This spring, Aimovig, the first drug approved specifically to prevent migraines, hit the market, and more drugs are quickly working their way through the U.S. Food and Drug Administration pipeline.
“This is the most exciting development in the treatment of headache, specifically migraine, for years,” says Dr. Elizabeth Leleszi, a pediatric neurologist and director of the Beaumont Headache Center. “Never once has there been an effective preventive treatment. One of the reasons people are so thrilled is that this drug really works, and works well, and without the side effects you see with the other medications [for migraines]. It’s going to revolutionize headache therapy.”
Migraines affect about 38 million Americans, mostly women, and the World Health Organization names it the seventh-most-disabling disease worldwide. However, the National Headache Foundation says about half of the sufferers in the United States aren’t diagnosed, and what constitutes a migraine, often isn’t well understood.
“Many patients have what they call sinus headaches, but more often than not, those are migraines that aren’t diagnosed,” says Dr. Ashhar Ali of Henry Ford Health System, who specializes in neurology. A migraine is defined as moderate to severe head pain, typically on one side of the head. It’s often, though not always, associated with nausea, vomiting, and sensitivity to light and noise. The reasons for this are not fully understood. However, medical researchers believe that migraine sufferers have a dysfunctional autonomic nervous system, which controls digestion. The nausea and vomiting might be due to delayed emptying of the stomach, along with inflammatory substances released in the brain. The sensitivity to light and sound is likely the result of an overall heightened sensitization of the body’s nervous system. “What’s unique is that migraines are worse with routine physical activity,” Ali says. “The sufferer would prefer to lie down, whereas someone with another type of headache wouldn’t generally improve with rest.”
Aimovig targets a specific molecule, called calcitonin gene-related peptide (CGRP), that’s found in many areas of the brain and spinal cord. One of the molecule’s functions is to transmit pain, and people with migraines tend to have higher levels of it. Aimovig and other medications slated to release in the coming months either attach to the molecule to make it non-functional or target its receptors so it can’t attach. Aimovig, which is taken as a monthly injection, does the latter.
“Never once has there been an effective preventive treatment. … It’s going to revolutionize headache therapy.”
— Dr. Elizabeth Leleszi
Aimovig will typically cut a person’s frequency of migraines by half, according to data from a one-year study on its efficacy released in June by its maker, Novartis. It’s easy to understand why the drug is being greeted with such excitement: The impact of chronic migraines on a person’s life can be debilitating.
For Kristen Berry, of Livonia, chronic migraines often interfere with her ability to plan her life. The 49-year-old mother of three first experienced migraines in middle school, and says they’ve grown progressively worse as she’s gotten older. “I went to a doctor and told him I had headaches, but I got blown off,” she says. “It just didn’t seem like people understood the different types of headaches and what to do.”
For chronic sufferers, Aimovig is not only promising for its effectiveness, but also because it legitimizes the biological basis of the disorder, says Dr. Larry Charleston, clinical associate professor in the Department of Neurology at University of Michigan. “Aimovig targets the CGRP receptor which is thought to play an integral role in the pathophysiology of migraine. In general, diagnosis of headache disorders is strongly based on a patient’s history. And importantly, migraine has complex pathophysiology. CGRP is just one of the targets, but it’s a big target.”
Berry eventually sought treatment at a pain clinic in Ann Arbor and started taking Topamax, an anti-seizure medication that’s also used to prevent migraines, which helped. But she had to go off the medication 18 months ago when she developed kidney stones, a possible side effect, and her insurance didn’t cover other viable medications. She began having migraines nearly every day; in August 2017, she started seeing Ali.
“I couldn’t bear it by the time I went to Dr. Ali,” she says. “He reworked my whole regimen. He put me on vitamins — magnesium, CoQ10 — and started me on Botox, which was very helpful.”
Like many migraine sufferers, Berry is on the waiting list for Aimovig; the high demand for the medication has led to supply shortages. She’s also waiting for word on whether her insurance will cover the costly drug. For now, she has two medications she can take when a migraine comes on, typically 12-15 times a month, but because there’s a limit to how often the medications can be taken, she has to ration them out and, on some days, simply endure.
“Even if Aimovig just cuts back on the frequency or some of the symptoms [it will help],” Berry says. “You just don’t want to give up hope.”