Breaking the grip of migraines
The latest medications for pain relief show great promise for reducing the frequency and severity of attacks
By Jessica Binkley Lain
Throbbing. Stabbing. Fiery. Electric. Like being in a vice. There are many ways that migraine sufferers describe their pain, but no matter the word to describe it, having migraines is a debilitating condition that often causes significant disruption to a person’s quality of life.
“A lot of people will suffer because they don’t know there’s something better out there. But there are many options and things that we can do for patients,” said Deborah Carver-Hodges, MD, a headache specialist and professor in the Department of Neurology at the Joe R. and Teresa Lozano Long School of Medicine.
Migraines are a type of headache disorder characterized by moderate to severe pain, often presenting on only one side of the head and worsened by physical activity, Carver-Hodges explained. The pain is frequently accompanied by nausea, vomiting and sensitivity to light and sound.
The welcome arrival of triptans
The introduction of triptans in the 1990s saw the rise of a class of medication specifically created for migraine pain relief, revolutionizing acute treatment. Triptans work by blocking the pain impulses in the brain and decreasing the release of inflammatory molecules and neuropeptides, including calcitonin gene-related peptide, one of the key culprits causing migraine attacks.
Calcitonin gene-related peptide, or CGRP, is a neuropeptide found in the nervous system that plays a pivotal role in triggering migraines, Carver- Hodges explained. This peptide has been found to be elevated in migraine sufferers and even further increased during a migraine attack.
CGRP’s release in the trigeminal nerve leads to a domino effect of localized neuroinflammation and vasoconstriction in the brain, resulting in profound pain. Triptans have been shown to decrease levels of CGRP, resulting in significant relief from pain during an acute migraine attack.
Yet, it wasn’t until 2018 that preventive medication designed specifically for migraine emerged.
Innovations in preventing pain
“In the past, the only medications available to prevent migraine headaches were repurposed from other categories of drugs, like antidepressants, blood pressure medicines and anti-seizure medicines, but we didn’t have any prevention medication specifically created for migraine headaches until recently,” Carver-Hodges said.
There are two types of this new class of medicine, which either block the CGRP receptor or the peptide itself, she explained. One type are monoclonal antibodies, administered as injections, which help to prevent migraines. The other class, known as gepants, are oral tablets that provide options for both acute treatment and prevention. Both types have shown promising clinical results, with approximately 50% of patients experiencing significant headache reduction. Their efficacy, coupled with minimal side effects compared to previous treatments, marks a substantial improvement in migraine care.
“There’s a lot about these medications that give providers reason to be optimistic,” Carver-Hodges said. “One is that they are specific to migraines, focusing on the pathophysiology of migraines. Another is that, in clinical studies so far, we’ve seen that the majority of patients respond really well, having low side-effect profiles and significant improvement in their migraine frequency.”
“There’s a lot about these medications that give providers reason to be optimistic. One is that they are specific to migraines, focusing on the pathophysiology of migraines. Another is that, in clinical studies so far, we’ve seen that the majority of patients respond really well, having low side-effect profiles and significant improvement in their migraine frequency.”
-Dr. Deborah Carver-Hodges
Reclaiming quality of life
This is especially good news for chronic migraine sufferers — typically defined as people who experience 15 or more migraine headaches per month. The recent monoclonal antibodies and gepants medications reduce both frequency and severity of attacks and can greatly enhance daily functioning for those with migraine, minimizing negative impacts to their work and family life.
“If you’re having several migraines per month, or losing a week of productivity due to migraine, you should really consider starting a preventative medication. It can help reduce not only migraine frequency, but also makes the attack less severe, which can have a huge impact on your life,” Carver-Hodges said. “For now, we might not be able to get rid of your migraines completely, but we can definitely make you more functional and improve quality of life.”
Ongoing research promises further insights into migraine pathophysiology and the development of even more effective therapies, noted Carver- Hodges. By understanding the complexities of migraines, migraine sufferers can reclaim their lives from the grasp of this debilitating condition.
