An interview by Maria Berentzen for web.de

Professor Dr. Göbel, a type of vaccine against migraines is supposed to be coming onto the market. What exactly is it?

Professor Dr. Hartmut Göbel : In a classic vaccination, for example against measles or polio, killed or weakened pathogens are administered. The body reacts to this by producing antibodies against these pathogens.

The new migraine therapy is called passive immunization. This means that patients do not produce the antibodies themselves. Instead, they receive antibodies that have been manufactured in a laboratory.

How do these antibodies work?

They intervene directly in the migraine mechanism and stop it before an attack even occurs. It has been found that during an attack, many patients release a specific inflammatory substance known as CGRP.

It acts locally on the arteries, causing inflammation of the skin around the blood vessels and dilation of the vessels themselves. As a result, patients often experience each pulse wave as a painful throbbing and pounding during an attack.

And what effect does passive immunization have?

Yes. If it is possible to block the messenger substance CGRP, then inflammation does not occur. In this way, a migraine attack is not triggered in the first place.

When will this new treatment be available?

The studies have now been completed and approval has been applied for for two active ingredients.

Experts anticipate that treatment will likely be possible from the second half of 2018.

Will this be able to free all those affected from their migraines?

Unfortunately not. CGRP is just one of the substances that plays a role in a migraine attack.

Unfortunately, this immunotherapy will offer little to no help to those in whom CGRP does not play a major role. However, studies have shown a significant reduction in headache days for approximately one-third to one-half of the patients.

However, one should not expect that the treatment will make one “immune” to migraines and that one can live as one wants without having attacks.

How does a seizure actually occur? Are all the mechanisms involved known?

It is now known that the predisposition to migraines is genetically determined. Sufferers can perceive stimuli very intensely and react to them quickly.

However, this also means their brains have a high energy consumption. Those affected are therefore essentially constantly operating at their performance limit. If behaviors or events occur that activate the nervous system too quickly, too intensely, and for too long, an energy deficit can develop in the nerve cells, potentially leading to a migraine attack.

It is therefore important that those affected structure their lives as evenly as possible, eat regularly and avoid any form of too rapid and excessive activation.

What was the problem with the previous medications for migraines?

Until now, there have been few ways to prevent a seizure. While there are specific medications, such as triptans, that can alleviate the pain of a seizure, they only suppress the pain and do not address the underlying mechanisms.

If patients suffer from frequent migraine attacks, there are medications that are supposed to prevent an attack. However, they do not work for all patients and were not specifically developed for migraines. They also have a number of side effects, so many patients do not want to take them long-term.

Regarding efficacy, there are currently no comparative studies that compare the effect of the new immunotherapy with the effectiveness of previous therapies.

And what side effects does passive immunization have? It's certainly conceivable that there could be side effects if a messenger substance in the body is permanently blocked.

The main side effects are pain at the injection site and inflammation in the nasopharynx. These side effects are usually mild. However, it's important to understand that this is a completely new therapy.

Long-term studies have not yet been published. CGRP is the most potent endogenous substance that causes vasodilation. The effects of long-term inhibition of this substance are unknown.

How often would one need to undergo treatment?

Treatment is usually administered at four-week intervals, although for one of the substances it may be every three months.

Research is also being conducted to determine whether patients can treat themselves so that they do not have to come to a clinic every month.

If the treatment is effective: Is it enough to get "vaccinated" against migraines – and then be rid of all the annoying symptoms?

Unfortunately not. That's a misconception. The brain remains extremely sensitive to stimuli. Anyone who doesn't adapt their life accordingly, who doesn't pay attention to routine, will hardly achieve a satisfactory outcome.

He might not get a migraine immediately, but he will likely feel chronically exhausted. Regular routines, relaxation, and careful management of personal energy reserves remain important for those affected.

Further information on this topic: Immunotherapy with CGRP antibodies reduces the number of headache days