June 1, 2011

Advancing From Ancient Remedies To Modern Brain Chemistry

Migraine specialists welcome a new era of discovery and advancement

Migraine researchers from all over the world are gathering in Washington, DC on June 2-5 to share important new scientific data on the disease at the annual conference of the American Headache Society, spotlighting "New Discoveries in Headache Medicine."

Among the important new work to be presented is groundbreaking new science in the unique role of the thalamus in migraine, implications of the recent identification of a gene for migraine with aura, and the correlation between childhood abuse and migraine in later life.

[A Partial Meeting Schedule is at the End of this Release]

"We may have reached the tipping point in our scientific understanding of this ancient and elusive disease," said David W. Dodick, MD, president of the American Headache Society. He noted that since the 1990s, we are coming to understand how regions of the brain regulate the transmission of migraine pain, notably the thalamus which controls sensation, spatial sense, and motor signals to the cerebral cortex, along with the regulation of consciousness, sleep, and alertness.

"The speed of understanding now has reached critical momentum where one advance builds on and triggers the next," he said. "We have made extraordinary strides in the last 20 years alone that now give us hope we can make important advances in the treatment of this disabling disease in the next decade."

Over the last 5,000 years, migraine sufferers subjected themselves to an array of extreme and bizarre treatments to find relief, he noted. These have included drilling a hole in the skull to let out the "bad humours," bloodletting, mystical rituals, ostracism, sorcery, inserting a garlic clove into the temple, binding a clay crocodile to the head, inserting the bones of a vulture into the nose.


"Elegant basic science and clinical experiments have recently demonstrated that the thalamus acts as a sort of railway station and integration center for the transmission of migraine pain," he said. "An impulse comes into the 'station' and the thalamus regulates how it will be passed on to the pain receptors in the brain, and the extent to which it is made worse by environmental stimuli, such as light." We are beginning to understand that the thalamus may be a target for current and future migraine treatments. A full plenary session, "The Role of the Thalamus in Migraine," will explore this subject.

A second plenary session will be devoted to the genetic aspects of migraine now that the gene for migraine with aura has been found.

"The discovery of a gene for migraine with aura last fall was important because it confirms the longstanding observation that migraine "runs" in some families," said R. Allan Purdy, MD, chairman of the AHS scientific committee which designed the agenda. "The presence of genetic factors in a common form of migraine holds promise for developing an effective treatment." Up to one-third of migraine sufferers experience aura prior to an attack, which is characterized by visual disturbances, illusions, zigzag lines, blind spots, speech disturbances, and tingling or numbness on one side of the body.


Another plenary session will look at the correlation between migraine in adults and childhood abuse. "We are finding an unusual prevalence of childhood abuse in migraine patients," said Gretchen E. Tietjen, MD, who has done leading research in the field and who co-chairs the session, "Maltreatment in Headache: Epidemiology, Neurobiology, Evaluation and Treatment." (11 am, Thursday, June 2)

"This seems to be more than a psychological reaction to maltreatment," she said. "It is possible that early abuse "“ whether sexual, physical or emotional "“ creates permanent changes in the brain of abused persons that may make them more prone to migraine pain." Dr. Tietjen said. "Many patients seem relieved when we ask them about abuse, but we need more research to tell us if such information can really influence how we treat them." In some cases patients are referred for psychological counseling which may or may not help their migraine condition, but Dr. Tietjen acknowledged that such questions may not be easy for neurologists to ask.

Another session, "The Premonitory Phase of Migraine," will explore why many migraine sufferers experience forewarnings about a migraine headache, often as early as one day before. "Migraine is for many people a storm that starts hours or days before like clouds, followed by the thunder of a migraine headache," Dr. Purdy said. "The premonitory phase is well-documented but only recently have scientists considered how migraine can be treated before a patient is in full attack mode."


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