Range of new fast-acting drugs can offer relief to migraine sufferers

Much-improved new drugs and other treatments will soon be available for those who experience migraine, one of the most intense forms of pain, according to a leading authority on headaches, Prof Michael Moskowitz of Harvard Medical School.

Speaking at an international conference on chronic pain management in Ennis, Co Clare, Prof Moskowitz said treatments were going to be significantly better, safer and quicker-acting. They would be highly selective, by targeting pain fibres rather than muscle to which they are linked. A migraine is a disorder of the brain and its blood vessels which occurs in an otherwise healthy individual and may last for hours or up to two days.

In addition, identification of the mechanism causing migraine had improved, notably in terms of genetic factors which can make people more susceptible. Scientists were beginning to recognise "what is going on in the brain in anticipation of headache". Research on the role of genes suggests the importance of "ion channels" and a defect in their function, he told some 300 pain specialists.

Up to half-a-dozen new orally administered drugs and a nasal spray were showing ability to tackle the pain at the "early onset" acute period. They are at "late clinical development stage" and proving to be much more selective in targeting the nerve transmitting the pain and altering the diameter of blood vessels.

Stress and lifestyle play into the frequency of migraine, but that is not the whole story, he said. The influence of hormones, particularly with women once they began menstruation, made them more susceptible. In any event, it was a "universal disease; one of the downsides of being human" as it did not seem to affect other animals.

The cause of pain in the jaw joint and associated headache is often very difficult to identify precisely, said Dr Sandro Palla of the University of Zurich. As there was a lot of misdiagnosis of "TMJ disorders" in traditional medicine, there was a need for dentists and physicians to work in close co-operation to establish the best treatment, he added.

A clear distinction had to be made between acute and chronic cases, he said. With patients who had chronic pain (which persists over a long period), traditional surgery and treatment did not help. But if they were treated through a "pain management programme" overseen by a multidisciplinary team, their quality of life improved significantly.

The conference staged by the European Academy of Cranio mandibular Diseases had revealed "new thinking on chronic pain" which affects such a significant proportion of the population, according to its president, Dr Geoffrey Kronn of St James's Hospital, Dublin. While some exciting research presented needed to be validated, new indications were surfacing on why we perceive pain and why people feel it differently.

The number of Irish pain clinics overseeing pain management plans for chronic patients was growing, said Dr Raymond Victory, anaesthetist and pain physician at St Vincent's and St Luke's hospitals, Dublin. They were not only treating chronic head, neck and back pain but also cancer patients, where conservative palliative care had not worked or, for example, there were too many side effects from morphine use.