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Coming Soon: CGRP Antagonist Nasal Spray

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This month the FDA in the USA approved the very first CGRP antagonist nasal spray, brand name Zavzpret. The drug is known as zavegepant. The new medication should be on the market as early as this July.

Zavzpret

You may remember that the “gepant” medications, such as zavegepant, seem to be good abortives – taken during a migraine attack, they fight symptoms at the time (as opposed to preventatives, which of course prevent attacks).

People who would prefer to avoid injections and pills often go to nasal sprays. Many people like the speed of injections, but don’t like the injections themselves. And with migraine nausea, pills can be hard to take.

However, nasal sprays also tend to be very fast-acting. Zavzpret as a medication seems to be pretty fast-acting itself, which is good news for those who want to stop those migraine symptoms from escalating. The most recent study showed relief from pain as quickly as in 15 minutes.

Zavzpret is also very simple to use. It will probably be prescribed as one spray (into one nostril) of 10mg, once. That’s all.

Another advantage of Zaczpret is that there seem to be very few side effects. The most common (though still only a minority of patients experienced it) was a change in your taste – in other words, foods might taste a little funny. This was just temporary.

For more information on Zavzpret:

New Triptan Study (and is it really useful?)

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Triptans – medications that were specifically designed to fight migraine pain – come in a number of varieties. So, which ones are the most effective? A new study attempts to answer that question.

oral medications

The study, published in the European Journal of Clinical Pharmacology, compared various triptan medications. Probably the most well known is sumatriptan, partly because it was the first one to come out years ago. But as we’re discussed in the past, sumatriptan doesn’t work for everyone. Some people who have not found it helpful at all have had great success with other triptans.

For more of an introduction to triptans, see 10 Triptan Facts You Need to Know Now.

So who was the “winner”? Surprisingly, it was eletriptan, a 40mg dose. The “loser” was naratriptan. Both of these were oral doses.

The difference between the two? Well, about three times more people were pain free at two hours with eletriptan than with naratriptan, so all the other triptans would fall between the two.

So – oral dose, you say. What about in injection? Or those nasal sprays? Aren’t they better?

Actually, they compared nasal sprays, oral, and subcutaneous (injections). Of course, most of the variety out there is with sumatriptan, so that’s where most of the information comes from. In short, the injections had the advantage of being quite a bit faster, but oral and nasal spray were about the same for effectiveness.

So just how useful is this information? Should everyone just run out to buy eletriptan? In oral form?

Well, there are some serious limitations with this study. As I suggested before, there’s a lot more information (and variety) for sumatriptan.

But perhaps even more importantly, there are some important reasons why one triptan may work for you and another may not. You may be taking other medications that could interact with a certain triptan. One may work better for women, or older patients.

So yes, maybe doctors and patients should pay a little more attention to eletriptan as a good option. Maybe you should even try it first (before other triptans, that is). But talk to your doctor, because she may have suggestions for you, far beyond “this happens to work better for most patients in clinical trials”. Everyone is different, with a different medical history and a different biological make up.

So how useful is this study? It’s worth raising an eyebrow and reconsidering what triptans we prioritize, as we look at it along with other trials. It also says good things about oral medications, and injections. But again, there are lots of other studies that say good things about nasal sprays – it depends on the person.

You can read the abstract here: Efficacy of triptans for the treatment of acute migraines: a quantitative comparison based on the dose-effect and time-course characteristics

The Battle of the Nasal Sprays

Occasional but Terrible Migraine Attack? You might want to try Sprix.

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New research is confirming the benefits of a medication that can fight episodic migraine. It might be just the thing to try if you haven’t had success with the medications your doctor has prescribed up to this point.

Many migraine patients are familiar with Toradol, or ketorolac tromethamine. Ketorolac is actually one of the top recommended drugs to give a migraine patient in emergency. It’s low on side effects and high on effectiveness.

Today, ketorolac is available as a nasal spray – perfect for those trying to avoid injections but who still want something that’s fast-acting. The nasal spray is commonly sold under the brand name Sprix.

The Battle of the Nasal SpraysBut how does this medication compare to migraine-specific medications, such as the ever-popular sumatriptan?

A study in the journal Headache this past February attempted to answer the question, pitting ketorolac nasal spray against sumatriptan nasal spray.

In a double-blind study of 72 randomized participants were treated for 152 migraine attacks.

The results? Ketorolac was every bit as good as sumatriptan – in fact, in some ways it had the edge. The pain relief seemed to last longer, and ketorolac was better at fighting nausea. It also helped fight photophobia, that painful sensitivity to light that many migraine patients experience.

More good news – none of the patients, taking either of the two medications, withdrew from the study due to side effects.

These things make a nasal spray such as Sprix very attractive for those with episodic migraine.

However, ketorolac is not recommended for chronic migraine. It is intended for very occasional use. There are cardiovascular and gostrointestinal risks if the medication is taken frequently, or if it’s taken constantly for more than a few days (read more here). For migraine patients who already may be at increased risk in these areas, frequent use of ketorolac should be avoided.

But those with episodic, or more occasional, migraine still face another hurdle. This medication can be very expensive. However, Dr. Alexander Mauskop from the New York Headache Clinic has an excellent suggestion to save money. He writes:

The main problem with intranasal ketorolac is its cost. On GoodRx.com the price of 5 vials of Sprix (with a coupon) is about $1,000. Each vial is good for one day of use; it contains 8 sprays (15 mg each) and the usual dose is one spray into each nostril, repeated every 6 hours as needed. However, there is a way around the cost of this medication. Ten 30 mg vials of generic ketorolac for injections cost $15. You just need to buy a nasal spray bottle, empty the contents of the vial into it and use it as needed.

Check with your doctor and your insurance company to confirm which option is best for you.

To read the ketorolac vs. sumatriptan study results, visit A Randomized Trial of Ketorolac vs Sumatripan vs Placebo Nasal Spray (KSPN) for Acute Migraine

Are You Experiencing Airplane Headache?

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Yes, airplane headache is a thing. A few years ago some researchers started noticing a common pattern – a headache which struck during flight, especially during the landing phase. And it’s much more common than you may think.

Airplane HeadacheNow, we all know that the changes in pressure can cause headaches. Some people will get migraine attacks during and after flights, or other types of headaches.

But the airplane headache is something a little bit unique. It seems to strike mostly men, lasts no more than 30 minutes, and, like a headache from migraine, is one sided.

There are not usually other symptoms (as is the case with migraine triggered during travel).

The airplane headache turned out to be so common that the authors of one airplane headache study suggested we may want to see it as an official headache classification.

These headaches may mostly be caused by a type of sinus barotrauma (also known as sinus squeeze). Barotrauma occurs due to a blockage in the sinuses, where the sinus is connected to the nasal cavity.

The age-old solution of chewing gum or swallowing will not work for this type of barotrauma. Those work well enough with your Eustachian tubes, allowing pressure equalization in the ear. But it won’t help with sinus barotrauma.

Sometimes the blockage is severe enough that surgery will be required. However, in most cases some medication will be a help..

The airplane headache may be better or worse from flight to flight. This could partly have to do with the level of blockage, which could vary due to allergies and infections.

Taking something for the pain is appropriate, but there are ways to minimize and prevent the pain in the first place. Topical decongestants (nasal spray) (such as those with oxymetazoline or phenylephrine) may help clear things up. Talk to your doctor especially if the pain lasts beyond 30 minutes, or is severe.

For more information:

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.