FDA approves new treatment for adults with migraine(fda.gov)
fda.gov
FDA approves new treatment for adults with migraine
https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-adults-migraine
44 comments
> A migraine is your body telling you something is wrong with your most valuable asset.
> Are you sure you want to sweep this problem under the rug?
> Good luck with your search for health and wellbeing.
Not saying you are quack, these days reading things like this sets off an alarm for me. I've learned all too-well by my years of dealings with "health-conscious self-help" community that a lot of it is just step away from medical quackery. I suspect the reason for this is D-K effect in people who think that by reading up things in internet they can somehow out-do existing research in the field. I know a person with masters degree in CS who managed to convince himself through the reading of wikipedia and "self-help" books that he was feeling bad due to levels of acidy in his body, condition which he "keeps under control" by drinking bottle of vinegar a day. That was weird, but nothing bad (I believe?), but over few months he became extremely preachy about modern medicine is a scam developed to sell people pills, and it's all solvable by diet and healthy living.
We don't know what causes migraines, and the subject is very hard to research because no there are no apparent differences in anatomy and bio-chemistry between people who suffer migraines and those who don't, and you would need to run tests on sufferer during migraine as it leaves no trace in the body few hours after it ends.
There been many leads that turned out as flukes over the years. Maybe it's something with hormones? Nope. Maybe its blood circulation in the brain? Nope. Pressure on blood vessels in the neck? Nope. Latest discovery is different levels of calcium in brain-spinal fluid in those that suffer migraines and those who don't... so naturally migrainers on Facebookgroups are now all the rage about removing salt from your diet (oh, but this from the top of the mountain salt ten times the price is good for you!).
Not saying you are quack, these days reading things like this sets off an alarm for me. I've learned all too-well by my years of dealings with "health-conscious self-help" community that a lot of it is just step away from medical quackery. I suspect the reason for this is D-K effect in people who think that by reading up things in internet they can somehow out-do existing research in the field. I know a person with masters degree in CS who managed to convince himself through the reading of wikipedia and "self-help" books that he was feeling bad due to levels of acidy in his body, condition which he "keeps under control" by drinking bottle of vinegar a day. That was weird, but nothing bad (I believe?), but over few months he became extremely preachy about modern medicine is a scam developed to sell people pills, and it's all solvable by diet and healthy living.
We don't know what causes migraines, and the subject is very hard to research because no there are no apparent differences in anatomy and bio-chemistry between people who suffer migraines and those who don't, and you would need to run tests on sufferer during migraine as it leaves no trace in the body few hours after it ends.
There been many leads that turned out as flukes over the years. Maybe it's something with hormones? Nope. Maybe its blood circulation in the brain? Nope. Pressure on blood vessels in the neck? Nope. Latest discovery is different levels of calcium in brain-spinal fluid in those that suffer migraines and those who don't... so naturally migrainers on Facebookgroups are now all the rage about removing salt from your diet (oh, but this from the top of the mountain salt ten times the price is good for you!).
I think your stretching/twisting what I said quite a bit.
I don't think you understand either the specificity or how debilitating a migraine can be. For example, mine (and those of many others) are preceded by a very clearly identifiable visual disturbances, called a migraine 'aura'. I get headaches once in a while too, but it's very easy to tell the difference. and trust me, nobody with migraines wants to sweep them under the rug, and painkillers really don't touch them.
The problem for migraines today is that anything stronger than caffeine starts to come with potentially nasty side effects. Imitrex is the first option people usually go to - for myself, I decided not to do that.
Almost everyone with migraines will be advised by their doctor to try to identify triggers, dietary or environmental. But it's tricky. I kept a food log for months to absolutely no avail. At some point after about 20 years of migraines, I finally figured out that looking at a really bright light (think sunlight reflection off of polished metal) would pretty reliably trigger a migraine. The existence of medications that reduced the severity of symptoms in no way stopped me or many others from trying to identify causes.
The problem for migraines today is that anything stronger than caffeine starts to come with potentially nasty side effects. Imitrex is the first option people usually go to - for myself, I decided not to do that.
Almost everyone with migraines will be advised by their doctor to try to identify triggers, dietary or environmental. But it's tricky. I kept a food log for months to absolutely no avail. At some point after about 20 years of migraines, I finally figured out that looking at a really bright light (think sunlight reflection off of polished metal) would pretty reliably trigger a migraine. The existence of medications that reduced the severity of symptoms in no way stopped me or many others from trying to identify causes.
