Stopping Migraines in Their Tracks

Join us as we explore Medical Frontiers！ Researchers say over a billion people worldwide suffer from migraines.

The pain and suffering can have a major impact on daily life, but the only way to deal with these headaches has been to take painkillers.

However, this is all about to change.

New drugs have been developed that prevent migraines.

There are high hopes that they will greatly improve the patients' quality of life.

This hospital has four headache specialists.

They have some 200 migraine patients in their care.

The team is led by Eiichiro Nagata.

He's been at the forefront of migraine treatment for 30 years.

He's also been involved in clinical trials for a new drug.

Hello.

This 47-year-old patient sees Nagata once a month.

It’s like the back of my eyes are being held tight.

There’s pain above my temples,
as if they’re being squeezed.

Sometimes, I also feel tightness in my back.

I can feel my headache spreading
from the back of my head to my entire head.

How long does the pain last?

It depends, but two to three days when it’s bad.

The woman has been suffering from migraines for 30 years.

I was 17, in my junior year of high school,
when I became aware of my migraines.

The pain would worsen during my periods,
often forcing me to stay in bed.

I could go to school, but I’d get severe
headaches and would need to lie down.

At first, she was able to bear the pain by taking over-the-counter painkillers.

But after she started working in her early 20s, severe headaches began that lasted for several days.

The pain was sometimes accompanied by nausea.

With the nausea, it was hard to even walk.

I’d lie down, but my headaches
would be so bad I couldn’t sleep.

The nausea would gradually worsen,
causing me to vomit.

I’d be in the bathroom for 10 minutes,
then return to bed, then get sick again.

I would go back and forth.

Migraines are a type of chronic headache　which means they occur frequently.

The most common type is the tension headache, which is caused by stiff muscles around the shoulders and other areas.

Migraines are said to have the most severe symptoms and the biggest impact on daily life.

To learn more about this mysterious debilitating condition, we spoke to Nagata.

Professor Nagata, thank you so much for your time today.

Our host, Erica, also suffers from migraines.

I've only started to get migraines, I think probably in the last five years.

I never had them when I was young.

What are the difference between people who tend to get migraines and those who don't?

Migraines are more common in women.
They’re said to get worse during periods.

The World Health Organization says migraines are up to three times more common in women than men.

Migraines mostly affect women
from adolescence to their 30s.

But some also complain of
very strong pain in their 50s or 60s.

There is so many different types of headaches, this tension headaches, this cluster headaches.

How do we know the difference between all of these different types of headaches in a migraine?

To diagnose a migraine,
certain conditions must be met.

Migraines often disrupt everyday activities.

They make patients want to
stay in a dark room and do nothing.

There’s also nausea and vomiting. Light, sounds
and smells may trigger or worsen migraines.

Migraines last maybe 3 days at most.

Let's look at how a migraine occurs using a three-dimensional computer model.

The key to understanding the mechanism is the trigeminal nerves, shown in yellow.

They run from the brain to the face.

The trigeminal nerves serve as sensors for detecting sensations such as pain and temperature.

We'll focus on CGRP, a substance that is secreted from the tips of some of the trigeminal nerves.

When CGRP is secreted, it attaches to receptors on the walls of blood vessels surrounded by the trigeminal nerves.

This usually results in a moderate expansion of the blood vessels.

In migraine patients, some kind of stimulus is believed to trigger the oversecretion of CGRP, causing excessive expansion of the blood vessels.

Overly expanded blood vessels put pressure on the trigeminal nerves.

Inflammation results, sending pain signals to the brain's center that generate strong, throbbing pain.

This is the most widely accepted explanation of how migraines occur, although experts have yet to reach a full understanding.

The standard therapy is to treat the symptoms.

Patients take medicine when they feel pain.

I feel anxious without it.
I carry it around with me every day.

Preventive treatments are available, but the drugs used are not specifically for migraines.

They involve anti-epileptic drugs and antidepressants.

Headaches have been around for such a long time, so why is the only symptomatic treatment?

Chronic headaches, including migraines, are not
life-threatening, so research on them is slow.

Generally, autopsies are done to help
uncover how a disease occurs.

But there are no autopsies to examine
how migraines happen.

What’s more, headaches are subjective.
You have to rely on the sufferer’s description.

It’s hard to study headaches.
That’s why progress in research has been slow.

Because of the slow advancement in headache research, there has been little understanding of migraine sufferers.

Soon after I started working,
I told my manager about my headaches.

The reply was, "You can work, right?"
That was the toughest time for me.

The woman's migraines worsened after she gave birth, and became more frequent during her periods.

She talked to a gynecologist, but the response was unexpected.

I was told, "Menstrual pain occurs
in the abdomen, not in the head."

"It’s probably best to take painkillers."
I didn’t get the response I’d wanted.

Ever since, I’ve been coping in my own way,
thinking that it’s my only choice.

