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A New Class of Migraine Medications Takes the Stage

New medications specifically for migraine headaches

CGRP Blockers show impressive results


By Paula Mendes, MD
Neurology
Boulder Medical Center

As migraine sufferers know, there are several medications that are commonly used to reduce the frequency of headaches. These fall into several broad classes:

    • Anti-hypertensive medications (blood pressure control drugs)
    • Anti-depressants
    • Anti-seizure drugs
    • Botulinum Toxin

Not a single one of these drug types was developed specifically for migraine, though an estimated 39 million Americans (one billion people worldwide) suffer from this disease.¹  While it’s fortunate that headache specialists are able to “borrow” such drugs for use with their patients, the medications are of varying effectiveness in preventing migraines, and may come with undesirable side effects (weight gain, sleepiness etc.). Importantly, these medications also may prove ineffective when a patient is rebounding (see my post on medication rebound).

Now for the (very!) good news: A new class of medications specifically developed for migraine has made its debut. I was pleased to participate in clinical trials for this new class of drugs, which are referred to collectively as Calcitonin Gene-Related Peptide (CGRP) Blockers. While an explanation of the science behind CGRP Blockers is beyond the scope of this post,²  suffice it to say that they target an entirely different physiological pathway and have shown extremely impressive results.

In the majority of cases they reduce the frequency of migraines by as much as 50 percent. While long-term data across a broad population of users is not yet available, patient experiences so far have been quite promising, and I’ve seen many positive outcomes with my own patients. In fact, CGRP Blockers are the most exciting new migraine treatment approach I’ve seen in many years. Three pharmaceutical companies currently offer CGRP-oriented medications.

From a lifestyle point of view, using CGRP Blockers can be quite a bit easier than using the older drugs. For one thing, these medications typically do not require you to take a daily dose; they are administered through a once-monthly subcutaneous injection. And the side effects of CGRP Blockers are often more minor and more tolerable than those of traditional therapies. Unlike other medications, there are no known drug interactions.

As always, it’s wise to consult with a headache specialist to determine whether it makes sense to pursue a different therapy for your migraines. It’s worth remembering that CGRP Blockers are new to the market, and while extensive clinical trials have been done, it will take time to accumulate the sort of broad-based, longitudinal data on efficacy and long-term side effects that is available for the older drugs. This too must be weighed in making treatment decisions. Your doctor can talk this through with you and can share the latest information on this promising new class of migraine medications.

Sources:
¹ Migraine Research Foundation, retrieved in August 2019
² Those interested in the underlying science can learn more from this paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612904/


About Dr. Paula Mendes
Neurologist

As a Board Certified Neurologist with over two decades of experience, Dr. Paula Mendes (pronounced MAIN-geez) addresses the full spectrum of adult neurology, including headache. She completed a three-year neurology residency at the Mayo Clinic and spent another year at the Jefferson Headache Center at Thomas Jefferson University Hospital, where she finished her subspecialty in headache medicine. Dr. Mendes welcomes patients to her clinic in Boulder, Colo.

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