Head to Head with Dr. Joel Saper

Head to Head with Dr. Joel Saper
Chair, MRF Medical Advisory Board and
Founder and Director of the Michigan Head Pain & Neurological Institute; Ann Arbor, MI

MRF asked Dr. Saper to reflect on the most important developments in the field of migraine medicine in the past 10 years. Here is what he said:

Improved Treatment
During the past decade, scientific discovery has improved treatment for migraine sufferers. Better understanding of brain chemistry disturbances during a migraine attack has led to the development of new medications, such as the triptans and the calcitonin gene-related peptide (CGRP) antagonists, currently under development by several drug companies. And as we begin to identify the genes related to the underlying mechanisms of migraine in each patient, we will see much more progress, including gene-specific therapy for each sufferer.

Medication Overuse Headache
The recognition and greater understanding of the influence of medication overuse on headache progression (from periodic to daily) and resistance to treatment is also important. Since the late 1970s, researchers have known that overuse of certain medications can prompt the progression of headaches and prevent appropriate treatments from working. Twenty-five years ago it was recognized that the use of certain pain medications more than 2-3 days per week over the course of months could cause the headache condition to worsen.  Scientists have now discovered many of the underlying mechanisms which explain these observations, known now as the syndrome of medication overuse headache.  Unfortunately, even today many patients and their physicians are unaware that the very medicines they are taking to feel better are actually promoting a worsening of their headache condition.

Specialized Treatment
I believe that the most important immediate benefit to patients in the past 10 years has been the development of a specialized corps of credentialed and certified physician specialists who have chosen to treat patients with complex headache disorders. Corresponding to this team of certified specialists is the development of advanced systems of care to treat patients with complex disorders. Many patients who suffer from complex headaches require more than simply a medication or even several medications. They require specialized systems of care that address the many coexisting symptoms and conditions that plague the lives of those in chronic pain. Some require hospitalization in specialized headache units to break persistent headache cycles. The advanced programs serve as referral centers for the most difficult cases.

Headache is now recognized as a major public health problem.  The Migraine Research Foundation (MRF) is committed to funding research projects that are likely to translate into better lives for those who suffer from migraine and other headache disorders.  While much progress has already been made, it is not nearly enough, and those of us in the headache field, together with the MRF, are doing all we can to improve the treatment of these conditions.