FINAL REPORT: Prediction of migraine prevention efficacy: Individualization of treatment by coupling drug’s mode of action with patient’s mechanism of pain modulation

The Journal of Pain, Vol 19, No 8 (August), 2018

Annals of Biodmedical Engineering

Summary

The aim of this study was to identify migraine patients likely to respond to amitriptyline for migraine prevention by using neurophysiological and psychophysical parameters of descending pain inhibition. We hypothesized that a patient whose high pain profile is a result of reduced pain inhibition capacity would gain from amitriptyline, a medication that augments this capacity. However, the psychophysical tool that measures pain inhibitory capacity did not show this. Instead, we found that a questionnaire that assesses high sensitivity to external stimuli predicted the efficacy of this drug for migraine patients, especially those who experience aura. This questionnaire is routinely used to diagnose children with “sensory modulation disorder” who exhibit a heightened response to touch, light, odor etc. to the point of substantial interference with life routines.

Hypothesis vs. findings

We hypothesized that dysfunctional pain inhibition is a major mechanism in migraine, and its capacity would determine the efficacy of drugs for migraine prevention. Instead, we found, at least for the purpose of migraine prevention, that the more relevant mechanism is pain augmentation, which is consistent with the literature on the sensitization of pain pathways in the central nervous system in migraine.

Unanswered Questions

Our findings open a door for comparative studies between migraine and sensory modulation disorder. Is there an overlap? Are children with this sensory syndrome at higher risk for developing migraine? Are those children responsive to amitriptyline as a possible treatment for this disorder? And what is the predictive capacity of the sensory modulation data for other migraine prevention drugs?

What This Research Means To You

These findings are a step toward a more personalized approach to treating migraine. While we still do not know which drug will help prevent migraine for a particular patient, we now know how to predict whether at least one drug, amitriptyline, might help. The next step is to explore the predictive power of this data on the effect of other preventive medications.