Migraine affects millions of people worldwide – and in the U.S. alone it is reported that more than 37 million suffer from migraine according to Migraine.com. This form of what may be an extremely debilitating headache accounts for loss of productivity, man hours and health care costs that run into billions ($17.2 billion on the higher side or more). Apart from this is the human cost – the pain, illness and psychological effects of this headache.
Some people suffer from occasional migraines that may last a short time and some have migraine headaches that are severe, long lasting and very difficult to manage. Some people are so badly affected that they land up in the emergency room. This syndrome affects the activities of daily life and the migraine sufferer may have to try a range of treatments that may or may not be effective or may not be effective enough. Often new drugs and treatments are welcomed, but the patient’s treatment, response is very individual, and what works for one person may be not work in the same degree in another.
The mind over body effect – how perception changes real effects
Recent research suggests that the efficacy of treatment may benefit a great deal if the mind perceives it as being something that will work. A study published online in the journal Science Translational Medicine January 8, 2014 issue, confirmed that the placebo effect had an important role to play in the efficacy of a drug and the pain relief it offered as far as migraine was concerned.
The research team led by Rami Burstein, PhD, Director of Pain Research in the Department of Anesthesia, Critical Care and Pain Medicine at BIDMC and Ted Kaptchuk, Director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at BIDMC and Harvard Medical School studied 66 individuals, regularly suffering from migraines. The patients were asked to report on all their symptoms before being given any medication and then six times after taking the medicines given.
They were given the migraine drug Maxalt (rizatriptan) or a placebo. They were given six envelopes; two were labeled Maxalt, two placebo and two Maxalt or placebo. So twice, they knew they were taking the drug, twice they knew they were taking the placebo and twice they did not know what they were taking. Each time they had fill in details about their symptoms and the relief they felt.
The results were startling: when the subjects knew they were taking the medicine, they reported substantial pain relief. Nevertheless, when they did not know what they were taking or when they knew they were taking a placebo, they still reported pain relief. This study shows that while the placebo afforded pain relief was only 50 percent of that when the actual drug was given, it still a great deal considering that no real drug was taken. So if doctor tell the patients they are going to experience relief with a drug and emphasizes its positive effects, the drug efficacy may be doubled or at least increase substantially. This may help giving better pain relief and perhaps also reduce the dosage of the drug.
TMS – another treatment for migraine relief
A magnetic device has been approved for migraine treatment in the U.K. NICE (National Institute for Health and Care Excellence) has reported that the TMS (transcranial magnetic stimulation) is a device that actually helps with pain relief for migraines. TMS uses electromagnetic conduction to generate a magnetic pulse that reaches the external parts of the brain. This device is easy to use as the patient simply has to hold it on the scalp and set it to deliver either one or more pulses.
The frequency, length and intensity of the pulses can be changed according to the individual’s response and the severity of the condition. This treatment is not to be used as a standalone treatment but along with a combination of other treatments and drugs. In a trial involving 164 patients, TMS works twice as well as a placebo and as many as 40 percent had no pain for a longer period.
In the U.S., too, the FDA approved a similar device called the Cerena in December 15, 2013. This hand-held device also works in the same way and is available on prescription only. The TMS can be used as soon as the episode starts to reduce the severity of the pain or regularly to reduce the incidence and frequency of the attacks.
OptiNose intranasal delivery system
While a range of medicines and drugs are used to treat migraines and the medical fraternity even advises alternative treatments like acupuncture, biofeedback and other such remedies, a more efficient drug delivery system may soon be available. Sumatriptan is a drug commonly prescribed to treat migraines and is available as an oral pill and a nasal spray. The new drug delivery system would combine the use Sumatriptan dry powder with the new device for efficacy in treating migraines.
OptiNose is a company that makes efficient targeted drug delivery systems and the company has submitted a new drug application (NDA) for AVP-825 to the FDA on January 27, 2014. It developed a close palate Breath Powered delivery technology device that uses the individual’s breath to deliver a liquid or powder drug deep into the nasal cavity.
According to a description given by the company, ‘To operate the powder delivery device, a disposable section is inserted into the device body and the piercing button on the side is depressed once. Two steel pins connected to the button pierce the capsule and are automatically retracted by spring action when the button is released. The user slides the nosepiece of the device into the nostril and the mouthpiece is inserted between the lips. The user then takes a deep breath closes the lips around the mouthpiece and exhales, delivering drug into the nasal cavity.’
This results in better delivery of the drug to the targeted areas and a low dose of Sumatriptan dry powder can be used via the nose for the first time if FDA approves the device.
Another drug that may work in some migraine sufferers
Candesartan (Atacand), a drug that is already in the market, may provide relief to people suffering from migraine and may be as effective as propranolol. The Norwegian National Headache Centre recently conducted a triple blind study led by Prof Lars Jacob Stovner on 72 patients. This was a follow up study on an earlier one 10-year-old one.
The patients used each treatment (Candesartan, propranolol or placebo) for 12 weeks, and stayed four weeks before the start of the medication and between the treatment periods without any medication at all. The patients were studied for the better part of a year. In addition, neither the patients, nor the doctors nor the researchers analyzing the data knew who had been given a placebo and who received the real medicine.
The results showed that Candesartan had a positive and preventive effect on 20-30 percent of the patients. As cheaper and generic versions of the drug are also available, this finding should lead to doctors prescribing it more frequently to prevent migraines and it may well become a standard treatment to prevent migraine.