Migraine sufferers were offered new hope after scientists discovered a gene responsible for the condition. The finding highlights how the tendency to suffer from debilitating headaches can be passed from parent to child and raises the prospect of a new class of drugs.
Researchers from Oxford University found a gene called Tresk in families of sufferers. When the gene is mutated, it can trigger the brain's pain centres and cause severe headaches, the researchers report in the journal Nature Genetics.
Around one in four women and one in 12 men experience migraine headaches.
Sufferers say they are set off by a range of triggers, including stress, fluorescent lighting and foods such as chocolate and caffeine. The World Health Organisation rates migraines as a major cause of disability worldwide and it has been estimated to be the most costly neurological disorder in Europe.
Dr Zameel Cader, who led the study by the Medical Research Council Functional Genomics Unit, said: "Migraines depend on how excitable our nerves are in specific parts of the brain. Finding the key player that controls this excitability will give us a chance to find a new way to fight migraines."
In one in six cases, a migraine is preceded by an "aura". Symptoms include flashing lights, blind spots, difficulty focusing and seeing things as though reflected in a broken mirror. During the headache stage, victims experience a throbbing pain, often on one side of head, sensitivity to bright lights and sound and nausea. Severe attacks can last for days. The causes of migraines are still a mystery, although some studies have linked them to hormonal changes. One in two migraine sufferers believes changes in the weather can trigger an attack. A study at Harvard University showed a drop in atmospheric pressure and a rise in temperature act as triggers.
Some researchers have argued a fall in air pressure reduces the amount of oxygen in the blood. Lower oxygen levels may cause blood vessels in the brain to dilate, triggering a persistent pain. Others have speculated that a drop in pressure affects the fluid protecting the brain inside the skull, leading to pressure on brain tissue.
Get an aspirin jab
A jab made from liquid aspirin, where the medicine is injected straight into the bloodstream, could be a powerful treatment for migraine.
Each injection contains a high dose of one gram of aspirin, more than ten times the amount most people would take to soothe a normal headache or joint pain.
New research shows pumping high doses of liquid aspirin into the blood can dampen pain in patients struck down by migraines so severe they end up needing hospital treatment.
Doctors behind the study, carried out at the University of California in San Francisco, hope the therapy can be used to help thousands more sufferers with less severe headaches.
Most people suffer from common migraine, which involves a severe throbbing headache, usually on one side of the head. Loss of appetite, nausea, constipation or diarrhoea are also common symptoms.
Sitting in a quiet, darkened room can help sufferers cope with an attack and over-the-counter painkilling tablets can ease mild cases. But for severe attacks, patients are given triptans, the more powerful prescription drugs that can be swallowed, injected or sprayed nasally.
Triptans work by restoring the chemical balance in the brain disrupted by migraines. Aspirin works by blocking the production of enzymes called cycloxygenases. These are crucial for the release of prostaglandins, hormones that help send pain signals through the nervous system. Injecting high doses stops this process — without the risk of stomach-bleeding, which comes with swallowing aspirin tablets. Liquid aspirin has been used as a migraine therapy for years in countries such as Germany.
Aspirin injections are a last resort for sufferers who have failed to respond to all other medications. But professor Peter Goadsby, a trustee of The Migraine Trust in the UK, said aspirin injections appear to be just as good as a commonly used medicine, sumatriptan, in the treatment of severe migraine.
"We have information from placebo-controlled trials that intravenous aspirin has a similar rate of success to six milligrams of injectable sumatriptan in acute migraine," he said.
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