Lewiston neurologist Carl Robinson breaks down the current state of migraine treatments:

Abortive medications: Meds taken as needed to halt a migraine headache that has already started. The standard medication in this category are the triptans. Triptan medications typically are named accordingly: Sumatriptan, rizatriptan, zolmitriptan, etc. This class of drugs has been around many years and began with sumatriptan, known commercially as Imatrex. 

There are also three new non-triptan abortive medications, one of which is called Reyvow (approved October 2019), the other two of which are called Ubrelvy (approved December 2019) and Nurtec (approved March 2020).  

“These three new medications are giving us new options for abortive treatment of migraine in those patients who cannot take triptans for some reason,” says Robinson, “or for whom the triptans are ineffective.” 

Preventative medications: Meds taken at regular intervals to help reduce the frequency of headaches. 

“We have a number of oral medications that were designed for other things — high blood pressure, seizures/epilepsy, depression, to name a few — that turn out for some people to be helpful for migraine,” says Robinson. “Topiramate (the generic name for the drug Topamax) is one of the more commonly prescribed medications from this category, as well as propranolol, a medication for high blood pressure or heart disease, or amitriptyline, an anti-depressant. These meds have been used for many, many years. They can be helpful for some, but sometimes side effects limit their use.” 

Botox has been FDA-approved for headache prevention in patients with chronic migraine (more than 15 headache days per month) since 2010. 

“The new migraine preventatives that block (the inflammatory protein) CGRP are called Aimovig, Emgality, Ajovy, and Vyepti,” according to Robinson. “The first three medications, all given as injections that patients administer themselves once per month, have been available since 2018. Vyepti is an IV infusion given every three months. These medications have offered relief for many patients who could not find relief from the oral medications, or patients who had side effects from these medications. 

“So you can see one of the main reasons for confusion,” Robinson says. “We have a number of new medications that block CGRP, but some are used as-needed, like Ubrelvy and Nurtec, and some are used as a preventative medication, like Aimovig, Emgality, Ajovy, and Vyepti.”