migraine preventative

25 July 2022

QULIPTA (Atogepant) Recent Reports

James Discoveries & Stats, Medications 0

It’s about time to have an update on QULIPTA, otherwise known as atogepant, a newer migraine preventative.

You may remember that we were talking about atogepant back in 2020. At a time when many medications were coming out as injections, atogepant was a bit of a breath of fresh air. A preventative, taken orally, and only taken once a day (10, 30 or 60mg), with or without food. Much more convenient even than many other oral preventatives.

Atogepant was approved by the FDA in 2021, but studies continue. QULIPTA came up at the June 2022 American Headache Society 64th Annual Scientific Meeting a number of times, and we’re learning more about it as it begins to be used more in the general population.

For example, it was found that some patients seem to lose weight when taking atogepant. It’s a minority, but still a significant number. Not only were patients less likely to gain weight, some actually lost weight taking the medication. Something to watch.

It was confirmed once again that you can take atogepant with or without food. The difference seems to be negligible.

It seems that although many patients find their symptoms diminishing in the first month of treatment, others do need to wait 2 or even 3 months before atogepant works for them. And so far, patients taking the preventative for a year seem to still benefit (we’ll keep watching this – remember, the medication is very new!).

A patient who took the COVID-19 mRNA vaccine experienced continuous migraine visual aura, and was successfully treated using atogepant. This may be a useful treatment for migraine symptoms after vaccination, another one to watch.

More studies have been done on the overall safety of QULIPTA. So far, the news is good – it seems to be generally safe. However, as with any medication, it is very important to tell your doctor about any supplements, medications, vitamins, and so on, that you may be taking. This may affect your dosage.

For more information about atogepant, visit the official QULIPTA site here.

17 June 2021

Big News for Nurtec ODT (Rimegepant)

James Medications, News 0

Last month it was announced that the migraine medication Nurtec ODT was approved for the preventative treatment of episodic migraine in adults. This is big news – but you need to understand a little bit of background.

Nurtec ODT, or rimegepant, is one of the new medications that targets CGRP. There are a number of different treatments that are emerging related to CGRP (calcitonin gene-related peptide). And researchers have been investigating which treatments might be better for prevention, and which may be better to take to stop a migraine attack as it happens.

Rimegepant is in the “gepant” class (hence the last part of its name), a CGRP receptor antagonist. It has been noted for a while that the gepant drugs tend to work very quickly – excellent as an abortive drug to take during a migraine attack. And when Nurtec ODT hit the market, one of its selling-points was that it came as a a fast-acting orally disintegrating tablet – ODT.

But while these drugs have been shuffled down into either the “preventative” or “abortive” category, the question has remained – is it possible that some may be effective as both? In the case of rimegepant, researchers noticed that it tended to have a more sustained effect than some other CGRP related medications. So it seemed like a good candidate for a preventative.

And it seems that this is the case. This from the Biohaven Pharmaceuticals press release:

This new approval makes NURTEC ODT the first oral CGRP antagonist approved for the preventive treatment of migraine, and the only migraine medication approved as a dual therapy for both the acute and preventive treatment. NURTEC ODT is approved for acute treatment in all eligible adult patients with migraine, regardless of the number of monthly migraine days.
FDA Approves Biohaven’s NURTEC® ODT (rimegepant) for Prevention

For abortive use, the medication is taken as a 75mg dose. Because of the sustained effect, only one tablet is taken within 24 hours.

For preventative use, it’s the same – 75mg, once every other day.

Not only does Nurtec ODT have a good safety record, it will be very attractive for patients who are looking for a preventative, especially if they don’t like to take a number of pills every day. Of course, you do have to find a way to remember to take it every other day – but migraine patients do learn to be organized!

So this is big news. We’ll see if other CGRP related medications also cross the line from one type of medication to another. Meanwhile, many migraine patients who are experiencing a lot of migraine symptoms in a given month will be looking to see if Nurtec ODT is right for them.

For more information:

22 October 2020

What Is Surprising Us About The New CGRP Preventatives?

James Discoveries & Stats, Medications, News 0

Can you believe it? It was in the spring of 2018 that Aimovig (erenumab) was approved in the USA. My! Time flies!

Really, all the CGRP related drugs are still extremely new, when it comes to prescription drugs for migraine. Long term trials are still a future hope. And we’re just starting to guess at some trends that we may be seeing from patients.

But what are some of the trends we’re seeing? Let’s take a moment to talk about them, and you can comment if you’ve had a similar of very different experience.

(1) For many, these drugs are working better than expected!

First, the (very) good news. For many patients, these CGRP inhibitors are working better than the clinical trials even led us to believe.

As drug companies rush to market new migraine drugs, we expect to see headlines that use phrases such as “life-changing!”. But in the case of drugs like Avojy and Aimovig, this does seem to be the case with many patients – a very significant improvement in their symptoms.

And these are not always “just any” patient. These are patients who have not had a lot of success with other medications.

So there are good reasons to have a lot of hope that these new drugs will help many more people around the world in the next few years.

(2) Sometimes these drugs are less effective after a while.

