Emerging Treatments and Sleep

Research from the past few years had led to a sudden influx of new pills and injections for migraine, with many more under investigation. But there could be an interesting connection between some of these treatments – your body’s regulation of sleep patterns.

Anyone with migraine will immediately know the connection if we say the words “sleep” and “light”. Sleep is a classic “abortive treatment” for migraine. Changes in sleep schedule are a classic trigger. For many, light patterns and flashes may trigger an attack – and once an attack starts, bright light is the last thing you want!

All this is related to your body’s “clock”. Except that it’s not really that simple. Although you could say that there’s a “master clock” in the hypothalamus, there are also many individual clocks. Some are trying to “sync” with their environment (light plays a big role in this). Others seem to have a mind of their own.

We usually think of the 24 hour clocks, but there are also yearly (circannual) cycles. Cluster headache patients are especially aware of certain rhythms that help explain the “clusters” of these terrible headaches.

Not only are we just beginning to understand how the body regulates all these things, we are really just starting to study these rhythms in migraine patients (and we have a lot to learn about cluster as well). So we have a very long way to go!

But Dr. Philip Holland of King’s College London is a lead researcher who is noticing an interesting connection between the body’s clocks and recent research into migraine treatments.

If you’ve been watching the news, you know that drugs acting on CGRP (calcitonin gene-related peptide – a peptide which occurs naturally in the body and is linked to the migraine chain-reaction) are all the rage. You may also know that there are many upcoming treatments targeting PACAP (pituitary adenylate cyclase-activating polypeptide) are being researched.

So – more drugs and injections. But one thing that CGRP and PACAP have in common is that they’re related to sleep regulation. PACAP works with light to help the function of the hypothalamus clock.

What if sleep patterns could tell us which drugs would work the best? Or what if, instead of developing new drugs, we could find natural ways using light and sleep schedules to minimize or eliminate migraine and cluster headache?

Of course, as we know, these behaviours are already being studied and used to fight headache. What’s new is that we’re starting to see how sleep/wake schedules work in the chemistry of the body. But emerging research is perhaps pointing to the fact that we need to pay more attention to light (think especially of how we use screens, or how working “by the clock” instead of “by the sun” effects us) and our sleep patterns.

By the way, we mentioned Dr. Holland. He is a runner-up in this year’s Medical Research Foundation Emerging Leaders Prize. Read more about the research he is doing at the link above, or at The Migraine Trust here. One of his recent papers can be accessed here: PACAP in hypothalamic regulation of sleep and circadian rhythm: importance for headache (pdf).