Migraine masters

Australian-born Peter Goadsby is one of four neuroscientists who have won this year’s prestigious international Brain Prize. The group has been recognised for discovering a key mechanism that causes migraines.

The prize-winning research – conducted by Lars Edvinsson (Sweden), Goadsby (Australia/UK/USA), Michael Moskowitz (USA) and Jes Olesen (Denmark) – is the culmination of four decades of developing new classes of migraine-specific drugs that are informed by the neurology of the brain.

The Brain Prize will be awarded at a ceremony on 25 October 2021 in Copenhagen. It is worth almost AUD$2 million and is the largest prize for brain research in the world.

Migraines are a serious neurological disease with symptoms such as severe head pain, nausea, vomiting and extreme light and sound sensitivity. For some, these can recur up to 15 times a month, and can become debilitating to quality of life.

Normally, the brain receives so much sensory information that it ignores some of it – you rarely notice your nose, or the intensity of office light, or the feeling of the air conditioner on your skin. During a migraine, the brain becomes hypersensitive to these sensations and the sensory overload can become unbearable.

These brain signals, combined with brain chemistry and grey matter, make studying the underlying causes of migraines complex, especially as each case could have unique causes.

These biological processes are necessary to identify and develop preventative therapies that specifically target that unique brain chemistry.

In 1979, Moskowitz proposed that migraines may involve a complex interaction between the trigeminal nerve, which helps detect sensations from the head and face, and the meninges, which are thin pain-sensing membranes surrounding the brain. He also proposed that blocking the action of some neuropeptides might provides a useful therapy for migraines.  

One of these peptides, discovered by Edvinsson and Goadsby, is of the neuropeptide CGRP, which is released during migraines and dilates blood vessels. Olesen then confirmed that CGRP release did indeed trigger migraines in patients, and was therefore a good candidate for targeted blocking with drugs.

This discovery has since informed drug design, with the first large-scale trial testing a CGRP blocking drug in 2004. Since then, the CGRP pathway has continued to be studied in migraines and cluster headaches using antagonist (blocking) drugs which were approved by the FDA in 2012.

“I feel privileged to work in medicine with patients’ headache disorders, and their families, to make some small differences and help the incredibly brave patients I see do just a little better,” says Goadsby.

2021 Brain Prize winners:

Lars Edvinsson is a Professor of Internal Medicine at Lund University, Sweden, President of the International Headache Society, and Professor in Clinical Pharmacology at Copenhagen University.

Peter Goadsby is the NIHR-Wellcome Trust King’s Clinical Research Facility at King’s College London in the United Kingdom and is Professor of Neurology at the University of California, Los Angeles, USA. He is also Honorary Consultant Neurologist at King’s College Hospital and the Hospital for Sick Children, Great Ormond St, London.

Michael Moskowitz is a Professor of Neurology at Harvard Medical School at the Massachusetts General Hospital, USA. 

Jes Olesen is a Professor of Neurology in the Department of Clinical Neurology, at the University of Copenhagen, Rigshospitalet, Denmark.