Any migraine is a complex neurological disorder that makes qualified neurologists and experienced scientists wonder. Unlike some other health conditions, the biology of migraines is not figured out. However, the great news is that people are getting closer and closer to understanding how migraine attacks manifest themselves and their pathophysiology. This knowledge revolutionized treatments and set off a number of promising studies and emerging therapies. For example, the main advances in treating migraines include the following:
• New anti-migraine meds for prevention and acute treatment;
• Unique ways to administer triptans, which are proven and tested anti-migraine drugs;
• Medical tools to both prevent and treat migraines.
Basic Information about Triptans
Triptans work by binding to serotonin brain receptors, and they’re often taken to treat moderate and severe migraines. They’re also taken to treat mild migraine attacks that can’t be relieved with NSAIDs. The greatest benefit of triptans is that they come in different forms, such as nasal sprays, standard and water-dissolving tablets, suppositories and subcutaneous injections. With all of these available options, patients with migraines and their doctors can pick triptans according to personal needs and preferences. Their basic considerations may include the following:
• Onset of action;
• Adverse reactions;
• Prices and convenience;
• Appeal to specific populations, such as people who experience vomiting and nausea and can’t tolerate oral meds.
It’s also worth mentioning that triptans can be administered in other unique ways in the nearest future. As an example, sumatriptan lingual sprays are being developed, just like rizatriptan mouth dissolving films and zolnitriptan inhalers. Don’t forget that new formulas may not always work well. Sumatriptan was available as special battery-powered transdermal patches applied to the thigh or upper arm. They penetrated the skin through their electric gradient system that delivered a certain dose of this medication each 4 hours. Nowadays, this treatment option isn’t on the market because of reports of scars and burns.
With new formulas and medications that are promised, there are certain nuances and hesitancy that should be considered. Besides, the treatment that works for some patients may not work for others, so you need to talk to doctors to determine the pros and cons of recommended migraine therapies.
New Anti-Migraine Meds
As scientists keep unveiling the biology and mechanisms of developing migraine attacks, they can target new receptors and pathways. Some important advances in migraine meds include:
• Meds that target CGRP;
• Drugs that target Glutamate;
• Lasmiditan, which is a medicine similar to other triptans, but it has a greater affinity for a particular serotonin receptor.
Lasmiditan as Serotonin Agonist
It’s developed as an alternative treatment to triprans. Why is this alternative required? There are several reasons, such as the following:
1. The latest research proves that about 35% of patients don’t get any relief from triptans.
2. Some patients don’t like how their intake makes them feel, because these meds may cause unpleasant adverse reactions, including chest, jaw and neck tightness, tingling and numbness.
3. Many people can’t take triptans, as they may lead to blood vessel constriction or vasoconstriction. That’s why they are contraindicated in patients with a medical history of stroke, heart disease, uncontrolled hypertension, peripheral vascular disease and specific migraine types, such as basilar and hemiplegic.
The good news about Lasmiditan is that this medicine selectively binds to certain serotonin brain receptors, thus, having less affinity for other similar receptors that may lead to unwanted vasoconstriction when being bound. Another important fact is that this medication used in different doses can relieve pain from severe to moderate headaches within 2 hours based on studies. This improvement depends on doses, which means the higher the dosage, the greater the relief from pain.
The most common side effects include dizziness, fatigue and vertigo. Unlike modern triptans, the exact binding of Lasmiditan may help patients avoid unwanted vasoconstrictive side effects, but it may result in more nervous system symptoms. So, more studies and research are needed to get a better idea of its mechanism of action.
CGRP, or Calcitonin Gene-Related Peptide
CGRP plays an important role in the pathogenesis of migraines. The latest research suggests that the trigeminal system is activated during migraines, thus, resulting in the release of CGRP. It works to dilate blood vessels in the brain and trigger an interesting phenomenon, which is known as neurogenic inflammation. These steps are responsible for generating migraine attacks.
Medications that work by blocking CGRP or its receptors are studied. The bad news is that some studies focused on CGRP-receptor antagonists are discontinued for many reasons, such as liver toxicity concerns. Ubriogepant is the only medicine that is well-tolerated and efficient. 3 anti-CGRP antibodies are developed to prevent migraine headaches, and their main idea is to remove excess CGRP during attacks. These medications show good results in many clinical trials.
Erenumab is a monoclonal antibody binding to CGRP receptors and administered underneath the skin. By binding to receptors, this medicine blocks them from signaling, and that’s why it’s researched as a migraine preventive treatment. It seems that targeting CGRP pathways offer quite promising treatment options for people with chronic or episodic migraine disorders.
Glutamate Receptor Antagonists
Glutamate is an important chemical or neurotransmitter in the brain. Based on both human and animal studies, it plays a big role in how migraine headaches manifest themselves. There are many meds linked to altering or blocking glutamate receptors that are studied. Some of them are targeted at treating acute migraines, while others are designed to prevent them. You may be familiar with preventive meds, including Topamax, which blocks the release of glutamate. It’s interesting that ketamine that blocks glutamate receptors in the brain can treat the migraine aura by suppressing cortical spreading depression.
Based on the study of patients who have their prolonged migraine aura, intranasal ketamine was compared to intranasal midazolam. It was proven that ketamine decreased the severity of this aura, but failed to achieve the same effect with its duration. Its possible adverse reactions include the following:
• Temporary mild giddiness;
• Feeling of unreality.
These symptoms last for about 30-45 minutes. The role played by glutamate and its pathway in chronic migraines and their aura are still a target of research with a hope for new therapies.
FDA-Approved Medical Tools to Treat Migraines
Creation of medical tools to prevent and treat migraines has revolutionized their therapy. They are quite convenient and easy to use and linked to minimal side effects. Their only cons include the price and the fact that some of them may not work for all patients. Investigating these devices is a reasonable option for many people with migraines, especially if available meds fail to work, or if they’re prone to developing medication overuse headaches.
Cefaly is one of these migraine-preventing devices, and it targets the supraorbital nerve that innervates a part of the scalp, forehead and upper eyelid. It’s a battery-operated tool that should be worn as a headband and used for 20 minutes on a daily basis. According to many studies, Cefaly is a user-friendly and well-tolerated device, because less than 5% users have reported side effects. It offers a great option for patients who can’t tolerate or don’t want to take oral migraine preventive drugs.
GammaCore, or nVNS, is another device that should be used by people to both treat and prevent acute migraines. Basically, it works by stimulating a vagus nerve, so this device should be held against the side of your neck for about 2 minutes after using special conductive gel. There’s an opinion that GammaCore works suppressing high glutamate levels in the trigeminal system. Based on many trials and tests, its use can result in improving a number of headaches each month and their pain intensity in patients with chronic and episodic migraine disorders. There are some side effects that can be experienced, but they are mild and include neck twitching and skin irritation.
The sTMS is another effective device approved by the FDA to treat migraines with the aura. It should be applied to the back of the head, and users need to press a button to release stimulating magnetic energy into their brain. It’s possible to use this device only once a day as a migraine treatment, and it works by suppressing cortical spreading depression.
Although the culmination of new migraine devices and therapies is quite promising and exciting, preventing and treating headache can be a malleable and tedious process. It involves a lot of trial and error that will alter as your lifestyle, migraines and personal preferences change. You should stay proactive by visiting neurologists and staying updated with the latest migraine news about emerging therapies.