Spreading Our Wings
Migraine specialist determined to get ahead of kids’ pain
Northern Alberta youngsters among first in the world to test new migraine medications
Thilinie Rajapakse & Taylor Ness
When the February forecast called for a sudden temperature swing, Thilinie Rajapakse revised her outlook to expect a busy week at the hospital.
Weather changes can trigger migraine, and the pediatric neurologist at the Stollery Children’s Hospital headache clinic is mindful of conditions that could make her young patients miserable.
She's also on top of opportunities to make their lives better.
In the coming months, Rajapakse will recruit patients to participate in international clinical trials testing two ground-breaking new migraine drugs on youngsters aged six to 17. The medications — eptinezumab and atogepant, both recently approved in North America for adults — are what she calls a “revolution” in migraine treatment.
“As researchers and clinicians, we felt like there was an onus to try this in children,” says Rajapakse, an assistant professor in the Department of Pediatrics. “We’re treating pediatric migraine pretty well — but not nearly as well as it could be treated, and not as well as it is already treated for adults.”
Migraine is a neurological disorder of sensory processing involving nerves and vessels of the head that has been around for thousands of years. The throbbing headaches, often accompanied by nausea, vomiting and sensitivity to light, can occur upwards of 15 days per month for chronic migraineurs. The condition affects close to seven per cent of children — that translates to about two or three kids in every child’s classroom — and is considered one of the world's most disabling maladies.
But for a long time, treatment was haphazard, with doctors throwing everything from anti-seizure meds to anti-depressants at it, Rajapakse says.
That was Taylor Ness’s experience after she began getting daily migraines in junior high. Her family doctor prescribed physiotherapy, acupuncture and different medications but nothing worked.
“Then she told me, ‘Oh, you might just have to live with it,’” recalls Ness, now in her first year of engineering at the University of Alberta. “As a 15-year-old girl, that’s really not what you want to hear.”
Eptinezumab and atogepant are different in that they’re designed specifically to prevent migraines by inhibiting the actions of a specific molecule — the calcitonin gene-related peptide. Eptinezumab is given intravenously every three months; atogepant is a daily pill.
Being part of a clinical trial is a big commitment for researchers and support from WCHRI is critical to making it happen, Rajapakse says.
It’s also a big commitment for families and patients. During the trial, youngsters must stop using other preventative treatments and for the 12-week double-blind phase may only get a placebo. After that, all participants get the medication, Rajapakse says. “Which is why I’m OK with this. It’s also a way for me to get the new drug for my patients.”
The Stollery’s headache clinic is a frontrunner in exploring new ways to manage migraine; Rajapakse says clinic founder and fellow WCHRI member Lawrence Richer, a “forward-thinking” pediatric neurologist who is now a vice-dean of research at the University of Alberta, blazed the trail.
In 2018, Rajapakse started the clinic’s interventional headache program offering injection therapies like Botox or nerve blocks to patients like Ness. The teen says the nerve block was a life-changer, decreasing the frequency of her migraines from several times a week to once or twice a month.
When Ness aged out of the pediatric clinic in the summer of 2022, she went from being Rajapakse’s patient to becoming the clinic’s first patient research partner and advocate. Ness helps provide the medical team with perspective on how patients might feel about different treatment options — like whether it’s scary, cumbersome or cool.
Ness sees her role as a chance to help young migraineurs know there is “a light at the end of the tunnel.”
For Rajapakse, the new patient research and advocate role is another way to understand and solve the problem.
“No one dies from migraine … so it’s not the top thing that the medical community gets really worried about,” she says. “However, it causes a lot of pain and disability and reduces quality of life significantly for millions of people.”