Andrew Charles, MD and Peter Goadsby, MBBS, MD, PhD: Migraine treatments; What are the latest advances?

"People struggling with migraine may benefit from research over the past decade that has led to impressive advances in treatment. “We are hearing the words from patients, ‘My life has changed,’ far more often,” says Andrew C. Charles, MD, director of the UCLA Goldberg Migraine Program. “There have been extraordinary breakthroughs in understanding the basic mechanisms of all types of headaches in recent years. For almost everyone who walks through our door, we have something to offer them.”

Migraine affects 10% of people worldwide, including 25% of adult women and 9% of children. A migraine attack is much more than just a severe headache; it is a constellation of symptoms that may include neck pain, nausea, dizziness, visual disturbances and sensitivity to light, sounds and smell among a variety of other manifestations Sufferers often lose hours or days disabled by the condition.  

In the past, doctors suspected that migraine was primarily a vascular condition, caused by abnormal dilation of brain blood vessels, and it was typically treated with non-specific pain medications. However, new research, including work by Dr. Charles and Peter Goadsby, MD, PhD, professor of neurology at the David Geffen School of Medicine, points to a much more complex picture involving dysfunction in the brain’s electrical networks and abnormal levels of particular neurochemicals.

This knowledge has led to a new class of medications called anti-CGRP (calcitonin gene-related peptide) drugs, which can be used acutely to treat a migraine attack once it begins, or to prevent migraine attacks from occurring.

Multiple anti-CGRP drugs are now on the market. Available as intravenous, injection or oral medications, some are aimed at prevention while others are approved to treat acute migraine. “A remarkable percentage of patients benefit from CGRP-targeting therapies” Dr. Charles says. “For some they are spectacularly effective and for most they are very well-tolerated. The problem is, they are expensive, so the current insurance guidelines state we should try other treatments before trying one of these. That’s a societal and ethical issue we’re dealing with now.”"

Read more at UCLA Health.