- More
than 1 billion people globally have at least one migraine headache each
year.
- Medications
are used to treat symptoms and lessen migraine episodes, but all therapies
do not work for everyone.
- Researchers
from the University of Bergen in Norway have identified which therapies
they feel tend to work best in preventing migraine.
More than 1 billion people around the world have
at least one migraine headache each year.
There is currently no
cure for migraine. Medications can
be used to help treat symptoms and
lessen the number of migraine headaches.
However, not all
therapies work for every person, so medications prescribed for people with
migraine are individualized based on the type of
headaches they have as well as other factors.
Previous research has
shown that taking too much medicine can worsen migraine.
To help shed some more
light on which migraine medications work the best, researchers from the
University of Bergen in Norway recently published a study on which therapies
they feel tend to work best in preventing migraine.
The findings were published in the European Journal of Neurology.
Comparing migraine medications
According to Dr. Marte-Helene Bjørk, a professor in the
Department of Clinical Medicine at the University of Bergen in Norway, a
consultant neurologist at Haukeland University Hospital, the vice director of
the NorHEAD Norwegian Research Center for headache, and lead author of this
study, the researchers wanted to conduct a study looking at which medicines
best prevent migraine.
She noted that these
medicines are rarely compared against each other.
“Usually, such medicines
are compared against placebo drugs,” Bjørk told Medical News Today.
“Therefore, it is hard to know which one works best in real life. Also,
migraine preventive drugs are usually tested on a selected group of people not
necessarily representative of the population that ends up using the drug.”
Beta-blockers are a preventive first
choice for migraine
For this study,
researchers used national register data from 2010 to 2020 that included more
than 100,000 people with migraine.
Scientists examined
which acute migraine medications were taken before and after starting
preventive treatment. They also measured how long the people with migraine used
the different preventive treatments.
After analyzing the
results, researchers reported that beta-blockers were normally used as the first
choice to prevent migraine headaches.
“Beta-blockers inhibit
the adrenergic responses in the drugs such as the effects of adrenaline,” Bjørk
explained. “They have many effects, including lowering of blood pressure and
heart rate, and are therefore used for hypertension, heart
arrhythmia, and heart failure.”
“By serendipity, it was
also discovered that they prevent episodic migraine in persons who do not have
these disorders,” she added. “This has been documented in many studies. These drugs are also fairly well
tolerated and inexpensive, they are therefore often the first choice to prevent
migraine.”
Three medications with better
preventive effects
As Bjørk and her team
dug further into the research results, they found that three other medications
had better preventive effects than beta-blockers — CGRP inhibitors, amitriptyline, and simvastatin.
“CGRP antibodies were
developed specifically to treat migraine by inhibiting CGRP, which is a signal
transmitter involved in the generation of migraine headache,” Bjørk explained.
“One of its effects is that it inhibits the dilation of blood vessels.”
“Amitriptyline was
previously used as an antidepressant drug but is currently used more to treat
different types of neuropathic pain and migraine and tension-type headache,”
she added. “Simvastatin lowers cholesterol and the patients in our study
probably used it for this purpose rather than for migraine. However, currently
some believe that simvastatin may reduce inflammation and stabilize blood
vessels, possibly that is why it might work to prevent migraine.”
Surprising results from
migraine drugs study
Bjørk commented the
findings were surprising, especially in regard to simvastatin being
consistently associated with a decrease in migraine.
“We measured migraine
reduction by looking at whether people stating simvastatin or the other
migraine preventive drugs filled less prescriptions for triptans — migraine acute medications
— after-versus before they filled the prescription,” she explained. “We were
surprised because simvastatin is not an established migraine preventive drug,
although some small randomized controlled studies have shown good effects on migraine.”
“We were less surprised
by the finding that CGRP antibodies and amitriptyline were associated with a
reduction in migraine as these are well-established migraine preventives,”
Bjørk added.
Additionally, the
researchers pointed out in their study that some established and cheaper
medicines available in Norway can have a similar migraine prevention effect as
the more expensive ones.
“(This) is significant
because most of the people (who) suffer from migraine in the world will never
be able to buy expensive migraine preventive drugs,” Bjørk said. “Because of
the large number of people with migraine, treatments that put less strain on
the national health budgets are also important.”
Effective, less expensive migraine
medications needed
Medical News Today also spoke with Dr. Monte Pellmar,
the director of the Headache and Migraine Center in the Hackensack Meridian
Neuroscience Institute at Jersey Shore University Medical Center in New Jersey,
about this study.
Pellmar said it is
important to note that this study was completed in Norway with their protocol
for treating migraine and their cost of medicine, which is different than the
United States.
“In the U.S., in order
for health insurance providers to approve the prescription of newer
medications, such as the mentioned CGRP antibodies, two or three of the oral
preventatives, including antidepressants (amitriptyline), beta-blockers (Inderal), and seizure medications (topiramate) need to
be first prescribed and deemed ineffective,” he explained. “As a result,
recommendations from Norway cannot be translated as advice for treating
migraine in the U.S.”
“Given the significant prevalence of people with migraine around the world, I do believe that finding effective, less expensive medication is important, and would welcome similar studies in the United States and other countries with comparable healthcare systems,” Pellmar added. “In the area of treatments preventing migraine, in my opinion, the most effective agent with the least side effects for chronic migraine is Botox, followed by the CGRP antibodies and the newer [class of drugs] gepants Qulipta and Nurtec.”
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