Hello, I’m Paul Richards with the Latest from Science.
It might be hard to believe but migraine is one of the leading causes of disability in
the world, with around a billion people suffering from them.
But there is hope. Scientists at Queensland University of Technology are involved in the
world’s biggest migraine study and are trying to determine which genes play a role in the
disorder to help develop treatments.
Joining us now is Professor Lyn Griffiths, a molecular geneticist who is the Executive
Director of the Institute of Health and Biomedical Innovation from QUT.
Welcome, Lyn. Hi, Paul.
Now firstly, do you know why so many people suffer from migraine disorder and can it be
inherited?
So migraine is a very common neurological disorder. In fact, it's the most common neurological
disorder in the world. Why is it so common? Well yes, it does have a very significant
genetic component, so it runs through families and in fact what you'll do is you'll find,
probably 90% of migraine sufferers have another close relative who suffers from the disorder.
Probably about 50% of the time, it will be one of the parents. So it's a very strongly
genetic disorder, runs through families, also doesn't affect mortality. So even though you
suffer from it, it doesn't actually reduce your lifespan. And so that's why it's kept
in the population and it continues through families.
And if you don't mind me asking, I understand that you have your own family history to do
with migraines. Is that what sort of led you into researching the problem in the first
place?
Yes, I'm a geneticist, so I was interested in trying to find genes that play a role in
disorders and I was working on neurological disorders and then started to go to more complex
ones. There are rare neurological disorders caused by single genes, but it turned out
that some of the studies I was doing made me believe that some of those single gene
disorders were in fact due to multiple genes. And so it made me start thinking you could
look at other sorts of disorders, more complex ones that involve multiple genes and yes,
because I suffered from migraine, my mum had suffered from migraine and when my son was
about four, he started suffering really badly from migraine as well. So that made me start
to think somebody really ought to be looking at this as a genetic disease because it's
pretty obvious that it runs through families. So this was way back in the 1990s I started
working on migraine. There were probably a number of people working on migraine, but
not from a genetics point of view then. So we were probably one of the first groups in
the world to start looking at it from that point of view and started a number of genetic
studies on migraine.
Now, a bit like getting confused between the common cold and having the flu, I think people
might not understand necessarily the difference between a common headache and a migraine.
What are the symptoms and how do you know if you're having a migraine?
Well, obviously a migraine has involved some head pain but it has a number of other symptoms
as well. The head pain for a start is very severe. It can go from between four hours
and up to 72 hours. So you can have migraine for days, and it's not just the head pain.
You have nausea and vomiting, photophobia and phonophobia. You can't stand bright lights
and loud noise. You have an aversion to physical activity because you're in a lot of pain.
And also, the pain tends to be throbbing and pulsating and usually one side of the head,
all of those are symptoms of migraine, not just headache. Headache is when you just have
a sore head. There's no necessarily specific triggers for migraine and it's also episodic.
It's something that if you get it once, it will come back again at different stages.
Hard to predict when you're actually going to get it as well. And I suppose the other
thing is all those symptoms I described are common to the two main types of migraine,
migraine with and without aura. But in addition, those who suffer from migraine with aura have
a number of neurological disturbances that occur either just before the head pain starts
or in the early stages. And these disturbances tend to be visual. So you have wavy lines,
blurred vision, tunnel vision, even complete loss of vision. You can have weakness through
parts of your body, you'll have trouble speaking normally. All sorts of strange neurological
things that occur are part of what's called the aura that you get with migraine.
Right, yeah, I was going to ask for clarification of the aura. So it ends up being something
sort of visual or something, you just sort of feel a bit odd.
Well, you definitely feel a bit odd. It can be so odd that you can actually lose your
eyesight. You can also get so weak that you can get it right through one half of your
body, so that it actually doesn't move normally and a lot of people have trouble speaking
normally. So these are neurological disturbances that occur in the early stages of migraine.
There are some types of migraine with aura that are much more severe than that as well.
