One of the most frequent health problems is the headache, also called headache or cephalalgia. Almost everyone will have it at some point in their lives, to the point that some statistics say that, over the course of a year, half of the planet’s population will suffer from an episode. But a headache is not, in itself, a disease, but a symptom that can be caused by things as serious as an infection, tumor, or trauma. However, the most frequent among the more than two hundred types of headache that have been described are the so-called primary ones, which are benign and are not the result of any underlying pathology. Migraines are included in this last group.
Migraine is a particularly intense form of recurring headache that is more common than it seems: up to a third of women and a fifth of men are thought to have it, making it the third most common most common disorders. In fact, it is estimated that up to one billion people suffer from it. And, despite not being serious, they can become very disabling in those individuals subjected to the more intense or long-lasting versions, which is why it is so important to find drugs that can solve them.
However, unfortunately, it is not that easy, because the causes are unknown and this makes it difficult to design a specific treatment. If the mildest forms can be controlled with common pain relievers, such as ibuprofen or paracetamol, some others can improve with compounds as diverse as triptans or ergotamines.
An alternative is to intervene prophylactically before the headache appears. This is possible because more than half of migraines are accompanied by what are called prodromes, a series of highly variable symptoms that, for unknown reasons, precede them by hours or even days. Those who experience them learn to recognize that unexpected fatigue, tension in the neck muscles, a special sensitivity to certain smells, or even an uncontrollable desire to eat certain foods (such as chocolate) are the warning that they are about to ‘arrive a crisis. In these situations, there are various drugs, such as beta-blockers or certain antidepressants, that can be effective in some people, but none are even remotely close to 100% successful.
Promising results
The group led by Dr. David W. Dodick, of the Albert Einstein College of Medicine, in New York, has recently published an article in the journal Neurology where he explains the study they have done on more than 500 volunteers to test ubrogepant, a drug that belongs to the group of CGRP inhibitors (the acronym in English for peptide related to the calcitonin gene). The results are promising, because patients mostly responded well to treatment if given during the prodrome, allowing many to lead normal lives.
CGRP is a molecule that, among other things, acts as a messenger between the nervous system and the immune system (specifically, macrophages, one of the white blood cells). It usually originates in the nerves that function as pain sensors and allows this information to be transmitted to other parts of the body. It also acts around the blood vessels (can cause them to constrict) and suppresses the feeling of hunger. For some unknown reason, more of it is made than usual during migraines.
Several CGRP inhibitor drugs are approved for use in humans in Europe, but ubrogepant is not yet (although it is in the United States). In fact, some of these are already used to prevent migraine, although they have the problem that they are expensive and public health does not always cover them. The key, in any case, is for the patient to have well-identified the symptoms of their prodromes so they know exactly when they should be taken. As this can be very subjective, it is looking to design devices that measure parameters such as heart rate or sweat and can deduce when the attack is approaching.
Also for endometriosis
Interestingly, it has recently been shown that CGRP inhibitors could also help with pain caused by endometriosis, a poorly studied disease that affects many women (estimated that nearly 200 million, 10% of those in reproductive age). In this case, pain is also one of the main symptoms, although it is usually more diffuse and does not affect the head as much, and the origin is the appearance of tissue similar to the inner lining of the uterus in areas of the body where it should not be.
There are few options for treating endometriosis, but, in early November, a group of scientists led by Dr. Michael S. Rogers, of Harvard Medical School, was publishing in the journal Science Translational Medicine a paper showing that CGRP inhibitors not only blocked pain signals, but also reduced the size of endometriosis lesions. The study was done in mice, so you can’t claim victory yet, but at least it opens up the possibility of clinical trials in humans to see if the response is similar.
