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What New Migraine Treatments Are on the Horizon?
Dr. Amaal Starling, a migraine specialist at Mayo Clinic, talks about recent advancements in migraine treatment, including FDA-approved CGRP-targeted medications and devices that are specifically designed to address the underlying mechanisms of migraines.
00:00:00:00 - 00:00:26:01
Dr. Starling
So many different treatment options that are available. I feel like every couple of months we have something new that is being FDA approved or FDA cleared. There are multiple new devices that have come out, and there are also new medications. So the most recent medications are targeting a system called C-G-R-P. It stands for a specific protein that rises during a migraine attack.
00:00:26:03 - 00:00:48:20
Dr. Starling
There are once-a-month injections, CGRP monoclonal antibodies that are being used for prevention. There's also these pills that are blocking the CGRP receptor that are being used for both prevention and as-needed treatment, and there are multiple devices that are being used for either prevention or as-needed treatment, but the key is not those specific devices or medications.
00:00:48:22 - 00:01:18:04
Dr. Starling
The key is this: Done are the days where we are just throwing medications at a disease, medications that were developed for different disease states. We now understand better what migraine disease is, so the treatment options that we are developing are disease specific. They're designed specifically for migraine. They're based on what we know is happening in the brain, so they are mechanism based.
00:01:18:07 - 00:01:51:25
Dr. Starling
They're targeted to specific proteins, so they're being better tolerated because we're targeting them to specific parts of the brain or specific proteins. So they're better tolerated than the prior medications that we had, and so these are these disease-specific, mechanism-based targeted treatment options that are not only working better, but better tolerated for patients. So it's an exciting era to be able to treat people with migraine and for patients to have migraine because we have better treatment options.
00:01:51:27 - 00:01:54:11
Dr. Starling
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Migraine isn’t just a headache — it’s a complex neurological condition that can seriously disrupt your daily life. Thanks to recent advances in migraine treatment, there are now more options than ever before, giving people with migraine new reasons to feel hopeful.
In this article, we’ll explore the latest ways to treat migraine, including new medications, devices that work on nerves, and therapies that are still being tested. You’ll find out how these therapies work, how effective they are, and how they might fit into your migraine treatment plan. If you have any questions about these new treatments, ask your healthcare provider.
Calcitonin gene-related peptide (CGRP) is a protein in the brain and nervous system that plays a major role in migraine attacks. When CGRP is released, it transmits pain signals and causes blood vessels to widen. During a migraine attack, CGRP levels rise, leading to more pain, inflammation, and other migraine symptoms.
Medications called CGRP inhibitors have revolutionized migraine treatment in recent years. These medications work by blocking CGRP and interrupting pain signals during a migraine attack. CGRP inhibitors can be separated into two main categories — monoclonal antibodies and small-molecule antagonists known as gepants.
Monoclonal antibodies target either the CGRP protein or its receptor. Both mechanisms work to prevent a migraine attack from taking hold.
Erenumab-aooe (Aimovig), the first anti-CGRP medication, was approved by the U.S. Food and Drug Administration (FDA) in May 2018. This monthly injectable treatment prevents migraine attacks by blocking the CGRP receptor, stopping the molecule from triggering migraine attacks. Studies show this drug can reduce migraine days by about six days a month for people with chronic migraine (defined as having attacks at least 15 days a month).
Fremanezumab-vfrm (Ajovy) works by directly targeting the CGRP protein to prevent it from binding to the CGRP receptor. This medication is given as either a monthly or quarterly injection, depending on the dosage. In clinical trials, treatment with fremanezumab-vfrm lowered the number of monthly migraine days by four to five days, on average.
Galcanezumab-gnlm (Emgality) was approved by the FDA in September 2018 and works by blocking the CGRP receptor. Given as a monthly injection, this medication has been shown to reduce migraine days by about 4.5 days a month for people with chronic migraine. Side effects are generally mild and include injection-site reactions.
Eptinezumab-jjmr (Vyepti) is the only anti-CGRP medication given by IV infusion, which is administered every three months at a healthcare facility. In clinical trials, eptinezumab-jjmr cut monthly migraine days by about half for many participants. For some, the benefits began within days of the first infusion. Approved by the FDA in February 2020, eptinezumab-jjmr is a treatment option for adults with chronic and episodic migraine (attacks that occur fewer than 15 days a month).
Gepants, such as ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT), block CGRP receptors and are taken as pills. Unlike older treatments such as triptans, gepants don’t narrow blood vessels, so they’re safe for people with some cardiovascular (heart and blood vessel) problems. Gepants can be used as needed to stop migraine attacks or as daily medication for prevention.
