Migraine treatments: What are the latest advances?

Recent research has led to a new class of medications.
Patient with doctor
Photo: iStock

People struggling with migraine may benefit from research over the past decade that has led to impressive advances in treatment. “We are hearing the words from patients, ‘My life has changed,’ far more often,” says Andrew C. Charles, MD, director of the UCLA Goldberg Migraine Program. “There have been extraordinary breakthroughs in understanding the basic mechanisms of all types of headaches in recent years. For almost everyone who walks through our door, we have something to offer them.” 

Migraine affects 10% of people worldwide, including 25% of adult women and 9% of children. A migraine attack is much more than just a severe headache; it is a constellation of symptoms that may include neck pain, nausea, dizziness, visual disturbances and sensitivity to light, sounds and smell among a variety of other manifestations Sufferers often lose hours or days disabled by the condition.  

In the past, doctors suspected that migraine was primarily a vascular condition, caused by abnormal dilation of brain blood vessels, and it was typically treated with non-specific pain medications. However, new research, including work by Dr. Charles and Peter Goadsby, MD, PhD, professor of neurology at the David Geffen School of Medicine, points to a much more complex picture involving dysfunction in the brain’s electrical networks and abnormal levels of particular neurochemicals. 

This knowledge has led to a new class of medications called anti-CGRP (calcitonin gene-related peptide) drugs, which can be used acutely to treat a migraine attack once it begins, or to prevent migraine attacks from occurring.  

Multiple anti-CGRP drugs are now on the market. Available as intravenous, injection or oral medications, some are aimed at prevention while others are approved to treat acute migraine. “A remarkable percentage of patients benefit from CGRP-targeting therapies” Dr. Charles says. “For some they are spectacularly effective and for most they are very well-tolerated. The problem is, they are expensive, so the current insurance guidelines state we should try other treatments before trying one of these. That’s a societal and ethical issue we’re dealing with now.” 

The CGRP inhibitors may be just the beginning. Dr Charles, Dr. Goadsby and colleagues are participating in research on another peptide, dubbed PACAP (pituitary adenylate cyclase-activating polypeptide), which is thought to play a role in migraine. Research is also underway on neuromodulation therapies — magnetic, electric or mechanical treatments that stimulate specific parts of the brain to interrupt migraine activity. 

Medication as well as non-medication therapies are offered at the UCLA Goldberg Migraine Program. Patients undergo a detailed diagnostic workup and are paired with physicians best suited to help them, such as specialists in migraine related to brain trauma or migraine linked to female hormones. “The first order of business is to make an appropriate diagnosis that guides therapy,” Dr. Charles says. “The ultimate cause of migraine may be the same in each individual, but the underlying factors may be very different, and the plan for management needs to be individualized.” 

While more treatment options are now available, many Americans have not been properly diagnosed or don’t know that there are newer, more effective medications, Dr. Charles says. “Even with all these new therapies, migraine is still tremendously under-diagnosed,” he says. “Now that we have all of these new therapeutic options, it’s important to get a correct diagnosis.”