Migraine Treatments on the Horizon

New knowledge about the biology behind migraine attacks means improved therapies

When it comes to treating migraines, major advancements have been made in recent years. Traditionally, migraine treatments consisted of medications approved for other conditions, but now there are drugs specifically indicated to treat and prevent multiple forms of migraine.

If you experience recurrent migraines, you can rest easy knowing there are several newer options to choose from and that scientific evidence about treating this condition continues to evolve.

Young woman having severe headache
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Novel Anti-Migraine Medications

A number of migraine medications that work in novel ways are being developed, and some have been approved by the Food and Drug Administration (FDA). Trying these medications may be a good option for you if you have not experienced relief or if you have had side effects with other migraine medicines.

Reyvow

Reyvow (lasmiditan) was approved by the FDA in late 2019 for treating acute migraine attacks. Although this medication works by targeting the hormone serotonin just like the mainstay migraine treatments, such as triptans and dihydroergotamines, it does not induce vasoconstriction (blood vessel constriction).

This difference means Reyvow is safer for people who have certain heart conditions, including a history of heart disease, stroke, peripheral vascular disease, or uncontrolled high blood pressure.

Calcitonin Gene-Related Peptide (cGRP) Blockers

Calcitonin gene-related peptide (cGRP) is a protein that affects pain, inflammation, and blood vessel activity. During a migraine attack, cGRP is released from trigeminal nerve endings, triggering inflammation.

The FDA has approved several medications that regulate cGRP in the body: cGRP antagonists, which are used to prevent migraines, and cGRP inhibitors, which are used to treat in-progress (acute) migraines.

One of these drugs, Nurtec ODT (rimegepant), has been approved to both treat and prevent migraines. Nurtec ODT is the first and only medication approved for both purposes.

PACAP38 Receptor Blockers

A relatively new approach to migraine treatment involves targeting the pituitary adenylate cyclase-activating peptide-38 (PACAP38) receptor. This peptide is believed to induce migraines, possibly through a mechanism of vasodilation (widening of the blood vessels) in the brain as well as inflammation.

Current animal and human studies evaluating the possibility of targeting the PACAP38 receptor for migraine therapy are underway.

Devices for Migraine Therapy

Several devices have been approved by the FDA for migraine treatment. These options use external electrical stimulation to prevent or treat migraines.

There is some evidence that disruption of electrical activity in the brain may be an early event in a migraine. The idea behind these devices is that they may alleviate altered electrical activity, preventing or reducing the symptoms of a migraine.

Cefaly

A device called Cefaly targeting the supraorbital nerve, which mediates pain sensation in part of the forehead, scalp, and upper eyelid, is approved to treat patients with migraine with and without aura. This battery-operated device is worn like a headband and can be used during an acute migraine attack or daily for migraine prevention.

Nerivio

Nerivio is the first FDA-approved, smartphone-controlled, prescription wearable device for acute migraine treatment of episodic or chronic migraine with or without aura. 

Nerivio is a wearable device that deploys remote electrical neuromodulation (REN). It works by stimulating small nerves in the upper arm. The message from the arm is transmitted up to a pain regulation center in the brainstem. This process results in pain relief that can end the migraine attack.

Nerivio is a band worn on the upper arm, and users can increase the intensity of the treatment with an accompanying smartphone app.

GammaCore

This non-invasive vagus nerve stimulation (nVNS) device can be used to treat acute migraine attacks. It is held against the side of the neck for approximately two minutes after applying a conductive gel, and it works by stimulating the vagus nerve.

Spring Transcranial Magnetic Stimulator (sTMS)

A third device called the Spring transcranial magnetic stimulator (sTMS) is FDA-approved for treating migraine with aura. You use this by applying the device to the back of your head and pressing a button, which releases stimulating magnetic energy into the brain. It is believed to work by suppressing cortical spreading depression, a wave of electrical activity that sweeps across the brain during a migraine.

A Word From Verywell

As you manage your migraines over the years, you may find a lifestyle and medication regimen that works for you. However, if you are not experiencing relief of your symptoms, or if you have side effects, then it may be worth trying new and emerging treatment options. You may even consider talking with your doctor about the possibility of participating in a clinical trial.

Migraine Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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