Headaches: 75% of cases under control thanks to new drugs

Seventy-five per cent of patients who use the new migraine treatment drugs manage to keep the condition under control without any particular side effects and finally find relief from a disease that has a major impact on their quality of life. The World Health Organisation (WHO), in fact, has defined it as the most disabling disease in the world in the 20-50 age group. Although at least 9 million people in Italia suffer from it, not all of them need the innovative therapies available today, but all of them must be correctly framed from a diagnostic point of view so that the symptomatology is not underestimated, thus reserving access to the most innovative treatments for those who need them, and also to avoid a dangerous 'do-it-yourself' approach.

The topic was discussed at the SISC Headache Academy, held in Florence on 27 and 28 February, on the occasion of the 50th anniversary of the Italian Society for the Study of Headaches (SISC). The research results of the last decades and studies published in the world's most important scientific journals converge on the fact that new molecules with monoclonal antibodies or gepants (such as oral tablets), which block the action of CGRP (calcitonin gene related peptide), which dilates the arteries and produces prolonged pain, are effective and also very safe.

This is a real revolution in therapies, the result of precision and increasingly personalised medicine. 'Anti-CGRP drugs,' explains Professor Pierangelo Geppetti, president emeritus of SISC, 'do not penetrate the central nervous system and act by selectively blocking the migraine pain signal pathway without interfering with other mechanisms and thus without the side effects that discouraged many patients from using the non-specific drugs available until now. Prior to the discoveries that led to anti-CGRP drugs, molecules were in fact already used for other diseases, such as antihypertensives, old antidepressants or antiepileptics, which, being non-specific for migraine, caused numerous side effects and showed partial efficacy.

A comparison of the weapons available against headaches in recent decades and those available today shows the difference in treatment options. Fifty years ago there were only two specific drugs to treat migraine and they were effective in 20-30% of cases compared to the 15 available today, thanks to which 70-80% of patients can be successfully treated. "The possibility of being able to treat a very disabling disease that lasts for decades is extremely important. It must be remembered that 70 per cent of cases are young women, who suffer from migraine from childhood or adolescence until around the age of 50-60, when the disease tends to regress spontaneously. However, this is precisely the part of life when the patient has to face the most im+portant family, professional, social and existential tasks,' Professor Geppetti recalled. Unfortunately, in many cases the severity of migraine is such that children and young people sometimes stop studying, some patients are forced to change jobs or even to give up work.

'In the 1990s, the discovery of triptans represented the first step towards a specific therapy,' explained Professor Marina De Tommaso, president of SISC. They are very effective, but can only be used as an acute treatment of a single attack and are sometimes not well tolerated, especially in patients with cardio- or cerebro-vascular problems. Although, to date, no drug can cure migraine, which has an as yet unknown and probably multifactorial genetic basis, we can prevent the disease with effective therapies but, considering that treatments can be very prolonged, above all very safe'.