A new injectable drug might finally put an end to some of the worst migraines out there, for which no other medication seems to work.

Credit: Flickr, Nial Bradshaw.

A migraine is too often trivialized as just a headache when, in reality, it can be a debilitating, chronic condition that can destroy lives.

They can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days, or even weeks, and can be so severe that the pain is disabling.

Although migraines are the most common neurological disorder, these are very difficult to treat, varying from moderate to severe pain. In the past 20 years, there has not been much progress in the field of migraine research, with patients having to rely on the same drugs for ages. Mild migraine suffers usually pop ibuprofin, while those with stronger migraines often resort to prescription drugs such as ergotamine and sumatripin.

However, some migraines are so bad that not even the strongest drugs currently available on the market can help. Fortunately, a new drug called erenumab, which was developed by Amgen and Novartis, could be the answer to the worst headaches. That’s according to preliminary results of a clinical trial that will be presented at the American Academy of Neurology’s 70th Annual Meeting in Los Angeles, April 21 to 27, 2018.

Drowning the pain

Erenumab is a synthetic monoclonal antibody that blocks pain signals by targeting a receptor for calcitonin gene-related peptide (CGRP) — a neural pathway that transmits migraine pain signals to the brain. Erenumab occupies the nerves to which CGRP would usually bind, canceling the pain signal before it gets to trigger a migraine.

Monthly doses as small as 70 mg or 140 mg were enough to significantly reduce migraines in some of the worst cases — and with no side effects to boot. Ergotamine and sumatriptan, on the other hand, produce unfortunate side effects like vertigo.

For the study, 246 participants who unresponsive to migraine treatments were given an injection of erenumab or a placebo once a month for three months. Of the participants, 39 percent had been treated unsuccessfully with two other medications, 38 percent with three medications and 23 percent with four medications. On average, participants experienced an average of nine migraine headaches a month and used an acute migraine drug to stop an attack five times a month.

“The people we included in our study were considered more difficult to treat, meaning that up to four other preventative treatments hadn’t worked for them,” said study author Uwe Reuter, a researcher at The Charité – University Medicine Berlin in Germany.

“Our study found that erenumab reduced the average number of monthly migraine headaches by more than 50 percent for nearly a third of study participants. That reduction in migraine headache frequency can greatly improve a person’s quality of life.”

Those treated with erenumab also experienced fewer days suffering from headaches or days when they needed to take medication to stop migraines. For those on erenumab, there was an average 1.6 times greater reduction in migraine days and a 1.7 times greater reduction in acute medication days compared to those on placebo.

What’s particularly promising about erenumab is that it is the first-ever migraine drug designed for prevention.

The authors of the new study report that phase III trials involving nearly 1,000 subjects are now complete, and seem to indicate that erenumab reduces three to four migraine days per month. For half of the participants, the number of migraine-inflicted days was reduced by 50 percent, as reported in The New England Journal of Medicine.

There’s also another migraine-specific drug that also seems to improve symptoms for some of the most difficult cases. The drug in question, Fremanezumab, was developed by Teva Pharmaceuticals. In a clinical trial, the drug was injected quarterly for 12 weeks to 1,1130 chronic migraine patients who achieved, on average, a 4.3-day reduction of migraine episodes from a baseline of 13.2 days/month. For some people, the attacks all but vanished. These findings were also published in The New England Journal of Medicine.

“Our results show that people who thought their migraines were difficult to prevent may actually have hope of finding pain relief,” said Reuter. “More research is now needed to understand who is most likely to benefit from this new treatment.”