Carl Cincinnato

This expert interview is from a recent interview at the Migraine World Summit. For more information visit:

Do you know the benchmark for a successful treatment of an acute migraine attack? What about the latest science about migraine? And what exactly happens during a migraine attack? What pieces are still missing for researchers and scientists? Answering these questions is Antoinette Maassen van den Brink, an Associate Professor at the Department of Pharmacology, Erasmus University Medical Center.

What do we know about what happens in the brain during a migraine attack?

Dr. Maassen van den Brink: “We know a lot but not everything yet, so I cannot give you a complete answer. But most likely, the migraine attack starts around the brain stem in lots of patients. Then there are processes going on around the cortex. And finally, there’s activation of the so-called trigeminovascular system. That’s one of the brain nerves; the cranial nerves are activated and that releases some peptides, and these lead to sensitization and sensation of pain.”

Some people have aura before a migraine attack, and there is also the term “cortical spreading depression” or CSD for short. Can you tell us a little bit more about what that is and how that happens?

Dr. Maassen van den Brink: “Cortical spreading depression, as the name already says, is a wave of depression that spreads around the cortex. It starts at the occipital, so at the back part of the brain, and propagates through the front. And this is likely to be the underlying mechanism of migraine aura, where patients see flickering or scintillating figures that also propagate in visual fields. It’s about the same (place in the brain), and maybe in patients without aura there’s a similar mechanism, but it’s not translated into the symptoms; that we don’t know yet.”

Do you think the amount of research and the attention and the interest is now starting to change with migraine, or is it still a big problem?

Dr. Maassen van den Brink: “I think both answers would be yes, because interest is increasing and I see positive developments. And this initiative is one of them. There’s more attention, more awareness about migraine. That’s very important. But on the other hand, if you compare migraine to other diseases, and you see the amount of suffering caused by migraine and the amount of patients suffering from migraine, and the funding for scientific studies that goes to migraine, it’s marginal, it’s hardly anything. So we need more.”

What is the benchmark of a successful acute treatment for migraine?

Dr. Maassen van den Brink: “Of course this is a personal issue. In clinical trials, we think it’s being completely headache-free in two hours, but there are multiple measures, and for an individual patient, it may differ a bit. So I think of course getting rid of the headache is very important, but also the amount of side effects that someone has and the general feeling. Some patients say: ‘I get rid of my headache, but I still can’t function.’ And how is a patient? What is he or she doing during the day? Is it affordable to go to bed? Or does a patient have the possibility to go to bed? So I think it’s a personal issue and therefore, sometimes there are clinical trial outcomes that are defined by scientists and medical doctors, like headache-free in two hours. But there are also other parameters, like patient preference where all these other parameters are also taken into account.”

Watch the full interview to find out:

What is a migraine attack?
What are the known mechanisms behind a migraine attack?
Is migraine purely genetic?
What is epigenetics?
What can you expect from a treatment plan for migraine?
What are triptans used for? How many kinds and formats are there?
How do migraine patients respond to different triptans?
At what point should a migraine patient consider non-triptan forms of abortive medication or preventive drug treatments?
What new treatments for migraine are coming out soon?

Watch Dr. Maassen van den Brink’s interview preview here or order it as part of the Migraine World Summit package from this page.

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