March 24, 2023

Experts describe the multifactorial association between migraine and comorbid psychiatric disease and consider the role of neurogenic inflammation.

What about the concept that’s going around that most psychiatric disorders are nur inflammatory disorders to the case there is someone he had bipolar disease they gave her a transplant olympos sites and her bipolar disorder went away and people are now commenting the fact that in many disease states the immune reaction is what drives it and if you eliminate the

Immune reaction so could all these factors that make migraine in these psychiatric disorders become morbid related to the immune system i don’t think i don’t think i don’t know the answer to that and i don’t know that anyone really knows the answer to that it’s probably multifactorial in the way that these genetic variances give rise to you know two different

Disease states so neuro inflammation is certainly in emerging in a growing field there’s no doubt but its role in migraine and its role in psychiatric disease and its role and many other disease states is really not clear yet but i do think it it behooves us to be thinking as neurologists to be thinking about each of these comorbid conditions as we reach out with

Our treatments and so if so it’s it really is very important to have a discussion about depression and anxiety and migraine and peptic ulcer disease because of the issue of using neural nonsteroidal antiinflammatory xin the setting of migraine because some of the medications that we prescribe have adverse effects on the comorbid illnesses and some can sometimes you

Can get a two for one as one treats and and if one doesn’t proactively seek out that history one can really not optimally treat i think it becomes it’s so common and it’s so important in the overlap that it really is part and parcel of every clinicians day-to-day interaction with a migraine patient from a mechanistic point of view i think the inflammatory story

Didn’t make much progress in the last 15 years in migraine when you look at the medicines that were developed to chase inflammatory tar got substance p antagonists the plasma protein extravasation inhibitors the trip v1 antagonist they all failed in control trials and we you know we during this discussion we’re going to be talking about things that have worked

And i think it’s important when i you know when we’re talking about these things that have happened that the we’ve learned a lot by negative things as well not everything works in migraine actually there are at least 10 examples of things that have failed miserably because the you know one of the nice things about migraine as a field is we’ve been able to really

Apply biology at several levels to understand it and get information that it’s positive and negative to kind of add things together so i at one level it’s disappointing that those medicines didn’t work but at another level it’s actually in for reinforces that when things work it’s pretty secure i couldn’t agree more because when you look at this field we’ve moved

Away from the vessel as a target and we for decades we were developing therapies that targeted the blood vessel and we wanted to constrict the blood vessel because we thought that was important in the biology of this disease we moved away for that as peter says we moved into this neurogenic inflammation and we chased you know two decades worth of taric you know

New molecules that all didn’t pan out now and we’ll talk about this obviously we have much more specific and much more relevant – much more robust targets that are giving rise to really therapies that are changing that are going to change this field forever good

Transcribed from video
Association Between Migraine and Depression By Neurology Live