Migraine sufferers who experience migraine attacks often find that it is more effective to treat them early than waiting until the attacks have progressed for two or more hours. They realize that there is a window of time during which they can resolve their headaches fully. However, if they wait too long, the treatment will not be as effective and the attacks will continue to progress.
Let’s start
Patients with migraines who are particularly attentive might notice that treatment fails to work when they reach an “allodynia” stage. This is when all things hurt, even a light touch to the skin or contact to a warm object. These kinds of observations are possible for people suffering from migraine since there have been good treatments.
Aspirin, which was first available in tablet form to treat migraine attacks, was made in 1915. These phenomena have been studied in depth in recent years, and some of the reasons for them have been revealed by scientific studies. Dr. Rami Burstein, along with colleagues at Beth Israel Deaconess Medical Center (Boston), conducted a study on the treatment outcomes for 61 migraine attacks that occurred in 31 patients.
Did you know?
Some attacks were treated within the hour of symptoms onset, while others were delayed until four hours later. The treatment was a “triptan” drug and not a painkiller. Triptans, a newer class of medications, act on some nerve system receptors for the natural chemical Serotonin. Each case involved a physical examination to determine if allodynia was present. The investigators discovered that the triptan was able to stop pain in only 15% of the 34 attacks in which allodynia was already present.
The triptan was successful in 93% (of the 27 attacks) where allodynia hadn’t yet developed. Allodynia was more common in late-treated attacks, but doctors found that allodynia’s presence or absence was more important than the fact that the treatment was successful. Dr. Burstein was also the leader of a team that included scientists who investigated why this was so.
Keep in mind
These experiments were done in laboratory rats because this information was not possible to obtain in humans, test tubes, or computers. Burstein devised a method to simulate migraine attacks in rats. Using tiny electrodes, he was able “listen in” to the electrical activity of individual brain and nerve cells as they developed. He discovered that nerve cells connecting the head and brain to each other were the first to experience an attack’s onset. These nerve cells’ excessive activity led to a second set pain-processing brain cells becoming hyperactive.
If the second group of cells remained hyperactive too long, they would become “sensitized” and continue firing away as if on autopilot, even though the nerve cells that started them were shut down. It could be shown that the nervous system treated normal, non-painful stimuli as though they were painful by this spontaneously self-regenerating state of pain-processing brain cell cells. Or, to put it another way, allodynia in rats indicates that pain-processing brain neurons have become sensitive. Triptan drugs can be administered to rats at different stages of migraine attacks, just as it is for humans.
Final note
Triptan could be administered before the pain-processing brain neurons become sensitive. This would stop the attack and shut down the firing cascade. Triptan that was administered after sensitization was occurring was ineffective. These studies in rats and humans show that humans must treat migraine attacks before their pain-processing brains become sensitive. The best way to determine if sensitization has occurred by examining whether or not normal, non-painful contact with the skin has become painful. Migraine patients must race the clock to get relief from their attacks before they develop allodynia.