Migraine medicine on 'cusp of remarkable advance'

A Canadianneurologist expects an advance in treating migraines in about the next five years.

"Not one single preventative medication has ever been developed for the treatment of migraine and that's about to change," says Dr. David Dodick, a Nova Scotia native and president of the American Headache Society.

"We're on the cusp I think within the next five years of seeing some remarkable advances."

Dodick says it's estimated that more than 20 per cent of Canadians live with migraine, a neurological disorder characterized by hyperexcitable brain networks and often debilitatingheadaches.

It is more common in women than men.

For Denise MacDonell, it's not the headaches that shedreads during a migraine attack, but the distorted vision that makes the Halifax woman feel as though she's just stared too long at a bright light bulb.

It's "absolutely the worst thing," says MacDonell, a 46-year-old stay-at-home mom who experienced her first migraine as a teenager.

"Your first thought is always, 'God, I don't want a migraine right now."'

MacDonell is among the estimated one-third of people with migraines who experience a visual or physical disturbance known as aura before the onset of head pain.

For many, aura is the first sign they're already in the middle of a full-blown migraine attack. By then, they can only hope to dull the pain and ride it out.

The American Headache Society a group of health-care professionals dedicated to the study and treatment of headache and face pain says migraine attacks can be triggered by a variety of stimuli from alcohol to fragrances.

In some cases, a migraine can come on seeminglyout of nowhere during sleep, for example. The headache phase of a migraine can be moderate or severe in intensity, and is often worsened by physical activity. Nausea and sensitivity to light are also common.

For MacDonell, the aura lasts about 45 minutes. It gives the married mother of two teenage girls just enough time to pop a few regular-strength ibuprofen and maybe catch some rest.

The ensuing headache is usually mild but MacDonell says it can take up to 24 hours before she feels like herself again.

MacDonell, who typically gets a migraine every month, says she briefly took prescription medication for it but stopped because the side effects made her feel "funky."

Migraine prevention goal

Dr. Guy Rouleau, a migraine researcher and professor of medicine at the University of Montreal, says while some medications diminish the occurrence of migraines, they prove ineffective at completely eliminating the attacks.

Other drugs, both prescription and over-the-counter, merely treat the symptoms after a migraine has already begun.

"The drugs we have now don't work very well," he says. "They all help and they all have a role, but we need new drugs for sure."

Last fall, Rouleau led a team of Canadian and British researchers that sequenced a gene linked to migraine. It's hoped the discovery will bring researchers closer to finding new and more effective medications.

"If we're rightand of course there's a lot of room between now and proof but that's what we would predict, that it would be something that would prevent migraine," says Rouleau, who recently spoke on the issue at the American Headache Society's annual scientific meeting in Washington.

The meeting attracted some 500 researchers and clinical specialists from around the world to discuss new breakthroughs and areas of interest, including what experts call a premonitory phase. It's when people with migraines experience symptoms even days in advance of an attack.

"When we bookmark an attack by the start and the stop of pain, often times we're shortchanging the extent of the disability," says Dodick.

The premonitory phase begins before aura and includes mainly nondescript symptoms such as fatigue, neck pain and yawning.

Dodick says while the symptoms can be difficult to pinpoint, the premonitory phase is another key part of discovering a preventative medicine.

"If we could actually find out where in the brain this premonitory phase is being generated, then we could know potentially where the generator for migraine is," he says.

"That would set up potential targets for therapy thatsomeone could set up well before the pain actually begins."