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Finding the Right Chronic Migraine Treatment

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New Medications May Reduce Migraine Frequency

Medically Reviewed By William C. Lloyd III, MD, FACS
Young African American female patient talking to young Asian American female doctor looking at tablet

If you suffer from frequent migraine-type headaches and haven’t found migraine relief with any of the preventive medications you’ve tried, there’s good news for you. The Food and Drug Administration (FDA) has approved three new migraine treatments in 2018 that may drastically reduce the number of headaches you experience.

One of the new migraine drugs, called Aimovig (erenumab), has shown significant results for patients who have episodic migraines as well as those who have chronic migraine—diagnosed when a person has at least 15 headaches per month, eight of which have the symptoms of migraine. Two other migraine drugs—Emgality (galcanezumab-gnlm) and Ajovy (fremanezumab-vfrm)—were approved by the FDA in September 2018 to prevent migraines and also showed significant results in reducing headache days every month.

Research and Results

Each of these migraine drugs underwent two or more stringent clinical trials involving about 2,000 or more people with either episodic or chronic migraine. During the trials, some people took a placebo while others were given the new migraine drugs. Aimovig comes in either 70 mg or 140 mg monthly doses. Emgality is a 120 mg monthly dose, and Ajovy requires a 225 mg monthly dose or a 675 mg dose every three months. A patient taking any of these drugs will inject them subcutaneously—under the skin.

Nearly half of patients who took Aimovig at the 70 mg dose experienced 50% fewer days with migraine per month, and half of patients who took the 140 mg dose had 50% fewer migraines. Patients in the Emgality and Ajovy clinical trials experienced similarly successful reductions in headache days.

Even better news is these results are averages. The FDA required that a significant percentage of people experience a reduction in migraine frequency before approving the new migraine drugs. But researchers say some patients who take these new migraine medications will see much greater migraine relief, with some even having no headaches at all.

How New Migraine Drugs Reduce Migraine Frequency

Aimovig, Emgality and Ajovy all use a human monoclonal antibody. These drugs cut back on migraine frequency by binding to receptors for the neuropeptide, calcitonin gene–related peptide (CGRP). Researchers think CGRP may cause headaches due to its connection to the body’s inflammatory processes. By suppressing CGRP-receptor function, the new migraine treatments are able to reduce the number of headache days many patients experience.

Other Preventive Migraine Treatments

Preventive treatment is always the goal for people who experience five or more migraines per month. Patients take these drugs every day to prevent migraine attacks.

Medications already on the market that work for some people include:

  • Blood pressure medications, such as beta-blockers and calcium-channel blockers
  • Antidepressants
  • Anticonvulsants
  • Serotonin antagonists
  • Botox injections (for chronic migraine only)
  • Combinations of vitamins, magnesium salts, and herbal remedies

However, not everyone who tries these preventive migraine treatments finds one that is effective. Many of these migraine medications also come with side effects, which some people might not tolerate well. As for Aimovig, Emgality and Ajovy, the most common side effect people reported after using the drugs during clinical trials were reactions at the injection site.

Potential Risks of CGRP Suppressors

Because these drugs have been in use for only about three years during clinical trials, long-term effects of the medications are unknown at this point. Researchers note there are some safety concerns because CGRP works in many body processes, particularly neurovascular processes. It is possible suppression of CGRP may increase the risk of stroke and heart attack; however, researchers haven’t seen any negative effects in usage so far.

It’s always a good idea to discuss all potential risks and benefits of new medications with your doctor. Your doctor will consider your entire health history and family’s medical history in making recommendations for you.

Many people with migraines experience debilitating pain that interferes with their daily life, causing them to miss work or other activities. But with this these new migraine treatments and others in development, researchers are hopeful more people will find relief.

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    of erenumab for episodic migraine. N Engl J Med. 2017;377:2123–32.
  2. FDA approves novel preventive treatment for migraine. U.S.
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  3. Reinke T. Aimovig for Migraine Prevention: The New Kid May
    Have Trouble Fitting in. Managed Care. 2018 Jul;27(7):10-11.
  4. Preventive Treatments. American Migraine Foundation.
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  6. What
    to Know About the New Anti CGRP Migraine Treatment Options. American Migraine
  7. Lilly's
    Emgality™ (galcanezumab-gnlm) Receives U.S. FDA Approval for the Preventive
    Treatment of Migraine in Adults. Eli Lilly and Company.
  8. Teva
    Announces U.S. Approval of AJOVY™ (fremanezumab-vfrm) Injection. Teva
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  9. FDA Approves Fremanezumab (Ajovy) for Migraine Prevention.

Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 21
View All Finding the Right Chronic Migraine Treatment Articles
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