MIGRAINES:CAN NEW TREATMENTS HELP EASE THE SUFFERING OF MILLIONS OF PEOPLE?

Better understanding of the processes driving migraine pain is leading to promising new remedies

- HAYLEY BENNETT

For centuries, scientists have debated whether migraines are caused by blood vessels in the head expanding or by some malfunctioning of the nerves. Over the last few decades, however, a more nuanced picture has emerged. A migraine attack starts when the trigeminal nerve, a big pain-sensing nerve in the head, is stimulated.

The source of that stimulation is hard to pin down, but some people who get migraines find they are triggered by caffeine, stress or lack of sleep. The trigeminal nerve sends chemical signals to the protective layers that wrap around the brain. The signals cause blood vessels in some of these layers to expand. Together, the expanding blood vessels and the pathways of nerve fibres connected to the trigeminal nerve, which also reach deeper into the brain, are thought to cause the pain.

Thanks to King's College London neurologist Prof Peter Goadsby and colleagues, we now know more about the chemical messengers responsible for the signals: neuropeptide molecules called calcitonin gene-related peptides (CGRPs). These are now the focus for new treatments.

Since the 1990s, we've relied on drugs called triptans to treat migraines. These target serotonin receptors in the brain and are thought to work by constricting blood flow and preventing the release of the neuropeptides involved in migraines. We are now, though, starting to capitalise on some of the research into the mechanisms that trigger and drive migraines, with the last five years seeing new drugs reaching the market.