Looking at Old Migraine Truths could provide New Answers


In the scientific community, it is no longer news that women are more prone to migraines than men. Some chemicals are also known to trigger migraines. In fact, there is a lot of evidence validating these truths based on general observation, but we can’t really pinpoint why these causes are valid.

One of the two studies funded by the NIH’s National Institute of Neurological Disorders and Stroke (NINDS) is a collaboration with Dr. Armen Akopian, Associate Professor of Endodontics at the UT Health Science Center at San Antonio. This study was conducted with animal specimen as both doctors study migraines and the hormones.

Dussor says, “The period during which women suffer migraine attacks strongly suggests a tie to reproductive hormones.”

“Before puberty and after menopause, men and women have about the same prevalence for migraine. In between, females’ migraine rate increases dramatically. Many women also have days of their menstrual cycle that are conducive to migraine, or dramatic shifts in attacks during pregnancy,” he continues.

After Dussor conducted some animal studies, it was observed that female subjects responded positively to migraine while male subjects didn’t respond at all.

There is the hypothesis by Dussor that prolactin is a factor that makes migraine more likely, though he doesn’t believe that it is the main cause of migraine.

The second NINDS study showed that among four migraine patients, three of them are affected by drugs that create nitric oxide in the body and cause migraine within six hours. Speaking about nitroglycerin, Dussor says, “We’ve known, since nitroglycerin was first synthesized in 1847, that it was a very reliable trigger of migraine attacks, but we don’t know what mechanism causes the attacks.”

To determine which nitric oxide metabolic product is relevant to migraine, Dussor and his team focused on a nitrogen radical known as peroxynitrite.

“Peroxynitrite is produced when nitric oxide reacts with superoxide, a negatively charged oxygen molecule,” Dussor said. “We chose peroxynitrite because we already know how to neutralize it, and because targeting it should not have major side effects. Some products of nitric oxide can’t be safely targeted.”

Migraine is a serious case and solutions are sought, but Dussor makes it clear that there may not be a particular drug that all migraine patients will react positively to.

“Drugs for other types of pain don’t work that well on migraine. Meanwhile, triptans, the drugs given for migraine attacks, aren’t given for any other type of pain,” he said. “There’s excitement around CGRP (calcitonin gene-related peptide) inhibitors right now. There are three new Food and Drug Administration-approved therapeutics based on that mechanism, and those will help a lot of people. But it’s already clear that they don’t work in everybody.”