A migraine is not your body telling you something is wrong. Sometimes they just happen. Not all migraines are triggered. Even when they are triggered the brain is mistaken that something is wrong. Please don't spread misinformation.
> Even when they are triggered the brain is mistaken that something is wrong.
Seems like pain is an indicator that something is wrong to me.
Seems like pain is an indicator that something is wrong to me.
nope. the brain can be broken or mistaken and just generate pain for no reason. ignoring/surpressing that pain is fine.
Indeed. Migraines for 30 years. Painkillers allows you to keep up with whatever wrong you are doing.
So if you have migraines, it is not normal. It is not incurable either. Use pain killers when you must, but keep looking for a solution.
The solution can be different for everybody. Start with diet, it's a very common cause for it. Don't limit yourself to what you think is right. Try things, even weird ones. Took me 3 decades of trials and errors to not need pain killers.
So if you have migraines, it is not normal. It is not incurable either. Use pain killers when you must, but keep looking for a solution.
The solution can be different for everybody. Start with diet, it's a very common cause for it. Don't limit yourself to what you think is right. Try things, even weird ones. Took me 3 decades of trials and errors to not need pain killers.
If pain killers worked for your migraines, they were extremely mild migraine.
OTC pain killers (and even prescribed pain killers) don't really do anything for the 3 people I know that get migraines. These people have to lay down under their sheets to block all sun light, they can not do absolutely anything at all during the episode but block sunlight and hope whatever medicine sort of worked last time will work this time.
Preaching and generalizing from your mild case helps no one.
OTC pain killers (and even prescribed pain killers) don't really do anything for the 3 people I know that get migraines. These people have to lay down under their sheets to block all sun light, they can not do absolutely anything at all during the episode but block sunlight and hope whatever medicine sort of worked last time will work this time.
Preaching and generalizing from your mild case helps no one.
Thanks for sharing about it taking thirty years. I can only imagine that it becomes so much harder of a problem to solve when the symptoms are as severe as a migraine.
Unfortunately, I don't think people understand how long it takes to get a grasp on everything we ingest. Someone in a sibling comment mentioned giving up after just a few months of "logging" their diet.
It took me years to narrow down an allergy/sensitivity to tannins. And it also took years to recognize the full extent of sugars' effect on my body.
Unfortunately, I don't think people understand how long it takes to get a grasp on everything we ingest. Someone in a sibling comment mentioned giving up after just a few months of "logging" their diet.
It took me years to narrow down an allergy/sensitivity to tannins. And it also took years to recognize the full extent of sugars' effect on my body.
Tbh I would rather have to take painkillers sometimes than do keto intermittent fasting every day with organic vegan weeks.
Besides, you might be confusing correlation with causation a bit? My sister and mother probably eat healthier than I do and still get disabling migraines sometimes. My diet is "basically whatever, just no animal parts and not too much junk food" and I've never gotten one.
Besides, you might be confusing correlation with causation a bit? My sister and mother probably eat healthier than I do and still get disabling migraines sometimes. My diet is "basically whatever, just no animal parts and not too much junk food" and I've never gotten one.
> Tbh I would rather have to take painkillers sometimes than do keto intermittent fasting every day with organic vegan weeks.
Lucky for you it seems you haven't been exposed to pain killer addiction and death.
But, not as lucky since you don't have someone that can create delicious meals from any ingredients (it's possible, see the TV show "Chopped").
> probably eats healthier
This would be much easier to answer if you spent 1% of the time you spend eating on learning about what it is that's going into your body.
Lucky for you it seems you haven't been exposed to pain killer addiction and death.
But, not as lucky since you don't have someone that can create delicious meals from any ingredients (it's possible, see the TV show "Chopped").
> probably eats healthier
This would be much easier to answer if you spent 1% of the time you spend eating on learning about what it is that's going into your body.
I’ve had migraines since I was a kid and have been fortunate to have identified my triggers(caffeine/cacao) and found medication that works when one comes on.
I can’t imagine how awful it is for folks who have no respite and hope this treatment can provide some relief.
I can’t imagine how awful it is for folks who have no respite and hope this treatment can provide some relief.
I used to get horrible migraines from high school age on, my triggers were bright reflections and too much MSG (I kept track of what I ate and then tried to avoid anything that triggered) and generally I was useless for at least 4 hrs several times a month. If I was really quick a single Vicodin would at least make it manageable but generally I could keep nothing down. As I got older the headache itself got less and less and mostly what I get now is the aura (freaky lightshow in your eyes) and a single Tylenol is fine. But for 20 years it was not a fun experience at all. I know people with way more frequency to the point of being unable to do much at all.
