We Need Better Migraine Meds.

00:14:42
https://www.youtube.com/watch?v=LGLyV9NPT7A

Resumo

TLDRVideoen tar for seg migrener, en tilstand som rammer mange mennesker og som har vært vanskelig å behandle. Behandlingene har utviklet seg fra giftige midler til moderne medisiner som triptaner og CGRP-antistoffer, men mange pasienter opplever fortsatt at de ikke får hjelp. Forskning fokuserer nå på å forstå migrener bedre, inkludert hvordan gliaceller påvirker tilstanden, for å utvikle mer effektive behandlinger. Det er også behov for å vurdere hvordan medisiner kan hjelpe i alle faser av migrene, ikke bare under akutte anfall.

Conclusões

  • 🧠 Migrener rammer en milliard mennesker globalt.
  • 💊 Behandlingene har utviklet seg sakte over tid.
  • 🔬 Forskning fokuserer på å forstå migrener bedre.
  • 💉 Botox kan redusere migreneanfall for noen pasienter.
  • 📉 Triptaner er redningsmedisiner, ikke forebyggende.
  • 🧪 CGRP er en viktig faktor i migreneutvikling.
  • 🧘‍♀️ Ikke-farmakologiske behandlinger kan gi lindring.
  • 🔍 Forskning på gliaceller kan føre til nye behandlinger.
  • 📅 Interictal fase er en stressende ventetid for pasienter.
  • 💰 Antistoffbehandlinger er dyre, men effektive for mange.

Linha do tempo

  • 00:00:00 - 00:05:00

    Migrene er en nevrologisk tilstand som forårsaker alvorlig hodepine, kvalme og hypersensitivitet. Behandlingene har utviklet seg over tid, fra giftige midler på 1800-tallet til moderne medisiner som tricykliske antidepressiva og betablokkere. Selv om disse kan redusere intensiteten av migrene for noen, fungerer de ikke for alle og kan ha alvorlige bivirkninger. Botox-injeksjoner har også blitt brukt, men er kun effektive for en liten andel av pasientene med hyppige migreneanfall.

  • 00:05:00 - 00:14:42

    Forskning har identifisert CGRP som en viktig faktor i migrene, og nye legemidler som gepanter og antistoffbehandlinger har vist seg å være effektive for mange pasienter. Imidlertid er disse behandlingene dyre og ikke alltid dekkes av forsikring. Det er behov for mer omfattende forskning for å forstå migrene bedre og utvikle nye behandlinger som kan hjelpe flere pasienter, inkludert kombinasjoner av eksisterende medisiner og målrettede terapier.

Mapa mental

Vídeo de perguntas e respostas

  • Hva er en migrene?

    Migrene er en nevrologisk tilstand som fører til alvorlig hodepine, kvalme og hypersensitivitet.

  • Hvor mange mennesker opplever migrene?

    Omtrent en milliard mennesker over hele verden opplever migrene.

  • Hvilke behandlinger finnes for migrene?

    Behandlinger inkluderer trisykliske antidepressiva, betablokkere, triptaner, botox og CGRP-antistoffer.

  • Hva er CGRP?

    CGRP er et protein som er knyttet til utvidelse av blodårer og endring av smertesensasjon i hjernen.

  • Hvordan fungerer botox for migrene?

    Botox injiseres i ansiktet, hodet og nakken for å hindre nerver i å kommunisere med muskler.

  • Hva er bivirkningene av migrenemedisiner?

    Bivirkninger kan inkludere depresjon, hjertebank, tretthet og i sjeldne tilfeller alvorlig leversykdom.

  • Hva er interictal fase?

    Interictal fase er perioden mellom migreneanfall, hvor pasienter kan oppleve mildere symptomer.

  • Hvordan kan forskning forbedre migrenebehandling?

    Ved å forstå hva som forårsaker migrene bedre, kan forskere utvikle mer effektive behandlinger.

  • Hva er sentral sensibilisering?

    Sentral sensibilisering er når hjernen blir mer følsom for smerte, noe som kan forverre migrene.

  • Hvilke ikke-farmakologiske behandlinger finnes for migrene?

    Behandlinger som kognitiv atferdsterapi og muskelavspenning kan gi noe lindring.

