New drugs, device offer help for migraine sufferers
Dr. Dolores Santamaria
Another new development to battle migraines is Nerivio, a smartphone-controlled armband that delivers electrical impulses to prevent symptoms.
The FDA approved the use of Nerivio in February.
Nerivio is a smartphone-controlled armband that delivers electrical impulses to inhibit migraines and associated symptoms.
If you suffer from migraines, you are in good company. Nearly 40 million Americans are affected by these painful, often debilitating headaches. Treatment used to consist of popping over-the-counter pain medication, putting a cool cloth on your head and lying in a darkened room to wait for relief.
Those were the old days, however, and recent years have brought new treatments including some that don’t involve medication.
What causes migraines and how do they differ from everyday headaches? Migraine is not just a headache but a complex neurological disorder in which the brain overreacts to certain triggers. Those triggers can include hormonal and lifestyle changes, stress or certain food and drinks leading to a cascade of symptoms severe enough to disrupt your daily life.
“There is a strong genetic predisposition, so if one parent has it, there is a 50% chance that someone down the line will have it,” says Dr. Dolores Santamaria, Director of the Allegheny Health Network (AHN) Headache Center. She says the goal is to discover new neurological pathways to block those responses and make those genes dormant.
Migraines are characterized by a throbbing headache on one side of the head and can also be accompanied by nausea and sensitivity to light – but not always. The confusion over migraine symptoms means many people who think they have tension headaches actually have migraines, or people who think they have sinus headaches actually have migraines. Migraines can worsen with physical activity, lights, sounds or even certain smells and can last for hours or even days.
“So many patients have been misinformed and mistreated and started to believe that they have to endure their pain and disability forever as they tried and failed so many treatments in the past,” Santamaria said. “There is hope, and all should have an opportunity to explore migraine-specific treatments. This is why American Headache Society is now talking about the paramount shift from old broad-spectrum treatment to those designed to treat migraine.”
New treatment options
That hope, in part, comes from new treatments recently approved by the U.S. Food and Drug Administration (FDA).
Historically, migraines have been managed through triptans, a class of drugs introduced in the 1990s specifically to treat migraines. New oral medications, injectable therapies, nasal sprays and even wearable devices now give patients more treatment options to fight pain and live migraine-free.
“We’re entering a new era of treatments,” says Santamaria. “Thirty years ago, patients might have taken a few over-the-counter pills and hoped for the best. But today, migraine treatments have changed dramatically. We now have new classes of drugs and new non-pharmacological therapies that have shown significant efficacy in migraine prevention and are true game changers for patients experiencing chronic primary headache pain.”
Earlier this year, the FDA signed off on Zavegepant, a new nasal spray that targets acute migraines. It can be an effective tool for patients who don’t tolerate oral medication or whose nausea during a migraine makes it tough to take pills. In 2020, the FDA approved Nurtec, which is the first oral calcitonin gene-related peptide (CBRP) antagonist aimed at acute and preventative migraine pain. In 2018, the FDA approved erenumab injection, which is the first monoclonal antibody therapy to block CGRP proteins from reaching the receptors that trigger a migraine. That approval was followed by several others in a new class of drugs specifically designed to treat migraine by targeting CGRP, a substance that was discovered to be elevated in blood serum during migraine attacks.
“The New Era of Migraine treatments refers to CGRP, which will block the most potent dilator of peripheral and cerebral blood vessels preventing migraine attacks,” explained Santamaria. “The most specific treatments known since 1992 are triptans, which includes Sumatriptan. These drugs will help with the attack. However, they are not to be used as preventive therapies. The new categories can be used to abort the attack as well as to prevent it.”
Another new development is Nerivio, a smartphone-controlled armband that delivers electrical impulses to inhibit migraines and associated symptoms. The FDA approved its use in February.
“Nerivio is used remotely to activate ascending neuronal pathways through the brainstem to prevent and abort migraine attacks,” Santamaria said. “It can be a good choice for those patients who are not keen on pharmacological therapies. It is also safe to use in pregnancy and can be considered a safe and effective treatment.”