Treating migraine effectively through the nose

TITLE: How can we treat migraine effectively through the nose?

Wade Cooper, DO: As a neurologist, we talk about the brain all the time, but for today, I want to focus on how cool the nose is and why it’s an important delivery for migraine medication.

When we talk about nasal anatomy, it’s important to know that all areas of the nose aren’t the same. The top of the nose, the back of the nose is really rich in both venous and arterial access. This, of course, is important because when you put medication in the anterior vestibule of the nose, it’s not ideal for medication absorption.

When we look at the lower nasal space, that anterior vestibule of the nose, it’s just not designed for medication absorption. It’s got squamous epithelium that acts almost like a raincoat and won’t let medication penetrate.

Now, if we focus on the upper nasal space, you’ll notice that the actual cells are different. These are columnar epithelial cells, and they’ve got cilia on them. But what’s interesting is that the cilia in the top of the nose are non-motile, which means that they don’t have a beating-like wave to move medication away.

And in my opinion, this is the most ideal area to deliver medications because these columnar epithelial cells are covered with mucus and able to absorb medication best for any spot in the nose.

If you can get medication to the top of the nose, where these blood vessels are ready to absorb medication, you’re going to get your optimal effect.

When we talk about the upper nasal space and why it’s so ideal for our migraine patients, we know that the upper nasal space is designed for phenomenal medication absorption. But we also know that medications that go to the upper nasal space avoid first-pass phenomenon in the gut and avoid you going through the liver to metabolize the medication down, and therefore giving you lower side effect options. And the third part about this is that medications, when they’re delivered in the upper nasal space, are also going to allow you to get past gut slowdown, which occurs when people have their acute migraine attacks.

So we know that traditional nasal atomizers, has a puff of medicine that goes into the front of the nose in what we call the nasal vestibule. And the reason why that medicine can’t go to the top of the nose is because of the portion of the nose called the internal nasal valve. The internal nasal valve isn’t an actual structure, it’s more of a stricture in the nasal passages, but it stops typical aerosolized medications from getting to the upper nasal space.

This becomes a huge barrier for delivering medicines to the top of the nose. And the POD® technology with Trudhesa gets medicine past this internal nasal valve and up to the target where it’s going to be best absorbed.