This is a biggie. Reports are coming in that, for many patients, the benefits tend to “wear off” after a while.

Will switching to another CGRP preventative help? It’s very possible, and it’s not at all a surprise that you may need to try more than one before you find the right fit.

But this is one that researchers are going to pay a lot of attention to in the next few years. Which patients are having this issue, and why? Will some CGRP preventatives work better than others? Even if they’re not as beneficial as they were in the first few weeks, do they still provide significant benefit? What’s your experience?

(3) Side Effects

Any surprises with side effects? Side effects are not a huge problem for many patients, but it is starting to sound like constipation is an issue for some, especially with Aimovig (and in this case, switching may provide significant benefit). It seems that it may be more likely to make constipation issues worse if you already have a pre-existing condition.

In a recent discussion published in The American Journal of Managed Care, two neurologists pointed out some of the other side effects they’re seeing – “. . . a worsening of Reynaud syndrome, fatigue, hair loss, sexual dysfunction, and in women, some reports of irregular menstrual periods.”

Again, discussing side effects shouldn’t make it sound like patients are running away from these medications in droves because they’re all having major problems. Side effects may be rare, but we have to keep an eye on them because certain patients may be more prone to certain side effects than others.

If you’ve been taking a new preventative, such as Vyepti, Aimovig, Ajovy, or Emgality, how long have you been on it? What has your experience been? Anything you might share could be a help for our community.

18 May 2018

Big News: First CGRP Inhibitor for migraine Approved in US – Aimovig

James Uncategorized 6

Yesterday, the FDA approved the first of a new class of migraine drugs – CGRP monoclonal antibodies. We’ve been talking about these drugs – and this one in particular, for many years. And it should be available in the USA in a couple of weeks.

Aimovig The drug is being sold as Aimovig, but we’ve known it by its earlier names, AMG 334 and erenumab.

Aimovig, and it has been approved as a migraine preventative. This is what the FDA had to say about it yesterday:

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.
[FDA Press Release]

For a somewhat lighthearted basic explanation from 2012, check out The Secret of CGRP.

Aimovig dosage

Aimovig Injector Aimovig is currently a 70mg injection taken each month. Some patients may take a double dose, which would mean two injections of 70mg taken the same day. The injection, done with a pen-like “autoinjector”, is taken in the abdomen, upper arm, or thigh. It’s designed to be injected by the patients, but there are some things to watch for, so talk to your doctor. The injection takes about 15 seconds.

Aimovig Side Effects and Other Concerns

Some of the headlines are claiming that this is a wonderful new side-effect-free medication, which is not strictly true. The side effects do seem to be minimal, which is certainly the general advantage. However, a few patients were irritated by the injection itself. Some also experienced constipation. There are also cautions because of the unknowns of taking Aimovig during pregnancy, and researchers are concerned that there may be an increased risk of preeclampsia.

But for most people, the side effects should be minimal or non-existent.

Advantages of Aimovig

Aimovig seems to be helpful for patients with episodic and chronic migraine, although you will need to discuss with your doctor if your attacks are frequent enough to warrant this type of medication.

As mentioned before, you may experience fewer (or no) side effects with this medication compared to what you have tried before. If you have not used a preventative medication before, your doctor will probably try some other drugs or treatments first before Aimovig.

Aimovig may not prevent all your attacks. If they cut your attacks by a third or a half, that will be a significant improvement.

However, using Aimovig with other treatments could mean a much more significant improvement. And remember, this is only the first of this type of drug to hit the market – other CGRP drugs could work better for you. And there are a whole new class of drugs coming after that.

Another interesting note – this drug is currently being investigated as a possible treatment for hot flashes during menopause.

We will look forward to hearing about your experiences with Aimovig. Once you’ve tried it, come back and comment!

6 March 2017

Candesartan for Migraine

James Medications 6

Recently a HeadWay subscriber mentioned a treatment that has been working well for her, and I realized that I haven’t mentioned it before. So here is a brief description of candesartan and its use in migraine treatment.

Candesartan is sold under the brand names Atacand, Amias, Blopress, and Ratacand, although it’s also available as a generic drug. It’s classified as an angiotensin II receptor blocker (ARB). ARBs are often used to treat hypertension, and candesartan is no exception. But antihypertensive drugs are also used as migraine preventatives.

In 2013, a study compared candesartan with a more common migraine preventative, propranolol. The study concluded that 16mg daily of candesartan was comparable to 160mg of propranolol – both led to fewer days with migraine symptoms. (see A comparative study of candesartan versus propranolol for migraine prophylaxis)

Sometimes we make the mistake of thinking that just because we’ve tried a certain kind of drug, we shouldn’t bother trying similar drugs. But the truth is that every drug – even sometimes different versions of the same drug, can have a different effect on an individual. That’s why candesartan can help a patient when propranolol might not, or vice versa.

As always, talk to your doctor before trying any medication. You may not need 16mg – a lower dose may be helpful. Candesartan is NOT for use by anyone who may be pregnant.

Another bit of good news is that candesartan may be a better option for patients concerned about weight gain.

If you’re interested in trying a new preventative medication, talk to your doctor about candesartan. It’s now an often recommended option.