Imagine this all-too familiar scenario—you’ve had an unrelenting migraine for three days and your regular meds haven’t touched it. You’re stuck in bed with the lights off and shades drawn, and you wince every time a family member so much as taps a pencil in another room. You’ve considered going to the ER, but last time the bright lights made the pain worse and the treatment didn’t help. On day four you call your doctor who fits you in later that afternoon. You’re not hoping for much, however.
Your physician welcomes you into his office, and this is where the scenario differs from the norm. He asks a few questions about your migraine and gives you a medication. Your pain and other symptoms start to fade. You go home with a prescription for the medication or some paperwork to take to the ER or urgent care for treatment. You’re prepared for the next unrelenting attack. No more trial and error and days on end in bed.
With some new research on the horizon, this positive outcome may play out more often.
The Migraine Research Foundation, which has been funding $50,000 seed money grants in both basic and clinical science for ten years, started discussing ideas for a larger study a few years ago—one that could bring revolutionary change to the treatment of migraine as quickly as possible. They and researchers came up with their first $250,000 Impact Award called Project Status Migrainosus, just announced in September. The researchers are Brian Grosberg, MD, the director of the Hartford Health Care Headache Center and Rami Burstein, PhD, a researcher at Beth Israel Deaconess Medical Center, Professor at Harvard Medical School and MRF medical advisory board member. The study, which is projected to take about three years, aims to discover which patients will respond to which medications in treating something called status migrainosus. Like the situation described at the beginning of this article, status migrainosus is a severe migraine attack that lasts for at least three days and doesn’t respond to your normal abortive medications.
“Often these patients are not only quite debilitated but the pain generally requires them to seek urgent visits to primary care or urgent care or often enough the ER,” says Grosberg. Some patients can become dehydrated from vomiting, and for many the pain alone is cause for seeking relief. It’s different from recurring headache, rebound headache and new daily persistent headache. Cathy Glaser, president of the MRF, explains, “These are people who have experience with migraine, who took their medication and it didn’t go away.”
At the moment there is no evidence-based decision making of what drugs to prescribe for these debilitating migraines. This leads to a trial and error process in prescribing treatments, which can mean prolonged pain without relief, as the longer you have status migrainosus the harder it is to treat. Personalized medicine has increased in popularity in recent years, and scientists are looking into biomarkers and genetics for many conditions. But discovering these biomarkers in an office setting is not often realistic because of limited time or money, so instead, Grosberg and Burstein are focusing on factors that could be easily identified during an appointment. They are doing separate intake interviews of all participants to try to determine what may correlate with someone being a responder or non-responder for a medication. “We are not going in with any preconceived notions. And what I mean by that is, we are taking extensive histories, and the histories will both be done by myself and Dr. Burstein,” says Grosberg.
The study will involve four groups of 50 patients, and will include four medications: bupivacaine nerve blocks, a course of naratriptan over five days, a steroid dexamethasone, and intravenous or intramuscular ketorolac. These drugs are all commonly used at headache centers, and the naratriptan, dexamethasone, and potentially the ketorolac injections could all be options for taking at-home.
You can hear the hopeful excitement in Grosberg’s voice as he explains the potential impact of the study: “If it works, it’ll basically be a game-changer and have a major impact on clinical practice because this will be something that anybody could implement easily in their own practice or center.” Glaser shares his optimism: “We are very excited about this study and hope it’s only the first in a long list of new Impact Grants.”
If you live near the Hartford Health Care Headache Center and are interested in participating in the study you can email firstname.lastname@example.org. Note that participants must be able to drive to the center.