One summer in college for a month I got a cluster headache every morning. 20 minutes of absolute agony that made migraines seem like a walk in the park. Thankfully those never came back.
I am glad research has been finding more ways to treat and even stop them.
One summer in college for a month I got a cluster headache every morning. 20 minutes of absolute agony that made migraines seem like a walk in the park. Thankfully those never came back.
I am glad research has been finding more ways to treat and even stop them.
> As I got older the headache itself got less and less and mostly what I get now is the aura (freaky lightshow in your eyes) and a single Tylenol is fine. But for 20 years it was not a fun experience at all. I know people with way more frequency to the point of being unable to do much at all.
I also started getting mine in high school (sophomore or junior year, I think?). Never had them frequently, just once or twice a year, which is plenty. I too have noticed a shift in their effect as I get older, away from my predictable blind-spots-followed-by-pain to a wider variety of visual effects and usually just feeling really weird and "off" for the rest of the day.
Oddest one so far involved fairly bad tunnel vision, which was new and I've not had again since, plus the usually just-off-center-of-vision blind spot I get, followed about a half hour later by needing to sleep. It wasn't the same feeling as being very tired, exactly, but I just needed to get in bed and go to sleep. No pain, just that. So weird.
I also started getting mine in high school (sophomore or junior year, I think?). Never had them frequently, just once or twice a year, which is plenty. I too have noticed a shift in their effect as I get older, away from my predictable blind-spots-followed-by-pain to a wider variety of visual effects and usually just feeling really weird and "off" for the rest of the day.
Oddest one so far involved fairly bad tunnel vision, which was new and I've not had again since, plus the usually just-off-center-of-vision blind spot I get, followed about a half hour later by needing to sleep. It wasn't the same feeling as being very tired, exactly, but I just needed to get in bed and go to sleep. No pain, just that. So weird.
That’s funny (not in a good way!) because caffeine is one of the go-to remedies for migraine attacks. It’s a vasoconstrictive and the best (triptans, at least as of yesterday) pharmaceuticals just basically took that vasoconstriction an order of magnitude or two higher (though with horrifying side effects).
Diclofenac works very well for me. Tablets work within an hour most of the time, and intramuscular shots work within about 20 minutes every time. But the long term potential side effects aren’t great, so new options would be fantastic.
Diclofenac is unfortunately extremely ill-suited for intramuscular injection, as its formulations come in a rather large fluid volume, at the upper end of the range with regards to how much even the best of IM injection sites can hold without causing pretty bad injection site pain (primarily ventrogluteal), depending of course on your body size. Dorsogluteal is better, but I don’t know many people than self-inject there.
How do you get the shot, logistically?
Once I have a migraine, travel is exceedingly difficult for me.
Once I have a migraine, travel is exceedingly difficult for me.
It was always terrible. I used to live half a block from my doctors office, so I’d just (slowly) walk then. Now my wife will drive me (probably only need a couple of them a year though).
Basically it just sucked. Especially sitting in the bright waiting room, sweating bullets, trying not to throw up before I was seen. My most serious migraines can last a couple of days, and are just awful. Making it go away almost instantly was alway worth the hour or so of additional suffering to get a shot. I’ve also got a rather high pain tolerance, and tend to only get worn down by pain that lasts a long time.
I don’t know if it would be as effective for anybody else, but if you get migraines that seem worse than death, I’d recommend asking your doctor about it.
Basically it just sucked. Especially sitting in the bright waiting room, sweating bullets, trying not to throw up before I was seen. My most serious migraines can last a couple of days, and are just awful. Making it go away almost instantly was alway worth the hour or so of additional suffering to get a shot. I’ve also got a rather high pain tolerance, and tend to only get worn down by pain that lasts a long time.
I don’t know if it would be as effective for anybody else, but if you get migraines that seem worse than death, I’d recommend asking your doctor about it.
How does cannabis affect your symptoms, if you vaporize some of that instead of heading for the Dr?
I only smoked weed when I was young, but it would generally make it worse (and would sometimes add nausea). I have some pretty good pain management techniques I use, and I think being high just takes my focus off them. I also can’t stand the dopey feeling and won’t even take opioids unless I really need to. I broke my leg a while ago and limped home on it thinking I’d just sprained it, eventually went to the ER and it took about 18 hours after the accident until I gave up and asked for some tramadol. The downside is, if I tell a nurse or doctor that I’m in extreme pain, they tend to not fully believe me because I’ll look quite calm.
