2017: A breakthrough year for migraine?

A New Year, and New Hope
January 2, 2017
Jim Carleton

The last year has been one of enormous promise for the prevention and treatment of migraine disease. Vigorous clinical trials of CGRP antibodies being aggressively pursued by Big Pharma, groundbreaking genetics research, and new developments in the area of neuromodulation have all led a renowned  migraine expert, Dr. David Dodick, Chair of the American Migraine Foundation, to declare "2017 will be a breakthrough year for migraine". Expectations are set very high indeed.

In our upcoming newsletters AMD will keep you informed about these exciting areas of progress, with a special emphasis on migraine prevention and the development of CGRP antibodies. Also we will be providing "boots on the ground" coverage of the February 2017 "Headache on the Hill" in Washington, DC. We really need to press whatever advantage as a field we may have right now, and the well-organized lobbying efforts at HOH is just the place to do it.

As the pace (and hopefully funding) of migraine research accelerates it is not surprising that several areas of interest have emerged outside of the more generally recognized triad of CGRP/Genetics/Neuromodulation. These two topics, namely Brain Derived Neurotrophic Factor (BDNF) and a new study suggesting that microbes in the mouth may play a role in the onset of a migraine, deserve close consideration and further research. In time these two areas may be linked to the currently more recognized themes, but for now they appear to be outliers. So, in order to round out our understanding of current research and understanding of migraine disease let's take a closer look at mouth microbes and BDNF.

Many migraineurs report that eating certain foods can trigger a migraine. A new study suggests that microbes in the mouth may be implicated in a migraine attack. Researchers from the University of California San Diego School of Medicine took another look at statistics from the American Gut Project and found a relationship between migraines and microbes that reduce nitrates, found in the mouth. It seems migraineurs had significantly more microbes in their mouths and gut that are involved in modifying nitrates than people who don't get migraines.

Some foods that trigger migraines like chocolate, wine, and other foods containing nitrates can also contribute to the presence nitrites in the mouth. Leafy green vegetables and processed meats were also identified.

These foods, green leafy vegetables and processed meats, are turned into nitrates due to bacteria in the mouth, and when they enter the bloodstream they can be transformed into nitric oxide in certain situations. While nitric acid can be therapeutic to cardiovascular health, about four in five cardiac patients taking nitrate-containing drugs report severe headaches as a side effect. So, vastly oversimplified, the mouths of migraineurs contained higher levels of these nitrite producing microbes. And, presence of nitrites is strongly associated with migraines.

Brain Derived Neurotrophic Factor (BDNF) has been suspected for some time to play a role in migraine attacks, but the process is ambiguous. Neuroscientists believe migraine attacks may originate in the meninges, membranes that encase and protect the brain and spinal cord, also known as the Central Nervous System (CNS). It is hypothesized that signals travel from the meninges by way of the trigeminal system into the brain stem. From there, the signals pass into the thalamus and other brain regions where it is ultimately experienced as pain. From hypothesis we move to animal models.

Researchers at the University of Texas-Dallas used a drug to basically soak up the BDNF from the brain stem area in rats. The result was that the animals became desensitized to migraines when they were later exposed to stimuli that usually would rouse a headache. Thus, BDNF is linked to migraine attacks in an animal model. Again, oversimplified, but you get the idea.

Two interesting and, at the present time, unrelated contributions to the growing body of migraine research. Also, useful tools under development for the migraine prevention toolbox. I hope this serves to round out your knowledge base for 2016 and prepare you for the exciting news that is just around the corner in 2017!