While there’s currently no cure for migraine, researchers are working on better understanding what actually causes migraine attacks. Because the better they understand that, the easier it is to develop a more effective medication, and hopefully one day, a cure.
The exciting news is that after years of seeing little progress in migraine research, new treatments are now in development and drug companies are racing against each other to provide the best possible treatments.
Here’s the latest on what you need to know about migraine treatments and research:
New migraine medications
Aimovig® (a.k.a. erenumab), the first anti-CGRP treatment
Status: FDA-approved
Treatment type: Preventive injection
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Erenumab—which you probably know better by the name Aimovig®—is a new kind of migraine medication that effectively targets the CGRP (calcitonin gene-related peptide) receptor. Recent research shows that CGRP levels are higher in migraine sufferers during an attack. While they don’t know why that’s the case, they do know targeting it seems to help. We explain the science behind anti-CGRP treatment right here.
Ajovy® (a.k.a. fremanezumab), an anti-CGRP injection
Status: FDA-approved
Treatment type: Preventive injection
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
While Aimovig® was first to the market, there are several different anti-CGRP treatments currently in development and starting to make headlines. Ajovy® autoinjector (fremanezumab-vfrm) is another anti-CGRP treatment that recently received FDA approval and is now available.
Emgality® (a.k.a. galcanezumab), another anti-CGRP injection
Status: FDA-approved
Treatment type: Preventive injection
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Emgality is another FDA-approved anti-CGRP option for preventing migraine attacks. Like Aimovig and Ajovy, it’s an injection you can have your doctor give you or perform yourself, once you get comfortable. What makes Emgality different? Well, it’s the only anti-CGRP that comes in a latex-free pen—good news if you happen to have a latex allergy.
Qulipta (a.k.a. atogepant), an anti-CGRP made for episodic migraine
Status: FDA-approved
Treatment type: Preventive oral tablet
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Qulipta stands out among the pack of new anti-CGRP migraine treatments because it’s the only one made specifically to prevent episodic migraine attacks (which means they happen less often than 15 times a month). In the studies that led the FDA to approve Qulipta for migraine, participants who took the daily oral medication saw a 50-100% reduction in their attack frequency. Those results are pretty promising—plus, if you’re not a fan of needles, Qulipta is one of your only non-injectable anti-CGRP options.
Reyvow™ (a.k.a. lasmitidan), a new type of acute medication
Status: FDA-approved
Treatment type: Acute oral tablet
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Reyvow™ was approved by the FDA after two clinical studies showed it was significantly more effective than a placebo at relieving pain, nausea, and light/sound sensitivity within two hours. The studies included over 3,000 adult migraine sufferers and suggested that side effects could include dizziness, fatigue, and a burning or prickling sensation in the skin. You can learn more about Reyvow™ here.
Ubrelvy (a.k.a. ubrogepant), an acute anti-CGRP medication
Status: FDA-approved
Treatment type: Acute oral tablet
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Ubrelvy is the first CGRP antagonist to be available in pill form. That alone makes it a better fit for people who are scared off by injections and infusions, but its form isn’t the only thing that makes Ubrelvy different from Aimovig and the other older anti-CGRPs. It’s also an acute treatment, which makes it the first anti-CGRP you can take for immediate migraine relief.
Vyepti® (a.k.a. eptinezumab), an anti-CGRP IV infusion
Status: FDA-approved
Treatment type: Preventive IV infusion
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Vyepti is a lot like other CGRP antagonists in that it aims to make migraine attacks less frequent. But unlike Ajovy, Emgality, and Aimovig, Vyepti can’t be administered at home with a quick injection. Instead, you’ll need to head to the doctor for a 30-minute IV infusion. The good news is you only need to do that four times per year. Plus, according to Cove Medical Director Dr. Sara Crystal, some patients show improvement as soon as the day after the infusion.
Nurtec™ ODT (a.k.a. rimegepant), an acute anti-CGRP that melts in your mouth
Status: FDA-approved
Treatment type: Acute orally-dissolving tablet
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
The “ODT” in Nurtec ODT stands for “orally-dissolving tablet,” and that’s exactly what makes this medication stand out among the CGRP antagonists. Like Ubrelvy, it’s an acute oral medication, but the fact that it melts in your mouth makes it a better fit for people who get nauseous during attacks. Plus, each dose is effective for up to 48 hours, so you can rest easy knowing that your migraine won’t be back in the morning.
Want to learn more about Nurtec ODT from someone who had a hand in developing it? Check out our Q&A with Biohaven CSO Dr. Charlie Conway.
New forms of migraine medication
Zomig®, a zolmitriptan nasal spray
Status: FDA-approved
Treatment type: Acute nasal spray
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Zomig is a zolmitriptan nasal spray that works faster than standard zolmitriptan tablets. Other than the shorter set-in time, the medication works just like a regular triptan, so you may want to consider giving it a try if triptans work for you and you’d like to get that effect faster.
