Are the Newest Migraine Prevention Drugs Right for You?

If you have frequent migraine headaches — occurring a few days a month or more — you know the toll they can take on your work and quality of life.

So how much of a difference might a new class of migraine-prevention drugs called CGRP inhibitors make for you?

“This is the first class of drugs that has specifically been developed for migraine prevention,” says Payal Soni, MD, a neurologist specializing in headaches.

How do they work?

Until now, drugs used to prevent migraines were actually developed to lower blood pressure, prevent seizures or treat depression. But they were later discovered to also help with migraines, so the drugs were prescribed in what’s called an “off-label” use.

CGRP inhibitors are a new class of medicines that address migraines head-on. Four drugs in this class have been approved by the U.S. Food and Drug Administration: erenumab (Aimogiv®), fremanezumab (Ajovy®), galcanezumab (Emgality®) and eptinezumab (Vyepti®).

CGRP stands for the scientific name of a protein that’s naturally found in the nervous system. The protein is released from nerve endings, including those surrounding the brain, where it widens blood vessels and may promote inflammation and pain. CGRP inhibitors work by blocking the protein and preventing or reducing pain in the process.

How effective are they?

Over several clinical studies, these drugs were associated with an average reduction of three to five headache days per month in people with frequent migraines.

Although that might seem pretty modest, it’s about the same benefit gained with the drugs traditionally used to prevent migraines. And the word average is key: Some people had much better results.

“Based on the clinical trials, these new drugs aren’t necessarily more effective than the drugs that we’ve had, but there are some positives,” Dr. Soni says.

First, they have what’s called a longer half-life, which means patients only need to take them once a month or once every three months instead of daily.

Another positive is they generally cause fewer and milder side effects than other drugs — mainly irritation at the injection site or constipation.

They also don’t typically interact with other drugs in a way that is dangerous for the people taking them. “They can be used in patients who have stroke, coronary artery disease, liver disease and liver disease,” she says.

How are they taken?

Erenumab, fremanezumab and galcanezumab are taken once a month by injection. A simple EpiPen®-like injector device makes it easy for people to self-administer the drug.

Eptinezumab, which was just FDA approved in February, is given through an IV every three months. This might be a preferable option for people who get bad swelling or bruising at the injection site with other CGRP inhibitors.

Other key considerations

Dr. Soni adds that a few other issues are crucial to determining with your doctor whether these medicines might make sense for you:

• Cost. “While there are lots of benefits to these drugs, one of the biggest disadvantages is the cost,” Dr. Soni says. “The cost for each varies, but it can be up to $700 a month. While some insurances pay for them, there are generally some strict guidelines that insurances have before these medicines can be approved.”
• Pregnancy. Little data is available on their use during pregnancy — or in children. To be on the safe side, Dr. Soni advises women who are pregnant or planning to get pregnant to talk with their doctor early.
• How good is your current therapy? If you’re already doing well on a different migraine drug, there’s no reason to switch.
• Long-term safety is not yet available. Since these are fairly new drugs, it will be important to see if any problems emerge when many more people are using them for long periods of time.