In the trigeminal vascular ganglion cgrp is released during a Migraine
Triptans inhibit release cgrp from being released
Other treatments mop up cgrp,
Cgrp antibody and cgrp receptor antibody
One group given true treatment and one given placebo. Same effect.
Super responders : complete remission from cgrps / ppl with more migraines per month than without. They stopped having migraines. Small part of population. It could be that they have the response in the synaptic gap. Or a different molecule is responding. Not final answer.
Expensive to produce. Will not work for everyone.
Similar to triptans. Triptans are for acute. This is preventative. Can this help if triptans help?
This worked when other preventives failed. But it’s like every other drug. It works for some. Not others. Needs more study.
Nerve blocks /
Anesthetic that feeds the nerves that go back to the brain stem – Migraine generator
Named for the region of nerves/ greater occipital nerve and trigeminal
Lots of dangerous side effects. Must have a headache specialist or pain specialist who has done it many times. Can do it on walk in basis.
When all other things have failed. Less time brain spends in Migraine state is better.
Used to think Migraine was blood vessel disease. It’s a brain disease. In the trigeminal nucleas cordalis in brain stem. TNC. All those nerves are pain fibers.
Allodynia: can’t interpret normal sensation as normal sensation. Happens around 1 hour into Migraine. Triptans work at this point. If you touch or brush your hair and it hurts, glasses hurt to have on, then it’s best to get a nerve block. With no steroids.
Steroids cause fat under skin to waste away.
Short and long acting anesthesia
Can be used as preventative *
For hard to treat Migraine !!!!!
Refractory : not responding : me*
Underutilized option. Should be first line of treatment. Can drive. Immediately relieved
Trigger points: knots in shoulders and neck from bad posture that trigger migraines. Not a cure. But physical therapy called scapula stabilization to improved alignment. Do if along with trigger point injections.
Migraine refers pain to the neck
Must address the brain issues first
Not good to go to ER in middle of bad Migraine. Better to see Dr. in quiet setting.