trigeminal nerve

15 September 2021

Another Clue into How Migraine Works

A study in JAMA published in August confirms yet another probable link in the migraine chain – something called vasoactive intestinal polypeptide (VIP).

VIP is a peptide hormone found naturally in the body. As an article in AJMC states, “Once the trigeminovascular system is activated, afferent and efferent nerve fibers release various VIPs, which stimulate G-protein coupled receptors (GPCRs).” The trigeminovascular system, the neurons in the trigeminal nerve in your face, are often associated with headache. So what do VIPs have to do with headache pain? Are they just incidental, or are they an important part of the migraine attack?

This particular study simply injected patients with VIPs to see if it would result in migraine headache symptoms. (Don’t worry – patients were warned that they might get a headache. But they didn’t know if they were getting a VIP injection or a placebo.)

71% of patients injected with VIP (and 5% – one patient with placebo) did indeed develop headache. This would seem to confirm that VIP does actually play an important role in the headache chain reaction.

But why? It could have to do with the messages VIP sends to blood vessels, causing them to dilate. Vasodilation does often occur in migraine attacks.

The purpose of this study was to see if VIP may be a target for future migraine treatments. In fact, several pharmaceutical companies were providing funding to some of the researchers in the study.

As we have discussed before, there are many things that happen in the body during a migraine attack. Finding one link in the chain, or one part of the puzzle, may help us find better treatments. But it’s probably a long way from truly understanding the root of migraine, and discovering a “cure”.

For more, check out this article from AJMC: Study Suggests Vasoactive Intestinal Polypeptide May Induce Migraine

18 April 2017

Migraine and TMD: A Complex Relationship (that should not be ignored)

James Discoveries & Stats, Information 3

Although it’s not news that there’s a relationship between migraine and TMD, it might be a surprise just how complex the relationship is.

TMD refers to temporomandibular disorder/dysfunction, actually a group of disorders that affect (but are not necessarily caused by) the temporomandibular joint (TMJ) and surrounding muscles, nerves, and tissues. TMD may be caused by an injury or a disease such as arthritis. There may also be a connection with structural issues, and even clenching and grinding of the teeth while you sleep.

TMD and Headache — Illustration courtesy Patrick J. Lynch

TMD is actually very poorly understood, and there is a lot of controversy about what causes it and how to treat it in specific cases. But when you think about the structure of the jaw, joint, and the trigeminal nerve system, which is all connected, it’s not surprising that researchers have been very interested in the connection between TMD and headache disorders. That nerve system may play a key role in starting headache pain in migraine disease. It seems that the way trigeminal pain is processed can become impaired, leading to a worsening of migraine. The new class of drugs (CGRP inhibitors) currently being developed play a role in controlling trigeminal pain messages.

A 2016 study concluded that the connection between migraine and TMD was complicated further because of other physical symptoms, and the presence of bruxism (clenching/grinding teeth during sleep). Researchers concluded that doctors need to treat both headache/migraine and TMD together.

A study earlier this year asked the question – can the presence of headache disorders, such as migraine, actually predict TMD? In other words, even though migraine may/may not directly cause TMD, does the presence of migraine or another headache disorder tell us that the patient has a good chance of getting TMD later on?

The answer was yes. Patients who had no sign of TMD, but who did have a headache disorder, were far more likely to end up with TMD. The headache condition also tended to worsen in patients who eventually had TMD symptoms. Patients frequently ended up with migraine and TMD.

Researchers again affirmed what I mentioned in our last podcast – headache conditions, migraine in particular, need to be treated (Migraine and Generalized Anxiety Disorder). If they aren’t, they may lead to other conditions. One of those conditions is TMD. And what if the presence of new TMD in turn worsens the migraine? That could may migraine more difficult to treat.

The relationship between TMD and migraine is complex. It’s not a simple case of one causing the other. There may be underlying causes of both.

Doctors and patients need to focus on treating both, and being aware of changing and worsening symptoms so they can be caught early. If migraine or TMD are ignored, or just treated with “painkillers”, patients may find themselves with more pain in the end.

25 April 2016

Chronic Migraine: Losing the Ability to Control Pain

James Discoveries & Stats 1

Dike (levee) system – just how safe are we sheep? 🙂

Imagine that a system of levees or dikes had been built to control the flow of a certain river. Although no levee is perfect, it does provide a certain amount of safety from flooding. Flooding may still happen, but hopefully it will happen on a smaller scale.

But maybe these dikes were built long ago. Maybe they’re getting old, and they’re starting to let water through, not only when there’s a very unusual amount of water, but even when the water is just a little higher than normal.

Could that be a good analogy for chronic migraine?

A big area of study right now is the question of just how and why migraine disease goes from being episodic (an attack once in a while) to chronic (an attack every day or two). One of the studies published this month in The Journal of Headache Pain was focused on a certain aspect of chronic migraine.

Research focused on female migraine patients and their responses to pain when they were not in the middle of a migraine attack. This is very important, because migraine does involve changes in the body that are present whether someone is actually having a “migraine attack” or not.

