Migraine Trust Archives - Headache and Migraine News

Migraine Trust

2 December 2019

Botox vs. CGRP Inhibitors – the fight begins…

Are the newcomers to migraine treatment really any better than Botox treatment?

That’s one of the key questions being asked now. And it’s an important one, because it’s affecting migraine patients and their insurance coverage.

Patient and doctors — Are important policies being decided “behind your back”?

For example, in England, NICE (National Institute for Health and Care Excellence) recently decided not to recommend Ajovy (fremanezumab) as one of the drugs provided under the NHS (National Health Service). Why? Because current evidence doesn’t show the Ajovy is that much better than Botox (onabotulinumtoxinA) for patients who have tried several treatments already. And if the difference in success is negligible, the difference in cost is not – onabotulinumtoxinA wins easily.

Botox, once the strange newcomer to migraine treatment, is now an old standard. And it may be difficult for policy makers and insurance companies to accept the newcomers, even if they may be better for some patients.

Interestingly enough, its affect on CGRP may be one of the reasons why onabotulinumtoxinA works for migraine patients, which may explain similar results. But we’re still waiting for some good head-to-head studies to really show us which is “better” – “better”, that is, for most patients in general, not necessarily better for you. Welcome to the real world. (Also see Botox and CGRP – and the Future of Migraine Treatment.)

If new studies confirm that Botox performs as well as CGRP inhibitors, of course doctors may want to recommend Botox first, as a less expensive option, to most patients. But Is that a reason to not recommend the CGRP inhibitors at all? Or not to cover it in an insurance policy?

~~Of course, all this has nothing to do with money and politics.~~ Well, ok, maybe it does. Allergan is busy trying to convince investors that Botox for migraine sales continue strong. And there is some evidence that onabotulinumtoxinA and CGRP inhibitors may turn out to be best friends, because the anti-CGRP drugs may help the migraine-fighting effects of Botox last longer (see Concurrent CGRP Inhibitor and OnabotulinumtoxinA Therapy Boosts Relief in Severe Chronic Migraine).

But with the current expense of the new drugs, and a lack of studies to show long term safety, Botox may still have a surprising advantage.

(You can see in detail the reasoning of NICE in their paper here: Fremanezumab for preventing migraine (pdf). Also see Results of The Migraine Trust’s latest patient survey to inform new migraine drug NICE consultation.)

27 June 2016

“Coming Out” As A Migraine Sufferer (and why we don’t)

James Tips 2

You have migraine? Sssshhhh… don’t tell anyone!

Has anyone ever given you that advice? Well, whether they have or not, chances are good that you’ve been reluctant, at one time or another, to admit that you have migraine.

Wendy Thomas, Chief Executive of The Migraine Trust, tells her story of moving to a small village about 15 years ago. Because of her interest in migraine, she eventually found out that there were six people in the village who suffered from migraine attacks.

But guess what? Not one of them knew that any of the others had migraine!

Closed mouth Why don’t we talk about it? Here are some possible reasons – feel free to add your own.

Superstition: If I talk about it, or even think about it, I might get migraine (or have an attack). If you think that you’re likely to change your physiology and genetics sufficiently just by mentioning to someone that you have migraine disease, or by discussing it with someone, you might also be worried about getting cancer by giving to cancer research.
Bad Memories: Some people don’t want to think about it or talk about it because the memory is painful. Why not be free of migraine when you’re not actually having an attack? Live a “normal” life instead of thinking about the disease?
Fear of disbelief: Some people are afraid (with reason, I’m afraid) that people won’t really believe them – that is, they’ll write off migraine as negative thinking or work avoidance, or “just a headache” (as if a headache is nothing!).
Fear of loss: Loss of a job, loss of friends, loss of opportunities. Will someone think that I can’t be trusted, because I have migraine? That I can’t get the job done? Even if it’s not true, the perception may be there.

These are not all reasons that are easily overcome. And yet, if no one talks about it, the results may be even more negative. Consider:

If no one wants to think about migraine between attacks, no one will want to give to migraine research. (Hey, consider giving a small amount right now – USA residents, UK residents, Other)
If no one talks about migraine, there will be no progress/research. Not just worldwide research, but even understanding your own condition better, and finding better treatments. While you’re in agony may not be the best time to find better solutions.
Talking to your doctor. Guess what? A lot of people will self-medicate for years before ever finding good treatments. Talk to a doctor who knows your medical history. Go to a specialist. Stop putting it off. Make an appointment today.
Feeling alone? Of course, because no one wants to talk about it. No, don’t dwell on it and obsess about it. But it’s a part of your life – be open about it and share, especially with others who are suffering or who have loves ones who are suffering.
Improving the lives of those around us is important. How many other people at your place of work may have migraine, or may in the future? At your school? Place of worship? It may be that you can recommend small improvements that will make life better for someone else.

Listen, this isn’t about selfishly making sure everyone knows how miserable you are. This is about everyone helping everyone.

Are you afraid to talk about migraine? Maybe you’re not ready to shout it out to the world. But maybe you can make a small difference today by talking to a family member, or your doctor. Make a small donation. If nothing else, leave a comment here or on Facebook.