New Migraine Treatments: What are they and How do they work?

28 March, 2022  |  Camran Khan

Based on recent advances in science, patients who suffer from migraines now have some of the best medication for migraines. Today, the broad range of new and alternative migraine treatments is the result of several new migraine-specific medications in recent years. If you suffer from migraine headaches, you should know what your options are and the possible benefits and risks of each option.

The new treatments that are available for migraine sufferers are good news for many patients with acute migraine. Before developing the migraine-specific class of drugs,  many patients were unable to get enough relief from their migraines, despite trying many older medications.

Because most of the medications used to treat migraines were created for other disorders such as epilepsy, the new class of drugs has the benefit of providing neurologists and other health professionals a better justification for approaching migraine treatment. The latest migraine drugs are specially designed to target pathophysiologic pathways in the brain that are involved in causing a migraine headache. These newer medications have the benefit of providing more significant pain relief while having fewer side effects. 

Older Migraine Treatments 

In the past, when health professionals had to treat migraine patients, the usual treatment was to prescribe medicines made to treat blood pressure problems or seizures. They prescribed these medications because they were moderately effective at lessening the pain of a headache. The drawback of such medications to migraine patients was that they did not work for everyone. They either gave partial relief or had no effect on migraines at all. This is why the invention of new drugs designed to deal with migraines are so important.  

Overview Of New Migraine Medications:

CGRP Inhibitors

Calcitonin gene-related peptide (CRGP) inhibitors are a recently developed class of preventive drugs that are a great new tool for preemptively stopping a migraine headache from occurring. CRGP inhibitors have monoclonal antibodies for migraine treatment that disrupts a brain pathway responsible for migraine headaches. 

Patients used to stop taking the older migraine medication due to the adverse side effect. However, the newer CRGP inhibitors have been received differently, and patients are starting to request them for treatment instead of other options. They are practical, and CGRP inhibitors side effects are minimal, which makes them easier for patients to take regularly.

The names of the particular CGRP migraine treatment are Erenumab, Galcanezumab and Fremanezumab. These CGRP inhibitors work by blocking the function of the antibodies that are involved in the migraine process. 

Erenumab stops these antibodies by binding themselves to the CGRP receptor, preventing the antibodies from binding themselves and causing a migraine. Fremanezumab, in comparison, works by attaching itself to the CGRP ligand.

These medicines come in the form of injectables and are administered to migraine patients once every three months. Erenumab has the possible side effect of constipation or hypersensitive reactions as side effects. Galcanezumab has fewer side effects, and it is also approved for treating cluster headaches.

A 4th CGRP migraine treatment is called Epinezumab, which works by binding itself to the CGRP ligand. It can be administered intravenously for preventing migraines. However, it was only recently approved for use in the United States, so most doctors are still not familiar with treating migraine headaches.

The FDA's clinical trials of CGRP inhibitors as part of their safety assessment showed that it effectively treated migraines for 50% to 60% of patients. While the possible long term side effects of CGRP inhibitors are unknown at the moment, they have shown a good safety profile so far, with far fewer side effects than other medications.

New Acute Therapies

A new class of oral medications has been invented recently. This class of drugs is called 'gepant', and Ubrogepant is the first medicine that has been developed in this class. Ubrogepant is a small molecule that works as a CGRP receptor antagonist. It was approved for use in migraine treatment in December of 2019. Unlike triptan medications, which have been chiefly used to lessen headaches' pain by constricting the blood vessels in the brain, this drug works to alleviate the pain of a headache without constricting blood vessels. This means that it is safer to treat headaches for patients with a history of heart disease or stroke, factors that made using triptans unsafe.

Another gepant class drug that was recently developed is Rimegepant, a dissolvable tablet approved for treating migraines. This drug also works without constricting blood vessels, making it a safe and more practical option for patients at risk of heart problems or stroke. Rimegepant has a half-life of 11 hours and is prescribed for use only when needed. 

Have Older Migraine Drugs Become Obsolete?

While these new medicines are an attractive option for treating migraines, they are still out of reach for people who cannot afford their high cost. As a result, triptans are still a popular option, and most insurance companies cover the cost of triptans while the new medications are not as readily covered. 

To determine which medication to take, assess the price and do a cost-benefit analysis, comparing it with the side effects of less expensive drugs.

Studies on using the newer classes of drugs are still being done. However, it may be possible in consultation with a doctor to take the new drugs in combination with older medications for effective migraine prevention therapy. 

Migraine can be a complicated condition, and some medications work for some patients, while others don't. It is up to the patient and their health provider to work together to determine which treatment will be effective and safe for individual patients.

If you or someone you know is suffering from migraine headaches, it is vital to learn about these new medications and their higher safety profile compared to other medicines. But ultimately, the patient and the doctor will have to decide which treatment is best for that patient. At IQ Doctor, we provide a free online consultation and offer a wide range of triptan class migraine medications.