So not only the head pain and all those things I've mentioned, but I've mentioned paralysis.
So sometimes that can be extended, it can actually go on for months. People can go into
a coma and the coma can go on for months. In some cases it's even, very rarely, but
sometimes it's actually lethal as well. This is one particular type of migraine with aura,
so it's not just a headache. It actually can be much worse.
Really awful. You mentioned that there's no clear trigger for migraines. In individual
studies, has there been any sort of indication for an individual whether there are certain
things that can lead into migraines? Not necessarily applicable to everyone, but say diet or other
things like that that can affect it?
So what we find now is that we believe that migraine has a genetic basis. And for those
with that genetic basis, they're susceptible to changes in their environment or triggers
that can bring on the migraine attack. And those triggers, well there's quite a large
number of them, and different triggers for different people. So it could be certain types
of food. It's usually really good ones, like changes in your coffee levels, chocolate,
nice wine, ripe cheeses. So the good things in life can quite often in some people trigger
it. Sometimes it's things like strong smells, like strong perfumes can trigger a migraine
attack. In some people, sometimes it's barometric pressure changes. So just before a storm is
going to come, the world feels a bit different. But people who suffer from migraine, that
can actually be a trigger for their migraine. Sometimes it's changes in stress levels. It
could be too much stress or what's worse, is going on a holiday and then finding you
get a migraine. So sometimes there are specific triggers for specific people and it can be
really important to keep a diary of what has been a trigger that might've brought on your
migraine so that you know what to watch out for in the future.
That's fascinating. And then research looking at, you know, there are dozens of genetic
risk factors for migraine. How do those findings help develop treatments?
So in actual fact, there are quite a number of genetic risk factors that have been identified
for migraine. And we keep identifying more of those as we study more people. And there's
two different types of those. Some of these are risk factors, meaning if you have that
genetic variation, you have an increased risk of having migraine. And those are the ones
that you find with the very common types of migraine. There are some, though, that are
worse than that. So there are some that are what's called causative and they're mutations
in specific genes. And if you have those mutations, it actually causes that type of migraine.
So I mentioned one before where you have paralysis down half of your body. You also can go into
a coma that can quite often be extended and you have very severe migraine as well. These
are inherited dominantly through families.
If you have it all your children have a 50% chance of having it. They also tend to have
an early age of onset. Quite often you'll find children who actually have this as well.
And this particular type of one is due to specific genes that cause it, not just increase
your risk, they cause it, and it's good to actually know about those because if you know
which particular causative mutation you have in your family, you can define what's an appropriate
treatment for those. So a number of these rare types of migraine with aura, we currently
do all the diagnostic testing for all of Australia and New Zealand for these types of migraine,
and also for some related conditions that are also caused by other genes. They're not
migraine, but migraine is one of the symptoms associated with it. So if you can define which
particular gene you have mutated, then you can also define what's the most appropriate
treatment for you. So for the known ones that we currently do diagnostics for, there are
some very good treatments when you know which specific gene it is, and it's a different
treatment depending on which gene it is. For the more common types of migraine, we haven't
got all of those genes yet, so there's a bit more work that we need to do to actually identify
the genes that play into this so that we can develop some new treatments.
Just finally, Lyn then, do you have any advice for anyone who's watching at the moment who
is themselves a migraine sufferer?
I think the most important thing to think about with migraine is that it's important
for you to think about your migraine to try and identify the triggers that might actually
be causing migraine in your case. So there could be certain types of food or pressure
changes or perfumes, et cetera. Try and identify those through something like a diary. The
second thing is, if you have tried some treatments and maybe they're not so effective, it's really
important to look around, because there are some incredibly good treatments for migraine
and if one didn't work for you, it's quite possible that another one would. So make sure
that you talk to your GP, make sure that you talk to your neurologist and work out what's
best for you, and also what might be better for your family as they may develop migraine
as well.
Well Lyn, congratulations on the work that you're doing. Good luck, on behalf of all
the migraine sufferers out there. And thank you very much for your time.