Despite the prevalence of migraine globally, effective and tailored medicines for this neurological disorder have left patients wanting. But could a new migraine injection, that works directly on the sites of the brain thought to be involved in migraine treatment, be the answer migraine patients have been waiting for? Here are 7 need-to-knows about migraine as well as some updates on the latest treatment developments.
1. Who gets migraines?
The estimated prevalence of migraine is around 6 - 8% in men and 15 - 25% in women, with chances that people have it for life at 43% and 18% respectively. This staggeringly high incidence of migraine is what places the disorder in the highest disability groupby the World Health Organisation.
It’s the fact that migraines ‘peak’ and occur more often in middle-age, when work, family and social life all take off that makes the symptoms of migraine especially impactful on quality of life — not only for the person who has the migraine, but for their loved-ones too. This can mean being in bed in a dark and quiet room for up to two days every two weeks.
2. How are migraines currently treated?
Treatment for migraines is divided generally into two methods: symptomatic treatment of migraine (also known as ‘acute’ treatment) and preventative treatment (also known as ‘prophylaxis’).
3. Symptomatic treatment of migraine
Symptomatic treatment aims to relieve the symptoms of migraine after and during its onset. Current treatments focus on painkillers such as aspirin, ibuprofen, acetaminophen, triptans, ergots and opioid medicines.
The shortcoming is that painkillers shouldn’t be taken for extended periods of time, which means they can’t be relied on as a long-term relief for chronic migraines. Extended or overuse of painkillers can lead to ulcers, gastrointestinal issues and habit formation — and that’s outside of the immediate side effects, which can include dizziness and nausea. People who take these medicines also tend to develop a need for higher and higher doses, the longer they they’re taking the medicine.
Possibly the most frustrating side effect of long-term use of painkillers is the development of medication withdrawal headaches — obviously not useful if you are already dealing with the challenge of chronic migraines.
4. Preventative treatment of migraine
Prophylactic treatment of migraines has traditionally included cardiovascular medicines such as propranolol and verapamil, antidepressants such as amitriptyline, anti-seizure medicines such as volproate and topiramate, non-steroidal anti-inflammatory drugs like naproxen and onabotulinum toxin A (botox).
Some preventative treatments also induce side effects. These can include sleepiness, dry mouth, constipation, nausea, weight loss and issues with concentration. A high price to pay for the prevention of a migraine.
For the reasons outlined above, it can be frustrating for people suffering from migraine to bear the side effects of the current forms of preventative and symptomatic treatment. People often discontinue these treatments, which may leave them with fewer and fewer options — all the more reason for an improved preventative migraine treatment.
5. So what’s new in migraine treatment?
Research and development, has shifted its focus in recent years to targeted treatment of migraine, in particular the role of calcitonin gene-related peptide (CGRP) in migraine. Much remains unknown about the role of CGRP in migraine, but one theory is that CGRP increases sensory activity during migraine, making individuals abnormally sensitive to light, smell, pain and sound. It’s also thought that CGRP causes blood vessels to expand (vasodilation) which may contribute to the pain felt during a migraine.
Multiple studies have been done on the role CGRP plays in migraine and they show that in some people there are elevated levels of CGRP during migraine attacks (though this is not the case for everyone). This led to the development of CGRP receptor antagonists: medicines that aim to prevent the uptake of CGRP by blocking their receptors.
To date, there have been multiple CGRP antagonists studied. Some were discontinued due to concerns about toxicity and challenges with administration of the medicine; while results from other studies are not yet conclusive.
Recently, however, there has been much research and evidence in the use of new targeted migraine treatments called monoclonal antibodies (mAbs). Monoclonal antibodies currently being studied include galcanezumab, eptinezumab and fremanezumab, though none of these are yet approved.
6. The first FDA-approved targeted therapy for migraine
The first CGRP receptor antagonist that received approval by the Food and Drug Administration (FDA) is erenumab (trade name Aimovig). This medicine is provided in the form of an injection, to be done by the patient.
Studies around erenumab showed a reduction in the overall number of headaches experienced by migraine patients, and less intense migraine when they did occur. Side effects were reactions at the point of injection and constipation (these were reported in 3% of the patients). You can check the full prescribing information for details about erenumab (Aimovig)7.
7. Is this targeted therapy available to you?
Erenumab (Aimovig) is currently only approved by the FDA, so may not yet be available to individuals outside of the USA. Most countries, however, allow for the importation of certain medicines on a ‘named patient basis’ for life-debilitating conditions — which migraine is considered to be.
If you suffer from chronic migraines we can help you access this medicine (or any other which is unavailable in your country). Our team organises daily deliveries of not yet approved medicines around the world, with service that’s highly rated by doctors and patients. For further assistance please contact us.
A way forward
The approval of erenumab and the study of other targeted migraine medicines presents a step forward in the development of more tolerable long-term prevention options for migraine. As research and development continues apace, we are continually tracking new developments and will update you on any new medications.
1. Russo, A. F. (2015). Calcitonin Gene-Related Peptide (CGRP): A New Target for Migraine. Annual Review of Pharmacology and Toxicology, 55, 533–552. http://doi.org/10.1146/annurev-pharmtox-010814-124701
2. D’Amico D, Tepper SJ. Prophylaxis of migraine: general principles and patient acceptance. Neuropsychiatric Disease and Treatment. 2008;4(6):1155-1167. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646645/
3. Mayo Clinic. Migraine. (Cited 11/07/2018) https://www.mayoclinic.org/diseases-conditions/migraine-headache/diagnosis-treatment/drc-20360207
4. Touch Neurology. Recent developments in the prevention and treatment of migraine. (Cited 10/07/2018) http://www.touchneurology.com/content/recent-developments-prevention-and-treatment-migraine
5. Tso AR, Goadsby PJ. Anti-CGRP Monoclonal Antibodies: the Next Era of Migraine Prevention? Current Treatment Options in Neurology. 2017;19(8):27. doi:10.1007/s11940-017-0463-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486583/
6. Drugs.com. Aimovig Approval History. Reviewed 18/05/2018. (Cited 11/07/2018) https://www.drugs.com/history/aimovig.html
7. Summary of Product Characteristics [FDA]: Aimovig (erenumab-aooe) [PDF], Amgen, May 2018.