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  • 00:00:00
    Maybe you’re familiar with the  debilitating pain migraines can cause.
  • 00:00:03
    I am.
  • 00:00:04
    Or the constant cycle of uncertainty.
  • 00:00:06
    Or the weird sensory issues.
  • 00:00:08
    Or the half dozen other things they do.
  • 00:00:10
    If not, you definitely know someone who is.
  • 00:00:13
    After all, a billion people around  the world experience migraines.
  • 00:00:17
    And unfortunately, migraine medications  don’t work for lots of them.
  • 00:00:21
    Here’s where I’d love to say  we’re about to tell you about
  • 00:00:23
    a new breakthrough in treatments for  migraines that will change everything.
  • 00:00:27
    But we’re not.
  • 00:00:28
    Research into migraine treatments,  which gained steam in the early 1900s,
  • 00:00:32
    has progressed frustratingly  slowly for several reasons.
  • 00:00:36
    So instead, we’re going to talk about  the many treatments patients have tried,
  • 00:00:40
    the reasons we haven’t made more progress, and  what we have to do to develop a better drug.
  • 00:00:45
    [♪ INTRO]
  • 00:00:48
    What is a migraine?
  • 00:00:49
    It’s an interesting question,  because our answer to it has changed.
  • 00:00:54
    And that actually explains part of why  treatment has progressed so slowly.
  • 00:00:58
    Migraines are a neurological  condition which culminates in
  • 00:01:01
    episodes of severe headache,  nausea, and hypersensitivity.
  • 00:01:04
    While current migraine treatments  leave much to be desired,
  • 00:01:07
    they’re still an improvement  over what we used to have.
  • 00:01:10
    Especially when you consider that 19th century
  • 00:01:12
    treatments included such poisons  as arsenic, cyanide, and hemlock.
  • 00:01:17
    Between the 60s and early 90s, and  before we had a bunch of drugs that
  • 00:01:21
    were approved specifically to treat  migraines, doctors and researchers
  • 00:01:24
    often turned to medications that were  already approved for other diseases.
  • 00:01:28
    They might not sound like migraine  treatments, so we’ll explain how they relate.
  • 00:01:32
    The first two were tricyclic  antidepressants for depression
  • 00:01:35
    and beta blockers for high blood pressure.
  • 00:01:37
    These are very different medications, but they  do something similar to our brains and nerves.
  • 00:01:43
    They target messages our brains are sending  to our bodies, either by making those messages
  • 00:01:48
    last longer or turning the volume down  on messages that aren’t helping anymore.
  • 00:01:52
    Other drugs that doctors tried target  the messengers themselves, our neurons.
  • 00:01:56
    They calm our neurons down, making them  less likely to overreact to something.
  • 00:01:59
    All of these can decrease the  intensity of migraines in some people,
  • 00:02:03
    and the biggest advantage was that they  are safe to take by mouth every day.
  • 00:02:06
    So they could be used for preventing attacks,  which most migraine meds don’t actually do.
  • 00:02:12
    However, they also don’t work for everyone and  can have nasty side effects including depression,
  • 00:02:18
    irregular heartbeats, and feeling very tired.
  • 00:02:21
    The last miscellaneous treatment was  discovered a bit later, but we’ll talk
  • 00:02:25
    about it now because it’s different from  all the others we’re about to get to.
  • 00:02:29
    And that’s botox injections.
  • 00:02:30
    Botox uses a toxin derived from bacteria to  prevent nerves from communicating with muscles.
  • 00:02:36
    Patients are given botox injections in the face,
  • 00:02:39
    head, and neck near nerves  associated with migraines.
  • 00:02:42
    While botox does not work for most people with  migraines, it can offer a sustained decrease
  • 00:02:48
    in symptoms for the unlucky fraction who have  migraine headaches 15 or more days a month.
  • 00:02:53
    In that same era between the 70s and 90s,
  • 00:02:56
    scientists were also thinking about treating  the physiological causes for migraine head on.
  • 00:03:01
    And a lot of them suspected  the blood vessels in the head.
  • 00:03:04
    There are no pain receptors in the brain itself,  so pain has to be caused by something else.
  • 00:03:10