Like this woman, many migraine sufferers give up on seeking medical advice.

Others don't see doctors at all.

They struggle with their migraines alone, taking nothing but over-the-counter painkillers.

However, migraine treatment is now going through a fundamental transformation.

In 2018, US authorities approved the world's first drug that is designed specifically to prevent migraines.

Researchers in Japan also conducted clinical trials, leading to the first government approval for a migraine medicine in 20 years.

Doctors started prescribing it in April 2021.

Three types of drugs are now available.

The medicines contain artificial antibodies.

They're injected subcutaneously.

The antibodies target CGRP, the substance that's believed to trigger migraines.

The drugs are divided into two kinds, depending on how they work.

In one type, the antibodies attach to the CGRP, keeping it from binding to the receptors on the blood-vessel walls.

In the other type, the antibodies attach to the receptors, blocking the CGRP.

Both types prevent CGRP from causing the excessive expansion of blood vessels, thereby averting pain.

Nagata took part in clinical trials aimed at confirming the effectiveness and safety of one of these drugs.

The researchers divided migraine patients into three groups and observed them for three months to see if the drug made any difference to the frequency of headaches.

One group received the drug over three shots.

The second group was given the entire amount in the first injection and two shots of a placebo.

The third had three injections of a placebo.

As a result, the group that wasn't given the new drug had a slight drop in pain due to the placebo effect.

But for both groups that were given the new drug, the number of days when headaches occurred fell by an average of half.

Nagata says 70 to 80 percent of the participants had a 50 percent drop in headache frequency.

About 10 percent of patients had a 100% drop.

He says he results were similar for all three types of drugs.

What was your impression of the study?

I was amazed. The drug is so effective,
it could trigger a paradigm shift.

The new drugs make it possible to prevent migraines, rather than simply treating their symptoms.

Doctors prescribe the drugs to patients who have at least four severe migraines a month consistantly.

The female patient found out about the new drugs through Nagata, and is having one of them administered.

Is the new drug making a difference?

Yes. I get headaches far less than half as often.

For a month after my first injection, I had almost
no headaches and didn’t need painkillers.

This happened for the first time in years.
It was such a wonderful month.

That’s honestly how I felt.

I wish this excellent drug had been
developed much sooner.

In Japan, the drugs are covered by the national health insurance.

One shot costs roughly 100 dollars.

Two of the drugs can be self-injected by patients into their abdomen or another part of the body.

That eliminates the need to see a doctor.

Is there any possible side effects which critical?

They’re injected, so they hurt. They can also
cause swelling, but that goes away quickly.

Some worry about anaphylactic shock,but
it’s unusual. If it happens, it’s not serious.

These are very effective drugs
without any major side effects.

But it’s been only about 5 years since
their launch in Japan and elsewhere.

There’s no long-term safety data
spanning 10 or 20 years.

It’s too soon to say they’re completely safe.

Many people improve significantly but some don’t.

We need to consider other drugs for them.

Aside from medication, there's another item that's essential to migraine patients and their doctors.

It's called a "headache diary."

Patients use it to keep track of when their headaches occur, the severity of the pain and its impact on daily life.

They also take note of whether they feel nausea, and what triggered the headache.

One page is used per month.

The form is duplicated, so doctors can receive a copy.

It helps to convey details that doctors wouldn't know just through observation.

56-year-old Inagaki Miho has had migraines for at least 30 years.

She's been keeping a headache diary for nearly 10 years.

Here are my diary entries for the last two years.

I had a headache in the evening. It was
still there in the morning, so I took medicine.

You wrote "regret in the morning."

Yes, I really regretted not taking it before bed.

Inagaki writes down key observations, such as her condition when the headache occurred,

as well as environmental changes, if any.

The diary is an important tool because over time, the entries show the characteristics and tendencies of a patient's headaches.

But filling it out each day is a challenging burden.

When I have a headache, I don’t feel like
filling it out, so I wait until the pain is gone.

But by then, I’m busy with other things and
I forget, so I decided to fill out a week’s worth on Saturday evenings. I keep notes during
the week and copy them into the diary.

That’s right.
You need separate notes for the diary?

Now a smartphone app has been released that makes it easier to keep a headache diary.

A Japanese company developed it with an eye to launching it abroad as well in the future.

Users can rate the intensity of pain on three levels...

and the effectiveness of the drug they're taking,...

and select possible causes of a migraine.

They can also enter the type and duration of a pain by simply tapping the options, including the location.

Inagaki began using this app in January 2022.

With the app, I can make entries
as soon as a headache is over.

I sometimes get headaches during a trip, when
I wouldn’t have the paper-based diary with me.

But I always carry my smartphone.

Once a headache is gone,
I can enter all the information on the spot.

The information entered by patients is shared with their doctors in real time.

This reduces the burden on the doctors and also gives them a better understanding of the patient's conditions.

