28 October 2023 , 11:31
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Migraine sufferers have been offered fresh hope after research discovered potential new ways of treating the debilitating headaches.
Around one in five women, one in 16 men, and one in 11 children have regular migraines - with attacks three times more prevalent in women. Now, an international study of the genetics of migraine has provided new insights into the biology behind the attacks.
Scientists say it will enable detection of rare variants protecting against migraine, opening an avenue for the potential development of new drugs to treat the problem. An international team of researchers, led by deCODE Genetics in Iceland, analysed genetic data from more than 1.3 million participants of which 80,000 had migraine.
One in 16 men suffer from migraines (Stock photo) (Getty Images)The scientists focused on detecting sequence variants associated with the the two main subtypes of migraine - migraine with aura, often referred to as "classical migraine", and migraine without aura. The results highlight several genes that affect one of the migraine subtypes over the other, and point to new biological pathways that could be targeted for therapeutic developments.
Although recent advances have been made in studies of the genetics and underlying biology of migraine and new treatments recently developed that are effective for many migraine sufferers, they do not work for all types of migraine. The new study, published in the journal Nature Genetics, discovered associations with 44 variants, 12 of which are new.
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Professor Kari Stefansson said: "Four novel migraine with aura associations were revealed and 13 variants associated primarily with migraine without aura. Of particular interest were three rare variants with large effects pointing to distinct pathologies underlying different types of migraine.
"Thus, a rare frameshift variant in the PRRT2 gene confers a large risk of migraine with aura and with another brain disease, epilepsy, but not of migraine without aura." In SCN11A, a gene known to play a key role in pain sensation, the scientists detected several rare loss-of-function variants associated with protection effects against migraine, while a common missense variant in the same gene is associated with a modest risk of migraine.
And a rare variant pointing to the KCNK5 gene, confers large protection against severe migraines and brain aneurysms, either identifying a common pathway between the two diseases or suggesting that some cases of early brain aneurysms may be misclassified as migraines. Prof Stefansson CEO of deCODE genetics, added: "What makes our study unique is that it includes large datasets from sequenced individuals enabling detection of rare variants protecting against migraine, potentially opening an avenue for development of novel drug targets."
Last month, we reported that the first oral drug to tackle the cause of migraines is being rolled out as a treatment on the NHS. The regulator said its approval of Rimegepant - taken as a wafer on the tongue - marks a "step-change in treatment" for the "invisible disability that affects all aspects of life".
Draft guidance by the National Institute for Health and Care Excellence (NICE) means the drug made by Pfizer will initially be offered to 13,000 patients hospitalised due to acute migraines in England. Helen Knight, NICE medicines director, said: "This is the first and only NICE-recommended medicine that can help alleviate the misery of acute migraines, and may be considered a step-change in treatment.
"Migraine is a condition described in comments to NICE from carers and people with migraine as an invisible disability that affects all aspects of life including work, education, finances, mental health, social activities, and family. Today's final draft guidance addresses the high unmet need for treatment options for acute migraine, once again demonstrating our ability to ensure clinically and cost-effective medicines are available to those who need them as quickly as possible."
Prof Peter Goadsby, top neurologist at King's College London, said: "Migraine can have a debilitating impact on those living with it. Today's decision, to offer a treatment which can be used at the onset of a migraine is a welcome step to help expand the options available to eligible patients." It is estimated that up to 43 million workdays are lost each year in the UK to migraine-related absenteeism.