Migraine 101 from Dr. Kate Mullin!
Dr. Kate Mullin is the Medical Director of Clinical Research at the New England Institute for Neurology and Headache (NEINH), a multi-disciplinary, tertiary care neurology and headache center headquartered in Stamford, CT. (To learn more about Dr. Mullin click here.) Board-certified in Neurology and Headache Medicine, Dr. Mullin treats adults and teens with all types of headaches, concussions and pain in the face, jaw, and neck. Recently, we spoke with Dr. Mullin about the latest, greatest treatment options for migraine suffers.
“It is an exciting time to be a headache doctor. The last few years there has been a boom in headache medications, procedures and devices,” says Dr. Mullin. With 30 million people being affected by migraines, she says “it’s about time pharmaceutical and technology companies started taking this population seriously.” Here’s what Dr. Mullin suggest any migraine sufferer should be considering:
In 2010 OnabotulinumtoxinA (Botox) was approved for the prevention of chronic migraine. This breakthrough treatment was important for many reasons, says Dr. Mullin. For one, until then patients had been taking daily medications (sometimes up to three times a day) to prevent their headaches—and it’s hard for patients to remember to take medications every day when they don’t see an immediate response. Botox is given once every 12 weeks as a series of small injections administered by your neurologist. “All you have to do is show up—no more forgetting to take your meds,” says Dr. Mullin. Additionally, these oral medications were absorbed systemically, metabolized through the kidneys or liver, potentially interacting with other medications, in addition to causing systemic side effects such as weight gain, lethargy, mood changes and hair loss. Botox demonstrated minimal side effects as it acts directly on the muscles in which it’s injected. Until Botox was official every medication approved by the FDA for migraine was for Episodic migraine, meaning patients suffering from LESS than 15 days of headache per month. Botox was the first treatment approved for the more refractory patients that experienced headaches most days of the month. “The tech industry over the last 5 years has recognized that headache patients are tired of taking daily medications and have developed devices that patients can use at home to help prevent and acutely treat their headaches,” says Dr. Mullin.
The Cefaly device was approved by the FDA in 2014 for both the prevention of as well as the acute treatment of migraine. It is an external nerve stimulation device placed on the forehead that sends electrical impulses through the trigeminal nerve (a sensory nerve to the face) suppressing head pain. When used for twenty minutes daily the device users had significantly less headache days. When used for one hour at the onset of headache, the device gave patients significant pain relief if not pain freedom. “Again, by using an external device, patients were able to take less medications both daily preventatives as well as acute medications,” notes Dr. Mullin. Cefaly is available by prescription from your neurologist.
In 2017, a neuromodulatory device called GammaCore was approved by the FDA for treatment of both cluster headaches as well as acute migraine attacks. GammaCore is a non invasive hand-held device that stimulates the vagus nerve. When used at the onset of pain, the device was able to provide patients with pain freedom earlier and longer than patients that used a sham device. “Again, without systemic absorption, GammaCore users do not have to worry about medication interactions, liver or kidney function tests or adverse effects such as hair loss, weight gain etc.,” says Dr. Mullin
Finally, a brand new class of medications called CGRPs antagonist have recently come to market in 2018. The current medications approved are Emgality, Ajovy and Aimovig. They all work similarly in blocking the CGRP pathway which is known to be involved and elevated in migraine patients. These drugs are approved for both episodic and chronic migraine patients. They are all administered subcutaneously once a month either by the patient at home, if they are comfortable, or at their doctors office by the neurologist or nurse on staff. All three medications significantly reduce headache frequency as early as the first month. Other than injection site irritation, pain etc., the side effect profiles of these medications have been promising (aside from some constipation from the Aimovig injection). “These medications do not seem to interact with any other meds so it is safe to take them regardless of what other meds a patient may be on,” says Dr. Mullin.
“As you can see, the headache community is starting to finally get recognized as a group in need of better treatment options,” explains Dr. Mullin. She adds, however, that this is just the tip of the iceberg. “There are even more possibilities coming down the pipeline that are currently in various phases of clinical trials. I encourage anyone who thinks they’ve “tried it all” to think again and go see a neurologist or headache specialist to find out if they are appropriate for any of the latest/greatest headache treatments.”
This post is sponsored by the New England Institute for Neurology & Headache, located at 30 Buxton Farm Road (Ste 230) in Stamford. To find out more or book an appointment, go to neinh.com or call (203) 914-1900.