Finding the right medication can be torture. But new migraine medications like erenumab and fremanezumab, designed specifically to target migraine attacks, are offering new found hope.
Now... do you want the good news or the bad news?
Let's start with the good news - the trial results are positive and they should be coming to market very soon.
Is this the start of real change? I think so. See this update.
If you struggle with chronic migraine attacks, you may already know there's a bunch of medications out there to try. I’ve written about the migraine-specific drugs you can take as 'rescue' medicine' to help stop an attack once it's already started.
And in case you don't already know, it’s more effective to take two medications simultaneously to prevent an acute attack like: a triptan and ibuprofen.
There are meds you can take every day to help prevent an attack too… but these drugs weren’t actually developed specifically for migraine attacks. They were discovered to help reduce migraine whilst helping other conditions like: depression, high blood pressure or epilepsy for example. So you might try: antidepressants, blood pressure medication, or anti-epilepsy drugs to help manage your attacks.
These meds can come with some serious side-effects.
Enter the exciting area of a new class of CGRP-targeting drugs.
CGRP receptor antagonists is a new class of medication being tested for potential abortive migraine therapy. "CGRP is a chemical released from nerve endings that causes vasodilation as part of inflammation. A pill version of a drug that blocks CGRP has proven effective at quelling migraines within two hours in about two-thirds of people, according to one preliminary study." 
So, the "CGRP’s dilate blood vessels along the meninges and flourish during migraines. The drug that shuts them down may fix migraines as often and longer than triptans, and without tripping warnings for patients with heart problems." 
As with many new migraine medications, this will not be a one size fits all solution for you as a migraine sufferer, but it could prove helpful if you've failed to respond to triptans or other anti-migraine medications.
These new migraine medications are in trials now.
Both drugs - Erenumab and Fremanezumab - act by mimicking the body’s immune cells. They are called monoclonal antibodies. These agents can bind to a protein within the body called calcitonin gene-related peptide (CGRP). CGRP is released when a person experiences migraine pain. So, researchers are speculating that blocking this protein could help reduce the severity and frequency of migraines.
There are two high-quality studies published in the New England Journal of Medicine that show promising results: 
The trial called STRIVE "tested injections of the drug erenumab as a preventative for episodic migraine in 955 patients across 121 study sites over the span of six months.
The team found that in their study population of episodic migraines with a baseline of 8.3 attack days per month, erenumab could reduce that number by 3.2 days at a 70-mg dose and by 3.7 days at a higher, 140-mg dose.
In the higher-dose group, half of the patients experienced a 50 percent or greater reduction of the mean number of migraine days, which means that from all the days they'd lose to a migraine every month, they got at least half of that precious time back." 
The lead researcher was the highly respected Dr. Peter Goadsby from King's College Hospital in London and NIHR-Wellcome Trust King's Clinical Research Facility.
The results of STRIVE represent a real transition for migraine patients from poorly understood, repurposed treatments, to a specific migraine-designed therapy.
~ Dr. Peter Goadsby
The drug erenumab blocks the receptor of CGRP in the brain, and to date, is the only drug to do so. Amgen and Novartis are developing it and sponsored the study. And more good news is that the companies have announced that the FDA has accepted their drug filing.
On February 21, 2020, the Food and Drug Administration (FDA) approved VYEPTI (eptinezumab-jjmr) for use in the prevention of episodic and chronic Migraine attacks. Vyepti is an anti-CGRP (calcitonin gene-related peptide) monoclonal antibody.
It is the first and only migraine prevention treatment available as an infusion. 
Eptinezumab joins Emgality (galcanezumab), Ajovy (fremanezumab), and Aimovig (erenumab) as the fourth anti-CGRP drug on the market to prevent Migraine attacks. 
THE first acute medication that works by blocking CGRP, Ubrelvy (ubrogepant) was approved by the FDA in December 2019. More acute meds in this 'gepant' category are expected to come on the market in the coming years. 
Aimovig will be delivered monthly using an injection device similar to an insulin pen.  I've written all about it, including pros and cons here - New Drug For Migraine Aimovig.
But wait… there’s more!
Another trial for a different drug called fremanezumab (developed by Teva Pharmaceuticals) is showing even better results for migraine sufferers. This trial included 1,130 chronic migraine patients.
"When injected quarterly for 12 weeks, the drug achieved a 4.3 day reduction of average headache days from a whopping 13.2 days each month. Unlike erenumab, this drug targets the CGRP molecule itself." 
