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For people with frequent migraines, side effects from treatments have often been so severe or unpleasant that those treatments have to be discontinued.
But a new injectable drug is available that may prevent migraines and in trials was associated with relatively mild side effects, including constipation and irritation at the site of the injection.
The drug is known as Aimovig and is currently available from two manufacturers, Amogen and Novartis. “As a headache specialist, [I’m] really excited and hopeful,” says Catherine Ham, director of the headache clinic at VCU and an assistant clinical professor in the neurology department in the VCU School of Medicine. “It’s going to be a real breakthrough.”
Catherine Ham (Photo by Allen Jones courtesy VCU Health)
Migraines involve the inside of the brain, while common tension headaches are muscle-based, and outside the brain, according to Ham. Consider a headache as akin to a cold, while migraines are more like full-blown flu. They often are described as causing intense, throbbing pain. Light and sound and any activity at all may make a migraine worse, and someone in the depths of a migraine may also experience nausea and vomiting.
One in 10 people suffer from migraines. The condition is three times more likely to occur in women than men.
Ham notes that migraines are misunderstood and under-diagnosed.
There is no cure. Treatment options have included a variety of medications that were developed to allay other conditions, including medication for high blood pressure and seizures or antidepressant medications, which decrease hypersensitivity of the brain. Botulinum Toxin A (often marketed as Botox) is also used.
There’s no way to test to see what individual will respond best to which particular medication, so doctors have to try to figure out which would be a good fit. It’s more of an art than a science to get it right, says Ham.
But side effects such as weight gain, brain fog and sleepiness can be a deterrence to people continuing treatment, even when they gain relief. About 85 percent of people stop taking the meds because of side effects, according to a New York Times report.
The new medication, Aimovig, was approved for use earlier in May by the U.S. Food and Drug Administration. It’s administered monthly through self-injection and works by blocking a protein fragment that’s involved in migraine attacks.
In three clinical trials, the drug was shown to reduce the number of days migraines occur. In one study over six months, participants with episodic migraines (people who experience migraines 4 to 14 days each month) receiving the drug reported that they had three or four fewer days of migraines. Subjects receiving placebos reported two fewer days of migraines.
In a second, three-month study, those with episodic migraines reported one fewer migraine day per month than subjects who received a placebo. And in a third three-month study of subjects with chronic migraines (migraines that occur 15 or more days in a month), those who received the medication reported six or seven fewer days with migraines, while those who received a placebo reported four fewer migraine days.
A year’s course currently costs $6,900. A manufacturer is offering two months free, and copay support may also be available.
Ham notes that migraines have a profound impact on quality of life. Patients coping with chronic migraines often suffer in silence, and feel like they’ve been not as good a parent or a partner in a relationship because they were dealing with the personal hell of a migraine and couldn’t be there for a loved one or child.
“This is a huge unmet need,” says Ham.
