If you live with migraine and are unsatisfied with your current treatment, these are the new options you’ll want to discuss with your doctor:
If we had one word to describe our feelings about the current state of migraine care it would be “hopeful.” We’re hopeful that medications will become easily accessible and that new treatments will be developed so the 40 million Americans living with this disease can find relief. This restored hope is due in part to the groundbreaking treatment developments made in the past three years.
If you live with migraine and are unsatisfied with your current treatment, here are new options you’ll want to discuss with your doctor:
Monoclonal antibodies CGRP-blockers
There are four calcitonin gene-related peptide (CGRP) blocking monoclonal antibodies: erenumab, galcanezumab, fremanezumab, and eptinezumab. They work to prevent attacks before they start, and are taken through subcutaneous or intravenous injection.
CGRP is a neurotransmitter that carries pain signals to the brain and causes blood vessels to swell, increasing blood in the brain during an attack. Blocking CGRP has been shown to effectively suppress migraine symptoms in at least 60 percent of patients in large clinical studies. CGRP blockers equal the efficacy of triptans, but are not associated with drug interactions and have minimal side effects.
Gepants also block the action of CGRP, however, they are taken at the onset of an attack. They are available as a pill and an orally dissolving tablet. Gepants have similar safety profiles to monoclonal antibodies. While gepants were originally approved for acute use, the FDA approved rimegepant for the preventive treatment of migraine in May.
Ditans are a new class of acute medication. Ditans block one specific serotonin receptor to abort migraine attacks. They do this without constricting blood vessels, making them safer for patients who have coronary risks.
Neuromodulation devices are noninvasive tools that change the way the brain processes pain. Devices for migraine include Nerivio, Cefaly, and gammaCore. Options are available for acute and prevention.
Managing migraine usually takes more than just one therapy. There are many medications that have shown positive results in combination with other therapies, including nerve blocks, Botox, and biofeedback. When over-the-counter medications no longer work, start the conversation with your doctor about what other options are available to you.