Over the past few years, several new migraine medications have entered the market. First approved by the U.S. Food and Drug Administration in 2018, this new class of drugs is designed to both treat and prevent migraines in adults. But are these medications miracle workers or just a tiny bit better than their predecessors?
“While some patients may find relief with these new migraine medications, they are not a cure-all for everyone,” says Rikha Pillai, MD, neurologist at Methodist Medical Group - Neurology. “However, they do represent a promising advance in the treatment of chronic migraine.”
Migraines Aren’t Normal Headaches
More than 37 million people in the U.S. experience migraines, a severe and often debilitating type of headache. Migraines are around three times more common in women — affecting more than 30% of all women. About 90% of people suffering from migraines say the pain or other symptoms negatively impact their work or schooling.
For many people, migraines are hard to treat. Over-the-counter pain medications that can help treat other types of headaches often have little effect on migraines. Additionally, many people have symptoms other than throbbing pain in their head, such as:
- Mood changes
- Sensitivity to light, noise or sound
- Visual disturbances (such as blurring or double vision)
Some people experience migraine attacks that last multiple days, which can greatly impact their quality of life. But even short-term migraines can make it hard to complete the activities of day-to-day life.
The Problems With Past Migraine Treatments
Prior to the past few years, there have been two main classes of drugs for acute treatment of migraine: triptans and ergot derivatives. Both types of medications work by affecting serotonin levels in the brain and causing blood vessels to constrict. (During a migraine, the blood vessels in your brain dilate — or widen — which contributes to the pain in your head but doesn’t necessarily initiate it.)
Triptans are the most commonly prescribed drugs to treat migraines. These include sumatriptan (Imitrex), naratriptan (Amerge), zolmitriptan (Zomig), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax). While some people with migraines find triptans helpful, they don’t work for everyone. These medications also have two significant drawbacks:
- Because triptans cause constriction of the arteries, they cannot be used in patients with high blood pressure or a history of heart or vascular disease.
- If taken 10 days or more during a month, triptans can cause rebound headaches.
“Triptans are not as effective if they’re not taken immediately at the onset of a migraine, which is another problem,” Dr. Pillai says. “But because most triptans have been around for a while and have generic formulations, they’re an affordable treatment option for many.”
How the New Migraine Medications Work
The newest migraine medications are designed to target calcitonin gene-related peptide (CGRP) pathways. CGRP is released during a migraine and increases blood-vessel dilation and inflammation. The new medications block CGRP receptors from interacting with the peptide, which helps mitigate the migraine.
There are two types of these medications:
- CGRP monoclonal antibodies. These medications are FDA-approved for preventive treatment of migraine with or without aura in adults and include erenumab (Aimovig), eptinezumab (Vyepti), fremanezumab (Ajovy) and galcanezumab (Emgality). Many of these are administered as monthly injections, with some, like fremanezumab, given every three months. Others, like eptinezumab, are given intravenously every three months.
- CGRP receptor antagonists, also called gepants. These medications are FDA-approved for acute treatment of migraines and include atogepant (Qulipta), rimegepant (Nurtec), ubrogepant (Ubrelvy) and zavegepant (Zavzpret). They’re available as oral medications or nasal sprays. Rimegepant can also be used for migraine prevention.
Generally, these new migraine medications seem to have fewer side effects than triptans and other medications, and they are safe for people with heart or vascular problems. Common side effects include constipation and nausea. However, the drugs are still so new that any long-term side effects are not yet known.
“Research so far has found that the CGRP monoclonal antibodies seem to work well to prevent migraine attacks and that gepants may help some people who do not respond to triptans,” Dr. Pillai says. “Unfortunately, other patients have not had any better results with these medications.”
Another drawback is that insurance companies will often not cover the new migraine medications until patients have tried multiple other options, making the cost prohibitive for many people.
Looking for Migraine Relief?
If you or a loved one is experiencing ongoing issues with migraine pain, the neurologists at Methodist Le Bonheur Healthcare can help.Find Care for Migraines