migraine

No pain, no migraine

Neurologist studies two new treatments for migraine patients



When Michelle Androulakis sees patients suffering from chronic headaches, she truly feels their pain. Chief of neurology at Dorn VA Hospital in Columbia and an assistant professor of clinical neurology at the School of Medicine, she has experienced plenty of migraines and has vivid memories of the debilitating headaches suffered by her mother.

But Androulakis offers more than empathy. She has conducted clinical trials for a non-invasive migraine procedure involving a tiny nasal catheter as well as for a new migraine drug. The catheter procedure is available now, and the FDA is expected to approve the drug for release later this year. “Neither of these is a cure, but both offer significant improvement,” she says.

In the 1990s, a class of drugs known as triptans were developed for migraines — they targeted serotonin, a neurotransmitter that causes narrowing of blood vessels in the brain. The new drug tested by Androulakis acts as an inhibitor of calcitonin gene-related peptide, a neuropeptide associated with pain. CGRP levels are usually elevated among migraine sufferers. The drug works by blocking activity of CGRP and therefore reducing pain and the body’s sensitivity to light and noise.

Androulakis says potential long-term side effects of the CGRP inhibitor are not yet known, though preliminary studies suggest it has no serious effects on the cardiovascular system.

It’s not just one region of the brain or one neurotransmitter involved. It’s more an issue of a brain network or several regions of the brain not working together.

Michelle Androulakis, chief of neurology at Dorn VA Hospital in Columbia and an assistant professor of clinical neurology at the School of Medicine

The migraine-alleviating procedure Androulakis has tested uses a very thin nasal catheter that is threaded to the sphenopalatine ganglion, a group of neurons under the nasal mucosa. The catheter delivers a small dose of marcaine, which temporarily blocks pain signals traveling through the ganglion and nearby trigeminal nerve. Participants in the study received the treatment twice per week for six weeks.

“We looked at their number of migraine days before and after the treatment and used the Headache Impact Test to measure how their headaches were impacting their functionality,” Androulakis says. “The most interesting thing we found was in the fMRI studies of chronic migraine patients who experienced medication-overuse headaches. Their scans showed significant improvement in the brain networks related to migraine headaches.”

These include the central executive network, which modulates the perception of pain, and the salient network, which detects internal and external stimuli. The networks appeared dysfunctional in the fMRI scans done before the nasal catheter treatment.

The complex function of the brain networks and their underlying role in migraines highlight the complexity of treating such headaches, Androulakis says. “It’s not just one region of the brain or one neurotransmitter involved. It’s more an issue of a brain network or several regions of the brain not working together.”

Androulakis says the benefits from the sphenopalatine ganglion block tend to wane after six months, requiring a booster treatment.

“It definitely helps improve quality of life for chronic migraine patients and with relatively few side effects,” she says. “The challenge with these treatments is insurance coverage. Insurance companies see this as investigational, not a standard of care treatment for migraine.”

Androulakis credits a $10,000 ASPIRE (Advanced Support for Innovative Research Excellence) grant from the University of South Carolina’s Office of Research that allowed her to start fMRI research at the McCausland Center for Brain Imaging and get published in Neurology, a top journal in her field.


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