A migraine is characterized by severe throbbing or pain that usually happens to one side of the head. In some instances, it can often also be accompanied by nausea, vomiting, or auras that signal an attack is imminent (such as visual flashes or tingling).¹
For those that suffer from migraines, living with the condition can be extremely disruptive to daily life — especially if they occur without warning. This is why many describe it as being "more than just a headache".
A common condition with not enough research
Despite its debilitating nature (and the fact that it affects approximately 11.1% of the US population and 1 billion people globally), breakthroughs in understanding and effectively treating the condition only started surfacing over the past few decades.² ³
Some experts attribute the lack of research in this area to several factors. Firstly, it's considered a less "glamorous" condition to investigate compared to others that get more limelight from public health or celebrity-led campaigns. Furthermore, with women being 3 times more likely to be affected by migraines than men, historical gender biases often result in clinicians linking symptoms to other conditions.⁴
As a result, migraines have been inaccurately conceptualized throughout the years as being the result of a solely vascular issue relating to blood flow in the brain, as well as a psychosomatic symptom of stress intolerance.
And while treatments have been available, they were all medications used to address other co-morbidities or conditions (like epilepsy and depression). It was only by chance that clinicians realized that they had a secondary benefit in alleviating some migraine symptoms. So while they were somewhat effective, these treatments were not really targeting the true causes of the pain.⁵
The 2 key players in migraines: CGRPs and serotonin
All this has changed recently with pioneering research conducted by Dr. Peter Goadsby, Director of NIHR Clinical Research Facility & Professor of Neurology at King's College London, and his team.
While the exact causes of migraine still remain unclear (everyone has different triggers and predispositions), they discovered a vital part of its underlying biological mechanism that forms the basis of the latest migraine treatments.⁶ ⁴
It turns out that the key to the migraine mystery lies in a neurotransmitter called calcitonin gene-related peptide (CGRP). When the trigeminal nerve in the brain (which controls pain signals) gets irritated by a trigger, it releases CGRPs.
This protein results in inflammation of certain brain cells and ultimately the pain symptoms that characterize migraines.⁷
Another neurotransmitter implicated in migraine development is serotonin (more specifically, the serotonin receptor system around the trigeminal nerve endings).⁸ It's been found that people who experience the condition have higher than usual levels of serotonin between attacks. But at the onset of a migraine, these levels drop.⁹ ¹⁰ ¹¹
The new migraine medications hitting the market
Targeting this neurological cascade of events sparked by CGRPs and serotonin imbalances is now the main goal in migraine treatment.
Here's a look at how they work:
Gepants (CGRP antagonists): Work by blocking off the brain cell receptors that CGRPs attach to.
Ditans (Serotonin (5-HT)1F receptor agonists): Works by binding to brain cell receptors to stimulate serotonin.¹²(Video) A Guide to Four Neuromodulation Devices for Migraine Treatment - Spotlight on Migraine S2:Ep9
Additionally, they can also be distinguished in terms of the stage at which they act:
Acute migraine medication is used to stop a migraine episode and works best when taken as soon as early symptoms are felt. This course of treatment is usually recommended if the person doesn't have frequent attacks.
Preventive migraine medication is a long-term treatment option for those that experience frequent (4 or more in a month) or severe episodes. They are taken regularly (sometimes daily) and are frequently used together with acute medications.
These medications can also be administered in various ways as oral tablets, intravenous infusions, or injections.
If you're suffering from regular headaches, it is essential to consult a medical professional to explore your treatment option.
Comparing gepants and ditans for treating migraines
New acute migraine medications¹³ ¹⁴
Gepants (CGRP antagonists)
Ditans (Serotonin (5-HT)1F receptor agonists)
New preventive migraine medications
Some gepants can also be used as longer-term preventive medication. But there is another class of CGRP-targeted medication that is similar to gepants called monoclonal antibody CGRP antagonists.
They’re human-made antibodies and are bigger molecules than gepants.¹³ ¹⁹
It stops the migraine-inducing action of CGRPs by either binding to them or blocking the brain cell receptors that CGRPs usually bind to.
