Migraine Treatments on the Horizon

New knowledge about the biology behind migraine attacks means improved therapies

Migraine therapy has seen advances in recent years, and emerging treatments are on the horizon. If you experience recurrent migraines, you will be seeing some new options to choose from, which will increase the chances that you will find the best fit for you.

Young woman having severe headache
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Triptans Delivered Uniquely

There are seven types of triptans, which is a category of prescription medications used for the treatment of acute migraine episodes. Triptans are already available in a variety of different formulations, including tablets, oral disintegrating wafers, nasal spray, subcutaneous injection (beneath the skin), and suppository.

Several manufacturers are developing new methods of administration. For example, Suda pharmaceuticals is developing SUD-001H, a fast-acting oral sumatriptan mist, and NAL pharma is developing a rizatriptan mouth dissolving film.

Keep in mind that new formulations don't always work out well. For instance, Zecuity (sumatriptan), a battery-powered transdermal patch that was formulated to be placed on the upper arm or thigh, was taken off the market due to reports of burns and scars.

New formulations of medications that have been proven effective come with promise, but also some hesitancy as the issues get sorted out.

Keep in mind that a formulation that works for one person may not work for another, so talk with your doctor to determine whether or not you might benefit from trying an alternative triptan formulation.

Novel Anti-Migraine Medications

A number of migraine medications that work in novel ways are being developed, and some have been approved by the 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.

Lasmiditan

Lasmiditan, a serotonin 5-HT1F agonist, is an FDA-approved treatment for acute migraine attacks. It is different from other widely used migraine treatments, such as triptans and dihydroergotamines, because it does not induce vasoconstriction (blood vessel constriction).

Lasmiditan may be safe for people who have a history of heart disease, stroke, peripheral vascular disease, uncontrolled high blood pressure, and/or certain types of migraines, like hemiplegic migraines or migraines with brainstem aura—conditions that preclude you from using triptans or ergotamines.

Calcitonin Gene-Related Peptide (CGRP)

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

Several anti-CGRP antibodies that block or inactivate CGRP have been approved by the FDA. These fall under two categories: CGRP-antagonists, which are used to prevent migraines, and CGRP-inhibitors, which are used for the acute treatment of migraines.

The four CGRP-antagonists that have been approved by the FDA are: Emgality (galcanezumab-gnlm), Vyepti (eptinezumab-jjmr), Aimovig (erenumab-aaoe), and Ajovy (fremanezumab-vfrm).

Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant) are both CGRP-inhibitors approved for the acute treatment of migraines with and without aura.

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.

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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  1. Vollesen ALH, Ashina M. Pacap38: emerging drug target in migraine and cluster headacheHeadache: The Journal of Head and Face Pain. 2017 May;57(2):56-63. doi:10.1111/head.13076

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