Elyxyb, an NSAID oral solution
Status: FDA-approved
Treatment type: Acute oral solution
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) that has been used to treat rheumatoid arthritis since the 1990s. So why did the FDA just approve a liquid form known as Elyxyb for acute treatment of migraine?
The answer lies in the results of two clinical trials that pitted Elyxb against placebo. Both included about 600 participants, and both showed that the medication was more effective than the placebo. In one of the studies, 35% of participants were pain-free two hours after taking Elyxb, while 56% said their most bothersome symptom was relieved. No serious side effects were reported.
Need another reason to keep your eye out for news about this drug? The oral solution form means that you can take a lower dosage than usual for NSAIDs and still get the same results — and a lower dosage can reduce your risk of unpleasant side effects.
Qtrypta™, a patch form of zolmitriptan
Status: Currently being reviewed by the FDA
Treatment type: Acute patch treatment
Effectiveness: Too soon to tell
Availability: Not on the market yet
As you know, migraine medication currently comes in a few forms: tablets, nasal sprays, and injections. Zosano Pharma’s currently testing a new delivery method—a migraine patch. In a report for KFVS 12, reporter Robbyn DeSpain says: “The system uses tiny needles coated with medication to deliver a migraine drug right into the bloodstream.” According to their website, Zosano Pharma expects the new treatment, named Qtrypta™, to hit the market in 2021.
Tosymra™, a sumatriptan nasal spray
Status: FDA-approved
Treatment type: Acute nasal spray
Effectiveness: Proven effective in clinical trials
Availability: Available with a prescription
Tosymra™ is a sumatriptan nasal spray that’s showing promising results for migraine sufferers due to its high absorption rate. An article on The American Migraine Foundation says, “The primary outcome showed that 43.8% of participants were pain-free at two hours post-dose.”
New migraine treatment devices
Nerivio®, a smartphone-operated armband
Status: Cleared by the FDA
Treatment type: Acute wearable device
Effectiveness: Works for some migraine sufferers
Availability: Available through Cove
Nerivio is an FDA-authorized migraine treatment device that uses electrical signals to relieve symptoms (and even stop an attack altogether). In one study, Nerivio lessened migraine pain within two hours for 66% of participants, and completely alleviated head pain for 37%. Want more details? Everything you need to know about the device is in our guide to Nerivio.
Nerivio is easy to use as long as you have a smartphone, and it’s easier to get than other treatment devices. You can get Nerivio delivered to your door with Cove.
Relivion, a headband-like neuromodulation device
Status: Still in development
Treatment type: Acute neuromodulation device
Effectiveness: Too soon to tell
Availability: Not yet available in the U.S.
Your first question’s probably, “sure, sure, but what’s a neuromodulation device?” Well, a neuromodulation device (also called a "neuro-modulator") is what a neuron releases to send messages across your central nervous system. Some researchers believe that migraine attacks are caused by abnormal neuron behavior. So this device would stop that abnormal behavior.
This device already exists, but in a much more invasive form called occipital nerve stimulation. The Mayo Clinic says, “The occipital nerve originates at the base of the neck. In occipital nerve stimulation, your doctor implants a small device at the base of the skull with leads connected to a power source (pulse generator) that sends electrical impulses to the occipital nerve.” As you can imagine, this is only for people who suffer from chronic migraine and don’t respond to other treatments.
An Israel company called Nuerolief is developing Relivion, a headband-like device that they claim could have the same effect, without a surgical procedure. It’s currently still in development and has not yet been approved by the FDA.
SpringTMS® (a.k.a. sTMS mini), a magnetic stimulation device
Status: Cleared by the FDA
Treatment type: Preventive magnetic device
Effectiveness: Promising, but needs more research
Availability: Available with a prescription
That’s right, a magnetic wand that never touches a patient’s head might actually work. (Nope, you didn’t just stumble into Hogwarts.) A recent study published in the Cephalagia journal showed that transmagnetic stimulation—waving a wand with magnetic waves over the brain, in order to impact the neural circuitry—could work to prevent migraine attacks.
gammaCore, an electrical device
Status: Cleared by the FDA
Treatment type: Acute electrical device
Effectiveness: Promising, but needs more research
Availability: Available with a prescription
Vestibular migraine, a type of migraine that causes intense vertigo with or without head pain, are notoriously difficult to treat. Pain relievers don’t treat dizziness, and medications for vertigo often make sufferers too drowsy to go about their day.
According to a new study published in Neurology, the electrical device gammaCore, which is already approved for the treatment of typical migraine attacks, might provide new hope for vestibular migraine sufferers. The handheld device works by stimulating the vagus nerve, one of many nerves that send messages back and forth between your brain and your body. “Stimulating the vagus nerve appears to calm down centers in the brain that cause migraine and vertigo,” Dr. Shin Beh, the study’s lead researcher, said.