Gepants (CGRP antagonists)¹³ ¹⁴ ²⁰ ²¹
Monoclonal antibody CGRP antagonists²² ²³ ²⁴ ²⁵ ²⁶ ²⁷
How do newer migraine treatments compare with older ones?
Before gepants and ditans came on the scene, here were some of the most common medicines used to treat migraine:²⁸ ¹⁹ ²⁹ ³⁰
The older acute treatments include:
Normal painkillers — such as paracetamol.
Anti-inflammatory painkillers — like Ibuprofen and aspirin.
Triptans (sumatriptan) that target serotonin pathways in the brain (which is similar to the ways ditans work).
For older preventive treatments, there are:
Beta-blockers which are traditionally used to reduce blood pressure. It was thought to be effective in reducing blood vessel dilation that occurs during migraines.
Antidepressants also target serotonin pathways (like ditans) and are usually used to address mental health conditions like depression and anxiety.
Antiseizure medications block electrical impulses in nerves and brain cells.
Botox was used to help reduce pain signals being transmitted to areas like the forehead and scalp.
Anti-sickness medication was used to address nausea symptoms.
Of all the older medications, triptans were considered the gold standard for treating migraines and it's still being used by clinicians today. But there is a major drawback to this medication.
Triptans target multiple serotonin receptors found on the brain and blood vessels, and one of its side effects was blood vessel constriction. This made it unsuitable for those with conditions like heart or vascular disease.³¹ ³² ³³
In response to this, researchers sought to develop a more streamlined medication that only acts on the brain cell receptors — and this was how ditans were created. However, ditans also have their own set of side effects. It causes drowsiness, and patients aren't allowed to drive 8 hours after taking the medication.
Given the limitations of ditans, this is why triptans still remain highly relevant these days. Some clinicians still use it as the first line of defense and administer it to patients that don't have a history of heart disease or stroke, while ditans may be used as an alternative for those with these comorbidities.
In recent years, triptans have also been updated. Here’s a list of some of the newer ones available now:
New Triptan Medications (Serotonin (5-HT)1F receptor agonists)¹³ ³⁴ ³⁵ ³⁶ ³⁷
4 tips for managing your migraine treatment
Great strides have been made in the treatment of migraines over the past several decades. But getting the right formula for addressing your symptoms must still be tailored to your individual health circumstance and needs.
Here are 4 tips for determining the best course of treatment for your migraine attacks:³⁸
Consider seeing a neurologist that specializes in migraines. Sometimes, seeing a GP or family doctor might be enough to help manage your symptoms. But if attacks become more frequent or intense, you might want to consider consulting a doctor that specializes in migraines.
Keep track of attacks in a headache journal. This should include information like the frequency, duration, and severity of your attacks. You can even note any other details like what you were doing before the onset of the migraine or what migraine medication you're taking. The more information you have, the better your physician will be able to tailor a treatment to your needs.
Note any rebound headaches (a result of medication overuse). Paradoxically, certain migraine medications like triptans can cause rebound headaches when taken too frequently. But preliminary research suggests that this effect is not seen in gepants. This is why there is such great interest in this class of medication to be used as both an acute and preventive measure.³⁹ ⁴⁰(Video) Ubrelvy / ubrogepant for Migraine: What YOU Need to Know
Inform your doctor about other medical conditions. Certain older migraine medications may not be suitable for you if you're at risk of stroke or heart disease because of their side effects.
After decades of being a neglected condition, we finally have a better understanding ofmigraines. Those who suffer from it can now access better medication that truly addresses the underlying mechanisms of its occurrence.
