Simone Golob / Getty Images
Simone Golob / Getty Images
People who experience frequent migraines may soon have access to a new clbad of medications.
In a couple of large studies, two drugs that modify the brain circuits involved in migraine showed that they could reduce the frequency of attacks without causing harm. The researchers report in the New England Journal of Medicine .
"They offer the first treatment for migraine that is actually aimed at the disorder," says Peter Goadsby, author of one of the studies and a professor. of neurology at King's College London.
Current treatments for the prevention of migraine consist mainly of drugs designed to treat high blood pressure, epilepsy and depression. "We give [patients] a choice between a beta-blocker where they'll feel tired, or we tell them they can take an antidepressant, which will make them sleepy and gain weight," says Goadsby.
The new drugs use special antibodies to buffer a system in the brain that modulates pain. The effect is something like soundproofing, says Stephen Silberstein, study author and director of the Jefferson Headache Center in Philadelphia.
"You have a guy next door making a lot of noise, you put soundproofing and suddenly you're calm," says Silberstein. "That's what antibodies do, they prevent noise from aggravating the system."
The idea is to prevent the full range of migraine symptoms, including headache, nausea and sensitivity to light and sound.
Silberstein's study gave monthly or quarterly injections of an antibody called fremanezumab to more than 700 patients who have chronic migraines. "These patients are having attacks almost daily and they are very affected by it," he says.
Almost half of the people who received the medication experienced fewer migraine attacks. And in some people the attacks almost vanished.
In the Goadsby study, a different antibody called erenumab produced similar results in patients who had up to 14 migraines per month. None of the medications seemed to cause more side effects than a placebo.
The results suggest a better future for patients with migraine, who have had rather limited options so far, says Goadsby. "I hope you show patients that this is not an impossible problem, it's a manageable problem."
But the drugs did not work for everyone, and their effectiveness was aided by a powerful placebo effect, says Andrew Hershey, who runs the headache center at Cincinnati Children's Hospital. Even people who received the placebo saw how migraine attacks fell more than 20 percent, which means that the treatment group did better than the placebo group, but not much better. Hershey, who was not badociated with any of the studies, wrote an editorial that accompanied the research.
In it, he describes the benefit of these drugs as "modest but significant".
In addition, "everything indicates that they will be quite expensive compounds," says Hershey, possibly costing thousands of dollars a month. That means they're probably reserved for patients suffering from severe migraines who have not received help from other, less expensive treatments, he says.
The Food and Drug Administration is expected to review the new drugs in the coming months. One or both could reach the market in 2018.