At least 39 million people in the United States experience the debilitating type of headache known as migraine, according to the American Migraine Foundation. But very few medications and therapies have been designed with the prevention of migraine in mind.

Instead, most of the existing migraine treatments have some other intended purpose that just happens to help people with migraine, too. Anti-epilepsy drugs, like topiramate (Topamax), or the antidepressants and blood pressure medications often prescribed to people with migraine, can lessen your number of headache days. But that’s not what they were made to do.

Thankfully, that is no longer the case. Researchers have been able to develop ways to target painful migraines with the help of advances in the use of monoclonal antibodies.

“Immune therapies useonoclonal antibodies to treat diseases. They work in a different way for migraines that don’t involve the immune system.”

Here is everything you need to know about the benefits of using a monoclonal antibodies. We will discuss several recently approved drugs that may give you some long-awaited relief from migraines.

Monoclonal antibodies are protein-based antibodies that can attach themselves to other proteins in the body.

How helpful is this for a person with a migraine? The CGRP is a type ofProtein that can be targeted and blocked by these antibodies. CGRP is one of the major sources of pain.

During a migraine attack, CGRP is often released in the nerve cells of the brain. This causes the blood vessels to widen and certain parts of your brain to become inflamed. Experts like the American Migraine Foundation believe the CGRP response causes the physical pain of a migraine episode for most people.

There are ways to reduce the effects of CGRP.

This is what the new generation of migraine drugs is designed to do. As antagonists to CGRP, they can prevent it from connecting with pain receptors and causing many of the physical symptoms of migraine.

Are monoclonal antibodies a form of immunotherapy?

Fight disease and infections with immunotherapy treatments that involve suppressing or boosting your immune system. Monoclonal antibodies are used as a form of immunotherapy by doctors.

  • cancer
  • Organ transplant rejection is related to organ transplant rejection.
  • There are allergies.
  • Rheumatoid arthritis is a disease.
  • inflammatory bowel disease is a disease.

Monoclonal antibodies are used to treat migraines. It is important to know that these drugs do not work on your immune system. They target CGRP.

Studies have found these drugs to be highly effective:

  • People taking monoclonal antibodies had fewer days of scurvy than placebo.
  • They had less headaches with chronic migraines compared to placebo.

Another way of looking at how effective these drugs are is to see how many people experience substantial improvement with use. One 2018 study found that 30 percent of participants saw a 50 percent improvement in their migraine days after just 4 weeks of using Aimovig, one of the earliest approved anti-CGRP drugs. A 2020 review suggests that smaller percentages of patients see even better results.

How do these drugs compare to other treatments? Here are some facts about how well preventive treatments work.

  • Blood pressure medications. Beta-blockers such as propranolol and timolol are often prescribed for migraine prevention, though different medications have different results. Propranolol is usually considered the most effective treatment. One 2019 review suggests it can reduce episodic migraine by 1 to 2 headaches per month and chronic migraine by up to 50 percent.
  • Antidepressants. Tricyclic antidepressants are typically prescribed for migraine prevention, though a 2017 review shows that other types such as selective serotonin reuptake inhibitors may be just as effective. That same review also suggests tricyclic antidepressants can reduce migraine days by up to 50 percent.
  • Anti-epilepsy drugs. Doctors commonly prescribe topiramate (Topamax) as a preventive medication. According to 2014 research, it seems to also have around a 50 percent rate for decreasing headache days.

The FDA approved four injections for migraines.

Erenumab (Aimovig)

Aimovig was the first injectable, anti-CGRP drug made available to patients in 2018. It works by binding itself to CGRP proteins. This prevents them from initiating the pain and inflammatory responses that cause migraine symptoms.

“Aimovig is a preventive medication, not an abortive one. It can reduce the number of headaches you get, but won’t relieve them on the spot or treat a head injury.”

Aimovig is injected either by you or a caregiver once per month into the thigh, upper arm, or stomach. Most people only inject 1 dose per month, but some may need or be approved for 2 doses per month.

Fremanezumab (Ajovy)

Ajovy is injected under the skin and blocks CGRP proteins from functioning. It’s a preventive, not an abortive medication.

