85% of all chronic migraine sufferers are women, and about 1 in 4 women will experience migraine over their lifetime. Yet, this complex illness remains underdiagnosed and most sufferers have inadequate access to care and treatment. For migraine basics, read my previous blog Is Migraine a Headache or an Illness?
As we still don’t completely understand what is going on in the brain during a migraine episode, we need continuing research and studies into the nerve pathways, brain chemistry, and genetic components involved. There are thought to be environmental triggers in the mix as well. So, there is a lot of trial and error and frustration for those trying to control this illness.
For decades many people treated their migraines by drinking coffee or a caffeinated cola and taking Acetaminophen. Many others resorted to lying down in a dark room with a cold towel on their heads and waited it out.
Many healthcare providers offered people medications that were used for other conditions Using these medications to treat migraine was considered separate from what the FDA approved those drugs for (on- label) and were considered “off-label” drugs primarily used to treat seizure disorder, high blood pressure, and depression as desperate patients looked for relief.
In 2010 Botox (OnabotulinumtoxinA) was discovered to have therapeutic value for some patients. Many of these drugs lost effectiveness over time or had significant side effects.
In 2010 Botox (OnabotulinumtoxinA) was discovered to have therapeutic value for some patients, when women who were receiving Botox injections in their foreheads to reverse wrinkling also found that their migraines improved. Now Botox injections are routinely used to treat people with chronic migraines.
A new class of drugs known as triptans hit the market in the early 1990s and continues to be the most prescribed treatment specifically for migraine pain. A simplified version of how triptans work is that they constrict the vascular system in the head and neck and calm down inflammation that can overstimulate cranial nerves. Triptans should be taken at the first sign of a headache because it’s effectiveness is reduced the longer the migraine continues. Triptans work well and in the hopes that its effects can be lessened, and come in regular pills, dissolvable pills, nasal sprays, injections, and patches.
A New Drug for Prevention
“The entire field is changing,” says Stephen Silberstein, director of the Headache Center at Jefferson Health in Philadelphia. “There is a revolution in migraine.” He is referring to the newly approved medication drugs like erenumab-aooe (Aimovig), which targets the pain transmitting signal calcitonin gene-related peptide (CGRP). This new drug, which is given by injection once a month, prevents migraine by blocking the CGRP receptor, stopping the protein that is believed to be key to the inflammatory processes that bring on the headache. Cost for this treatment is over $6,000 per year.
Many people want to find a non-drug way to control their headaches. Women who are pregnant or trying to get pregnant, those with other illnesses or allergies, and those who can’t tolerate the side effects have a few new “neuromodulation” devices to try. One is called Cefaly, a transcutaneous electrical nerve stimulation device that is FDA approved. It is attached to the forehead for 20 minutes a day, sending micro-impulses through the electrode to the upper branch of the trigeminal nerve to relieve headache pain or ward off future episodes.
Friends or family members who have migraine can almost always certainly tell you their what “triggers.” their migraines. For some, it’s lack of sleep, extra stress, certain foods, dehydration, bright lights and many more all seem to play a role for some people. Avoiding these triggers and as always, the healthier your diet and lifestyle, the more your body (and mind) will be able to deal with this or any other illness or condition.