Are Migraine Researchers Preoccupied with Pain?

by James on 15 November 2013

There’s no doubt that, for most people with migraine, pain is a big concern.  But the truth is, pain is not the only symptom of migraine.  And it could be that our focus on pain is hindering research.

Dr. Peter Goadsby of the University of California San Francisco Medical Center, is one of the researchers who is concerned that too many are focused on pain, thinking that the pain of migraine is simply causing other symptoms.

Of course, many migraine sufferers will realize that this idea is suspect.  After all, what about the symptoms that typically appear before the pain?

But another question is, what about the symptoms that often go with the pain?  Is pain simply causing nausea, or is the nausea simply caused by an underlying problem?  What about the feeling of heaviness some patients describe, or sensitivity to light?

There is a lingering supposition that pain is simply causing problems in the head – changes in blood vessels, for example.  But if there’s an underlying condition of the brain that leads to most migraine symptoms – we must find a treatment for that condition.

Dr. Goadsby’s Study: A Disorder of the Brain

In a study presented earlier this year, Dr. Goadsby believes he has confirmed yet again that migraine symptoms come from a disorder of the brain.  In his words:

This is an important step in solidifying our ideas that migraine is fundamentally a disorder of the brain, not a disorder of structures outside the brain.  We were able to address the question that people have wondered about for many, many years, that is, what is the degree to which pain is driving the initial symptomatology — and we got clear answers to that.

The study used brain scans, but did something that is rare in migraine research.  Brains were scanned before the headache hit.  This allowed researchers to study migraine symptoms that were present before there was any pain.

So were there changes in the brain before headache?  You guessed it – the answer is yes.  And we have been able to get a glimpse into which parts of the brain change in the “early stages” of an attack.

For example, the hypothalamus.  Just above the brainstem, the hypothalamus is known to be key in cluster headache.  It’s key for functions like sleep and mood.

The midbrain was also involved, confirming earlier studies.

The visual cortex was active in patients with visual problems.  And the medulla in the brainstem was active in patients experiencing nausea.

This may all seem rather obvious, but the key here is that these patients had not yet experienced migraine headache.  So in the case of nausea, for example, it could be that it’s not dependent on the pain, but simply another result of the changes in the brain that cause migraine.  Dr. Goadsby explains:

…it’s entirely plausible that those areas are activated by the migraine process and that’s why nausea and vomiting are so common in migraine; it’s not simply a response to the pain … It was thought that nausea and pain were highly linked, but that doesn’t seem to necessarily be the case.

A New Research Manifesto?

Treating symptoms is very important – but we want a cure to migraine – a cure that will end all migraine symptoms.

Research and treatment need to be dealing with the brain.  The other symptoms of migraine need to be taken seriously, so that we’re not just stopping pain (often that approach doesn’t work anyway), but stopping migraine.

Patients also need to be cautious of “treating pain” with “painkillers”, and instead look to a complete and targeted migraine treatment plan.

Dr. Goadsby hopes that there will be a shift in thinking when it comes to migraine.  “From a big picture treatment perspective, this says to me that we probably won’t get away with developing drugs that don’t get into the brain to have substantial effects on migraine prevention”.

Read more:  Migraine: A Brain Disorder

via:  “Migraine Really is a Brain Disorder”

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{ 11 comments… read them below or add one }

Shelia Hammock November 15, 2013 at 9:33 pm

I suffered with bad migraines for several years and I’m blessed to be migraine pain free !!

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Angel Clark November 15, 2013 at 10:37 pm

i have been suffering with migraines for over 16 years and the past 5 years have been brutal, getting 6-10 attacks a day. but i am now about 15 days free from them. so i might of found the trigger

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Deepak Jain November 15, 2013 at 11:20 pm

Angel Clark may i know wat trigger u get.. coz my dad also migraine. He is also suffering from migraines from several years

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Theresa Maddox November 15, 2013 at 11:42 pm

Don’t know about that , but us chronic migraineurs are preoccupied with our pain. It sucks the life out of us! Been over two decades for me and they’re daily. I’m glad some of u have found relief!

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Georgia Theodorou November 16, 2013 at 2:34 am

I’m so glad that researchers have finally figured out that pain is only a symptom of migraine and unless they find out what happens to give you the pain, they will never ever be able to find a cure. For me the pain is bearable with painkillers & sleep. However I seem to be blighted with several quite frightening neurological symptoms which by far outweigh the distress & debilitation of the headache & last for days!
The only medicine that has helped me is anti-epilepsy medication, but it comes with intolerable side – effects. That’s seems to be common with medications that affect the brain. However if the medication is designed for migraine (as opposed to experimented for migraine) perhaps these medicines will have less side effects?
Good work; keep it up!! :-)

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Jude Hawes November 16, 2013 at 3:36 am

One of my symptoms is collapsing my legs shake violently and then they give way. The docs have never said if this is related but if it carries on they will do tests

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Nikki Gordon Lightbody November 16, 2013 at 6:26 am

I also suffer daily sadly only those of us who suffer understand the constant pain fatigue how it gets u down & makes u short fused Mine have been more frequent & severe past few months n daily life is a constant struggle :(

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J November 16, 2013 at 1:00 pm

I would also like to address the quote from this article, “Patients also need to be cautious of “treating pain” with “painkillers”, and instead look to a complete and targeted migraine treatment plan.” Although I agree that abortives, rescue, and daily medications should be part of the first line defense in migraine, they do not always work. We need to be aware that there has been a huge shift in the medical community in regards to narcotics (and I realize the quote also addresses OTC painkillers, but narcotics is what gets the most attention and hand-wringing). Many physicians are very antsy about prescribing any type of narcotic because of the current political climate in medicine that narcotic use is bad because a very small number of patients may become addicted. I have tried everything my neurologist has suggested over the course of 9 years and we also have not yet found a daily medication that actually works for me. So I use Triptans, NSAID injections and rescue medications and I also have to use Tylenol 3 at times. Having had migraines since I was a child has made my migraine journey more complicated. I get tired of hearing that narcotics don’t work and often wonder if the physicians suggesting this have ever had a migraine. I could be in the hospital several times a month or take several Tylenol 3 (across a day) when my “targeted migraine plan” does not work. Some months are better than others, so my usage varies. It is a relief to know that if I have tried everything else available to me, I don’t have to spend the rest of the day (or several days) in excruciating pain. Research also shows that physicians should be more concerned about acetaminophen use over narcotic use as acetaminophen can very easily be overused as a so-called safer alternative to narcotics, yet it can cause liver and kidney damage. The result is dialysis and OTC acetaminophen overuse is one of the leading causes of the need for dialysis. The recommended maximum daily dosage for acetaminophen has gone down more recently because of this. Yet the mainstream medical community is biased against narcotics and most neurologists won’t prescribe them. That seems inhumane when someone is dealing with chronic migraine and has followed/tried all non-narcotic medication possibilities. Chronic migraine patients should not be treated in a shaming way and as if they are an illicit drug user when they might need to take a narcotic in order to function and break the pain cycle. Eventually the pendulum will swing back to a more reasoned approach in regards to narcotics, realizing that people with chronic migraine do not always respond to non-narcotic medications.

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