Rethinking Migraine Prevention Drugs

Timothy C. Hain, M.D. Chicago IL. Page last modified: May 15, 2016

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Although "migraine" is immensely common in the United States, with studies suggesting that about 15% of the entire population are sufferers, this presumes that "migraine" is a disease. Our position is that "Migraine" is actually just a label for a set of symptoms, caused by many underlying factors, some of which include genetic predisposition, environmental stressors, damage to the head/neck, etc.

If one considers this idea carefully, then the general idea that there should be uniform "treatment" for migraine, is difficult to swallow. Instead, one would think that given that one can sort "migraine" into categories that more closely reflect underlying pathophysiology, one might then be able to rationally suggest treatment.

This problem is thorny - -it is a many: many mapping. We have many ways to "slice up" the "migraine" diagnosis, and also many variants of medication or other treatment.

Diagnostic Slices:

Genetic testing

One can easily make jokes about genetic testing in Migraine, because nearly every time that another family is tested, another gene is reported. This is great for researchers who need to publish or perish, but not especially useful for those attempting to categorize headache patients using this method.

Ducros (2013) stated that "Since 2010, three large genome-wide association studies (GWAS) have identified six genetic variants associated with migraine. Each variant has only a modest contribution to the overall genetic risk of migraine, suggesting a marked genetic heterogeneity." -- "The vast majority of the migraine genes are still to be identified."

This is not a good situation. Six genes. Vast majority. There could be 50 genes out there -- or 500. Genetic testing is very expensive. Splitting along genetic lines seems pretty much impossible.