From the Guidelines
New migraine treatments include CGRP antagonists like Aimovig, Ajovy, and Emgality, which are monthly or quarterly injections that prevent migraines by blocking pain pathways, and have been shown to reduce migraine days by 50% in many patients 1.
Treatment Options
- CGRP antagonists: Aimovig, Ajovy, and Emgality, which are monthly or quarterly injections that prevent migraines by blocking pain pathways
- Newer oral CGRP antagonists: Ubrelvy and Nurtec ODT, which provide acute relief during attacks, working within 1-2 hours
- Neuromodulation devices: Cefaly (electrical stimulation) and gammaCore (vagus nerve stimulation), which offer non-medication options with minimal side effects
- Botox injections: administered every 12 weeks by a specialist, remain effective for chronic migraine sufferers
Lifestyle Modifications
- Regular sleep
- Stress management
- Identifying food triggers
Pharmacologic Treatment
- Ibuprofen: recommended for treating pain in children and adolescents 1
- Sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral: considered for adolescents 1
- Preventive treatments: considered for children and adolescents with frequent or disabling headaches or medication overuse 1
Important Considerations
- Treatment should be individualized based on migraine frequency, severity, and patient preferences, often requiring a combination approach for optimal management
- Patients should be educated on lifestyle factors, migraine triggers, and avoidance of acute medication overuse 1
From the FDA Drug Label
The primary efficacy endpoint was the change from baseline in monthly migraine days at month 3 The primary efficacy endpoint for Studies 1 and 2 was the mean change from baseline in the number of monthly migraine headache days over the 6-month treatment period
New treatments for migraine headaches include:
- Erenumab (SQ): demonstrated statistically significant improvements for key efficacy endpoints compared to placebo, as summarized in Table 4 2
- Galcanezumab (SQ): demonstrated statistically significant improvements for efficacy endpoints compared to placebo over the 6-month period, as summarized in Table 2 3 Key benefits of these treatments include:
- Reduction in monthly migraine days
- Reduction in monthly acute migraine-specific medication days
- Improvement in response rates (percentage of patients reaching at least 50%, 75%, and 100% reduction from baseline in the number of monthly migraine headache days)
From the Research
New Treatments for Migraine Headaches
- Erenumab and galcanezumab, two monoclonal antibodies targeting calcitonin gene-related peptide, have shown effectiveness in preventing chronic and episodic migraine 4
- These treatments have been found to reduce monthly headache days, acute migraine-specific medication days, and improve quality of life 4
- Calcitonin gene-related peptide-targeting therapies, including erenumab, fremanezumab, galcanezumab, and eptinezumab, are now considered a first-line option for migraine prevention 5
- Lifestyle modifications, such as maintaining a regular sleep schedule, eating a balanced diet, staying hydrated, and engaging in regular physical activity, can also help prevent headaches 6
- Supplements like magnesium, Petasites hybridus, feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid may be effective in preventing migraines 7
CGRP-Targeting Therapies
- CGRP-targeting therapies have been found to be effective in reducing the frequency and severity of migraine headaches 4, 5
- These therapies have a favorable safety profile and are well-tolerated by patients 4, 5
- The American Headache Society recommends CGRP-targeting therapies as a first-line treatment for migraine prevention 5
Lifestyle Modifications and Supplements
- Lifestyle modifications can help reduce the frequency and severity of headaches, especially in pediatric patients 6
- Supplements like magnesium, Petasites hybridus, feverfew, coenzyme Q10, riboflavin, and alpha lipoic acid may be effective in preventing migraines, but more research is needed to confirm their efficacy 7