The main difference between Ajovy and other injectables is that Ajovy can be long acting, so you have a choice when it comes to dosing. You can inject 1 dose per month or opt for a quarterly schedule, injecting 3 separate doses once every 3 months.

Galcanezumab (Emgality)

Emgality is another injectable, though it may be more likely to cause side effects than the others. It’s a preventive injection taken once per month in the thigh, abdomen, buttock, or the back of your upper arm.

Emgality is slightly different in that your first dose is called a loading dose. This means you take double the amount of Emgality the first time and then move down to the standard dose the following month.

Eptinezumab (Vyepti)

Vyepti works the same way as the other three injectables in terms of mechanism. It binds to CGRP proteins and blocks them from causing a nerve response. It’s also a preventive medication, not an abortive one.

But Vyepti isn’t an injectable. It’s an intravenous (IV) infusion given every 3 months at your doctor’s office. It takes about 30 minutes to receive the full dose of the medication. Most people take a 100-milligram dose of Vyepti, but some people need a 300-milligram dose.

“The side effects of most monoclonal antibodies are the same. Doctors consider them to be equally safe despite the minor differences. These drugs are easy to combine with other therapies because they don’t have any listed interactions with other drugs.”

Common side effects

According to Migraine Canada, clinical studies found that possible side effects include:

There were additional side effects noted in clinical settings. If your doctor has patients taking these drugs, you can be sure of the effects. They include:

There is also the potential for allergic reactions in some people. Let your doctor know if you have a history of There are allergies. to medications.

One 2017 review acknowledges that there are some risks to monoclonal antibodies but that so far, the benefits seem to outweigh those risks.

Cardiovascular side effects

Experts are still discussing the effects of anti-CGRP drugs on heart health. CGRP widens blood vessels, and these drugs block that process. There are concerns that this could lead to hypertension or even a ministroke.

But a 2020 review found no evidence that anti-CGRP drugs have a negative effect on the heart. People with a history of cardiovascular problems don’t seem to be at an increased risk when taking these drugs.

Side effects of other drugs used to treat migraine

The potential side effects of a new class of drugs can be intimidating. Traditional migraines have side effects, which are similar to anti-CGRP drugs.

Drug type Side effects
beta-blockers • fatigue
• dizziness
• poor circulation
• gastrointestinal (GI) distress
tricyclic antidepressants • increased headache
• GI distress
• dizziness
• fatigue
• weight gain
anti-epilepsy drugs • memory loss
• brain fog
• fatigue
• mood changes
• nausea
• increased risk of kidney stones, according to 2017 research

Most people can use the monoclonal antibodies for migraines. Your doctor will look at your medical history to decide if this treatment is right for you.

Researchers are looking into other possible treatments for migraines, despiteonoclonal antibodies being an effective way to prevent them.

Gepants

Anti-CGRP therapies are also possible with gepants. They are not injected or IV drugs.

They are usually taken orally, either as pills or dissolvable tablets, so they work faster and don’t stay in your system as long. This allows them to be used as abortive medications, stopping symptoms of a migraine, as well as preventives.

The first gepant was approved by the FDA in December 2019. The two most well known gepants are:

Only Nurtec ODT is approved for both preventive and abortive use.

In general, gepants are tolerated well and cause few side effects, according to 2020 research.

Clinical trials

As of 2022, several current clinical trials in various phases are looking into new pathways to prevent migraine. Areas of interest include:

  • The type 1 receptor inhibitors block aProtein that causes headaches.
  • ditans, which are currently used for acute treatment but not prevention
  • orexin receptor inhibitors, which block pathways in the hypothalamus of the brain
  • The production of aProtein that releases CGRP is lowered by kallikrein blockers.
  • Eliminating the chemicals that contribute to the pain of the migraines is called ketamine.

Learn more about clinical trials for migraine prevention.

The past treatments of the migraines were designed to treat other conditions, but the new treatments target the source of the pain. They:

  • are as effective as, if not more effective than, traditional migraine prevention therapies
  • Do not take other prescription drugs.
  • It is easy to self-administer.

Monoclonal antibodies for migraines are not as risky as they might seem, and the benefits outweigh the risks.