Implications of 2006 Study:
This study and Dr. Aurora's section of the Medscape CME presentation show a clear need for more studies in this area. For acute Migraine treatment to be successful, we must either find a way to address gastric stasis or decrease our dependency on oral delivery of medications.
At this time, there are some Migraine abortives available in forms other than oral administration:
- DHE45 injections (dihydroergotamine)
- Migranal Nasal Spray (dihydroergotamine)
- Imitrex STATdose injections (sumatriptan)
- Imitex Nasal Spray (sumatriptan)
- Zomig Nasal Spray (zolmitriptan)
Even so, in the Medscape presentation, Dr. Aurora comments, "Patients were asked what their choices were for treatment. The injection was rated the lowest, and the tablet was rated the highest. So even though pain relief, as we've shown, is much better through the nonoral route -- and particularly the injectable route -- still the oral tablets seem to be what patients prefer the most."
In 2007, another study was conducted to evaluate gastric motility and emptying during spontaneous Migraines (not induced) and compare the data to the 2006 study in which Migraines were induced.
2007 Study Methods:
Three Migraineurs were observed during three periods:
- during a spontaneous Migraine
- during an induced Migraine
- during the interictal period (between Migraines).
Gastric scintigraphy was performed following a standard meal.
2007 Study Results:
Similar gastric slowing was seen in all 3 groups.
2007 Study Results and Implications:
"These studies continue to provide evidence of a dysfunction in the autonomic system in a subset of migraineurs. Previous imaging studies have demonstrated a dysfunction in the periaqueductal gray (PAG). High field strength MRI testing determined that iron accumulation occurred in the PAG and that these changes correlate with duration of migraine frequency, are not independent of the presence of aura, and do not correlate with patient age. Recent imaging studies have demonstrated that the hypothalamus, the main area of the brain which controls the autonomic system and also the area of the brain which potentially triggers a migraine, had increased blood flow during migraine. An abnormality of this area inherited or otherwise may indeed be a key factor in causation of migraine.
Future studies are warranted to include establishing a relationship between gastric stasis and migraine disease burden; any correlation to disease phenotype; correlation to changes in the brain stem, hypothalamus, and other areas; and correlation to other autonomic changes in migraineurs. In conclusion, based on these data, it appears that some migraineurs have abnormal gastric emptying, both during and outside of an attack. Further exploration of the implications of this to therapeutic interventions is warranted."3
