a clinician to be able to help them," said Dias.