In this case, sure enough, researchers found that there was a significant difference in “trigeminal pain processing” (how trigeminal (a certain type of nerve) pain was managed by the body) between patients with episodic migraine and patients with chronic migraine.

We know that migraine involves “hyperexcitability” – that is, the brain seems to over-react to stimuli. But this hyperexcitability seems to be different in different types of migraine, in this case chronic or episodic.

It could be that the brain’s natural mechanisms for controlling the flow of pain and other symptoms are actually impaired, or completely broken, in the case of chronic migraine. If so, is there a way to “repair the levees” and reduce the migraine attacks?

Many patients have successfully reduced their attacks. But the more we know about the actual function of chronic migraine and other chronic pain conditions, the more easily and quickly we’ll be able to fix the problem.

Study abstract: Differences in central facilitation between episodic and chronic migraineurs in nociceptive-specific trigeminal pathways.

14 May 2015

Headache? Instead of a pill, rub this on your skin…

James Discoveries & Stats, Medications 2

Which would you prefer – taking a pill for headache pain, or rubbing something on your skin? It might be faster to swallow something, but why send something all the way to your stomach when the pain is in your head?

Of course, that’s a drastic over-simplification, but it does make a point. Often times, pills that are swallowed are not as “targeted” as we would like. Would it work better to apply something right where the pain is – on the head?

TOPOFEN for Migraine Achelios Therapeutics is working on that very thing with TOPOFEN, a gel that can be applied to the skin.

TOPOFEN is actually a formulation of ketoprofen, a nonsteroidal anti-infammatory drug (NSAID) which is sometimes used for hormonal related headache, as well as menstrual pain in general. It’s also used for other headaches, and pain from osteoarthritis.

At the 67th Annual Meeting for the American Academy of Neurology, a report was given on the latest trial of TOPOFEN for use in migraine treatment. 42 adults with migraine with aura and migraine without aura were given the gel. Each person was asked to take a pea-sized amount and rub it on the skin over the peripheral trigeminal nerve ends – that is, six points on the face, both sides (even if they headache pain was only on one side). 49 severe attacks were treated, 22 with TOPOFEN and 27 with a placebo.

77% of patients had some relief using TOPOFEN. After 4 hours, 23% were completely pain-free, and after 24 hours 50% were pain-free (double the success of those using the placebo).

At first these results may not seem too amazing. But remember, this is not a special migraine drug, this is a NSAID (ibuprofen or Advil is a NSAID as well, though a different type). Taking that into consideration, these are actually pretty good results. No pill was taken; all we’re talking about is a little gel rubbed on the skin.

Not only was their pain relief, patients also found relief from other symptoms, such as nausea and photophobia.

After 24 hours, the medication was still in the tissue – it was still working after 24 hours.

So what are the upsides and downsides to this kind of treatment?

The gel did cause temporary skin irritation in some people, usually moderate or mild. It could be there a small percentage of people would not be able to use this drug – but that’s common with any medication or treatment.

But a major downside of NSAIDs is avoided here – stomach problems. Applying the gel near where the actual pain is could be a much more direct way to calm migraine symptoms.

We still have a lot to learn about topical treatments for migraine, but so far TOPOFEN seems to be a great start – quickly absorbed and effective in the treatment of migraine pain and other symptoms.

12 January 2015

New Insights Into Trigeminal Neuralgia

James Discoveries & Stats, Information 2

Researchers in Denmark are providing new insights into the painful condition known as trigeminal neuralgia (TN).

Have you ever had a stabbing pain on one side of your face – almost like an electric shock? Maybe it just happens, or maybe it seems to come when you’re brushing your teeth, or even putting on makeup.

Trigeminal neuralgia is not a common disease, and so it hasn’t been studied nearly as much as many other pain disorders. But this study of 158 patients gives us a clearer picture.

TN seems to strike later in life than conditions like migraine. The average age when symptoms appeared was about 53 years.
Although both men and women get TN, it is somewhat more likely to affect women.
Almost 50% of patients had persistent pain in addition to the stabbing pain. Sometime TN with persistent pain has been called “atypical”, but it doesn’t seem to be as atypical as some think (the more proper name, by the way, is classical trigeminal neuralgia with concomitant persistent facial pain. Has a ring to it, wouldn’t you say?).
The pain is more often on the right side.
A little less than a third had “autonomic symptoms”, such as dizziness, and a little less than a third had “sensory abnormalities”, even if they hadn’t had surgery.

Researchers also investigated the nerve that TN affects. TN can affect different branches of the trigeminal nerve in the face. They discovered that the first branch alone was rarely the problem. Usually the culprits were the second and/or third branches.

TN is usually treated with medications such as anticonvulsants and muscle relaxants. Botox has also been used successfully for TN, and in much smaller doses than are used for migraine.

In rare cases, surgery is recommended. However, surgery is not always a guarantee that the pain is gone for good.

A clinical trial is beginning in the USA also, in Philadelphia, to investigate the use of Botox for TN. If you would like to be a part of the study, you can find more information by clicking the last link below.

For more information: