Migraines are one of those diseases that require little introduction. It is a condition whose main characteristic is a severe, pulsating headache, often accompanied by sensitivity to light and/or sound, and nausea. It typically occurs on just one side of the head, being unilateral.
Severe cases can be debilitating for the individual. They consist of acute episodes that last between 4 and 72 hours if untreated. Sensitivity to light, combined with the fact that physical exertion worsens the pain, means that affected individuals retreat to dark rooms and rest, waiting for the symptoms to subside.
Before the pain stage, there can be a preceding painless phase with atypical symptoms, such as tingling in the tongue or visual disturbances. These don’t last more than an hour and fade without leaving any after-effects.
Being a common disease with evident symptoms, it was documented and described more than 2,000 years ago.
And yet, its mechanisms have still not been established. It’s considered to fall under the category of complex diseases, where several inherited genes play a part, and it is influenced by environmental factors.
The three main suspects are:
- Vascular theory, due to cranial arteries that undergo initial vasoconstriction, followed by vasodilation, causing the pulsating pain.
- Neurogenic theory, where the culprit is hyperexcitability in the cerebral cortex that would eventually activate the trigeminal nerve, responsible for pain.
- And a third theory blames the gut-brain axis, based on the observation that changes in diets reduced, or even eliminated, the occurrence of migraines in affected patients.
What have we learned during this time?
The disease has a genetic basis, but many patients have reported environmental factors as migraine triggers. The most commonly cited are changes in people’s routines, especially if they affect sleep cycles or create situations of stress and anxiety, and in the case of women, the menstrual cycle. The latter often coincides with drops in estrogen levels, which naturally occur before menstruation.
According to the World Health Organization (WHO), between 15 and 18% of the global population suffers from migraines, with severe or chronic cases affecting 4 out of every 100 people worldwide. They are more prevalent in women.
Although it is less severe in young people and presents some differences in its characteristics, 6% of adolescents suffer from it, and 18% of patients claim to have experienced their first episode before the age of 10.
Migraine is a relentless hammer in the skull, but it can get worse. Among these are migraines that exceed 72 hours in duration (which may require hospitalization), chronic migraine, which occurs at least 15 days a month, or epileptic seizures triggered by migraine episodes.
Besides being a highly underestimated public health problem, migraine is, according to WHO itself and despite its lack of recognition, the sixth most disabling disease. Insufficient attention to these problems results in a high financial cost to society due to the absenteeism they cause since the symptoms are more severe during people’s productive years.
Proper treatment of these disorders is based on three points:
- Training health professionals to establish accurate diagnoses. There are many types of migraines and they don’t all respond equally to treatments.
- Proper treatment with effective drugs. Non-steroidal anti-inflammatory drugs (such as ibuprofen), ergotamine, and triptans. The last two are specific in the treatment of migraines, have side effects, and ergotamine has been largely displaced in its use in favor of triptans.
There are drugs that work as preventives, reducing the occurrence of migraine episodes. For example, beta-blockers or anticonvulsants. However, these drugs are of no use during the acute episode. - Lifestyle changes and patient education. The goal is for patients to establish a routine and stick to it.
In recent years, professionals and scientists are addressing this problem more thoroughly.
tellmeGen and headaches
Aware that there’s still much work ahead, at tellmeGen, we have developed a pioneering observational study in Spain with our users who suffer from migraines and other types of headaches. We aim to find the genetic markers that might help select the appropriate drugs for each person and thus reduce therapeutic failures.
This is the basis of pharmacogenetics, a scientific discipline that, in recent years, is becoming a reality.
“Thanks to the study, we are observing that many patients do not improve their symptoms because they are taking a “drug treatment that is not appropriate” from a genetic standpoint. However, when we study the genes involved in therapeutic success, prescriptions can be personalized, efficient, and safe. We are systematically observing this and hope that this study serves as a basis for more thorough ones,” stress Dr. Silvia Tamborero and Celia Martínez, responsible for the study.
The goal of this study is to become the first company to offer a pharmacogenetic panel through which the best treatment for each case can be prescribed.
“Pharmacogenetics is the tool that will help us be more precise and efficient, and as a company, we are very committed to these highly disabling neurological disorders,” says Dr. Ana Romero, director of the Genetics Department at tellmeGen.
More information about the role of genetics in migraine drugs:
With the tellmeGen genetic test, you can learn many unique characteristics, among which stand out how migraine-associated medications affect you and the implications they may have on your health.
