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.
However, with new treatments on the market during the past few years and research continuing at a record pace, patients and their providers may be able to find an optimal treatment plan.
- CGRP Monoclonal Antibodies
Since 2018, there have been a number of breakthroughs in migraine treatment. The first drugs approved by the Food and Drug Administration (FDA) were a new class called monoclonal antibodies that target calcitonin gene-related peptide (CGRP). These drugs prevent migraines before they happen by stopping the release of proteins that prevent inflammation.
CGRP monoclonal antibodies are the first migraine prevention drugs designed specifically for that purpose. Prior to this, drugs used for migraine prevention had been designed for other uses but were found to be effective for stopping migraines. Beta-blockers, anti-seizure medications, anti-depressants, and even onabotulinum toxin have all helped people with migraine to varying degrees.
However, the monoclonal antibodies don't work for everyone. "These really were the first designer drugs for migraine prevention,” says Kathleen Digre, MD, former chief of the Division of Headache and Neuro-Ophthalmology at University of Utah Health. “For some people, one of these treatments may be really helpful. However, it's not going to be always magic".
Some of these medications also have side effects that may make them less than attractive to patients. Those can range from constipation to a loss of libido, changes in thinking, or blood pressure issues, according to Digre. Providers need to work closely with patients to make sure the risks don't outweigh the benefits.
Gepants are taken orally and are small CGRP molecule blockers. Instead of lasting a full month for prevention, they must be taken every day or every other day to prevent a migraine. But not all gepants have been approved as a preventive treatment.
CGRP monoclonal antibodies and Gepant preventives are the “new kids on the block” when it comes to migraine treatment. 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.
Like triptans, gepants bind to the blood vessel; unlike triptans, gepants don’t constrict the blood vessel. This may make gepants a better solution for patients with cardiovascular disease, according to an article posted by the National Institutes for Health. A triptan-like drug, lasmitidan affects the 5HT1F receptor and does not cause vaso-constriction although it can cause drowsiness.
New acute and preventive treatments may be on the way. Migraine specialists like Digre expect other therapies to be coming.
Aside from medications, new devices also offer help to individuals with migraine. The FDA recently cleared 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," Digre says. "Perhaps somebody whois pregnant doesn't want to ingest a medication—one of these devices may help."
It’s important that patients not forget basic health advice like staying hydrated, eating a balanced diet, getting enough sleep, exercising regularly, and learning stress reduction techniques. These lifestyle choices can help, Digre says. She advises patients to check out the website of Dawn Buse, PhD, a University of Utah graduate dedicated to providing free educational materials and resources about migraines, including downloadable audio files with breathing relaxation and guided visual imagery techniques for pain reduction.
How to Get the Best Treatment for You
People who suffer from migraine should work with their care provider to determine the correct diagnosis and what treatment is right for them. Digre also suggests that patients:
- Educate themselves about migraine to better understand their condition and take ownership of it. University of Utah Health's Headache School covers topics online that are important for people with migraine and other types of headaches. The American Migraine Foundation also has excellent free information on various aspects of migraine and cluster headache.
- See a specialist if treatment doesn’t seem to be working. A specialist can help determine if systemic conditions are contributing to the headaches. At specialized clinics, they can look for red flags and help determine the cause and association of the headache or migraine.
"Migraine is a chronic disease just like diabetes or asthma,” Digre says. “And like other chronic conditions, educational programs and materials are available for patients. We need patients to help us understand the disease of migraine.”