Migraines: Can New Drugs Stop Debilitating Headaches Before They Start?

A man suffering from a headache is tormented by a horde of little demons. 'Headache' by Cruikshank. Hulton Archive/Getty Images

Updated | After decades without effective medications to prevent migraines, sufferers may have new options coming to the market soon. Two new drugs targeting the same pathway in the brain may cut down on the number and the length of migraines people suffer, separate studies published Wednesday in the New England Journal of Medicine have shown.

Migraines are not just headaches. There is a headache involved, certainly, but migraine pain is far more severe. People may also be extremely sensitive to light and sound while a migraine is happening and even vomit. Some people can predict when a migraine will next strike because of warning signs they feel, called auras. According to MedlinePlus, up to 12 percent of Americans have migraines.

Currently, the most effective drugs used to treat migraines are primarily designed to be used once a migraine starts. People may also adjust their lives to avoid things that trigger the migraines or use drugs not intended to specifically treat migraines.

People with migraines are thought to have too much of a protein called calcitonin gene-related peptide (CGRP) in their brains; both drugs work to try and reduce the effect of CGRP on neurons in different ways. One, fremanezumab, binds to CGRP directly so it can't bind to brain cells and have an effect. The other, erenumab, blocks the receptor on brain cells to which CGRP binds.

"These drugs may find a specific role in the treatment of patients who have migraines that are refractory to treatment or who are severely disabled by headaches," wrote from the Cincinnati Children's Hospital Medical Center in an editorial that accompanied the studies.

One of the authors of the erenumab study was more direct about the drug's potential impact in an interview with the BBC. "It's a huge deal because it offers an advance in understanding the disorder and a designer migraine treatment," Dr. Peter Goadsby at King's College Hospital said. "These patients will have parts of their life back and society will have these people back functioning."

Man holding head
Trader Thomas Mulchrone reacts in the Euro Dollar pit at the Chicago Mercantile Exchange October 8, 2008. REUTERS/John Gress

In addition to acting differently, the two drugs were also tested for different types of migraines: episodic vs. chronic. People with chronic migraines have more episodes over a longer period of time than those with episodic migraines. One drug, erenumab, was used specifically to prevent episodic migraines.

The study followed nearly 1,000 people over six months and tested two different dosages of the drug. When patients began the trial, most were suffering from migraines at least eight days each month. About half of the patients taking the drug had at least three to four fewer migraine days per month than they were having before, regardless of the dose.

Similar results were seen for fremanezumab, which was tested for chronic migraine patients. On average, patients who took the drug—regardless of the dosing schedule, which was either once every three months or once every month—had about four fewer days with headaches than those who were on a placebo drug. About 40 percent of the patients on the drug had half as many headache days on the drug. At the beginning of the trial, the average person was affected for nearly half of the month.

Each of the studies were funded by the companies developing the drugs; Amgen and Novartis are responsible for erenumab, while Teva is working on fremanezumab.

According to Amgen's pipeline, which lists all the drugs the company is currently developing, erenumab will be called Aimovig when and if it reaches the U.S. market. (Amgen is developing the drug with Novartis.) The FDA may approve the drug for one group of migraine patients—those who have at least four migraine days per month—in May.

Teva is the pharmaceutical company behind second drug, fremanezumab, intended to prevent migraines. The company just submitted an application to the FDA for the drug's approval in October.

Correction: A previous version of this article misspelled fremanezumab and misstated which kinds of migraines the drug is meant to prevent.