Various medications and therapies can provide relief, but the FDA has approved the first in a new class of drug aimed at heading off migraine headaches before they start.
There are headaches, and then there are migraines.
“Oh, my god. I can’t tell you how disabling migraines can be,” said Dr. Priyanka Chaudhry, a neurologist at Baylor University Medical Center specializing in headaches.
“When patients come to me, they often say, ‘When I have a bad headache, I’m missing a social event. I’m missing time with my family. I can’t go out or do work.’ So, it’s that disabling.”
The new drug is a CGRP monoclonal antibody developed to prevent headaches.
“It’s a once-a-month injection used to decrease the number of headache days that they have in a month,” Chaudhry said. “In some cases, it will also make sure that you have less intense headache or the duration of the headache actually goes down.”
On the importance of the new drug: This is the most exciting phase in the headache world because in the last several years, we have not had a new drug which has been developed specifically for migraine. This drug is a CGRP monoclonal antibody. The fancy name is "calcitonin gene-related peptide," which basically was developed to prevent headaches or to use it as a rescue. It’s one-of-a kind because CGRP is released when someone has a migraine or a head attack and [the drug] actually helps to inhibit or to antagonize the effects of CGRP.
How the new drug works: It’s a once-a-month injection used to decrease the number of headache days that they have in a month. In some cases, it will also make sure that you have a less intense headache or the duration of the headache actually goes down.
How the new drug differs from current medication: We use two kind of medications now: One is rescue, usually use triptans or over-the-counter inserts, and then, preventives like antidepressants, anti-nausea medication, antihypertensive — something you use once a day. The problem with preventives is the high side effects and it takes a long time for them to work.
What we’re noticing with this new drug is that patients don’t really get much side effects. Also, it works a lot faster. It works within a month where as some of the other drugs can take eight to 10 weeks to show an efficacy.
The drug's cost ($6,900 per year, depending on insurance): The company is providing at least two doses free, which means you get to experience the drug and see if it’s even worthwhile. And then the company will work with your insurance and try writing preauthorization letters and letters of appeal to see if we can get you on the drug.
Hopefully, I’m assuming, when insurance companies start seeing how much it prevents patients from going to the ER, how much it prevents patients coming to doctors again and again for headaches and it helps with their migraine, this will soon be on most commercial plans.
Other similar medications to come: There are three more in the pipeline and hopefully we’ll have some of those by the end of the year. There is one more that is presumed to come next year, hopefully.
Are we close to a cure for migraine: No. We can improve the quality of life with these medications to the point where patients either don’t have that many headaches or when they have a headache, they’re able to break it pretty quickly so they can go back to what they were doing. The problem is that there is no real path of physiology of migraine.
Migraine can happen due to various reasons. There are several theories that we know, but there’s just one pathway that we know. However, with this new drug, we are a lot closer than we were a couple of years ago to finding a good, happy balance to someone having a migraine but still having a great quality of life.