Of the 14 participants treated for vestibular migraine in the study, 13 said their symptoms improved and two said their vertigo disappeared completely. Participants who experienced head pain along with dizziness said the device relieved their headache too. Results like these are hard to ignore, especially for a condition as overlooked as vestibular migraine, but it’s difficult to draw firm conclusions from such a small study.
So, what’s the big takeaway here? The medical community’s (finally) taking migraine seriously and they’re spending a lot of money to understand them better and find better treatments.
If you’re looking for an effective treatment plan today, get started with Cove. We provide affordable treatment plans that are personalized for every single patient. And, in addition to that, we do everything online. That means you can connect with a licensed doctor from the comfort of home. Start your consultation now.
Disclaimer
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Nerivio should not be used by people with congestive heart failure, severe cardiac or cerebrovascular disease, or uncontrolled epilepsy. Nerivio should not be used by anyone with active implantable medical devices (e.g. pacemaker, hearing aid implant). It should only be applied on the upper arm over dry, healthy skin with normal physical sensation. Nerivio should not be used directly over or in close proximity to any metallic implants or cancerous lesions. Nerivio has not been evaluated in pregnancy or those under the age of 18. For full use instructions and safety information, please see the Nerivio User Manual. Click here for the QuickStart guide.
Tosymra (sumatriptan nasal spray) is a prescription medicine used to treat acute migraine headaches with or without aura in adults. Tosymra is not used as a preventive treatment for migraine. Do not use Tosymra if you are allergic to sumatriptan; are taking monoamine oxidase (MAO)-A inhibitors; or have a history of heart problems, peripheral vascular disease, uncontrolled high blood pressure, severe liver problems, problems with blood circulation (or a history of stroke), or hemiplegic or basilar migraines. Do not take Tosymra within 24 hours of any other triptan or ergotamines. Tell your doctor if you have any risk factors for heart disease, such as high blood pressure, high cholesterol, obesity, or diabetes. Before taking Tosymra, tell your healthcare provider about any other medications you are taking. Tosymra can cause serious side effects, including heart attack and other heart problems, which may lead to death. Stop Tosymra and get emergency medical help if you have any signs of heart attack. Call your doctor right away if you experience discomfort in the center of your chest; severe tightness, pain, or pressure in your chest, throat, neck, or jaw; pain or discomfort in your arms, back, neck, jaw, or stomach; shortness of breath; cold sweats; nausea or vomiting; lightheadedness; fast heartbeat; seizures; signs of an allergic reaction like hives, itching, rash, or swelling of the face, lips, or tongue; mental changes such as hallucinations or irritability; or if your headaches get worse. Don’t drive or use machinery until you know how this medicine affects you. You can read more about Tosymra’s side effects, warnings, and precautions here and see instructions for use here. Full prescribing information for Tosymra is available here. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Photo by Kelsey Chance on Unsplash
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Nerivio should not be used by people with congestive heart failure, severe cardiac or cerebrovascular disease, or uncontrolled epilepsy. Nerivio should not be used by anyone with active implantable medical devices (e.g. pacemaker, hearing aid implant). It should only be applied on the upper arm over dry, healthy skin with normal physical sensation. Nerivio should not be used directly over or in close proximity to any metallic implants or cancerous lesions. Nerivio has not been evaluated in pregnancy or those under the age of 18. For full use instructions and safety information, please see the Nerivio User Manual. Click here for the QuickStart guide.
Tosymra (sumatriptan nasal spray) is a prescription medicine used to treat acute migraine headaches with or without aura in adults. Tosymra is not used as a preventive treatment for migraine. Do not use Tosymra if you are allergic to sumatriptan; are taking monoamine oxidase (MAO)-A inhibitors; or have a history of heart problems, peripheral vascular disease, uncontrolled high blood pressure, severe liver problems, problems with blood circulation (or a history of stroke), or hemiplegic or basilar migraines. Do not take Tosymra within 24 hours of any other triptan or ergotamines. Tell your doctor if you have any risk factors for heart disease, such as high blood pressure, high cholesterol, obesity, or diabetes. Before taking Tosymra, tell your healthcare provider about any other medications you are taking. Tosymra can cause serious side effects, including heart attack and other heart problems, which may lead to death. Stop Tosymra and get emergency medical help if you have any signs of heart attack. Call your doctor right away if you experience discomfort in the center of your chest; severe tightness, pain, or pressure in your chest, throat, neck, or jaw; pain or discomfort in your arms, back, neck, jaw, or stomach; shortness of breath; cold sweats; nausea or vomiting; lightheadedness; fast heartbeat; seizures; signs of an allergic reaction like hives, itching, rash, or swelling of the face, lips, or tongue; mental changes such as hallucinations or irritability; or if your headaches get worse. Don’t drive or use machinery until you know how this medicine affects you. You can read more about Tosymra’s side effects, warnings, and precautions here and see instructions for use here. Full prescribing information for Tosymra is available here. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.
Photo by Kelsey Chance on Unsplash
