Updated August 28, 2019
Your fingers start to tingle. You try to focus your eyes, but nothing looks quite right. Your head feels fuzzy, and you’re unable to think clearly. Then comes the pain — dull and throbbing, or intense like a screwdriver. You feel like you might throw up. If you suffer from migraine headaches, you know these feelings all too well. Up until now treatment for migraines addressed the symptoms but new migraine medications are being used to prevent them from starting in the first place.
Migraines seemingly spare no one, wherever they live. “It feels like your head is in a vice and it keeps getting tighter and tighter,” says 50-year-old Samantha Simmons of San Diego, Calif., who is on disability in part due to migraines.
“My jaw is sore, as though I’ve been grinding my teeth for hours,” says Casey Seyb, 48, a science data archivist in Sierra Madre, Calif. “Sometimes there’s a strange taste in my mouth.”
“My ribs can actually be pulled out of alignment and I get sensitive to light and sound,” says Theodore Holdt, 46, an artist in Portland, Ore.
“Feels like my head is going to explode and I want to crawl up in a ball and sleep,” says Lynn Cooper, 38, a marketing consultant in Washington, D.C.
Symptoms might be different for each sufferer, but they are uniformly terrible. In the United States alone, more than 37 million people experience migraine headaches — the majority of them women. It’s the sixth-most disabling illness in the world, according to the Migraine Research Foundation.
Fortunately, two new medications may bring relief to migraine sufferers. Erenumab and fremanezumab showed promise in two recent large studies published in the New England Journal of Medicine. Unlike most drugs currently used for migraines, these new drugs — by the Israeli pharmaceutical company Teva — are used as a preventative, rather than taken at the onset of migraine symptoms.
Approved by the Food and Drug Administration in 2018, both of these drugs are now available to migraine sufferers.
There are dozens of potential treatment options, including natural remedies, Botox and over-the-counter and prescription medications. Current treatments, however, are often drugs designed for treating other ailments such as depression, epilepsy and high-blood pressure. All usually have unpleasant side effects, including weight gain and fatigue.
The new drugs are the first aimed directly at migraines, says Dr. Peter J. Goadsby, a professor of neurology at King’s College in London, who led one of the studies.
Some researchers liken migraines to unpredictable electric storms zooming through the brain. One of the key migraine chemicals is a protein called calcitonin gene-related peptide, or CGRP. Both fremanezumab and erenumab can bind to CGRP, thus blocking it from releasing its full havoc in the brain. Dr. Stephen Silberstein, a Pennsylvania neurologist and leader of the fremanezumab study, has compared this effect to soundproofing a room.
The erenumab study, led by Goadsby, involved giving patients different doses of the drug along with a placebo. Researchers found that monthly doses of erenumab significantly reduced migraine frequency, the effects of migraines on daily activities and the use of acute migraine-specific medication over a period of six months.
Silberstein, who heads The Headache Center in Philadelphia, focused his fremanezumab study on even more severe cases — patients who suffered from headaches at least 15 days per month and had migraines on eight or more days per month. He compared groups with a quarterly, monthly and placebo dose of the medication. The monthly schedule saw the greatest success, with 41 percent reporting half or fewer their usual number of headaches. The biggest side effects — at least in the short term — were pain and hardening of skin at the injection site. There was, however, a powerful placebo effect, with patients who got the placebo also reporting a drop in migraines.
Still, Dr. Andrew Hershey, who directs the headache center at Cincinnati Children’s Hospital in Ohio, called the new drugs “modest but meaningful” in an editorial accompanying the research.
Other migraine drugs could be coming down the pipeline as well. Indiana-based Eli Lilly and Company is developing a monthly CGRP medication — galcanezumab — to prevent migraine and cluster headaches. The medication would be a once-monthly, self-administered injection and is currently being reviewed by the FDA.
“Preventive treatments are used to reduce the number of migraine attacks, lessen the intensity of pain and prevent the onset of future attacks,” says Dr. Eric Pearlman, a medical fellow with Eli Lilly and Company.
Millions of patients suffering from migraines are losing at least one month per year to their migraine headaches, Pearlman says, and the estimated healthcare and lost productivity costs may reach as high as $36 billion annually. “We hope and believe the CGRP class will substantially improve care for these patients,” he says.
