What’s New in the Treatment of Migraine?

By: Taryn Smith, MD Posted on July 24, 2019

What’s New in the Treatment of Migraine?

If you are like many women you either suffer from migraines or know someone who does.

Patients with migraine usually experience a severe, throbbing headache that is often on one side of the head. Attacks can be associated with nausea, vomiting and sensitivity to light and/or sounds. These symptoms can last for several hours or even a few days!

What are the types of Migraines?

There are multiple types of migraines. In general migraines are broken up into the following categories:

  • Migraine with aura: Auras are sensory disturbances that can include tingling in the face or hands or temporary visual disturbances like blind spots or flashing lights. Aura can occur with migraines or independent of the headache.
  • Migraine without aura: This is when there is no aura associated with the migraine.
  • Episodic migraine: Episodes occur less than 15 times per month.
  • Chronic migraine: Episodes occur more than 15 times per month for at least 3 months. At least 8 headaches per month must display typical migraine features.

What are the types of Migraine Treatments?

Additionally, treatment options for migraine can also be broken up into the following categories:

  • Abortive therapy: This class of medication stops migraines once they occur. These include: 
    • NSAIDs and over-the-counter pain medicines (Ibuprofen like Motrin®, Acetaminophen/Tylenol®, Excedrin® a combination of aspirin, caffeine and acetaminophen)
    • Prescription medications like Dihydroergotamine (DHE) and various triptans (i.e., sumatriptan/Imitrex®, Zomig®, Maxalt®, Relpax®, Frova®)
  • Prophylactic therapy: This class of medication is used for chronic migraine sufferers to stop migraines from happening. These include:
    • OnabotulinumtoxinA (Botox®)
    • Topiramate (Topamax®)
    • Propranolol (Inderal®) or similar, Divalproex sodium (Depakote®)
    • Venlafaxine (Effexor®) 
    • Dietary supplements (B-complex vitamins including riboflavin (B2) and magnesium) 

New Migraine Treatments

In the last several years, we have seen the addition of multiple new therapies for the treatment of migraine. For the migraine sufferer, these advances can be life-changing.

Botox® (Onabotulinumtoxin A)

Botox is used for prophylactic treatment of chronic migraine. It works by blocking neurotransmitters that transmit pain signals to the brain. Each treatment session consists of a series of 31 injections around the head and neck. Sessions are spaced out every 12 weeks and usually take 10-15 minutes to complete.

Common side effects
  • neck pain
  • headache
  • eyelid drooping
  • muscle weakness
  • stiffness
  • pain or spasm
  • injection site pain
Serious side effects
  • weakening of muscles leading to difficulty swallowing
  • breathing or speaking
  • blurred vision
  • loss of voice
  • loss of bladder control
Contraindications 
  • infection at injection site
  • allergy to botulinum toxin

Aimovig® (Erenumab)

Aimovig® was the first medication in its class to be approved by the U.S. Food and Drug Administration to prevent both chronic and episodic migraine. Aimovig is a once, monthly injection that blocks the neurotransmitter calcitonin gene-related peptide (CGRP) in the brain.

Common side effects
  • Constipation
  • injection site reaction
Contraindications
  • Aimovig should be avoided in people who are allergic to erenumab.

Ajovy® (Fremanezumab)

Ajovy® like Aimovig®, is a CGRP antagonist for the prevention of migraine headache. Ajovy® is available in two doses which allows for monthly or quarterly injections.

Common side effects
  • injection site reaction
Contraindications
  • Ajovy® should be avoided in people who are allergic to fremanezumab

Emgality® (Galcanezumab)

Emgality® is another once, monthly injectable CGRP antagonist. Unlike Aimovig® and Ajovy®, Emaglity® can be used for prevention of migraine headache and the treatment of cluster headache.

Common side effects
  • injection site reactions
Contraindications
  • Emgality® should be avoided in people who are allergic to galcanezumab

New Non-Medication Treatment for Migraine

Nerivio Migra

Nerivio Migra is a wearable, electronic device used for treatment of acute migraine. This device is worn on the upper arm during acute migraine attacks. Using smartphone enabled technology, the device relieves migraine through electronic pulses that block pain. This device is not used for chronic migraine suffers. It is a good option for those with episodic migraine who do not tolerate the side effects of medications.

Common side effects
  • Sensation of warmth
  • arm pain
  • redness
  • numbness

Nerivio Migra is expected to be on the market later this year.

If you suffer from migraine headaches check with your doctor to see what option is best for you!

Be Strong. Be Healthy. Be in Charge! 

Taryn Smith, MD
Senior Fellow, Specialized Women’s Health
Center for Specialized Women’s Health


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