New migraine therapies promise prevention

M igraine has been documented almost from the beginning of recorded history and was one of the first targets of pain relief therapies, though most were ineffective until the 20 century. Even today when effective drugs are available for treating attacks, there is no cure beyond the fact that in some people the condition diminishes or disappears with age. Migraine remains one of the world’s most common afflictions with relatively little regional variation around a global average of 15% that is skewed three to one towards women. In the USA, the incidence of migraine or severe headache ranges from 26.1% within a 3-month period among women aged 18–44 at the top end to 4.6% among men older than 75 at the bottom [1]. According to the non-profit organization Migraine Research Foundation, this equates to 113 million lost workdays per year costing employers an estimated US$13 billion. Around 14 million people in the USA—or 4.5% of the population—suffer from chronic and severe headaches on an almost daily basis; treatment comes in at an estimated annual cost of US$50 billion on top of lost productivity (http://www.migraineresearchfoundation.org/frequently-asked-questions. html). With this background, it is hardly surprising that migraine has been a major focus of research and clinical development. Yet, and in common with other areas of pain relief, treatment of migraine has evolved almost in the dark without a firm understanding of the condition’s underlying biology. Nevertheless, after many years of work, there is now considerable optimism that the field is on the verge of substantive progress, even though the fundamental mechanism remains elusive. “We are currently at an exciting time for migraine research and therapy with several novel therapies in the pipeline”, said Philip Holland, Head of Preclinical Research in the Headache Group at King’s College, London. A new generation of drugs and non-drug therapies could prevent the headaches from appearing rather than nip attacks in the bud after the first symptoms have occurred.