Inside the Lab: Migraine Treatment
By: Brooklyn A. Bradley, BS; Medically Edited By Deena E. Kuruvilla, MD
Dr. Kuruvilla recently collaborated with MedicalNewsToday in a feature titled, “Inside The Lab: Migraine Treatment.” Today’s blog post will dive into the innovative ideas, research, and new treatments in the migraine space that Dr. Kuruvilla mentioned in the feature. The link to the video is at the end of this post :)
We are fortunate to have two new families of as needed migraine treatments, the gepants and ditans (1). The goal of gepants is to inhibit calcitonin gene-related peptide (CGRP) from binding to its receptor (2). CGRP carries pain signals along nerves responsible for pain seen in migraine patients; thus gepants are trying to block these pain signals. The most common side effect seen with the two available gepants (ubrogepant and rimegepant), is nausea. (3). Ditans work by activating serotonin, but at a different serotonin type than triptans do. For this reason, they do not affect the blood vessels. The only available ditan, lasmiditan, is beneficial for people who cannot take triptans due to side effects, who have a history of heart disease or a history of stroke (3). Lasmiditan has a good track record of providing pain freedom but comes with potential side effects such as sedation and light-headedness. There is also a driving restriction with lasmiditan. Driving is not advised for 8 hours after taking the medication.
Triptans are migraine as needed medications which have been around since the 90s. Triptans are serotonin agonists, meaning they increase the activity of the chemical serotonin (1). Serotonin is involved in mood, sleep, digestion, nausea, and many other processes. Triptans play a role in migraine relief by blocking inflammation and constricting blood vessels. Migraine attacks often cause nerves to be overactive, thus triptans work to reverse this process (1). In a randomized trial measuring the effects of sumatriptan-naproxen for the as needed treatment of migraine, researchers reported that sumatriptan (85 mg) plus naproxen sodium (500 mg) as a single tablet for acute treatment of migraine led to favorable clinical benefits, and had a well-tolerated adverse effect profile (2). While we focus on as needed treatments here, most people with migraine may also need a preventive treatment also.
Medical Devices:
The Relivion® MG device is the most recently approved device for migraine as needed treatment. This device stimulates the nerves in the forehead and the back of the head (4). In a clinical trial studying this noninvasive occipital and trigeminal neuromodulation technology for the acute treatment of migraine, 46% of the patients in the treatment group reached complete pain freedom in comparison to 11.8% of patients in the control group (5). In addition, no serious adverse events were reported (5). The Relivion® MG device has the capacity to be an effective drug free treatment for migraine, especially for those patients who did not respond successfully to mainstream medical therapy (4).
The Cefaly® device is another drug free migraine treatment that can aid in quality of life and migraine pain levels (6). It stimulates the nerves within the forehead, the supraorbital and supratrochlear nerves. This can be used in the acute and preventive treatment of migraine. In a randomized controlled trial measuring the prevention of migraine by supraorbital transcutaneous neurostimulation using the Cefaly® device, researchers reported that between the first and the 3rd month of treatment the mean number of migraine days decreased significantly in the treatment group (4.88 vs. 6.94) (7). In addition, the monthly migraine attacks and monthly headache days were significantly reduced in the treatment group (7). Overall, the Cefaly® device may help to treat acute migraine attacks and prevent future episodes.
Conclusion:
In conclusion, there are emerging ideas and treatments in the migraine world today. Migraine affects a large percentage of the world population, and it is vital that research is continued in this field so that more patients are able to find a therapy option suitable for their needs. It is important for patients to discuss the drug free treatment options with their provider to evaluate the benefits of the treatment.
Check out the video at the link below!
https://www.medicalnewstoday.com/articles/migraine-treatment-resources#1
References:
- Loder, Elizabeth. “Triptan Therapy in Migraine.” New England Journal of Medicine, vol. 363, no. 1, July 2010, pp. 63–70. Taylor and Francis+NEJM, https://doi.org/10.1056/NEJMct0910887.
- Brandes, Jan Lewis, et al. “Sumatriptan-Naproxen for Acute Treatment of MigraineA Randomized Trial.” JAMA, vol. 297, no. 13, Apr. 2007, pp. 1443–54. Silverchair, https://doi.org/10.1001/jama.297.13.1443.
- “Gepants and Ditans Therapies.” American Migraine Foundation, https://americanmigrainefoundation.org/resource-library/gepants-ditans-therapies/. Accessed 2 Aug. 2022.
- “Relivion® MG.” Relivion® MG, https://www.relivion.com/. Accessed 2 Aug. 2022.
- “Noninvasive Occipital and Trigeminal Neuromodulation Technology Cleared by FDA for the Acute Treatment of Migraine.” American Headache Society, https://americanheadachesociety.org/news/neurolief-relivion-announcement/. Accessed 2 Aug. 2022.
- “Homepage.” Cefaly, https://www.cefaly.com/. Accessed 2 Aug. 2022.
- Schoenen, J., et al. “Prevention of Migraine by Supraorbital Transcutaneous Neurostimulation Using the Cefaly® Device (PREMICE): A Multi-Centre, Randomized, Sham-Controlled Trial.” The Journal of Headache and Pain, vol. 14, no. 1, Feb. 2013, p. P184. BioMed Central, https://doi.org/10.1186/1129-2377-14-S1-P184.
- Migraine Treatment Videos. 20 Apr. 2022, https://www.medicalnewstoday.com/articles/migraine-treatment-resources.