Despite being a prevalent condition, migraines are often difficult to treat — and there’s much we don’t know about them. Now, a study sheds new light on which treatments work best — and there’s a bit of good news. You don’t always need expensive treatments to deal with migraines.

Migraines, a neurological condition marked by intense, pulsating headaches often accompanied by nausea and sensitivity to light and sound, afflict millions worldwide. They’re not just painful but also a leading cause of disability, especially among women under 50. Despite the availability of preventive medications, their usage is surprisingly low, with adherence rates struggling. A reason for that may be cost.

A new study from Norway, spanning a decade (2010-2020), offers invaluable information on the effectiveness and retention rates of different migraine preventive medications. This large-scale, registry-based cohort study analyzed data from 104,072 patients, providing a robust and comprehensive understanding of migraine treatments in a real-world setting.

The research compared various drugs against beta blockers, the most prescribed migraine preventive drug in Norway (other countries have different recommended migrained treatments).

Migraine prevention treatments encompass a range of medications. There are the more traditional generic options such as beta-blockers, antidepressants, and anticonvulsants. And recently there have been innovations like monoclonal antibodies targeting the calcitonin gene-related peptide pathway (CGRP mABs) and botulinum toxin A (BtA or Botox), specifically for chronic migraines. Individuals suffering from chronic migraines, as opposed to episodic ones, often need extensive pharmaceutical intervention, which can become rather expensive.

Effective alternatives

Now, researchers have found that three medicines were better at preventing migraines than beta blockers: CGRP inhibitors, amitriptyline and simvastatin. Simvastatin had higher effectiveness and retention than beta blockers, whereas amitriptyline had higher effectiveness but lower retention during the first 90 days of treatment.

“The latter two medicines are also established medicines used for depression, chronic pain and high cholesterol, respectively, while CGRP inhibitors are developed and used specifically for chronic migraine”, says Professor Marte-Helene Bjørk at the Department of Clinical Medicine, University of Bergen, who led the research.

Of these, CGRP inhibitors stand out as the most expensive option. However, the other two are relatively cheap treatment options.

“Our analysis shows that some established and cheaper medicines can have a similar treatment effect as the more expensive ones. This may be of great significance both for the patient group and Norwegian health care”, says Bjørk.

Since the study was conducted in Norway and involved Norwegian patients, the findings may not be generalizable to populations in other countries with different genetics, lifestyles, or healthcare systems. However, if the findings are confirmed in a more generalizable population, it could lead to revamping how we deal with migraines and even highlight new treatment avenues.

The researchers have now started a larger study to measure the effect of other cholesterol-lowering medications as preventive measures against migraines.

The study was published in the European Journal of Neurology.