Therapy options for patients with migraines have expanded over the past couple of years, with several new drug classes specific to the disorder. Leading migraine experts discuss how they decide to choose one therapy over another.

Treatment options for migraine have expanded considerably over the past two years, with several new classes of targeted, migraine-specific drugs coming to the market.

The expansion of therapies for acute migraine and migraine prevention is welcome news for migraine sufferers, many of whom do not get adequate relief despite trying multiple treatments.

For neurologists and others who treat migraine patients, the new options may provide a clearer rationale for how to approach treatment because, until recently, most of the drugs used for migraine were developed for other conditions such as epilepsy. The newer medications are designed to target pathophysiologic pathways involved in the migraine process in the hope of achieving better pain relief with fewer side effects.

“For our patients with migraine, we often have to say, ‘I am going to give you this medicine that was originally created to help seizures (or blood pressure, or depression), and it is going to help your headache,’” said Rebecca E. Wells, MD, MPH, associate professor of neurology and founder and director of the Comprehensive Headache Program at Wake Forest Baptist Health.

With the new drugs, she now can tell patients how the drug is different and how it targets the pathophysiology of how migraine is working in their brain.

The CGRP Inhibitors

Among the newer class of preventive drugs generating excitement are calcitonin gene-related peptide (CRGP) inhibitors, monoclonal antibodies that block a pathway involved in the migraine process.

“There are over 30 million people (in the US) with migraine, and yet only about 40 percent of them get adequate treatment,” said Jessica Ailani, MD, FAAN, director of Medstar Georgetown Headache Center and professor of clinical neurology at Medstar Georgetown University Hospital.

She and other migraine experts say the newer migraine drugs aren’t a panacea for all patients and don’t render obsolete the older, less expensive migraine therapies that work well for many people. But they hope that a broader range of treatments will lead to more people being effectively treated and sticking with their medicines because of fewer side effects.

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