For those who experience migraines, the FDA just released some good news. In 2019, the U.S Food and Drug Administration approved three drugs that are aimed to help prevent migraines from happening, and, over time, it can help make them less intense and less frequent.
New migraine treatment
Treating migraine pain while an attack is underway is a big challenge. Triptans are the most popular medications that are used for this purpose, but they do not work for everyone. A study was published in the Journal of Medicine, and the researchers reported some encouraging results with an impressive class of oral drugs that are called gepants.
Gepants are meant to be taken while having a migraine attack. They target calcitonin gene-related peptide or CGRP receptors that are located on blood vessels and the nerve cells that are connected to pain in the brain.
The study was led by Dr. David Dodick, a professor of neurology at Mayo Clinic. The study included 1,672 people with a history of migraine who were randomly assigned to get a placebo pill or one of two dosage levels of ubrogepant.
Ubrogepant is a drug that blocks the CGRP from binding to its receptors and setting off pain alarms in the brain. After the first use, almost twice as many people taking the highest dose of the drug said that they were pain-free after two hours compared to those taking placebo. Around 28% of people in the placebo pill group reported no sensitivity to sound or light, which are some of the more debilitating symptoms of migraine, at two hours, 38% of those in the highest ubrogepant group did.
Dr. Dodick said that they do not think there is any question that they have identified as a key player in migraine pain. In previous studies, the researchers found that during migraine attacks, the levels of CGRP tend to rise in the blood and drop after the attack subsides. When scientists injected CGRP intravenously into people with a history of migraine, the infusion triggered a migraine that was indistinguishable from naturally occurring episodes.
Dodick also said that they are still not entirely sure how ubrogepant works in the brain, but based on the previous work on CGRP, experts believe that the drug mainly works on tamping down pain signals in the trigeminal nerve system.
The trigeminal nerve system is a neural network implicated in migraine that wires the muscles, face, teeth, and tendons. Ubrogepant is one of the two gepants that are being developed by Allergan, a company that sponsored the study and worked with researchers at the Mayo Clinic, Georgetown University, Albert Einstein College of Medicine and Montefiore in order to analyze the results.
While the study is encouraging, the findings of the study need to be confirmed in larger groups of migraine sufferers, and they should be studied over longer periods of time. The current trial had analyzed the data after one episode of migraine pain, but researchers still need to know the impacts of continued use of ubrogepant to treat several attacks.
Dodick said that he would also be interested to know how patients respond when they intervene earlier. In the trial that they made, the patients were asked only to take the drug after they felt moderate to severe pain. Usually, doctors advise their patients to start taking medicine as soon as they feel an aura, like a warning that a migraine attack is coming.
Ubrogepant's impact on health
Dodick added that he thinks the future of migraine treatment will involve intervening as early as possible in the course of an attack. The researchers are also still learning about ubrogepant's side effects.
In a current study, up to 5% of people on the drug reported nausea, dry mount, and feeling sleepy. A lot of people experienced more serious adverse events like appendicitis and seizure within the first month after dosing. A lot of scientists are working on a different gepant terminated their study after it was linked to serious liver toxicity.