    And many types of headaches are  caused or worsened by problems
  • 00:03:14
    with blood flow going in and out of our heads.
  • 00:03:16
    For migraines, researchers thought the culprit  might be too much blood flowing into the skull,
  • 00:03:22
    creating pressure, and activating the nerves that  sense pain in the membranes surrounding the brain.
  • 00:03:27
    Researchers investigated drugs that could  partially close off those blood vessels,
  • 00:03:31
    in order to reduce the amount  of blood flowing into the brain.
  • 00:03:34
    Triptans, the first major drug family that  could do this, hit the market in the 1990s.
  • 00:03:39
    They’re still in use, and they  do work for lots of people.
  • 00:03:42
    The drawback is triptans are a “rescue  medication,” not one you take every day.
  • 00:03:47
    Patients start taking them at the  first sign of a migraine coming on.
  • 00:03:50
    Which takes the edge off, but  can’t prevent migraines altogether.
  • 00:03:54
    Though, some people can predict  exactly when the migraines are coming.
  • 00:03:58
    For example, some people reliably experience  migraines along with their period.
  • 00:04:02
    In this case, they may be able to start taking  triptans a couple days before their period starts,
  • 00:04:07
    and that may enable them to  prevent migraines entirely.
  • 00:04:10
    But since triptans’ discovery, research  has suggested that migraines may be more
  • 00:04:14
    of a neurological disorder than a vascular one.
  • 00:04:17
    Which begs the question, why  do the triptans work at all?
  • 00:04:20
    Well, it turns out triptans bind receptors that  influence both blood flow and pain sensation.
  • 00:04:26
    When researchers made a drug  that only targeted just those
  • 00:04:30
    pain sensation nerves, it also treated migraines.
  • 00:04:33
    Except it was less effective  than the original triptans,
  • 00:04:37
    so we’re still not a hundred  percent on what’s going on there.
  • 00:04:40
    Researchers continued working on this though.
  • 00:04:42
    In the late 1990s and 2000s, researchers  honed in on a small protein called CGRP
  • 00:04:49
    they thought may be the root cause of migraines.
  • 00:04:51
    CGRP does a lot of things,
  • 00:04:53
    but it’s linked to dilating blood vessels  and altering pain reception in the brain.
  • 00:04:57
    In clinical trials, if you inject humans  who are susceptible to migraines with CGRP,
  • 00:05:02
    most develop migraine-like  symptoms, like a severe headache.
  • 00:05:06
    So, two types of drugs were made to target CGRP.
  • 00:05:09
    And the fact that both were effective  further underlined that CGRP was important.
  • 00:05:14
    The first is gepants.
  • 00:05:16
    Gepants bind up CGRP,
  • 00:05:18
    reducing the number available to do  whatever harm they do during migraines.
  • 00:05:22
    Gepants come in pill form.
  • 00:05:24
    Some of them are rescue medications, and  some can be taken daily to prevent headaches.
  • 00:05:29
    Lastly we have antibody treatments.
  • 00:05:31
    As background, antibodies are created by  our immune system to fight off infections.
  • 00:05:36
    They bind to things like viruses and tell the immune system, “Hey! Get ‘em!”
  • 00:05:41
    We can also engineer antibodies  to bind other things – like CGRP.
  • 00:05:46
    For every CGRP that binds an antibody,
  • 00:05:49
    that’s one fewer binding the  nerves associated with migraines.
  • 00:05:53
    Antibody treatments cut the  number of headache days in half
  • 00:05:56
    or better for about 60% of people with  migraines after 3 months of treatment.
  • 00:06:01
    That rises to a little over 90% after 11 months.
  • 00:06:05
    Antibodies are also nice because  it’s just one injection a month,
  • 00:06:09
    and they often work for people whose  other migraine treatments have failed.
  • 00:06:12
    But antibody treatments are super expensive  – they can cost hundreds of dollars per dose.
  • 00:06:18
    And insurance will often refuse to cover  them unless you try many other options first.
  • 00:06:23
    That is a steep price to pay, especially if you
  • 00:06:26
    have to wait 11 months just  to know if they work for you!
  • 00:06:29
    Moreover, both gepants and antibodies can  have side effects, ranging from common but
  • 00:06:35
