New Gains to Ease Migraine

“As people, particularly females, get older and hormones change after menopause, they may drop the headache altogether and their migraine may be aura-only,” says Barbara L. Nye, M.D., clinical associate professor in neurology at Wake Forest University School of Medicine. “Aura” refers to visual changes — flashes, bright spots, shapes, blind spots, or blurred or lost vision — that typically precede a headache. “You may be driving down your street and see a shimmer in your vision or partially blocked vision,” Nye says. Imagine the panic, since these can also be signs of a stroke. (See “When to See the Doctor”) 

Powerful new treatment options

More than half of those with migraine say they’re constantly juggling treatments in search of the right one, according to 2021 data from the National Headache Foundation. Over the past five years, however, new therapies have emerged that are changing the way migraine is managed. Historically, the only therapies available were medications used for other diseases, such as seizure disorder, depression or high blood pressure, Nye says. 

Though these remain viable and effective options, some are not safe for older adults with conditions such as heart disease. So it’s a relief that a number of new therapies, including drugs and devices, have been designed specifically to prevent and treat migraine — and many have proven to be better suited for older adults.

ORAL MEDICATIONS​

The new generation of migraine drugs is called CGRP antagonists (or “gepants”). These drugs — rimegepant (Nurtec), ubrogepant (Ubrelvy) and atogepant (Qulipta) — block the action of a pathway, or connection of brain cells, involved in triggering migraine attacks. Typically, these are used “as needed” to treat a migraine in progress, but the Food and Drug Administration expanded the approval of Qulipta, allowing it to be used as a daily preventative for people who experience at least 15 headache days a month (called chronic migraine). Clinical trials on this group found that 41 percent of patients experienced at least a 50 percent reduction in their headache days every month when given one of three dosage levels, compared with 29 percent of those taking a placebo. 

Gepants are an especially useful alternative for people who don’t respond to triptans, a more traditional migraine medication, and a safer type of drug for those with heart disease, a 2022 review suggests. 

NASAL SPRAY

​Zavegepant (Zavzpret), a gepant nasal spray used to treat migraine, can bring relief within 30 minutes. Approved by the FDA last year and launched over the summer, “the spray provides a quicker onset of action compared to oral rescue medications, which is good for ​patients whose migraines come on fast and severe,” Carroll says. (If you experience nausea and vomiting, this is a good option should you have trouble keeping down a pill.)

INJECTABLES

Galcanezumab (Emgality), erenumab (Aimovig) and fremanezumab (Ajovy) are self-injected drugs, called CGRP monoclonal antibodies, that prevent the onset of an attack by blocking the migraine pathway. “We are using these for prevention, and they don’t usually interact with other medications,” Riggins says.

NEUROMODULATION

These wearable devices — five are FDA-cleared: Cefaly, SAVI, gammaCore, Relivion and Nerivio — stimulate nerves to help regulate nervous system function, which decreases migraine. “These can be an excellent tool to prevent and treat migraine. They’re considered safe devices, and many of my patients find them relaxing to use,” Nye says, although they can’t be used by people with pacemakers. Riggins says people often have to use both medication and neuromodulation, but these devices can cut down on the amount of meds they need to take.

GREEN LIGHT

​Whereas blue light is agitating to the migraine brain, green light is considered to be brain-friendly. A small study in the journal Cephalalgia showed that green light exposure for one to two hours per day from 7.9 per month to 2.4 per month, on average. In those with chronic migraine, the green light cut headache days by more than half, according to this study. Green light may act on cells in your retina that alter your perception of pain. The Allay Lamp is a green light lamp developed by Harvard Medical School neuroscientist Rami Burstein specifically for migraine control. Other options include Gamma’s Soothe lamp, as well as green light bulbs from Hooga or Norb.