"Recent advances in the understanding of migraine mechanisms and the availability of new migraine treatments have made the headache field one of the most interesting and exciting neurologic subspecialties.”
- Todd Schwedt, MD, Professor of Neurology, Mayo Clinic Board of Directors, Executive Committee, American Headache Society Board of Trustees, International Headache Society Board of Directors, American Migraine Foundation
Migraine is a neurological disease with a prevalence of 12% in the general population. Migraine attacks are disabling neurologic events that include moderate to severe headaches with a combination of painful hypersensitivities to lights, sounds, odors, and touch of the skin, as well as nausea and vomiting. Although the most prominent symptoms of migraine occur during individual attacks, people with frequent migraine attacks, such as those with chronic migraine, often have migraine symptoms that persist between attacks.
Todd Schwedt, MD, is a professor of neurology at the Mayo Clinic in Phoenix, Arizona; a member of the ANA, and a board member of the American Headache Society. He will co-chair two events at ANA2019 in St. Louis: the ANA-AHS Headache session on Monday, October 14, from 3 to 5 p.m., and the Interactive Lunch Workshop, “An Update on Migraine Pathophysiological Mechanisms and Emerging Treatments,” Sunday, October 13, 11:45 a.m. to 1 p.m. We asked Dr. Schwedt to discuss the state of migraine treatment and research.
What progress have we seen recently in understanding and treating migraine?
Recent advances in the understanding of migraine mechanisms and the availability of new migraine treatments have made the headache field one of the most interesting and exciting neurologic subspecialties.
There are several new and emerging treatments for migraine prevention and for treating individual migraine attacks. In 2018, three different calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) received FDA approval for migraine prevention. CGRP plays a key role in the pathophysiology of the migraine attack. mAbs that either target the CGRP receptor or the ligand are effective and well-tolerated for migraine prevention. Over the last few years, several non-invasive neuromodulation devices have received FDA clearance for the treatment of migraine, including transcranial magnetic stimulation (TMS), supraorbital/supratrochlear nerve stimulation, and vagus nerve stimulation (VNS). Additional migraine treatments are either in phase III trials or are currently under FDA review.
What challenges remain?
A challenge that still exists when treating patients with migraine is the lack of ability to accurately predict who will respond best to which individual migraine treatment. Prediction of treatment responses might be accomplished through the use of patient characteristic, patient symptom, genetic, brain imaging, and neurophysiologic data. The American Migraine Foundation, a division of the American Headache Society, sponsors the American Registry for Migraine Research (ARMR). ARMR collects in-depth longitudinal data from patients with migraine and other headaches, as well as biospecimens and neuroimaging data. One of the main goals of ARMR is the development of models that predict which treatment is most likely to be effective and well-tolerated for individual patients.
What should ANA members know about headache and migraine treatment?
The headache sub-specialty has matured over the last several years with the accreditation of academic headache programs and certification of headache specialists. However, since the current number of headache specialists is not nearly enough to meet the patient demand for specialized headache care, additional growth is desperately needed. It is essential that the ANA and its members continue to support and promote the headache specialty. One way that the ANA is doing this is via inclusion of headache sessions during the Annual Meeting. This year there will be a headache special interest group session and an interactive lunch workshop during which the latest advances in migraine management will be discussed.