Around 39 million Americans experience migraine headaches, according to the Migraine Research Foundation.
If you’re one of these people, you know the sometimes debilitating symptoms they can cause and the toll they take on your quality of life. May 17, 2018 marked a breakthrough in migraine prevention therapy when the Food and Drug Administration (FDA) approved Aimovig (erenumab). Since its release over 120,000 patients have been prescribed Aimovig in the U.S.
Well-Being spoke to Christina Treppendahl, FNPBC, AQH, of The Headache Center in Ridgeland about this and other similar drugs, now approved by the FDA for the prevention of migraine headaches. Before getting into the discussion about how this new class of drugs works and what she has observed so far in terms of their effectiveness, Ms.Treppendahl described how clinicians differentiate between drugs designed to treat migraine pain from those designed to prevent the onset of migraine symptoms.
“Treating a headache or migraine attack after the pain starts, is what we call abortive therapy or acute attack therapy,” notes Treppendahl. “Treating the condition of migraine with the intention of not ever having a migraine, is preventive therapy or prophylaxis.”
Until recently, there have been only 3 classes of medications available for migraine prevention (antihypertensives, antidepressants and antiepileptics) and one therapeutic drug indicated for the prevention of chronic migraine (onobotulinumtoxinA – a cosmetic agent). This new class of drugs was developed to specifically target key mediators involved in the pathophysiology of migraine.
How Migraine Prevention Drugs Work
“It’s important to understand how drugs like Aimovig are different from what was available prior to their approval this year,” she continues. “Aimovig is the first monthly self-administered injection available to prevent migraine. This novel class of drugs was designed to decrease the number of monthly migraine days by blocking a targeted neuropeptide (calcitonin gene-related peptide or CGRP). This neuropeptide has been studied for over 30 years by neuroscientists due to the key role it plays in migraine pathophysiology and head pain.”
Two additional medications, Ajovy (fremanezumab) and Emgality (galcanezumab), now have been approved by the Food and Drug Administration for the prevention of migraine in adults. They are similar in method of delivery (self-administered injections – monthly or quarterly) and employ similar mechanisms of action (blocking the release of CGRP into trigeminovascular system during a migraine attack).
Drug Effectiveness So Far
Since their FDA approval, The Headache Center in Ridgeland, has prescribed this new class of drugs for approximately 700-800 patients, and according to Ms. Treppendahl, they have seen some very dramatic improvements in a large percentage of these patients.
“While we have had a small handful of patients report no improvement, which is to be expected, fortunately, the majority of patients are reporting significant improvements,” she reports. “This has been a real game changer for patients that have ‘tried everything’ for prevention and never had any success.”
During clinical trials for the drugs, many patients were on other preventive medications, or they were overusing attack medications (more than 3 days per week), and they still had a significant positive response compared to the placebo group. Some decreased their monthly migraine or headache days by 50%. Others reported a 75% reduction in headache days and some super-responders (those that reported zero headache days during one month with Aimovig on board).
When discussing prevention, it is important to know what the goal is.
“First, we would like to be able to cut the number of headache days in half,” Ms. Treppendahl explains. “We call this the 50% responder rate. That is the minimally acceptable goal. Of course, we prefer to cut headache days down by 75% or even by 100%. In addition to decreased headache days per month, we look for other things such as a reduction in the severity of attacks, attacks that respond more readily to treatment, decreased use of medications to abort attacks, less days with disability, no missed work or school or social functions and patient satisfaction and report of an improved overall quality of life.”
Other Migraine Therapies and Behavioral Modification
Of course there are a number of other drug therapies and methodologies that are used to treat migraine pain. These range from anti-seizure medications, to antihypertensives or beta blockers, neurotoxin injections such as BotoxTM, antidepressants and neuromodulation devices. There are also specific actions a person can take:
• Trigger avoidance: Managing triggers
– Headache Diary to help identify potential triggers
– Smartphone Apps
• Lifestyle modification: “Prescribed” lifestyle changes
– Good sleep hygiene
– Healthy diet and exercise
• Mind-body therapies have proven efficacy and benefit in migraine mangagement:
– Cognitive Behavioral Therapy (CBT)
– Progressive Muscle Relaxation
Call to Action
In closing, Ms. Treppendahl offered a word of encouragement and a call to action for those who suffer chronic, debilitating migraine pain.
“Don’t wait another day. If you suffer from frequent or severe head, face or neck pain, please seek out a headache specialist to get treatment before the condition progresses and you lose time and years of what could have been, a more productive and rewarding life.”
Christina Treppendahl, FNP-BC, AQH, is Founder and Director of The Headache Center at 1000 Highland Colony Parkway, Suite 7205 in Ridgeland. She is a Family Nurse Practitioner with a Master of Science degree in Neonatal Nursing from Vanderbilt University and a Post-Master’s degree in Family Nursing from The W in Columbus, Mississippi. Ms. Treppendahl is currently enrolled in the Master’s of Headache Disorders program abroad at the University of Copenhagen. She is certified in headache medicine by the National Headache Foundation.
Ms. Treppendahl is a national speaker for migraine-specific FDA-approved pharmacologic therapies and has given presentations for the National Headache Foundation and the American Academy of Nurse Practitioners. She is also Founder and Director of The Headache Center Institute, a non-profit organization promoting patient awareness and provider training. She is currently enrolled in the Master’s of Headache Disorders program abroad at the University of Copenhagen.
In addition to the clinical practice, The Headache Center has a robust research center that enrolls patients in national clinical studies for migraine and cluster treatment.
published in the magazine’s January/February 2019 issue. For more from Well-Being