If you suffer from migraine headaches, you know the misery of terrible one-sided head pain, nausea, and an inability to tolerate light or sound. Those who have recurrent migraines dread the possibility that they will trigger one somehow. Until fairly recently, physicians used drugs initially approved for other purposes to prevent migraines. However, calcium channel blockers, beta blockers topiramate and other such drugs do not work for everyone. That explains why some migraineurs are turning to a new type of medication for recurrent migraines.
Aimovig Cut Frequency of Recurrent Migraines:
Q. About a year ago, I learned about a new migraine medicine called Aimovig. I asked my neurologist if he could prescribe it, since I was averaging nine major headaches and 18 days off work each month.
At first, he was reluctant to prescribe Aimovig because it was so new. But all my other medications were barely working, so he finally agreed.
This drug changed my life. I inject it every 28 days and now average just one headache a month. That means a lot less missed work and a lot less suffering. I have experienced no side effects, and I hope others can benefit as I have.
A Whole New Class of Migraine Prevention Medicines:
A. Other readers have also reported substantial improvement with erenumab (Aimovig). The FDA has also approved two other injectable drugs in this class: fremanezumab (Ajovy) and galcanezumab (Emgality). Aside from rimegepant (Nurtec), they are for migraine prevention rather than treatment. Some migraine sufferers welcome a pill that can be used for treatment as well as prevention.
Head-to-Head Comparison Comes Out Even:
It’s rare for drug companies to compare competitive medications. That often makes it harder for physicians to determine the best treatment for a particular condition. Over the last few years, pharmaceutical companies have introduced a number of new migraine medications. Many have a similar mechanism of action, as all of the anti-CGRP migraine medicines do.
In an unusual face off, Eli Lilly recently compared its injectable migraine medicine Emgality against the oral migraine drug Nurtec. In this head-to-head trial dubbed CHALLENGE-MIG, both medicines worked equally well to reduce the number of days patients suffered from migraine headaches. Although results from the study have not yet been published in full, apparently neither company can claim a better migraine medicine (Practical Neurology, June 19, 2023).
Nurtec ODT Made a Difference in Summer Storm Migraines:
Q. After hearing your interview on new medicines for migraine headaches, I saw my doctor. The Nurtec ODT she prescribed for me has changed my life.
Before starting, I would suffer multiple migraines a month, especially when the weather changed. I was in misery too much of the time. This month we’ve had a number of thunderstorms sweep through, and to my surprise only one has triggered a migraine. I am so grateful for Nurtec.
A. Nurtec ODT is a relatively new medication, rimegepant, that can treat recurrent migraines as well as prevent them. The ODT stands for orally disintegrating tablet, an advantage for a migraine sufferer who is nauseated and has trouble keeping pills down.
Rimegepant can be used by people who can’t tolerate the side effects of triptan medicines such as chest pain. Its primary side effects include nausea, rash and shortness of breath. Additional medicines in this category include atogepant (Qulipta) and ubrogepant (Ubrelvy).
To learn more about these and other new migraine medications, you may wish to consult our eGuide to Headaches and Migraines. This online resource also contains nondrug approaches. Others may wish to listen to our interviews on the most recent medications. It is Show 1294: New Treatments for Migraine Headaches.
Other readers have also reported benefit in reducing recurrent migraines. Keep reading for more stories.
Nurtec ODT Reduced Recurrent Migraines:
Q. I’ve suffered from migraines for 25 years, particularly menstrual migraines. I’ve been taking Nurtec as a preventative for the past nine months. Along with hormonal treatment, Nurtec has changed my life.
I still get occasional regular headaches. However, migraines are not like they used to be. The frequency and the severity are far less.
A. As noted above, Nurtec ODT (rimegepant) belongs to a class of migraine medicines called “gepants.” They are also described as calcitonin-gene-related peptide (CGRP) blockers. Other gepants include atogepant (Qulipta) and ubrogepant (Ubrelvy). A recent review describes these migraine meds as “efficacious, safe, and well tolerated” (Journal of Clinical Medicine, March, 2022). Nurtec ODT may cause nausea and stomachache.
The gepants are not the only drugs revolutionizing migraine treatment. Over the last several years, doctors have been able to prescribe monthly injections to prevent migraine headaches. You can learn more about CGRP inhibitors like Aimovig, Ajovy and Emgality in our eGuide to Headaches & Migraines. In it, we also discuss gepants as well as more conventional migraine treatments and some intriguing home remedies.
Ajovy Makes a Difference:
Q. I started having migraines a couple of decades ago. They ramped up until they occurred more than half the month.
I have tried ever so many treatments, including hormones, supplements, prophylactic and rescue medications, exercise, acupuncture, massage, Botox and food sensitivity testing with major dietary changes. What helped me the most was Ajovy.
It took some time before I really learned how to self-inject properly, but since then I have suffered much less.
Preventing and Treating Recurrent Migraines:
A. Migraine prevention and treatment have changed radically over the last few years. Recent drug introductions include fremanezumab (Ajovy), erenumab (Aimovig) and galcanezumab (Emgality). These are all self-injectable preventive medications appropriate for people who, like you, have frequent recurrent migraines. Sadly, they are all expensive, ranging from about $600 to $800 for a monthly shot.
Side Effects:
Side effects include constipation, nausea, muscle cramps and injection site reaction for Aimovig. People using Ajovy may experience rash, itching, hives, severe allergic reactions including angioedema and injection site reaction. Reactions to Emgality include rash, hives, trouble breathing and allergic reactions ranging from mild to live-threatening.
Other Medicine for Recurrent Migraines:
Oral medications that affect the same CGRP (calcitonin gene-related peptide) pathway have also become available recently. Such drugs include atogepant (Qulipta), rimegepant (Nurtec ODT) and ubrogepant (Ubrelvy). These are even pricier, at around $1,000 a month.
There are several other new migraine treatments as well. Finding the right match of treatment for each patient can be challenging. Getting insurance companies to pay is another hurdle. But when patients get the right mix of treatments, the results are excellent.
For example, Kathy R. wrote:
“Aimovig is wonderful – cutting my migraines in half! I still take topiramate but at a lower dose.”
Jan is also enthusiastic:
“I have had chronic migraines for over 18 years. My doctors have prescribed most of the triptans with varying degrees of success, also, Botox, Cambia, and injectable Imitrex.
“I started Aimovig last August, using two self-injected shots every month. I also started ketamine infusions. Together they prevent nearly all my recurrent migraines. I do get random headaches but they rarely rise to the level of a migraine.”
Learn More:
To learn more about this intriguing new migraine medicine and other headache treatments, you may wish to listen to the free podcast of our interview with Dr. Jennifer Kriegler, director of the Headache Medicine Fellowship at the Cleveland Clinic. It is Show 1133: How Can You Overcome Migraine Headaches?
We recently spoke with a producer and a speaker for the Migraine World Summit. You can listen to the free podcast for Show 1294: New Treatments for Migraine Headaches. The show notes give you more information about the Migraine World Summit.