Migraine | Mayo Clinic
Migraine prevalence, disease burden, and the need for preventive therapy (2007)
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Can migraines be untangled by new medical thinking? | The Guardian
Scientists who discovered migraine mechanism win £1.1m Brain prize | The Guardian
Causes - migraine | NHS
What is migraine? Your guide to talking about the condition | SingleCare
What is the role of serotonin in the pathogenesis of migraine? | Medscape
High brain serotonin levels in migraine between attacks: A 5-HT4 receptor binding PET study (2018)
The science of migraines | American Association for the Advancement of Science
Facts about triptans | National Headache Foundation
What are the new drugs for the treatment of migraines? | Drugs.com
Your guide to the newest migraine medications | SingleCare
What is nurtec ODT (rimegepant) used for and how does it work? | Drugs.com
Ubrelvy efficacy results | UBRELVY
Reyvow (lasmiditan) | REYVOW
All about reyvow | Healthline
New drugs that block a brain chemical are game changers for some migraine sufferers (2021)(Video) What you need to know about Aimovig, the new migraine shot
FDA approves QULIPTA™ (atogepant), the first and only oral CGRP receptor antagonist specifically developed for the preventive treatment of migraine | Abbvie
Eptinezumab in episodic migraine: A randomized, double-blind, placebo-controlled study (PROMISE-1) (2020)
Patients experienced significantly more migraine-free days with AJOVY vs placebo in the HALO + Long-Term Extension Studies | AJOVY
Migraine: Triptans | Mayo Clinic
Topamax for migraine prevention | Very Well Health
How gepants and ditans complement existing therapies | American Migraine Foundation
Sumatriptan | NHS
Lasmiditan: New first-in-class drug treatment approved for migraine | Harvard Health Publishing
Tosymra | Tosymra
Zembrace symtouch | Drugs.com
Onzetra xsail (sumatriptan) nasal powder | Good Rx
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Stopping the vicious cycle of rebound headaches | Harvard Health Publishing
Gepants (2020)(Video) Treating Migraine in 2022
The author, Dawn Teh, is a health writer and former psychologist who enjoys exploring topics about the mind, body, and what helps humans thrive.
What are the new treatments for migraines 2022? ›
FDA approves QULIPTA™ (atogepant), the first and only oral CGRP receptor antagonist specifically developed for the preventive treatment of migraine | Abbvie. Qulipta (atogepant): Side effects (2022)What is the new FDA approved migraine medicine? ›
The Food and Drug Administration approved the most recent, atogepant (Qulipta), in September 2021. Lasmiditan (Reyvow) is a separate type of treatment that targets the serotonin receptors on brain nerve endings to halt migraine attacks as they occur.What treatments are FDA approved for chronic migraine? ›
Researchers aren't certain how this process works to prevent migraine headaches, but it does so safely and effectively for most patients. The specific anti-seizure drugs that have FDA approval for migraine prophylaxis are: Depakote, Depakote ER (divalproex) Topamax, Qudexy XR, and Trokendi XR (topiramate)What is the best migraine treatment in the world? ›
Triptans. Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine.What new medication for migraine seems effective? ›
A small-molecule drug that blocks pain transmission in the trigeminovascular system is the first in its class to be approved for adults who have migraine headaches with or without aura. Ubrogepant, marketed as Ubrelvy, is an oral calcitonin gene–related peptide receptor antagonist.What is the permanent treatment of migraine? ›
There's currently no cure for migraines, although a number of treatments are available to help ease the symptoms. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones.How is QULIPTA different than Nurtec? ›
Qulipta is taken to prevent migraines and is taken once a day with or without food. Nurtec ODT is taken when you have a migraine (one tablet only over a 24 hour period), with a maximum of 18 tablets over 30 days. To prevent migraines, one tablet of Nurtec ODT is taken every other day.What is the new migraine shot? ›
Aimovig is FDA-approved to prevent migraine headaches in adults. These severe headaches are the most common symptom of migraine, which is a neurological condition. Other symptoms can occur with a migraine headache, such as: nausea.What is the success rate of Vyepti? ›
After the second dose, ~40% of patients experienced at least 75% fewer migraine days6*What is the new migraine infusion? ›
Vyepti (eptinezumab) is the first intravenous (IV) medication approved for preventing migraines. Vyepti is a monoclonal antibody that targets and blocks the binding site of a protein called calcitonin gene-related peptide (CGRP). This protein is believed to be the cause behind the pain of most migraine attacks.
What do ER doctors give for migraines? ›
Treatments in the ER
Some pain medications you may get at the ER as an IV treatment for migraine include: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac. Acetaminophen. Corticosteroids such as dexamethasone (Decadron), which can prevent recurring migraines.
Are they taken to treat or prevent a migraine? Ubrelvy is used to treat migraines with or without aura. Qulipta is taken to prevent episodic migraines. Nurtec ODT is taken to treat migraines with or without aura and also to prevent episodic migraines.