Clinicians describe chronic migraine as having at least 15 days per month of headache for more than three months with at least two aggravating symptoms. The pain tends to come with a pulsating quality. Sufferers often feel nausea, an aversion to light, or other discomfort severe enough to disrupt normal activity.
Nearly 2,000 children and teens visit the Headache Center at Cincinnati Children’s each year seeking help to relieve misery that often keeps them out of school, off the field and curled up in a dark room. Many families hope that doctors can simply prescribe a pill to make the pain stop. Many are surprised to find out that medications—especially by themselves—are not necessarily the right answer.
Experts in the field say a seismic shift is occurring in migraine pain management. While one surprisng study reports that two of the most frequently prescribed migraine medications show no better results than placebo, other studies suggest promising results from non-medication approaches such as cognitive behavioral therapy (CBT).
Now, a team of scientists at Cincinnati Children’s is working to learn more about why. They are combining expertise in brain imaging technology, neurology, behavioral therapy, and other fields to lay the foundation for a new set of best practices in migraine control.
Bringing varied skill sets to bear in the hunt for better solutions for migraine pain is no accident. Forging working partnerships from bench to bedside is a prime mission of the Mind Brain Behavior Collaborative, say co-leaders Lori Stark, PhD, Director of Behavioral Medicine and Clinical Psychology, and Tracy Glauser, MD, Associate Director of the Cincinnati Children’s Research Foundation.
“One of our strengths over the years has been our collaborative nature. But collaboration can either occur passively, or we can actively encourage and support collaboration by being a catalyst,” Glauser says. “The pain group is a perfect example of bringing medical providers, behavioral health providers, researchers, patients and families, all together in an active fashion to allow them to improve care and make discoveries.”
Moving Forward by Going Back to the Bench
A surprising study of teens with migraines, published in 2017 in The New England Journal of Medicine, helped spark a fundamental reexamination of pain treatment. The study, led by Cincinnati Children’s investigators Scott Powers, PhD, and Andrew Hershey, MD, PhD, reported finding no statistical difference between the two most-prescribed migraine medications—amitriptyline and topiramate—and placebo.