“When we know those variants, we can actually calculate someone’s individual risk,” David Dodick, MD, a migraine specialist at the Mayo Clinic, tells SELF. “The number of characteristics you inherit, versus the number I inherit, will predict how you express your illness and how I express mine.”
This can be done by determining someone’s genetic risk score, also known as a polygenic risk score.8 This is calculated by considering all of the migraine-associated genetic variants of a person has, plus the incision of each one. (Some genetic variations are “riskier” than others.) Higher polygenic risk scores are associated with earlier onset of migraines and more frequent and severe attacks.8 Currently, polygenic risk scores aren’t routinely done in the health care setting.
Why is knowing your family history helpful?
At the moment, this research is mostly useful for the scientific community. Until experts are able to use this information to develop new treatments and preventatives for the public, these insights are mostly academic.
However, understanding the role that genetics play in migraine can be helpful. The heritability of migraine means that if multiple people in a family have migraine, then there are often inherited genetic risk regions that the family members share. While the sum of their genetic risks (known as a genetic risk score) won’t be identical, there will be similarities that can give clues to how treatment might work for you.8 Currently, migraine treatment is still very much a trial-and-error approach, so any guidance can be useful to identify an effective medication sooner.
For instance, the latest migraine treatments on the market target specific migraine-causing molecules, such as calcitonin gene-related peptide (CGRP).6 This peptide is encoded within the genes CALCA/CALCB, meaning that if you have that genetic risk variation, then this CGRP inhibitor medication may be more effective.6 Of course, this isn’t 100% proven, and most people won’t know their specific genetic variations. Additionally, these medications won’t prove effective for everyone. However, if someone in your family is using the CGRP inhibitor and it’s working well, this could be a clue that it will work well for you due to your higher common variant burden.
This could also be true for other forms of treatment, such as triptans. Triptans, which are serotonin 5-HT1B/1D receptor agonists,6 are one of the most common medications prescribed for people with migraine. While they do not work for everyone, they may work better in people with a higher genetic risk score4.
Of course, these theories should not replace doctor consultations. Your primary care physician will help you find a treatment and prevention plan that works for you—but your family history is important to share with your doctor and could provide a useful clue on where to start.
What does the future look like for migraine and genetics research?
Experts have currently identified over 100 different genetic risk regions for migraine.6 The grand-scale discoveries of Dr. Hautakanga and her team’s study were made possible due to the larger research samples available. Now that this is available to the scientific community, doctors are very optimism about the future insights. We stand to gain through new research.