New relief for migraines

If you’re one of the 15% of Americans battling migraines, there’s good news for the fight ahead.

The selection of treatments has grown in recent years.

“There are a lot of treatment options available,” said Jared Pomeroy, MD, a Spectrum Health physician specializing in headache neurology. “Treatment is much different today from what it was five years ago, so there are a lot of new opportunities for people to find relief.”

For many, the symptoms of migraine are unmistakable.

Throbbing head pain. Sensitivity to light and sound. Nausea. Vomiting. Strange vision disturbances called aura.

It can often mean hours or even days with pain so severe that day-to-day activities are too much to bear.

“Migraines are a tremendously important problem for people,” Dr. Pomeroy said. “If you go household to household, it will not take long to find one that’s affected by them.”

Fortunately, the medicines of yesterday are giving way to new options.

Triptans—common brands including Imitrex (sumatriptan) and Maxalt (rizatriptan)—were created in the early 1990s, and there hadn’t been much new in migraine medications in the 25 years since, Dr. Pomeroy said.

Those medications work by stimulating serotonin and reducing inflammation, but they don’t work for everyone and may cause bothersome side effects for others. And they are not an option for patients with cardiovascular disease because they constrict blood vessels, Dr. Pomeroy said.

In recent years, two new classes of medications have come onto the scene: gepants and ditans.

“These classes are new developments that are very exciting,” he said.

Gepents, known under brand names Ubrelvy, Nurtec ODT and Qulipta, are unique as they can be used for treatment of an existing headache, or for prevention.

“This is one class that can be used for acute migraine relief and prevention, which is a tremendous difference from the old distinction,” he said. “There’s not another class of agents that are used in this way.”

They also don’t cause rebound headaches—another great advance, he said.

Ditans, available in the form of lasmiditan, can be a great option to treat acute migraines, especially for people who cannot safely use triptans.

There’s yet another advance on the preventive side: monoclonal antibodies that block calcitonin gene-related peptide, which is involved in inflammation and pain in the nervous system of those who have migraine attacks.

These are available as injectables on a monthly or quarterly basis. They can stop migraines from ever starting.

“These are a tremendous advantage because we never had preventive options designed specifically for migraines until we had these,” Dr. Pomeroy said.

It’s best to meet with your primary care doctor or a specialist if you’re a new migraine sufferer, or even if you were diagnosed and treated years ago.

“We have seen patients, who were stuck in the past, getting better,” Dr. Pomeroy said. “The options for getting relief in 2021 compared to 2017 are markedly different. If you went through migraine treatment and gave up, maybe it’s time to re-engage with your physician.”

Dr. Pomeroy knows that, for patients whose lives are up-ended by migraines, that’s a big ask.

Migraine sufferers can sometimes face stigma when others don’t understand their condition. 

“Migraines are tremendously disabling, but it’s not obvious to the casual observer,” he said. “If I was missing my foot, everyone would understand why I was limping. But with a migraine you don’t always have that blatantly obvious sign of disability.”

Keeping a headache diary can help, noting any changes in diet or other triggers that might contribute to the migraine attacks. This may be more helpful to those who suffer three to four migraines a month than for those who have 15 or more migraines per month, Dr. Pomeroy said.

While everyone is different, a few diet and lifestyle tips could help.

Avoid heavily processed food and eat multiple small meals throughout the day to keep your body from entering a fasting state, Dr. Pomeroy said.

Some foods can also be common triggers, including the flavor enhancer monosodium glutamate, red wine and even chocolate.

But each patient is different, Dr. Pomeroy said.

He urges compassion for yourself and other migraine sufferers.

“It’s very easy for someone to feel like, ‘I did this, so I got a migraine.’ It can easily make someone feel like it’s their fault,” Dr. Pomeroy said. “We have work to do to de-stigmatize the disease.”