    unpleasant – like constipation – to rare  but dangerous – like severe liver disease.
  • 00:06:41
    We’re gonna get to why these don’t  work for everyone, but first,
  • 00:06:44
    all science needs funding,  so here’s a quick break.
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  • 00:08:02
    Okay, so we’ve named a handful of families of  drugs that each treat migraines for some people.
  • 00:08:07
    It’s possible that a single drug that  works for everyone just doesn’t exist.
  • 00:08:12
    If our research strategy had been  comprehensive and flawless up to
  • 00:08:16
    this point, then I might even say that’s probable.
  • 00:08:18
    But our research into migraine treatments  has not been comprehensive or flawless.
  • 00:08:23
    In fact, most treatments are only tested  on a small subset of migraine symptoms.
  • 00:08:28
    Namely, the “headache so  bad I’m throwing up” phase.
  • 00:08:32
    And to what extent the drugs could  reduce the number of days with headache.
  • 00:08:36
    Which means we’re finally ready  to come back to the question at
  • 00:08:38
    the start of this video: “What is a migraine?”
  • 00:08:41
    If you don’t get migraines, you might be under the  impression that they’re just really bad headaches.
  • 00:08:46
    An event that happens and then goes away.
  • 00:08:49
    But not everyone with migraines gets headaches,  and you never really stop getting migraines.
  • 00:08:55
    Migraine is a cycling neurological  condition that has two major phases.
  • 00:09:01
    The headache happens in the ictal phase.
  • 00:09:03
    This phase can be further broken down into the  wind-up, the attack itself, and the aftermath.
  • 00:09:09
    In the multi-hour to multi-day wind-up, patients  can experience brain fog, nausea, and tiredness.
  • 00:09:15
    In the final stretch, some feel aura,  which is a sort of brain misfire where
  • 00:09:20
    someone might see flashes that  aren’t there or feel tingling.
  • 00:09:24
    Then comes the full-blown, hours-to-days-long,  mind-splitting headache that’s often
  • 00:09:29
    accompanied by vomiting and extreme  sensitivity to light, sound, and smell.
  • 00:09:34
    In the wind-down, patients feel  tired, mentally and physically.
  • 00:09:38
    They can have difficulty concentrating  and often feel dehydrated.
  • 00:09:42
    Almost like a neurological hangover.
  • 00:09:44
    After that, they enter the interictal phase.
  • 00:09:47
    But this isn’t just a waiting  period between attacks.
  • 00:09:50
    This phase often has milder  versions of the same symptoms.
  • 00:09:54
    That waiting period is stressful too.
  • 00:09:57
    Having no idea when the next attack will turn your
  • 00:09:59
    life upside down can have a huge impact  on your mental health and social life.
  • 00:10:04
    Up to this point, treatments have been  focused on headache severity and frequency,
  • 00:10:08
    but that misses a big chunk of the picture.
  • 00:10:11
    Drug studies should be assessed based on  how well drugs offer relief throughout the
  • 00:10:16
    migraine cycle, for the full range  of symptoms patients experience.
  • 00:10:21
    That strategy could be used to  reassess the drugs we already have.
  • 00:10:25
    Some of them might be helpful  in the interictal phase.
  • 00:10:28
    But even if we do that research, and we should,
  • 00:10:31
    it wouldn’t change that these  drugs don’t work for everyone.
  • 00:10:34
    We need new treatment options.
  • 00:10:36
    How do we find them?
  • 00:10:37
    Well, the simplest but least inspiring answer  is combining the medications we already have.
  • 00:10:43
    The thought process here is that each of these  drugs treats migraines in a different way.
  • 00:10:48
    If we combine them, they  might have an additive effect.
  • 00:10:51
    Early research shows that this might work  when combining antibody treatments with
  • 00:10:56
    botox, perhaps because they both  target different pain pathways.
  • 00:11:00
    But remember that botox is used for patients  who have 15 or more headache days a month.
  • 00:11:05
    Meaning this strategy is benefiting only  the absolute most severe of sufferers.
  • 00:11:10
    While any relief for those patients is good,
  • 00:11:12
    this isn’t an option for 80 to  90% of people with migraines.
  • 00:11:16
