Dear industry, it is all wrong: go for migraine

First impressions form the Headache Congress IHC2011.

One day left of the 15th Congress of the International Headache Society (IHC2011) in Berlin, yet I already have picked my favorite talk. It was the talk entitled: "Possible new targets for migraine drugs" from Dr. Jes Olesen: "the people's neurologist" [1]. 

To start with, his work had a great influence on my own. In particular his data from 1981 on the regional cerebral blood flow in migraine with aura and the possible link to a phenomenon called cortical spreading depression (CSD). It started a very provocative discussion in a series of scientific papers on whether or not "the results indicate that the vasospastic model of the migraine attack is too simplistic" [2], which I would enjoy reading when I chose to start my academic path in this field ten years later.

Another ten years later, the lab of Dr. Michael Moskowitz published a paper on CSD observed with fMRI in a migraineur. He called this "a defining moment" in his talk that made him put all his lab efforts to study CSD and migraine. And here we are, another ten years later. Todate, it is generally accepted that CSD plays an important role. But the actual reason for my pick of the congress is this slide.

Why so little interest?

• Lack of validated animal models with predictive power
• Target identification method unusual
• Prejudice against migraine
• Belief that triptans are sufficient
• Belief that prophylactic market is small

Dear industry, it is all wrong go for migraine.

Well, I'm afraid that there was (or still is?) also a lack of academic interest.  Let's wait for another ten years—or maybe only seven. Tomorrow, I will hear Dr. Peter Goadsby talking about "Migraine treatment anno 2018". 

References

[1] Ruth Williams, "Jes Olesen: the people's neurologist", The Lancet Neurology, 98, 1050 (2010) (doi:10.1016/S1474-4422(10)70265-9)

[2] J Olesen, B Larsen, M Lauritzen "Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine", Annals of neurology. 9,344-352 (1981). (doi:10.1002/ana.410090406)

[3] Nouchine Hadjikhani, Margarita Sanchez del Rio, Ona Wu, Denis Schwartz, Dick Bakker,Bruce Fischl, Kenneth K. Kwong,F. Michael Cutrer,Bruce R. Rosen, Roger B. H. Tootell, A. Gregory Sorensen, and Michael A. Moskowitz, "Mechanisms of migraine aura revealed by functional MRI in human visual cortex", PNAS, 9,4687-4692 (2011) (doi:10.1073/pnas.071582498)