The pain and discomfort migraines cause can only be truly understood by someone who has experienced one. I have never experienced one however those close to me have. Sure, I’ve had headaches here and there but nothing that could completely knock me on my ass and keep me there until it’s gone. Migraines can completely bring people’s lives to a halt until they pass. This causes people to struggle with work, school, or everyday life if they are suffering from them. We have pain medications for all sorts of problems in our body and most of the time we have a long-term fix for what’s causing the pain. However, why is it that migraines are not just like other problems? Why can’t we just get them taken care of for good? Well, to fix something that is wrong you need to start at the beginning. The problem with migraines is that the beginning of them remains elusive to researchers.
The pain experienced in migraines ultimately results from vasodilation of cerebral blood vessels. The vasodilation occurs because neuropeptides are released (primarily CGRP) by intrinsic nerves and prompt and inflammatory response in that area. This activates the sensory neurons in the area of the vasodilation. The primary source of sensory neurons in the head comes from Cranial Nerve V (Trigeminal Nerve). There are three branches to the nerve and they are the mandibular, maxillary, and ophthalmic branches. The maxillary and ophthalmic are purely sensory branches and are believed to be responsible for responding to the release of the neuropeptide CGRP causing a synapse through the brain stem. This synapse continues through the thalamus and then to the cortex of the brain and is interpreted as pain. The beginning cause of the migraine is hypothesized to originate somewhere in the brainstem however a specific pathway or location is not yet discovered. Though we cannot eliminate migraines from our world yet, we can manage them and treat those with them using drugs classified as either Gepants or Triptans.
Triptans are a class of drugs that act as agonists (activators) of 5-HT receptors on cranial blood vessels which causes constriction of the vessels. This class of drugs also acts as inhibitors of the release of pro-inflammatory neuropeptides. Triptans are not used as preventative they only can be used to treat single migraine episodes. Triptans should be taken with caution due to their vasoconstrictive nature. Gepants act as CGRP-antagonists in order to act as a preventative medication for those who regularly suffer from migraines. Because Gepants are not vasoconstrictors they don’t have adverse side-effects and are a positive light of hope for those who suffer from migraines.
There is still a lot of research that needs to be done in order to find an end-all cure for migraines because we can’t hope to end them if we don’t truly know where or how they begin. However, thanks to breakthroughs in medications like those with triptans and gepants, those who suffer from migraines can get back to their lives quicker than ever.
Until next time,
Sebastian
Migraines: Breakthroughs Still Needed
