Diabetes jab to beat chronic blinding headaches

Thousands of Britons who suffered from ‘blinding’ headaches were able to reduce their attacks by a third thanks to a drug used to treat diabetes.

At least 2,000 people in the UK suffer from idiopathic intracranial hypertension. The main symptom of the condition, in which excess fluid builds up around the brain, is a persistent, debilitating headache.

But in some cases, the increased pressure in the skull can also damage the nerve that connects the eyes and brain, causing blindness.

Global cases of the condition have risen 350 percent in the past decade, presumably because the problem may be caused by obesity. There are no approved treatments, so doctors rely on drugs used to treat similar illnesses.

Now researchers at the University of Birmingham have found that regular injections of exenatide, a drug used to help diabetics lose weight, is both safe and effective.

Now researchers at the University of Birmingham have found that regular injections of exenatide, a drug used to help diabetics lose weight, are both safe and effective

‘This is the first drug that has been found to have a strong effect,’ says Professor Alexandra Sinclair, consultant neurologist at University Hospitals Birmingham NHS Foundation Trust and principal investigator on the study. “It acts directly on the part of the brain that produces fluid, slowing its release and, as a result, lowering the pressure.”

Idiopathic intracranial hypertension develops as a result of an excess of cerebrospinal fluid — the protective, fluid cushioning that surrounds the brain and spinal cord. Over time, this puts pressure on the delicate blood vessels that line the brain, as well as the optic nerves that transmit visual information. The pressure leads to severe headaches – which can be constant – and loss of vision. Patients may also experience nausea and tinnitus – constant ringing in the ears.

Experts aren’t sure what causes idiopathic intracranial hypertension, but it’s believed to be a disturbance in the balance of hormones that control cerebrospinal fluid release. Studies show that people with a higher body weight are at greater risk.

“The same hormonal issues that cause some people to gain weight may also be behind the condition,” says Prof. Sinclair.

A lumbar puncture is used for diagnosis. This is a procedure in which a sample of cerebrospinal fluid is taken through a needle in the lower back and the pressure is measured. Doctors also rule out other diseases that have similar symptoms, such as brain tumors.

With few treatments available, specialists often prescribe diuretics or water pills, such as the glaucoma drug acetazolamide, to help expel excess fluid – but half of patients experience side effects.

In extreme cases, doctors may perform surgery to drain excess fluid from the brain. This is a last resort as risks include infection and cerebral hemorrhage.

But now the University of Birmingham team has conducted a 12-week clinical trial in which seven patients were given exenatide twice a day. At the start, participants had headaches on average 22 days per month. During the trial, the drug reduced pressure in the brain. Participants’ headache frequency was also reduced by 36 percent — for up to 14 days. ‘We also saw improvement in vision,’ says Prof. Sinclair.

The team is now conducting a follow-up study with 240 patients around the world and has reformulated the drug into a weekly injection.

Liz Formby “begged” Professor Sinclair to let her stay on the drug as the trial drew to a close. “My headaches were gone and the worsening of my eyesight stopped,” she said.

Liz, 63, was diagnosed with idiopathic intracranial hypertension in her late 30s after a vision loss nearly caused a car accident.

“I had headaches that felt like my head was being ripped off,” she said.

An optician referred Liz to neurologists at her local hospital, where she underwent tests and was diagnosed. Doctors prescribed painkillers and advised Liz to lose weight.

In 2018, she participated in a clinical trial of exenatide, injecting herself twice a day for three months.

“I felt bad for the first two weeks,” Liz said, “but then the headache subsided. Instead of four a week, it was one and much less intense. My vision didn’t improve, but it didn’t get any worse.’

When the trial was over, Liz said, “The sharp pain came back.”

She added: “People asked why I took an experimental drug and put myself in danger. It was a good idea for me – I want to help doctors help people like me. And it is clear that this medicine helps.’