Scientists win prize for migraine research that offers 'light at the end of the tunnel'

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Neuroscientist Peter Goadsby wants the millions of people who suffer from migraines to know that there is hope. And now his research into the long misunderstood disorder has been recognized by the world's largest neuroscience prize. 

Goadsby and his colleagues have been awarded the Brain Prize for their research into the cause and treatment of migraines. The prize, worth 10 million Danish kroner ($2 million Cdn), is awarded yearly by the The Lundbeck Foundation in Denmark for outstanding and ongoing research in neuroscience. 

Goadsby discovered how a molecule called calcitonin gene-related peptide, or CGRP, causes migraines. Working alongside Michael Moskowitz of Harvard University, Lars Edvinsson of Lund University in Sweden and Jes Olesen of the University of Copenhagen, the scientists created a new type of treatment. 

The research has already led to the development of new drugs for migraine prevention, sold under brand names like Aimovig and Emgality, both of which have been approved for use in Canada in recent years.   

Goadsby, a professor of neurology at the David Geffen School of Medicine at UCLA, spoke with As It Happens host Carol Off about what his research means for those who suffer from migraines. 

Migraines, of course, are something that devastate so many people, especially women. What were the common assumptions about what caused migraines before your breakthrough? 

I think if you look back to before the work that myself and the co-winners have done, you're looking back 40, 50 years, and the first assumption was that migration was more or less a soft disorder, perhaps a disorder of one's ability to cope.... a disorder that was not to be taken seriously ... almost psychological. 

What you and the others have determined or identified are something called neuropeptides that seem to be the trigger for migraine attacks. Just knowing you're speaking to a lay audience, can you tell us what they are and what they do? 

Neuropeptides are small chemicals that are in the blood that are released from nerves. They allow nerves to talk with each other. 

And what our work has shown was that the crucial neuropeptide, this crucial small molecule ...  is something called — and this is a mouthful — calcitonin gene-related peptide. For its friends, it gets called CGRP and that would be absolutely fine.

And so we predicted that if that was blocked, its action was stopped, that you could control and improve migraines. And certainly that's turned out to be the case for quite a substantial number of patients. 

How does the treatment work? I mean, is this something that once somebody is having a migraine, or they know one is coming on, that can stop the pain? Or is … your hope is that it could be something that could actually prevent migraines? 

If you target it properly, you can do both. 

So if you said to me that you wanted an acute treatment, then you can design something targeting CGRP to do that. Or if you want a preventive, you can do the same thing. That is probably the most revolutionary aspect of what's gone on. 

What this shows is that if you get the research right, you understand what's going on well enough, you can start to design drugs that fit around what the patient needs, rather than trying to shoehorn them into what you have available.

What does this actually mean for people who suffer from migraines? 

What it's done is shown how you can solve it for some, not for everybody.  

But for those who get a response, for example, for prevention, what does it mean? It means you can do this interview when you say you're going to do it instead of having a migraine and not be able to. It means that if you're about to get in the car and drive somewhere while you're listening to this, you'll be able to drive there. 

So instead of migraine controlling their life, they control their life. 

Why do you think that migraine sufferers so often are women? 

Oh, I can more or less explain that, at one level, and then it gets embarrassingly unresearched because migraine research is relatively underfunded. 

So the cycling of estrogen, the change in levels of the female hormone estrogen, is crucial in bringing out migraines. So if you look at boys and girls, it's about one-to-one. It starts to increase when women start having their periods and it peaks about the age of 41, where there are three females for every male. The number of women reduces around menopause, but never goes back to one-to-one. It stabilizes during pregnancy estrogen levels.

And so in pregnancy, migraine tends to be better. So it's reasonably clear that there's an effect of estrogen in toning up and turning on sensitising the migraine brain, if you like, to have attacks. 

Now, how it does it, and what that relationship might be, for example, with CGRP is something that's the subject of ongoing examination.  

What does it mean? It means you can do this interview when you say you're going to do it instead of having a migraine and not be able to. It means that if you're about to get in the car and drive somewhere while you're listening to this, you'll be able to drive there.- Neuroscientist Peter Goadsby

As you point out, there is so little research being done into migraines, and yet they have such an extraordinary effect on people who suffer from them, and especially ... women who suffer from migraines, this idea that they were weak or that they weren't coping very well. What does this kind of research ... actually do to help change the perception of people who suffer from migraines? 

I think more important than the individual outcome, the fact that you can reduce half people's attacks by 50 per cent, is that what it shows is there's a serious biology. 

And that really changes attitudes because ... you can't speculate on craziness if you can start to measure and determine and treat very specifically migraine as a disorder. 

And what this research tells you is that there is light at the end of the tunnel. There is sunshine coming. And the perception of the disorder has moved from this sort of wishy-washy thing into it being a serious neurological condition, a condition of the brain, that you can study and you can improve. 

Written by Sarah Jackson. Produced by John McGill. Q&A has been edited for length and clarity.