Would you mind elaborating on the pain management techniques?
Mostly slow deep breathing and focusing on relaxing and trying to lower your heart rate, basically just trying to calm down. Pain is just signals in your brain like any other though or feeling. I’m pretty convinced you can exert a reasonable amount of control over it. I’m no expert on the subject and I haven’t trained to do it or anything, I’ve just injured myself a lot and that’s what has worked for me. It’s gotten me through a fair amount of serious injuries without much stress, the only trouble I’ve found is that I need to continually focus on doing it, and if I’ve been up in the hospital all night, I’ll eventually get worn out and exhausted, and it won’t work quite as well.
I don’t think there’s any limit to how proficient you can get at it. I think about that Vietnamese monk who set himself on fire and managed to calmly sit through burning to death, there’s no way anybody could do that without having total control over their pain response. I’ve obviously never experienced anything that traumatic, but I have been in situations where I felt the symptoms of shock setting in and managed to calm myself down enough to get on with things.
I don’t think there’s any limit to how proficient you can get at it. I think about that Vietnamese monk who set himself on fire and managed to calmly sit through burning to death, there’s no way anybody could do that without having total control over their pain response. I’ve obviously never experienced anything that traumatic, but I have been in situations where I felt the symptoms of shock setting in and managed to calm myself down enough to get on with things.
Smoking will of course make it worse, it worsens vascular problems of any kind.
Please vaporize or use it sublingually - it may change everything.
Please vaporize or use it sublingually - it may change everything.
It sounds enticing, but I would need a few days advance notice to see my doctor.
I will ask, though.
I will ask, though.
> https://www.drugs.com/uk/pdf/leaflet/801174.pdf
self injection is an option, apparently.
self injection is an option, apparently.
Diclofenac is an NSAID painkiller. It comes with all the usual risks and contraindications of any other NSAID.
Migraine abortives like triptans and migraine inhibitors like these CGRP antagonists (erenumab and now ubrogepant) are not painkillers. They attempt to stop the migraine, not just numb the pain. They're both in a league of their own.
Migraine abortives like triptans and migraine inhibitors like these CGRP antagonists (erenumab and now ubrogepant) are not painkillers. They attempt to stop the migraine, not just numb the pain. They're both in a league of their own.
Does anyone know if they publish details about the size/strength of the effect anywhere or a link to the actual numbers for the study population?
Looks like it "works" (2-hour pain free marker) for ~10% of people.
https://www.evaluate.com/vantage/articles/news/snippets/ubre...
https://www.evaluate.com/vantage/articles/news/snippets/ubre...
It might not sound impressive, but I think this is great news for two reasons:
1) Even if only 10% of people respond, this is likely going to give thousands of people for whom nothing else works a drug that actually does something.
2) Nearly all existing migraine meds fall into the "triptan" class of drugs. This is an entirely new class (CGRP antagonist), and may pave the way to new treatments even if this specific iteration isn't as effective as future ones.
1) Even if only 10% of people respond, this is likely going to give thousands of people for whom nothing else works a drug that actually does something.
2) Nearly all existing migraine meds fall into the "triptan" class of drugs. This is an entirely new class (CGRP antagonist), and may pave the way to new treatments even if this specific iteration isn't as effective as future ones.
for 2), this is not news, back in October 2019 Lilly got their drug approved as well in this class: https://www.bloomberg.com/news/articles/2018-09-28/eli-lilly...
The news here is that ubrogepant is a tablet taken as an abortive, while emgality etc are injections taken as a preventative.
I've had migraines for 40 years, and suffered much before being prescribed Sumatriptan. It relieves the migraine completely in about 30min. Doesn't work for my wife who also has migraines but an alternate formulation, Rizatriptan, does. My migraines have also evolved over the years from intense day long affairs to duller 3-day ones. Sometimes I need a subcutaneous triptan shot which relieves it in, I kid you not, 1 minute.
I tried preventative medications but the cure seemed worse than the disease. One, Topiramate, made me forget things and lose my train of thought. No thank you.
I also tried keto for a while and noticed that I hardly had any migraines while on it.
There are a lot of options available now. If you suffer from migraines, go talk to a neurologist with current knowledge, not something they learned 30 years ago.
I tried preventative medications but the cure seemed worse than the disease. One, Topiramate, made me forget things and lose my train of thought. No thank you.
I also tried keto for a while and noticed that I hardly had any migraines while on it.
