More than 40 years of research has led to the development of medicine which significantly improves the quality of life of people suffering from migraine.
The four researchers to receive this year’s Brain Prize – the most prestigious brain research prize in the world, awarded by the Lundbeck Foundation – are responsible for a significant part of this development. Two of the researchers are based at Rigshospitalet and the University of Copenhagen, namely Professors Jes Olesen and Lars Edvinsson. The other two are Peter Goadsby from the UK and Michael Moskowitz from the US.
The four migraine pioneers receive the prize of DKK 10 million for their discovery of an essential mechanism causing migraine attacks. Knowledge of this mechanism has led to the development of a brand new type of medicine targeted at the transmitter substance CGRP, which can alleviate the disorder and reduce the amount of attacks – without a lot of the adverse effects that people suffering from migraine previously had to accept.
Migraine can cause severe side effects such as intense headache, nausea, vomiting and hypersensitivity to e.g. light and sound. Before 1979, migraine was considered an unexplainable mental disorder, but with the help of the four award-winning researchers in particular, it is now a recognised neurological disease which can to some extent be both explained and treated.
This year’s Brain Prize celebrates Lars Edvinsson and Jes Olesen, who have dedicated their careers to helping people suffering from highly disabling migraine attacks. The two front figures can take a great deal of the credit for the fact that Denmark and Rigshospitalet are now world-leading players within headache research.
Grateful patients and increased attention
Lars Edvinsson is Professor at the Department of Clinical Medicine at the University of Copenhagen, Professor at Lund University and Head of the Department of Clinical Experimental Research at the Glostrup Research Institute, Rigshospitalet. He stresses that receiving the prize is a great honour, but what matters the most is the positive results for people suffering from migraine.
‘The Brain Prize is the most prestigious recognition a scientist within the fields of brain research and neuroscience can receive. The prize is a recognition of my research and success in establishing the role played by CGRP in headache disorders – and of its importance in the development of new types of medicine which each day help a lot of migraine patients throughout the world. Each day, I receive emails from grateful patients. It warms my heart, and the thought of the many positive changes reported by these people makes me very happy’, says Lars Edvinsson.
Jes Olesen is Professor at the Department of Clinical Medicine at the University of Copenhagen and the founder of the Danish Headache Center at the Department of Neurology, Rigshospitalet, to which he continues to be affiliated as a researcher and doctor.
‘I have spent my entire career getting migraine accepted as a neurological disorder. I am therefore extremely pleased to receive this great recognition. The Brain Prize will help increase recognition of migraine as a serious and widespread disorder. Even academia has failed to recognise the disease. The prize will change that. It will lead to more research in the area and thus the development of even better medicine of benefit to patients’, says Jes Olesen.
40 years of ground-breaking research
The research careers of the four winners largely outline the entire history of development within modern migraine medicine. The first ground-breaking breakthrough came in 1979, when Michael Moskowitz, Professor of Neurology at Harvard Medical School, Massachusetts General Hospital, USA, in a scientific article presented a brand new theory: Migraine attacks involve interaction between the trigeminal nerve and the meninges.
The meninges are the thin membranes surrounding the brain, and they are the only structure in the brain to sense pain. The trigeminal nerve is responsible both for sensation and motor functions, and it sends impulses to the head and face.
In a model study, Moskowitz demonstrated that a migraine attack is triggered when the trigeminal nerve releases chemical transmitter substances, neuropeptides, which expand the blood vessels in the meninges and cause infection and pain.
In continuation hereof, Moskowitz suggested that blocking the effect of these transmitter substances might constitute a new way of treating migraine.
Tracing the transmitter substance CGRP
A few years later, Professor Lars Edvinsson and Peter Goadsby, Professor of Neurology at King’s College London, UK, launched a collaboration on the transmitter substance CGRP.
It is a substance which sends pain impulses to the brain, and together Edvinsson and Goadsby were able to demonstrate that the trigeminal nerve releases CGRP, which is also a neuropeptide, in connection with migraine attacks.
Furthermore, the two researchers showed that CGRP to a very large extent indeed causes an expansion of the blood vessels in the meninges, which made it probable that the substance could play a key role in migraine attacks.
However, in order to advance their CGRP discovery and eventually translate it into treatment for migraine, they first had to answer the question: Is the release of CGRP the cause of migraine attacks – or a result hereof?
Medicine blocking CGRP
Professor Jes Olesen was the brain researcher who answered this question. In a test study, Olesen gave CGRP to migraine patients and was thus able to prove that the substance can cause migraine attacks.
He subsequently showed that substances capable of blocking CGRP, so-called antagonists, could be used to treat migraine. At the same time, he proved that CGRP might constitute an important target for potential new migraine treatments. And then in 2004, based on a large-scale test study, Jes Olesen and his research team showed that a CGRP antagonist drug proved effective in acute treatment of migraine attacks.
Jes Olesen helped launch research studies which provoked migraine attacks in order to better study the biology and characteristics of the disorder. He is also responsible for the international classification of headache disorders including more than a hundred headache diagnosis criteria, e.g. various forms of migraine.
Lars Edvinsson and Peter Goadsby have continued their collaboration, focussing on migraine and cluster headache. In the past 10 years, though, their original idea of fighting migraine attacks by blocking the signalling pathways of CGRP has moved in a slightly new direction. And this development has led to the emergence of a new migraine medicine based on monoclonal antibodies (MABs).
Short presentation of this year’s winners
Lars Edvinsson. Swedish citizen. Professor of Internal Medicine at Lund University, Sweden. President of the International Headache Society and Professor of Clinical Pharmacology at the University of Copenhagen. Went to Medical School and wrote his PhD at Lund University. Founder of the Glostrup Research Institute, Rigshospitalet, and Head of the Institute for the past 15 years.
Jes Olesen. Danish citizen. Professor of Clinical Neurology at Rigshospitalet. Trained as a doctor at the University of Copenhagen. Founder of the International Headache Society. For many years, Head of the Danish Headache Center, to which he is still affiliated as doctor.
Peter Goadsby. Australian/British citizen. Director of the NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College London, UK. Professor of Neurology at the University of California, Los Angeles, USA. Trained as a doctor at the University of New South Wales, Australia.Michael Moskowitz
. US citizen. Professor of Neurology at the Harvard Medical School, Massachusetts General Hospital, USA. Trained as a doctor at John Hopkins University and Tufts University School of Medicine, USA. Affiliated to the Massachusetts Institute of Technology (MIT) for a number of years.
Migraine is more than severe headache. It is a serious neurological disease with disabling symptoms such as severe, continuous and returning headaches. Nausea, vomiting, dizziness and hypersensitivity to light, touch and sound are also common consequences of the disease.
Migraine attacks can last for several days, and the most severely affected patients experience at least 15 attacks a month. For a lot of people, the disease leads to reduced quality of life, difficulties keeping a normal job and possibly depression, anxiety and sleeping disorders.
One in seven adults worldwide is expected to experience major or minor migraine attacks at some point in their lives, and migraine is one of the most expensive diseases for society due to the large number of sick days.