A New Research Grant Studies a Severe Form of Migraine

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 headacheresearch@hhchealth.org. Note that participants must be able to drive to the center.

 

 

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (10)
  • Diane1010
    2 years ago

    If I don’t treat my pain by the time it hits 5, it usually cycles into a status migrainosus. I used to try to wait them out at home. I’d become a pro at dealing with the pain. Then realized — the intense pain sends my blood pressure up past 220. I also am not rational enough to decide when or if I should go to the hospital, truth be told.

    Luckily, I am blessed with a wonderful, military emergency room. No waiting in line, if they are aware of my condition. I’m taken directly to a dark quiet room.

    My only complaints –
    The room needs a bathroom. The migraine and ivs make me pee every ten minutes.
    They avoid giving magnesium IVs because the heart must be closely monitored. ( I was told.)
    They sometimes are taking part of a study. Ie – I was given haldol in my cocktail mix, without my permission, for a headache I’d had for 7 days. It made me want to get up and jog around the building. I couldn’t lay still. It felt horrifying.
    Any time they get near my iv with a needle, I demand to know what exactly is being put into my body. .
    New research is a good thing.

    Sorry for any typos. Not feeling well.

  • Lisa Robin Benson moderator author
    2 years ago

    Hi Diane1010,
    Thanks so much for your comments. It’s useful to see someone else’s ER strategies. It’s amazing the amount of pain we learn to deal with.
    Be well,
    Lisa

  • Andrea
    2 years ago

    I was fortunate enough to have been a patient of Dr. Grosberg’s at The Montefiore Headache Center in New York City before he left to open and run the Hartford Health Care Headache Center. Hartford is too far for me to drive while working full-time to be able to continue to work with Dr. Grosberg. However the headache specialist I’m now seeing at Montefiore was trained by him, so she works very much in his gentle and caring style. If anyone qualifies to be a part of this study and has the opportunity to work with Dr, Grosberg, I urge you to do so. Oddly enough the rain and drop in the barometic pressure in the Northeast this past week, triggered an episode of status migrainosus for me, which lasted 5 days and I needed a 3-day taper of the steroid dexamethasone to break it. The timing of this study has not come soon enough!

  • Lisa Robin Benson moderator author
    2 years ago

    Very cool to hear about your experiences with Dr. Grosberg. I do hope the study helps many get relief more quickly.

  • Katie M. Golden moderator
    2 years ago

    Thanks for this wonderful news Lisa! It gives me hope. Every dollar counts!
    -Katie

  • Lisa Robin Benson moderator author
    2 years ago

    Agreed Katie!

  • Lisa A
    2 years ago

    I am honored and fortunate enough to be a patient of Dr Grosberg. He is a fabulous Dr and human being. He has a heart of gold and is brilliant!! I am excited about this study as I suffer from chronic M with status migrainosus quite often. Horrible. May research funds continue so that living with M disease will be less debilitating and more hopeful for those who suffer.

  • Lisa Robin Benson moderator author
    2 years ago

    Lisa, great to hear about your experience, and I too hope the study helps!

  • tlocker
    2 years ago

    This is great news; having twice in 3 months had 4-6 day runs of status migranousus. I been horribly treated, on Day 3, in a local ER (even WITH a letter from my Neurologist in my hospital chart AND provided to him by my husband) was greeted at second visit with an MD who opened with, “I’m Dr. X, I don’t give narcotics for headaches”. I had not asked for narcotics, in fact HAD them at home, but was still have breakthrough pain and dehydration that DID need treated but wasn’t, as I got up to leave. It’s not worth the fight for ANY care, and I will not return to that ER, although the nearest alternative is 50 miles away. There is just NO point, and those 30% of us who cannot tolerate triptan class are in an even tougher spot, as that is always where they want to start. I am writing a letter of complaint to the hospital and enclosing the latest two research reviews showing recommended treatments. Neither of which includes the oral Xanax (tranquilizer?! oral!?) I was offered at the previous visit. I hope and pray other can get relief from this pilot project.

  • Lisa Robin Benson moderator author
    2 years ago

    I’m so sorry to hear about your experiences, Tlocker, but good for you to advocate for yourself! I will be hoping as well that the research gives us all better options!

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