Migraine is not a headache disorder that happens to involve pain.
Durante décadas, la migraña fue tratada como un simple dolor de cabeza, cuando en realidad es la primera causa de discapacidad mundial en menores de cincuenta años. En España, más de cuatro millones de personas —en su mayoría mujeres— conviven con esta enfermedad neurológica compleja que puede arrebatarles la capacidad de trabajar, cuidar de sus hijos y participar en la vida cotidiana. El descubrimiento del péptido CGRP como mecanismo central del dolor ha abierto una nueva era terapéutica: por primera vez, los médicos pueden tratar no los síntomas, sino las causas mismas de la enfermedad.
- La migraña ocupa el primer puesto mundial en discapacidad para menores de cincuenta años, pero sigue siendo subestimada como si fuera un simple dolor de cabeza pasajero.
- Millones de pacientes —especialmente mujeres— han perdido años de vida laboral y familiar porque los tratamientos disponibles eran genéricos e ineficaces para muchos de ellos.
- La identificación del péptido CGRP como detonante clave del ataque migrañoso ha permitido desarrollar anticuerpos monoclonales y gepants que atacan directamente el mecanismo neurológico de la enfermedad.
- Pacientes con enfermedades cardiovasculares, antes excluidos de los tratamientos con triptanes, encuentran ahora en el lasmiditan una alternativa segura y eficaz.
- La posibilidad de personalizar el tratamiento según el perfil de cada paciente está reduciendo la discapacidad y devolviendo a las personas a sus vidas productivas.
Más de cuatro millones de personas en España viven con migraña, y la mayoría son mujeres. Es la primera causa de discapacidad mundial en menores de cincuenta años, aunque la sociedad sigue hablando de ella como si fuera un simple dolor de cabeza. El neurólogo Jonathan López Fernández, del Hospital San Juan de Dios de Tenerife, lleva años combatiendo ese malentendido: la migraña es una enfermedad neurológica compleja que se despliega en varias fases, con síntomas —alteraciones visuales, náuseas, niebla cognitiva, hipersensibilidad sensorial— que pueden ser tan incapacitantes como el propio dolor.
Durante décadas, los médicos recetaron los mismos fármacos a todos los pacientes sin distinción. Muchos no encontraban alivio y simplemente aprendían a soportar una discapacidad que se agravaba con los años. El punto de inflexión llegó cuando los científicos identificaron el péptido CGRP como uno de los principales responsables del dolor migrañoso: liberado durante el ataque, activa el sistema trigémino-vascular y desencadena toda la cascada neurológica de la enfermedad.
Ese hallazgo abrió la puerta a una nueva generación de tratamientos. Los anticuerpos monoclonales anti-CGRP han demostrado reducir tanto la frecuencia como la intensidad de los ataques. Los gepants actúan por una vía distinta pero con resultados similares. Y el lasmiditan ofrece por primera vez una opción segura para pacientes con enfermedades cardiovasculares que no podían tomar triptanes.
Lo verdaderamente transformador no es solo que estos fármacos funcionen, sino que permiten personalizar el tratamiento según la enfermedad concreta de cada persona. La discapacidad disminuye, la calidad de vida mejora y muchos pacientes recuperan su capacidad de trabajar y de estar presentes en sus familias. La migraña no tiene cura todavía, pero por primera vez existe la posibilidad real de recuperar la vida que la enfermedad había arrebatado.
More than four million people in Spain live with migraine, and the vast majority of them are women. It is the leading cause of disability worldwide for anyone under fifty years old—a fact that sits uneasily against the casual way most people speak about it, as though it were nothing more than a bad headache that will pass with time and aspirin.
At San Juan de Dios Hospital in Tenerife, neurologist Jonathan López Fernández has spent his career trying to correct this misunderstanding. Migraine, he explains, is not a headache disorder that happens to involve pain. It is a complex neurological disease that unfolds across multiple phases, with symptoms that can be just as disabling as the physical pain itself. A patient might experience visual disturbances, nausea, sensitivity to light and sound, cognitive fog—any of which can render a person unable to work, unable to care for children, unable to function in the ordinary world. The headache is only part of the story.
For decades, treatment options were limited and crude. Doctors prescribed the same medications to every patient, regardless of how their disease actually manifested. Some patients responded well; others found no relief at all. The lack of individualized approaches meant that many people simply endured, their disability deepening year after year.
Then came a crucial discovery. Scientists identified a molecule called CGRP—calcitonin gene-related peptide—as one of the primary drivers of migraine pain. This peptide is released during a migraine attack and activates the trigeminal-vascular system, triggering the cascade of neurological events that define the disease. Understanding CGRP's role was transformative because it pointed toward a new strategy: instead of treating symptoms broadly, doctors could now target the specific mechanisms that cause migraine to occur in the first place.
That understanding has yielded a generation of new medications. Monoclonal antibodies designed to block CGRP have shown remarkable effectiveness at reducing both how often migraines strike and how severe they are when they do. A separate class of drugs called gepants works through a different mechanism but achieves similar results. For patients with cardiovascular disease—a group that was previously unable to take traditional migraine medications like triptanes because of dangerous interactions—a new drug called lasmiditán offers a viable alternative.
What makes these advances genuinely significant is not just that they work, but that they allow doctors to tailor treatment to each patient's particular disease. One person's migraine may respond best to one medication; another person's may require a different approach. The ability to choose, to adjust, to individualize care transforms the clinical picture. Disability decreases. Quality of life improves. People return to work, to their families, to the lives they had before migraine consumed them.
The World Health Organization ranks migraine as the sixth leading cause of lost health globally. But among people under fifty, it stands alone at the top. That distinction matters. It means that for an entire generation—people in their most productive years, raising families, building careers—migraine is the single greatest threat to their ability to function. The new treatments do not cure the disease. But they offer something that has been missing for a long time: the genuine possibility that a person with migraine might reclaim their life.
Citações Notáveis
Migraine is not simply a headache—it is a complex neurological disease that unfolds across multiple phases, with accompanying symptoms that can be as disabling as the pain itself.— Dr. Jonathan López Fernández, neurologist at San Juan de Dios Hospital, Tenerife
Understanding CGRP's role was a turning point because it allowed us to develop treatments that target the actual mechanisms of migraine rather than just its symptoms.— Dr. Jonathan López Fernández
A Conversa do Hearth Outra perspectiva sobre a história
Why has migraine been so consistently underestimated, even by people who have it?
Because it's invisible. A broken leg is obvious. Migraine happens inside the brain, and the person looks fine from the outside. So there's this cultural assumption that it can't be that bad—that you're exaggerating, or that you just need to push through it.
And the new drugs work differently than the old ones?
Completely differently. Triptanes were like throwing a blanket over the fire. They constricted blood vessels and dampened pain signals, but they worked the same way for everyone. The new drugs go after the actual mechanism—they stop CGRP from doing its job in the first place. It's the difference between treating a symptom and treating the disease.
What changes for a patient when they find the right medication?
Everything. They go from planning their life around migraine attacks—which days they can work, which days they can't—to actually having control. They get their time back. They get their identity back. They're not the person with migraine anymore; they're just a person who happens to have migraine.
Why does it matter that lasmiditán exists for people with heart disease?
Because until now, those patients were trapped. Their hearts made them ineligible for the drugs that actually work. Lasmiditán doesn't constrict blood vessels, so it's safe for them. It's the difference between having no options and having a real choice.
Is this the end of the story, or the beginning?
The beginning. We understand CGRP now, but there are other pathways we're still learning about. And we're learning how to predict which patients will respond to which drugs. The real revolution is still coming.