Inagaki's doctor, Shoji Kikui, is a headache specialist.

He has always used the paper version of the diary in treating his patients.

But he started using the app as soon as it became available.

He's having 19 patients, including Inagaki, try it out.

A headache diary is like a journal
that is shared by patients and doctors.

For us doctors, a paper diary is hard to maintain.

We have to scan each page and store it in the
patients’ file. It’s hard to go back and review it.

But now, when patients input their data,
I can see it on my computer.

It’s very clear.

When a patient enters data, Kikui can see it immediately on this page.

Migraines are shown as a line graph over a one-month period.

This makes it easy to see which days headaches occurred, as well as the intensity of the pain and how effective the drugs were.

When the cursor is moved to the peaks on the graph, the patient's notes appear.

With a paper diary, I have to wait for patients
to visit so they can bring new entries.

But the app lets me see their daily updates.
I can check their conditions before they visit.

This allows me to make efficient use of
the time during patient visits.

Kikui pays special attention to how effective a drug is in controlling the pain from a headache.

He looked at Inagaki's latest data before her next visit and noticed something.

One entry says she took an over-the-counter painkiller in the morning, but it didn't work.

The prescribed medicine she took in the afternoon was slightly effective.

Kikui assumed that Inagaki first took an over-the-counter painkiller because she thought she could manage with it,

but later took a prescribed drug since the pain didn't go away.

She took the prescribed drug a little late,
which is probably why it wasn’t that effective.

Please come in.

Kikui says advance access to data better prepares him for a patient's visit, enabling efficient consultations.

The first drug didn’t work, so you took another?

I see.
At first, I had stiff shoulders.

My shoulders were really stiff,
so I took a painkiller in the morning.

But the pain continued and felt like a migraine.

It’s hard to tell the difference.
It’s okay to take a prescribed drug even when you’re not having a migraine.
Please take it if you’re not sure.

How was your reading of her data?

I think I was about 80% correct. Her comments
about stiff shoulders were unexpected.

Kikui wants to use the app for online consultations in the future.

He hopes for a system that allows patients to talk to doctors at their convenience and seek medical advice when necessary.

With an electronic diary, we can each
look at the data on a different screen.

The app has a lot of potential.
Migraines affect many people in their 20 to 40s.

Such people may be busy from work or childcare,
and unable to make time to visit the hospital.

Maybe the app can help us make
it easier to receive consultations.

Innovative new drugs and the latest technology connecting patients with their doctors are giving hope to the countless people suffering from migraines.

I sincerely hope researchers will make progress in uncovering actual mechanism behind the disease and also having even great impact on patients' quality of life.

Now, Nagata will explain how to avoid possible migraine triggers so that patients have a better chance of living pain-free and in comfort.

First, let's look at how to deal with light, especially blue light.

Blue light is contained in sunlight.

It is also emitted by electronic devices such as computers and smartphones.

Many migraine patients believe that they're affected by it.

These are video clips from an experiment that Nagata conducted.

The eye on the left belongs to a person who doesn't get migraines.

On the right is the eye of a migraine patient.

When blue light is shone on the eyes, the migraine patient's pupil shrinks significantly.

Even after the light is turned off, the pupil is slow to return to its original state.

Research is still ongoing.

But Nagata believes that special light-sensitive cells at the back of the eye play a role in this response and in triggering migraines.

In migraine patients, these cells
are probably very sensitive.

The cells’ sensitivity to blue light
may be triggering migraines.

The effects of blue light can be minimized by wearing glasses that block it, or by using a parasol or sunglasses when going out on a sunny day.

Next, we look at how to cope with stress.

Migraines tend to occur when you’re stressed
or when your stress is released.

But the problem is we can’t escape stress.

It’s important for people to find
their own best way to deal with stress.

I try and do some stretches before bed.

I think that’s an excellent idea.

The female patient we saw earlier has also found ways to relax.

They involve enjoying her favorite aroma and giving herself a head massage with an electric scalp massager.

Finally, Nagata will show us a couple of simple stretches that can prevent migraines.

The first one involves arm movements.

Bend your arms and raise them to shoulder height.

While facing forward, swivel from side to side so each elbow in turn aligns with your chest.

Keeping alternating between left and right
to relax your neck muscles.

Stiff, tight muscles around the neck can lead to headaches.

This exercise is effective when done slowly for two minutes a day while focusing on the body's axis.

The second exercise focuses on the shoulders.

Move your elbows in a circular motion so your shoulders rotate back and forth.

By moving them slowly, the shoulder muscles and joints will be stretched thoroughly.

Do this exercise for two minutes a day.

This one feels great because I get a lot of tension between my shoulder blades.

Rather than relying on medication, it’s good to
exercise like this to relax and reduce headaches.

I think for so many people, not just people with migraines, I think these are going to be great exercises for those working all day on the computer

and also looking at phones and devices the whole day.

Please try them.