July 01, 2019

Migraine prevention medications — A new era

A new era of specific migraine treatments is dawning. Advancing research is unraveling many of the complex pathways that can contribute to migraines. This has provided new targets for therapy, including a protein called calcitonin gene-related peptide (CGRP) that's released during a migraine attack.

In 2018, three similar medications — erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) — were approved by the Food and Drug Administration to reduce monthly headache days through the reduction of CGRP activity. In numerous studies involving many people — mostly people with frequent migraines and limited treatment options — about 40% to 50% of those taking the drugs experienced at least a 50% reduction in migraine frequency. Put another way, for people with 12 migraine days a month, there was about a 50% chance that the drug would reduce this to six or fewer monthly migraines. Not everyone responds to these drugs, but some people had a more dramatic response than described above.

The medications are injected beneath the skin monthly or quarterly. So far, the main side effect appears to be irritation at the site of injection, with constipation as a potential side effect of erenumab in some of people.

Mayo Clinic migraine experts are using these medications in people with frequent and debilitating migraine attacks. They emphasize that CGRP inhibitors only target one pathway of a complex brain disease and won't be helpful for everyone. However, they're excited to have an expanded toolbox for migraine treatment — with tools specifically designed for the job.