Medications developed over the past few years to treat migraines are significantly improving the quality of life for those with the debilitating condition, according to an expert from global health system Cleveland Clinic.

 

“Before 2018, when the FDA-approved the first calcitonin gene-related peptide (CGRP) inhibitor to prevent migraines, we had to rely on medications originally designed to treat other diseases, says Emad Estemalik MD, MBA, Section Head for Headache and Facial Pain at Cleveland Clinic’s Neurological Institute. “Today, however, there are several CGRP inhibitors available that have been developed to prevent or to relieve the symptoms of migraines specifically.” 

 

Dr Estemalik says that for many patients, the new drugs are life-changing as a migraine is a debilitating neurological disorder with no cure. “Migraines are far more debilitating than other headaches and can last anywhere from four to 72 hours. Symptoms can include pain, tiredness, nausea, visual disturbances, numbness and tingling, irritability, difficulty speaking, temporary loss of vision and more,” he says. “Migraines are also prevalent, with around 16-20% of women and 6-8% of men suffering from them on a regular basis.”

 

Migraine triggers

Medications are only one part of an effective treatment plan, Dr Estemalik points out. “The first step is to identify and avoid an individual’s specific migraine triggers. These vary from person to person, and common examples include certain food types, dehydration, poor sleep, movement, light, sound and caffeine withdrawal. Next, we will need to address any comorbidities that can predispose a person to migraines. These comorbidities include, for example, obesity, anxiety and depression and sleep disorders. Finally, if the migraines persist or are very severe, we consider pharmacological interventions.”

 

Traditionally, pharmacological interventions are categorised as either preventative, which aims to reduce the frequency and severity of the migraine, or abortive, which provides relief when a patient is experiencing a migraine attack. The good news, says Dr Estemalik, is that in the past five years, eight new prescription preventative and abortive medications have been approved for use by the FDA, greatly expanding treatment options.  

 

“Historically, the medications available for migraine prevention were those initially developed to treat seizures, high blood pressure, depression and other conditions; as well as therapies such as onabotulinumtoxinA, which paralyses certain head and neck muscles to help prevent chronic migraines,” says Dr Estemalik. “For abortive action, we had only three classes of medication, namely, over-the-counter pain relievers, ergot alkaloids and the triptan family of medicines.” 

 

CGRP inhibitors

Dr Estemalik says that since 2018, two types of CGRP inhibitors have been FDA-approved for treating migraines – CGRP monoclonal antibodies aimed at prevention and small molecule CGRP antagonists for abortive and preventive action. “The advantages are that these medications work quickly, are highly effective, have few side effects, and they come in different formats – some are injections while others are oral pills, infusions or nasal sprays,” he says.  

 

Describing the mechanisms behind CGRP inhibitors, Dr Estemalik explains that CGRP is a sensory neuropeptide that exists in the brain’s trigeminal ganglion and has been found to have a correlation with migraine pain and other symptoms. CGRP inhibitors help prevent or stop a migraine attack by either blocking CGRP itself, or blocking the ligand or receptor in the brain to which CGRP binds.

 

“With these advances in drug development as well as emerging therapies such as neuromodulation – a non-invasive technology that acts directly on the nerves – patients’ quality of life improves enormously. In some cases, a quarterly infusion or daily pill might be all a patient needs to prevent migraines,” Dr Estemalik concludes.-- TradeArabia News Service