"The important takeaway from these trials is that the drugs are definitely performing better than placebo, but researchers acknowledge that more research will be needed to determine whether the medications continue to work and remain safe in the long term." 
So with these impressive results it looks like we'll be hearing more about CGRP monoclonal antibodies. There are two other companies – Amgen and Eli Lilly - that also have their own version of these meds in the pipeline "and there's talk that at least one of these four meds will end up on pharmacy shelves next year." 
The bad news is that the price predictions on these meds might be too high for us to even consider. They could end up costing $8,500 US a year which is way out of my price range, that’s for sure.
Hopefully the fierce competition for new migraine medications will bring the price down to a more affordable level.
Currently there 4 monoclonal antibodies in development. Amgen, Teva Pharmaceutical Industries Ltd., Lilly Bio-Medicines, Alder Biopharmaceuticals, Biohaven Pharmaceuticals and Allergan have CGRPs for migraine in the pipeline. 
Gepant is a CGRP small molecule for acute migraine treatment currently in phase 3 clinical trials. 
This oral acute medication will be good if you can't take a triptan. It has no cardiovascular risk like the triptans.
And I'm excited that these medications in different combinations will move us closer to achieving complete pain elimination.
I've written more about gepants here - CGRP Drugs For Migraine.
Inhaled Dihydroergotamine (DHE): is an orally inhaled form of DHE that is delivered via the Tempo® inhaler.
Initial testing has shown that this special inhaled form of DHE curbed migraine pain in only ten minutes. The lungs are an excellent quick absorption delivery system. This drug also was found to ease nausea and sensitivity to light and sound in the early testing. 
This drug is normally used to treat other conditions, which is the way most new migraine medications in the past have been discovered.
Doxycycline is a common antibiotic that fights bacteria in the body.
According to drugs.com "Doxycycline is an antibiotic used to treat bacterial infections, such as urinary tract infections, acne, periodontitis (gum disease) and chlamydia."
Case reports, according to Doctors Rizzoli, et al, authors of The Migraine Solution, suggest a significant benefit when used with new daily persistent headache or unusual patterns of migraine.
This is a N-Methyl-D-Aspartate (NMDA) receptor blocker medication that is normally used to treat memory disorders (Parkinson's Disease). In small studies, it has also shown some benefit to reduce the pain of migraine along with associated aura symptoms.
More studies are needed to see if these new migraine medications will be approved by the FDA for migraine treatment.
Who knows what the future of gene testing holds for us, but there is even more potential for more targeted new migraine medications... that's for sure.
We can buy almost anything over the internet these days.
Please only get your prescriptions from a reliable source.
I realize this may be more expensive, but I think it is more important to be safe than sorry (or dead)!
Talk to your pharmacist, they are a wealth of information especially if you have a new prescription drug.
I have a step by step pain management plan in my course where we cover finding the right medication with your doctor.
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New Migraine Medications References:
1. Rizzoli, P MD, Loder E., MD and Neporent L. (2011) The Migraine Solution: A Complete Guide to Diagnosis, Treatment and Pain Management. St. Martin's Press: NY. (pp.139 – 141).
2. Levy, A (2009) A Migraine Diary: A Brain Wider Than The Sky. Simon & Schuster: NY. (p. 207).
3. Dean, S. (2017) These Groundbreaking Migraine Prevention Drugs Just Smashed Clinical Trials. Available [online] at: https://www.sciencealert.com/new-migraine-drug-cgrp-erenumab-fremanezumab-clinical-trials-amgen-novartis-teva
4. Migraine Action (2017) Pivotal Data Showing New Treatment Erenumab To Cut Migraine By Half. Available [online] at: http://www.migraine.org.uk/latest-news/pivotal-data-showing-new-treatment-erenumab-to-cut-migraine-by-half/
5. Edvinsson, L. MD (2018) Treatment spotlight: Anti CGRP Treatments for Migraine. Available [online] at: https://www.migrainesavvy.com/summit
6. Drug Development Technology (2018) Aimovig (erenumab) for the Treatment of Episodic Migraine. Available [online] at: https://www.drugdevelopment-technology.com/projects/aimovig-erenumab-treatment-episodic-migraine/
7. Migraine Again (2020) VYEPTI for Migraine Prevention Approved by FDA. Available [online] at: https://migraineagain.com/new-vyepti-for-migraine-prevention-approved-by-fda/ Accessed Feb. 28, 2020