10 April 2020

10 new weapons in the war on migraines

Over the past six years several new treatments for migraines have been approved by the US Food and Drug Administration (FDA).

There is no cure for migraines – a headache disorder that can cause sensory disturbances and nausea – but several new treatments may help people with the debilitating condition, a neurologist says.

"Ten new treatments for migraines have been approved by the US Food and Drug Administration [FDA] over the past six years," said Dr Stephen Ross, from Penn State Health Neuroscience Institute, in Hershey, Pennsylvania.

About 38 million Americans experience migraines – some many times per month. These episodes are most common from the teens through the 40s, but can occur at any age. About 20% of women and 6% of men are affected.

Treatment doesn't work for everyone, but "people can go into remission, with no attacks for months or even years", Ross said in a Penn State news release.

Prevention better than cure

And many of the newer treatments offer moderate to significant benefits for patients, he added. These treatments include calcitonin gene-related peptide (CGRP) inhibitors; medical devices; a serotonin 1F receptor agonist; and Botox.

CGRP inhibitors are preventive treatments that disrupt a protein called CGRP, which is particularly active in people with migraines.

"They block the flow of CGRP to the brain, disrupting the signal that causes migraines," Ross explained.

Unlike traditional migraine meds, such as sumatriptan (Imitrex), CGRP inhibitors don't constrict blood vessels, so they're safe for people who've had a stroke, heart attack or vascular disease.

Three CGRP inhibitors – erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab-gnlm (Emgality) – are injected once a month. A fourth – eptinezumab-jjmr (Vyepti) – was approved in February. It's the first drug for migraine prevention through IV infusion.

Two other CGRP inhibitors – ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT) – are pills designed to stop a migraine when it occurs. Both received FDA approval last month, according to the news release.

Botox effective for chronic migraine

In addition, three new, non-invasive medical devices are available for migraine patients.

Cefaly is placed on the forehead to stimulate a nerve that impedes migraine pathways. SpringTMS is a magnetic stimulator placed on the back of the head to disrupt migraine signals in the brain. Both can be used as prevention or when a migraine strikes.

A third device called gammaCore is placed at the front of the neck and stimulates the vagus nerve. It's used when a migraine occurs.

In addition to these remedies, Lasmiditan (Reyvow) is the first in a brand-new class of drugs that stimulate the serotonin 1F receptor, believed to be involved in causing migraines.

"These medications slow down the body's pain pathways," Ross explained.

Botox isn't a new treatment, but is effective in people with chronic migraine, according to Ross. It's delivered through a quarterly series of scalp injections.

Image credit: iStock


Ask the Expert

Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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