Can you predict a migraine attack?
A chair tipping over serves as a metaphor for a migraine attack in Thijs Perenboom’s PhD research at Leiden University Medical Center (LUMC). He wants to unravel whether and how we can predict migraine attacks. He will defend his thesis on Tuesday 21 June.
Perenboom’s research is based on an, in his own words, unusual metaphor: ‘The closer a chair is to its tipping point, the softer the push needed to topple it. We seem to see a similar concept with migraines. The closer patients are to a migraine attack, the more strongly their brains react to light. At least, that’s what we’re trying to prove.’ In his research, he has developed several methods to help confirm this theory.
Excitability
‘People with migraine often indicate that they’re extra sensitive to light just before an attack. There are special tests that measure this degree of excitability. Light is shone in the eyes in different patterns and strengths, and then the reaction in the brain is measured with electrodes,’ Perenboom explains. He developed a questionnaire that makes such time-consuming measurements to some extent unnecessary. ‘We saw that the results from the questionnaires and measurements were very similar. If a patient indicated they were close to a migraine attack, we also measured this in the brain.’
Before the study in humans, Perenboom tested the reactions of mice to flashes of light. ‘This enabled us to select the most interesting light patterns to make the human study less taxing,’ he says. Although the research on humans is still in full swing, he is cautiously optimistic: ‘We can see that patients react more intensely to light patterns when they are closer to a migraine attack, so that offers a new perspective.’
Reassuring
Perenboom has also created a new method to measure excitability. ‘When working with light, there are a still some steps that can influence the process because a signal is first sent from the eyes to the brain. If we use magnets, we can stimulate the brain directly. In the future, this will allow us to determine even more precisely what exactly is happening in the brain just before an attack.’
Being able to predict an attack would be a great relief for migraine patients. ‘Then they’d be able to prepare by rescheduling appointments, for example. But what would be most reassuring would be knowing when they aren’t going to have an attack. They’d be free to go about their lives without the worry of when the next attack might occur,’ says Perenboom. ‘And they’d be able to make more effective use of their migraine prevention medication.’
Researchers would also benefit from being able to predict migraine attacks: ‘We’d then be more certain that patients will actually have an attack when they come in for our tests and the research would the best results for us and the patient.’
For the latest developments or to participate in migraine research, see hoofdpijnonderzoek.nl.
Text: LUMC