By some estimates, migraine is the third most common illness in the world. And migraines disproportionately affect women. Eighteen percent of American women suffer from the debilitating head pain the condition causes—while it affects just 6% of men.
That said, new migraine treatments are much needed. And a promising one might be on the way, according to a report published yesterday in the New England Journal of Medicine.
The journal published the results of a phase three trial for a medication called rimegepant. Researchers gave 537 people the medication, and 535 received a placebo. Nearly 90% of the study participants were women. Two hours after taking the pill, significantly more participants in the rimegepant group, compared with patients taking a placebo, were free of their worst migraine symptoms. (The new research was funded by Biohaven Pharmaceuticals.)
But, the new report cautions, nausea and urinary tract infections affected 1.8% and 1.5%, respectively, of participants who took rimegepant.
How are migraines currently treated?
Migraines are now treated with a number of medications. These range in strength from over-the-counter pain relivers, such as Advil, to opioid medications, which are highly addictive painkillers that kill thousands of Americans who overdose on them every year.
In addition, medications known as triptans are used to treat migraines. These are prescription drugs that obstruct pain pathways in your brain, Mayo Clinic explains.
However, triptans can cause recurring migraines, sometimes called “rebound headaches,” the American Migraine Foundation (AMF) says.
Two opioids used for emergency relief of migraines, oxycodone and hydrocodone, can also cause rebound headaches, the AMF says. “Even taking them just once per week can cause headaches to get worse in frequency and severity, the foundation notes.
And for some patients who take triptans, the medications don’t relieve migraine symptoms at all, according to the new report.
Rimegepant “may be effective in patients whose symptoms do not respond to triptans, owing to their different mechanisms of action,” the report says.
Triptans also present problems for cardiovascular patients. The new report notes that triptans can cause what’s called vasoconstriction, which is the technical term for the narrowing of blood vessels. For this reason, triptans aren’t ideal for heart patients.
“Currently available treatments may not work at all, may not work fast enough, may have undesirable side effects,” Mia Minen, MD, headache neurologist and assistant professor in the departments of neurology and population health at NYU Langone Health, tells Health.
How will rimegepant work differently?
The new report says rimegepant could work as a treatment for cardiovascular patients for whom triptans aren’t safe.
The new medication does not present the vasoconstrictive effects that triptans sometimes produce, the report says.
And this population of people who have both cardiovascular trouble and migraine is probably larger than you imagined: 3.5 million of the 40 million Americans who get migraines either can’t take triptans or have to take them with caution due to heart trouble, the new report says.
But, Dr. Minen points out, more research needs to be done on the safety of this medicine for cardiovascular patients.
Research also needs to be conducted on the long-term effects of the drug, Dr. Minen says. And before the drug is available to the public, it must undergo FDA review. But, Dr. Minen adds, because of problems with the currently available medications, “we always look for new abortive migraine treatments for our patients."
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