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HeadWay, Issue #182 Forward or Backward? New Migraine Treatments
October 21, 2019

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In this issue:

Forward or Backward? New Migraine Treatments

New at Headache and Migraine News...

Say what?! Antagonist

Forward or Backward? New Migraine Treatments

Where is migraine treatment going in the next year or two? A look at recent research and discussion gives us everything from unbridled optimism - that we have finally reached a tipping-point - that "real" treatment is finally available - to warnings that we're only repeating a cycle of past mistakes.

So where are we at?

First the ones we've all heard of - the CGRP inhibiting monoclonal antibodies (mAbs). These include erenumab (Aimovig), galcanezumab (Emgality), fremanezumab (Ajovy), and eptinezumab (not yet approved).

These do represent a major step into new types of treatment for migraine. They appear to have minimal side effects in the short term, and may help many who have tried other medications without success.

However, many researchers are warning us that, at this point, we do not know what the long term effects of these drugs may be. As writer and migraineur Holly Baddour recently pointed out, we have to make "peace with a personal decision" about whether or not to take the risk.

Similar but different are the up-and-coming "gepant" drugs. Gepants are CGRP receptor antagonists. While the mAbs above are focused on prevention, the gepants in development (ubrogepant and rimegepant) are taken to fight your current attack.

Also appearing to have few side effects, these drugs may help patients who haven't responded to conventional treatments, such as aspirin or triptans. But the jury is still out as to whether these drugs will be any better in general than previous treatments.

Next in the parade are the "ditans", which are 5-HT1F agonists. Lasmiditan (Reyvow) has actually been in the pipeline for many years as an abortive drug, and was finally approved by the FDA this month.

But there's more coming. Either a sign of hope, or a reminder that we're only in a cycle of new mediocre treatments, research into new ways to treat migraine continues. Anti-PAC 1 drugs are an example of another possible targeted migraine drug.

But with all these drugs to try or look forward to, it's easy to forget progress in other areas. Many patients are taking matters into their own hands and making major improvements to their diet to fight migraine. There are also new novel treatments such as smart-phone-controlled Nerivio Migra that will be here soon. If you're unsure about CGRP related treatments, there are many other options to explore.

Am I hopeful or pessimistic? Yes. Increasing research into the mechanism and possible treatment of migraine is a positive step. However, money and politics often obscure the reality of what may work best for patients. And the results of trials and patient experience from the past few months reminds us again - there is no miracle cure. And maybe the best treatments for most of us are still not found in the newest pill or injection.

New at Headache and Migraine News...

A few recent articles you might have missed:

Say what?! Antagonist

Just what is a CGRP antagonist? An antagonist in general inhibits or nullifies the effectiveness of something else. You could also say it "blocks" something. You'll often hear those adjectives used interchangeably. So a CGRP antagonist blocks the effect of CGRP in your body. (Note: This has a different meaning from "agonist" - maybe a word for an upcoming issue!

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