New tablet promises to prevent AND treat crippling MIGRAINES
As experts hail the biggest breakthrough in years...
For almost three decades, Jennifer Farrington’s life had been dominated by migraines so bad that the GP had to go on sick leave for nine months. Then three months ago she was offered a chance to try a monthly injection of a preventative treatment called fremanezumab. The effect has been transformative — not only halving the number of days she gets migraines, but when she does feel one coming on, it’s more likely to respond to painkillers such as ibuprofen. ‘I feel I’ve got my life back,’ says Jennifer.
Fremanezumab is one of a wave of new drugs that have recently become available in the UK for chronic migraine — defined as having headaches more than 15 days a month — and episodic migraine, where it occurs less than 15 days a month.
These monthly jabs (the others include erenumab and galcanezumab) are administered into the stomach or thigh, and block a chemical, calcitonin gene-related peptide (CGrP), that is released in the brain.
They have made a big difference to Jennifer, who had previously been pinned to her bed for days on end with crippling, pulsing pain behind one eye, nausea and vomiting, before feeling wiped out for at least two days afterwards.
‘It has been horrific,’ says Jennifer, 42, who lives in Alsager, Cheshire, with her husband Gary, 47, a teacher, and their daughters Amy, 15, and Abigail, 14. ‘I would just get over one migraine, and another would start straight away within hours — it was unbearable.’
Jennifer was so debilitated by constant pain that she reluctantly went on sick leave last June.
However, in January this year, Jennifer’s neurologist suggested fremanezumab.
She is now starting to work again — and, ‘most important of all, I now get very little of the aftereffects of the migraine, which was at least two days of feeling completely exhausted. But this has almost stopped with the injections.’
THE good news for migraine patients is that trials have shown that a new form of tablet that targets the same CGrP pathway can also help prevent attacks — and unusually, could alleviate symptoms when a migraine starts too.
one such drug, rimegepant, is licensed in the U.S. (as Nurtec) and is being considered by european regulators as both a rescue and preventative treatment.
A study in The Lancet in December, involving more than 700 migraine sufferers, found those who received rimegepant experienced migraines on 4.3 fewer days a month, compared with 3.5 fewer days in the placebo group.
Half said they had a drop of 50 per cent or more of their severe migraine days, compared with 41 per cent of the placebo group.
one of those involved in the rimegepant trials, Darlene LeBlanc, 63, describes how the drug was the first treatment she’d tried in over 40 years that worked well for her debilitating symptoms.
Darlene, from Tampa, Florida, developed migraines at the age of 27, following the birth of her first child, and the mother of three has suffered between three and five attacks a month ever since.
‘It had such a big impact on not just me but my whole family,’ she says. ‘I was bedridden for 15 or 20 days a month.’
Darlene, who lives with her husband Kevin, 60, who works in insurance, tried many treatments which had no effect on her migraines and left her feeling ‘unlike herself’. The only treatments that made a difference were triptans, drugs that help relieve but won’t prevent symptoms.
‘They lessened the migraine so that I could just about get up and function, but I still had an underlying migraine, the sensitivity to light, and nausea,’ says Darlene.
Two years ago she joined the drug trial and after just one tablet, the crippling pain, nausea and running eyes were gone.
Darlene is now prescribed the medication by her doctor and takes three to five tablets a month, when an attack starts. A single tablet is generally enough to halt all her symptoms.
In trials, rimegepant is taken as a tablet (which melts under the tongue) as a preventative every two days, but can also be taken if patients feel an attack coming.
Another tablet that works in a similar way is already licensed in the U.S., with others in development. None has had approval for use in the UK yet, but the hope is that at least one will soon.
They would be an easy option for the six million people in the UK who suffer from migraines.
Three times more common in women (as a result of hormonal differences, it is thought), migraines occur when nerves and blood vessels at the top and front of the brain release CGrP, a chemical that carries messages between cells. research suggests that CGrP promotes pain signals in the head.
The injectable preventatives are laboratoryproduced proteins that prevent CGrP molecules from docking onto receptors, where they would prompt and continue a migraine.
Brendan Davies, a consultant neurologist and headache research lead at University Hospitals of North Midlands NHS Foundation Trust, says these drugs represent a major step forward in migraine treatment. ‘The CGrP drugs are the biggest change I have seen for people with migraines in the 18 years I have worked in headache care,’ he says. The new tablets could be easily prescribed by GPs and be more widely available than prevention treatments that must be prescribed by specialists. Around 25 per cent of people with migraines respond to CGrP treatments, and ‘they do spectacularly well on them’, says Peter Goadsby, a professor of neurology at King’s College London, who first identified the CGrP mechanism to treat migraines. ‘For those who don’t, there is probably another mechanism, and different chemicals, causing their migraine.’ Furthermore, with studies showing the side-effects
are that minimal, these the drugs fact both prevent and treat the problem is a major advance.
‘It totally changes how we look at medication,’ says Professor Goadsby. ‘With a single packet of tablets, people could potentially take the drug as and when they need it. If they feel they are at high risk of having a migraine, they could take a tablet every day as a preventative.’
Most existing migraine treatments were developed for other conditions and come with sideeffects, include which beta-blockers, can be severe. such as They propranolol, which were originally developed to treat high blood pressure, and which can’t be taken by people with asthma — side-effects include tiredness and fatigue.
MEANWHILE, tricyclic antidepressants, which block serotonin, a brain chemical thought to also have a role in migraines, can make people feel drowsy and cause weight gain.
The CGrP tablet and injections, have fewer side- effects so far — about 2 per cent of patients report having nausea.
Andrew Dowson, the clinical lead for east Kent Headache Service, cautions that while the new injections and tablets are an exciting development: ‘ We need to sound a note of realism that a lot of people with migraines will not be eligible for these treatments.’
The injections are only available to those who have failed on three other preventative treatments. ‘even when people access them, they may not work,’ adds Dr Dowson. ‘The big hope is they will help those who can’t take existing options.’
Jennifer tried all standard therapies, including Botox injections (the mechanism by which it works is not fully understood), and while they had varying success, ‘the sideeffects are terrible’, she says.
And none helped with the migraine after- effects. She now self-injects into the stomach or thigh muscle once a month. ‘It has given me back to my family — and to my patients,’ she says.