My migraines respond very well to sumatriptan, but I do like to try new treatments that I recommend to my patients.
A few months ago two new abortive drugs to treat acute migraine attacks were approved by the FDA. Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant) block CGRP, a substance released during a migraine attack. They work in a similar way to four injectable drugs used for the prevention of migraines – erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti). I’ve tried erenumab and fremanezumab with some relief, but stopped both because sumatriptan works well and I don’t really need any preventive medications.
Because the two injectable drugs did help, I expected the two new oral medications to work as well. Alas, neither one had any effect. This suggests that CGRP is not very operational in my case. The fact that sumatriptan, a drug that works on serotonin receptors works so well indicates that the serotonin system is dominant in producing my migraines.
Migraine is a very heterogeneous disorder with a variety of clinical presentations and with dozens of identified genetic abnormalities that predispose one to migraines. This means that we are not likely to have a drug that works for all migraine patients. What we do expect, is the advent of personalized medicine – having tests that predict which drug will work for which patient.
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