Some amazing things are happening in the field of migraine treatment. Seven new drugs have been introduced in the past few years, which is “unprecedented in the history of migraine,” David Dodick, M.D., said at the 2021 Migraine World Summit. Dr. Dodick is medical director of the headache program and concussion program at the Mayo Clinic in Arizona, as well as serving as board chair of the American Brain Foundation.
What’s really exciting, Dr. Dodick explained, “is that these are precision medicines, which means that they have a very precise target. And what this means is that we understand the biology of this disease now at a molecular level. And these are disease-specific treatments; they’re not drugs that have been developed for another disease and then co-opted because they have an effect on migraine.”
It’s great news that people living with migraine now have a wide array of pharmaceutical treatments to try. However, there’s no single migraine medication that works well for everyone. We’ll look at some of the newest migraine drugs to become available in the U.S.
CGRP Migraine Medications
What are CGRP migraine medications?
Also called anti-CGRP, CGRP inhibitor and CGRP antagonist treatments, these preventive migraine medications target a protein called calcitonin gene-related peptide (CGRP). CGRP carries migraine pain signals along nerves. It also affects the dilation of blood vessels, so these medications may affect your blood pressure and heart.
CGRP medications are typically self-injected or administered intravenously at regular intervals.
How effective are CGRP migraine medications?
According to the studies done thus far, Dr. Dodick says, they appear to work equally well for people with episodic and chronic migraine. They also seem to work well for people who have failed to respond to many other preventive therapies and for people living with other chronic pain disorders. People may, however, find that CGRP medications become less effective as they wear off, at the end of a treatment cycle.
What are brand names of CGRP medications?
- erenumab (Aimovig®)
- epitinezumab (VYEPTI®)
- fremanezumab (AJOVY®)
- galcanezumab (Emgality®)
What are gepants?
Approved in 2019, gepants are a type of migraine medication that’s taken orally, at the onset of a migraine attack. They bind to CGRP receptors on the trigeminal nerve — the primary pathway for migraine pain — and block the effect of CGRP.
How effective are gepants?
Gepants appear to be most effective for people who can’t tolerate triptans, or who need an additional medication to complement their use of triptans. They may not work right away, becoming more effective 2-8 hours following the dose. “Efficacy has been reasonable, with a paucity of adverse effects,” Dr. Lawrence Robbins, MD wrote about ubrogepant in Practical Pain Management. In plain language, they’re considered to be mild drugs with few side effects.
Rimegepant, branded as Nurtec® ODT, is the only oral CGRP receptor antagonist that is FDA-approved for both the acute and preventive treatment of migraine in adults. Zavegepant, a new gepant that may be administered nasally, is still in development.
What are brand names of gepants?
- ubrogepant (UBRELVY™)
- rimegepant (Nurtec® ODT)
- atogepant (Qulipta™)
What are ditans?
A type of acute/abortive migraine medication, ditans act as targeted and specific antagonists at the 5-HT 1F serotonin receptor. “A ditan is the sister to a triptan,” explains Dr. Uwe Reuter, professor of neurology at Charité University Hospital of Berlin. They act differently, however, because “ditans penetrate into the central nervous system, meaning they go across the blood-brain barrier right into your brain and they get into the brain.” Lasmiditan is the ditan approved in the U.S. in 2019 for acute treatment of migraine with or without aura.
How effective are ditans?
Lasmiditan doesn’t constrict blood vessels and can be an effective migraine treatment for people who can’t tolerate triptans. However, lasmiditan is a controlled substance that can cause fatigue and dizziness, meaning patients are cautioned not to drive for 8 hours after taking it. Other side effects of lasmiditan may include numbness and tingling, sedation, nausea and vomiting.
What are brand names of ditans?
- Lasmiditan (Reyvow®)
What are some other new migraine medications?
Dihydroergotamine mesylate (Trudhesa™) is an ergotamine derivative that was approved in 2021 for the acute treatment of migraine with or without aura in adults. While dihydroergotamine (EDT) isn’t new, this formulation is: Trudhesa is a nasal spray for easier, more rapid absorption. According to the makers of Trudhesa, pain relief can occur in as little as 15 minutes and last for up to 2 days.
Celecoxib (ELYXYB™) oral solution is a nonsteroidal anti-inflammatory drug (NSAID). Still in development, it’s the only FDA-approved COX-2 inhibitor formulated as a ready-to-use oral solution for the acute treatment of migraine with or without aura in adults.
What if migraine medications aren’t working for you?
Don’t lose heart. People with migraine often need to try different routines and combinations of treatments before they find one that works for them.
It can be really helpful to record your migraine experiences with the free CeCe migraine management app. CeCe is an intuitive way to log your migraine triggers, symptoms and treatments so you can recognize trends over time. Then, you can talk to your healthcare provider about what’s working and what’s not.
Sometimes you have to try two or three medicines to get effective relief, Dr. Dodick said at the 2021 Migraine World Summit: “Oftentimes, it requires combinations of medications, or combinations of modalities, like a medicine and a neuromodulation device.”
Consider making CEFALY part of your migraine treatment routine! CEFALY, a safe and non-invasive neuromodulation device, is clinically proven to provide acute migraine pain relief. In a double-blind, randomized, sham-controlled study conducted across multiple headache centers in the U.S., 79% of acute migraine patients saw pain relief following a 60-minute ACUTE treatment session with CEFALY, and 32% saw pain freedom.
With compliant daily use, CEFALY DUAL Enhanced’s PREVENT setting desensitizes the trigeminal nerve over time to reduce the frequency and severity of migraine attacks, thus reducing the need for pain-relieving medication.