    And waiting for your migraines to get bad  enough to be eligible just sounds miserable.
  • 00:11:21
    So, how do we make new treatments?
  • 00:11:24
    Well, in general, designing new medicines
  • 00:11:26
    starts with having a strong fundamental  understanding of what causes a disease.
  • 00:11:31
    But for long stretches of history, what  we thought caused migraines was either
  • 00:11:35
    flawed or incomplete looking at you,  “migraines are a blood vessel thing.”
  • 00:11:39
    We need to keep refining our molecular  definition of what a migraine is.
  • 00:11:43
    Beyond even CGRP.
  • 00:11:45
    Yes, it seems to be a factor,  but if it was the only cause,
  • 00:11:48
    we would expect treatments targeting  it to be effective in more people.
  • 00:11:52
    That means we need to look even harder.
  • 00:11:54
    What does it look like when a migraine starts?
  • 00:11:56
    What happens just before that?
  • 00:11:58
    These are types of questions  that nuts-and-bolts lab research,
  • 00:12:02
    what we call basic science, can answer.
  • 00:12:04
    It’s not always flashy, but it helps us understand
  • 00:12:07
    how our bodies work so we can design  a cure, rationally and intentionally.
  • 00:12:12
    It turns out that glial cells, the cells in  our brain which support and defend our neurons,
  • 00:12:17
    play a critical role in initiating aura.
  • 00:12:20
    Glial cells also influence how sensitive our
  • 00:12:22
    brains are to pain which might be  crucial for treating migraines.
  • 00:12:26
    We can think of pain as our body’s fire alarm.
  • 00:12:30
    When something in our body is wrong, our  brains will pull the alarm making us feel pain.
  • 00:12:35
    In normal one-off situations, like when you put  your hand on a hot stove, that pain is helpful.
  • 00:12:40
    It prompts you to pull your hand back.
  • 00:12:42
    But that same process can cause problems  in people who have chronic or recurring
  • 00:12:46
    bouts of pain in the same body  part—like migraine patients.
  • 00:12:50
    In a process called central sensitization,
  • 00:12:53
    our brains get better at sensing  anything wrong in that area of our body.
  • 00:12:59
    But that also makes them more  trigger happy with the alarm.
  • 00:13:02
    Eventually, our brains start pulling that severe,
  • 00:13:05
    knee-buckling pain alarm for things that  would only give other people mild discomfort.
  • 00:13:10
    This doesn’t just affect migraine patients,  it affects everyone with chronic pain.
  • 00:13:15
    And since glial cells play a role  in this process and migraine aura,
  • 00:13:20
    scientists have started looking  at drugs that could target them.
  • 00:13:23
    They haven’t found any that were  effective at treating migraines yet.
  • 00:13:27
    The current versions don’t specifically  target glial cells, which may be the problem.
  • 00:13:31
    So scientists are exploring other ways to target
  • 00:13:34
    glial cells, like using viruses or  regrowing glial cells from scratch.
  • 00:13:39
    In the meantime, some non-pharmacological  treatments have been shown to help migraine
  • 00:13:43
    patients, though to a lesser  extent than proven drugs.
  • 00:13:47
    Still, treatments on top of meds  like cognitive behavioral therapy,
  • 00:13:51
    conscious relaxation of muscles in the head  and neck, and working with doctors to train
  • 00:13:56
    your brain to process pain differently  can provide some relief to patients.
  • 00:14:01
    At least in the interim.
  • 00:14:02
    We’re way behind on understanding  and treating migraines.
  • 00:14:06
    There’s no getting around that, but  we’re making progress every year.
  • 00:14:09
    Soon, we should be able to create drugs  which interrupt earlier steps of the process.
  • 00:14:14
    And when those drugs make it to clinical trials,
  • 00:14:17
    we can test how well they treat  all of migraine’s symptoms.
  • 00:14:21
    With these steps, and continued funding, we  hope to eventually find a treatment strategy
  • 00:14:26
    that can bring relief to all patients  who suffer from this horrible condition.
  • 00:14:32
    [♪ OUTRO]
Etiquetas
  • migrene
  • behandling
  • CGRP
  • triptaner
  • botox
  • nevrale tilstander
  • forskning
  • symptomer
  • bivirkninger
  • interictal fase