Rimegepant is taken as a tablet that’s placed under the tongue and dissolves quickly without water. In clinical trials, rimegepant was shown to significantly reduce pain and other migraine symptoms in as soon as two hours. The FDA approved this medication in February 2020 for acute or preventive migraine treatment. It should be taken as needed for acute attacks and can be taken every other day to prevent migraine attacks.
Atogepant (Qulipta) is specifically for preventing episodic migraine. This medication is taken once daily as a pill, making it a convenient option for long-term migraine management. Studies show that atogepant can reduce monthly migraine days by an average of three to four days.
Ubrogepant was approved by the FDA in December 2019 as an acute treatment for migraine attacks. This medication works quickly to block CGRP and relieve symptoms without causing extreme drowsiness. Clinical trials show that many people experience relief quickly, sometimes within two hours of treatment. Ubrogepant is taken as needed, and a second dose can be taken within 24 hours if symptoms persist. Side effects include nausea, tiredness, and dry mouth.
The FDA approved zavegepant (Zavzpret), a nasal spray that treats migraine attacks in adults, in March 2023. Zavegepant helps address symptoms such as pain, nausea, and sensitivity to sound and light. Side effects include nausea, an unusual taste, and vomiting.
Noninvasive neuromodulation devices are a promising addition to the migraine treatment tool kit. These devices use electrical or magnetic stimulation to calm overactive nerves involved in migraine attacks.
The transcutaneous supraorbital nerve stimulation (Cefaly) device targets the supraorbital nerve, which is involved in migraine pain pathways. This treatment is FDA approved for both acute and preventive treatment. Worn on the forehead, the device sends gentle electrical impulses to reduce pain during a migraine attack or prevent future episodes. Many people living with migraine find it to be effective and easy to use, with minimal side effects.
The external trigeminal nerve stimulation device (Cefaly Dual), a newer version of Cefaly, targets the trigeminal nerve, another major part of the migraine pain pathway. Like the original version, it’s worn on the forehead to deliver electrical pulses to prevent or interrupt migraine. Studies indicate that Cefaly Dual can significantly reduce migraine frequency and severity. This device is a good option for people who haven’t had success with medications or prefer nondrug treatments.
The single-pulse transcranial magnetic stimulation device (sTMS, SAVI Dual) is another type of neuromodulation device. This wearable device uses magnetic pulses to change brain activity associated with migraine. The FDA approved sTMS for both acute and preventive use in people over age 12. Clinical studies show that consistent use can reduce the frequency and severity of migraine attacks.
Studies show that the vagus nerve also plays a role in the brain’s migraine pathway. The noninvasive vagus nerve stimulation device (GammaCore) targets the vagus nerve through mild electrical pulses. This device is FDA approved for both acute and preventive treatment. Many people report that regular use leads to significant pain relief and fewer migraine days per month.
The field of migraine research continues to evolve, with several exciting therapies on the horizon. These include new medications and cutting-edge technologies.
Ditans represent a new class of migraine medications that target serotonin receptors in the brain. Unlike triptans, these drugs don’t constrict blood vessels, making them a safer option for people with heart problems. Lasmiditan (Reyvow), an oral medication in this category, is approved for acute migraine and works fast to relieve pain and other symptoms. Common side effects include dizziness and fatigue (extreme tiredness).
Ongoing studies are exploring new ways to treat migraine. Some research aims to develop anti-CGRP drugs that last longer and require fewer doses. Other studies are looking at combining medications with neuromodulation devices. Researchers are also testing new ways to deliver drugs, such as patches or inhalers. These methods may help people get relief faster and make treatments easier to use.
Migraine treatments have changed a lot in recent years. Anti-CGRP drugs offer targeted relief with fewer side effects, and neuromodulation devices provide nondrug alternatives. Emerging therapies, such as ditans, offer promise for even greater improvements in the near future.
If you’re living with migraine, it’s important to discuss these options with your healthcare team. Together, you can create a plan that fits your needs. With so many advances on the horizon, there’s reason to feel hopeful about managing migraine more effectively than ever before.
On MyMigraineTeam, the social network for people with migraine, more than 84,000 members come together to ask questions, give advice, and share their experiences with others who understand life with migraine.
Have you tried any of the latest treatments for migraine? How did they work for you, and what advice would you offer others? Share your experience in the comments below or on your Activities page.
Jazmin N. McSwain, Pharm.D., BCPS
completed pharmacy school at the University of South Florida College of Pharmacy and residency training at Bay Pines Veterans Affairs.
Learn more about her here.
Zoe Owrutsky, Ph.D.
earned her Bachelor of Science from the University of Pittsburgh in 2014 and her Ph.D. in neuroscience from the University of Colorado Anschutz Medical Campus in 2023.
Learn more about her here.
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