A new treatment is giving migraine sufferers their lives back
Those who suffer from migraines can attest to just how debilitating they can be. These severe, often one-sided, throbbing headaches can result in light and sound sensitivity, nausea and/or vomiting, vision changes, fatigue, among other symptoms – all of which severely disrupt a person’s normal routine.
Migraines peak between the ages of 20 to 40 years old, occur more often in women than men and tend to be genetic. For years, migraine treatment options left patients with medication side effects. I’ve had patients tell me the side effects are sometimes worse than the migraine pain itself. For those who opted to try migraine preventive medication, they were prescribed drugs intended to manage other conditions, such as seizures, blood pressure and depression. While effective, the adverse side effects often limited a patient’s ability to get to effective doses, leading to poor migraine management.
For the first time in 30 years, a new drug class known as the CGRP-Antagonists (calcitonin gene-related peptide) has emerged. These medications are proving to be highly effective for migraine treatment without the unpleasant side effects. They block the signaling protein CGRP, which plays a crucial role in migraine pathophysiology.
We all have CGRP in our body. It is responsible for tasks including healing, digestion and inflammation. But in the context of migraines, CGRP dilates blood vessels and transmits pain signals. When a patient is actively experiencing a migraine, CGRP levels in the blood increase. When CGRP is given to migraine patients, it can trigger a migraine. These findings have led to targeting CGRP for the treatment of migraine. The medications can be taken orally, injected monthly or infused via IV every three months, depending on which medication.
Anyone 18 years and older who suffers from migraines may be a candidate for these medications. However, it’s important to establish what we call good headache hygiene before discussing medications with your doctor. Migraine brains like routine, so going to bed and waking up at the same time each day is key. I also recommend avoiding triggers such as acute stressors, scents, food triggers and certain lights. Unfortunately, triggers such as weather and hormones are uncontrollable.
From there, we discuss rescue (what to take when pain starts) and prevention treatments with the goal of decreasing the frequency, severity and duration of migraine attacks. Everyone with migraines should have a good toolbox of rescue treatments. Not every patient needs migraine prevention, but they are typically a good candidate if they experience four or more headache days per month or two severe headache days per month, if they are missing work or activities with friends and family, or if they are running out of rescue tools each month.
The longer migraines go untreated, the more frequent and unresponsive to treatment they can become. Migraine is a disease of the brain. Do not hesitate to reach out to your doctor if you are suffering.
Dr. Ashley Holdridge is a neurologist at Aurora Health Care.
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