Thirteen percent of Americans (about 38 million people) suffer from migraine, and every one of them has a different experience with the condition. Treatment has to be as individualized as they are. Unfortunately, that isn't what isn't offered now, though it is where the science wants to go. "I would love to have something like a Dr. Seuss type- machine where we put a person in and when they come out the other side we have the perfect treatment for them," said Kathleen Digre, MD, a migraine specialist with University of Utah Health. "We aren't there yet."
The most recent breakthrough in migraine treatment was the approval by the FDA of a new class of drugs--monoclonal antibodies targeting calcitonin gene-related peptide (CGRP). These drugs prevent migraines before they happen by stopping the release of proteins that cause arteries, veins and parts of the covering of the brain to swell. However, they don't work for everyone. "This really is the first designer drug for migraine prevention, and for some people, it's going to be really helpful," said Digre, "However, it's not going to be a magic".
CGRP monoclonal antibodies are the first migraine preventative drugs designed specifically for that purpose. Prior to this, drugs used for migraine prevention had been designed for other uses, but then found to be effective for stopping migraines. Beta-blockers, anti-seizure medications, anti-depressants, and even Botox have all helped people with migraine to varying degrees. "Many of these medications also have side effects that may make them less than attractive to patients," said Digre. "Those can range from a loss of libido to changes in thinking to blood pressure issues. Providers need to work closely with patients to make sure the risks don't outweigh the benefits."
Preventatives are not the only medications used to treat migraine. There are many acute treatments as well. The biggest breakthrough in this category came in the 1990s with the introduction of triptans. These drugs work to relieve migraine symptoms by binding serotonin receptors in the brain and blood vessels. New acute treatments could be coming though. "We are expecting a version of CGRP inhibiting medication that works acutely and another serotonin affecting medication that won't have some of the adverse effects on blood vessels," said Digre. "Though it is not known when these will likely get FDA approval."
Aside from medications there are new devices offering help individuals with migraine. The FDA has recently approved three devices available by prescription. Two of them use electric impulses to stimulate different nerves in the head and scramble pain signals. The third uses a magnetic pulse to interrupt brain activity linked to migraine. "These devices are for people who can't tolerate medications, or who have contraindication to medications," said Digre. "Perhaps somebody who's pregnant doesn't want to ingest a medication. One of these devices could help."
People who suffer from migraine should work with their care provider to determine the correct diagnosis and what treatment is right for them. They also should educate themselves about migraine to better understand their condition and take ownership of it. "Migraine is a chronic disease just like diabetes, or asthma, or any other chronic disease. And like other chronic conditions there are educational programs and materials available for patients." said Digre. "Here at the University of Utah, we started a Headache School that covers topics that are important for people with migraine and other types of headaches. The American Migraine Foundation is another excellent resource for migraine education."
People with migraine should be involved with research as well. They are an important part of charting the future of migraine treatment. Just as there are many types of migraine and headache there are many different types of research being done. "We need patients to help us understand the disease of migraine," said Digre. "We just joined a national consortium called the American Registry for Migraine Research, ARMR. We are asking all of our patients to donate some time to fill out some questionnaires about their own migraine. Then, we can use data that's assembled from across the United States on people who have migraines to start answering questions about the disease."