There are a lot of options available now. If you suffer from migraines, go talk to a neurologist with current knowledge, not something they learned 30 years ago.
Topiramate (topomax) is the antidote worse than the disease. It turned me into a zombie, literally living in my head but too dead to even open my mouth to say “hi” or “good morning” when I made eye contact with a stranger (yes, I’m from the Midwest and we do that here).
(Venlafaxine on the other hand is like a shock collar wrapped tightly around your brain waiting for you to miss a dose by even two hours, after which it’ll punish you for the next twenty four hours with electric shocks and spasms in your freaking brain. It’s a real pity it actually kind of worked :/ I still don’t know if I would ever do it again.)
(Venlafaxine on the other hand is like a shock collar wrapped tightly around your brain waiting for you to miss a dose by even two hours, after which it’ll punish you for the next twenty four hours with electric shocks and spasms in your freaking brain. It’s a real pity it actually kind of worked :/ I still don’t know if I would ever do it again.)
About a year ago there is this one... https://www.theguardian.com/science/2018/jul/31/first-ever-p...
I've also had migraine on-and-off, and I had one even this night. So I went up and took my medicine, and I can function fairly well today.
Before I had this medicine the whole day would've been ruined, and I would be very inefficient and lazy tomorrow as well. While I don't get migraine that often, it makes a world of difference when I do get them.
Before I had this medicine the whole day would've been ruined, and I would be very inefficient and lazy tomorrow as well. While I don't get migraine that often, it makes a world of difference when I do get them.
Triptans changed my life in this way.
Moderate to heavy doses of psilocybin at quarterly intervals can eliminate migranes and cluster headaches.
They are somewhat chemically similar to triptans, and consequently usually do not work for migraines resistant to triptans. But then, there's a lot of variance there.
But yes, they do sometimes work and when they do it's relatively long term compared to regular triptan use. And allegedly they're much more potent, especially when it comes to aborting migraines. Some non-hallucinogenic chemical variants are being also researched, both of psilocybin and LSD. LSA has also shown effectiveness sometimes.
At least 3 phase 1/2B-style RCTs of hallucinogens are under way. (Finding working doses, schedules, cataloguing side effects.) Expect results of one for psilocybin mid 2020. There's also long running RCT of LSD, finishing in 2023. I think both of these are for cluster headaches rather than migraines, but close enough.
Pilot trials have been done a long time ago by MAPS, with success. Now it's time for bigger science.
The link is also somewhat interestingly tenuous with ECT and seizures. (In that migraines and seizures rarely coexist, but share symptoms in some cases.)
But yes, they do sometimes work and when they do it's relatively long term compared to regular triptan use. And allegedly they're much more potent, especially when it comes to aborting migraines. Some non-hallucinogenic chemical variants are being also researched, both of psilocybin and LSD. LSA has also shown effectiveness sometimes.
At least 3 phase 1/2B-style RCTs of hallucinogens are under way. (Finding working doses, schedules, cataloguing side effects.) Expect results of one for psilocybin mid 2020. There's also long running RCT of LSD, finishing in 2023. I think both of these are for cluster headaches rather than migraines, but close enough.
Pilot trials have been done a long time ago by MAPS, with success. Now it's time for bigger science.
The link is also somewhat interestingly tenuous with ECT and seizures. (In that migraines and seizures rarely coexist, but share symptoms in some cases.)
had to go to wikipedia for the MOA
> It is a small-molecule calcitonin gene-related peptide receptor antagonist
> It is a small-molecule calcitonin gene-related peptide receptor antagonist
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If only someone would remove the headache of pharmaceutical companies artificially increasing the costs of drugs, particularly when drugs like triptans reach the generic market.
That has lead to me avoiding all medicines every time I get a headache (yes, I understand correlation is not causation).
My primary route to solve any headache is hydration. Adding electrolytes is also important because too much water without them can also give you a headache.
My experience has also lead me to focus on consuming the healthiest diet I can find (currently intermittent fasting + keto with intermittent-vegan weeks, mostly organic, with all nutrients from food sources).
On the other hand, my mother, who could convince the majority she's healthy based on her weight and latest diet buzzwords, has had migraines for the past 30 years, maybe longer — even landing her in the hospital on many occasions.
A migraine is your body telling you something is wrong with your most valuable asset.
Are you sure you want to sweep this problem under the rug?
There is a documentary on Amazon called "Fat". It illustrates how many children with epilepsy were harmed by the combination of 1. lack of understanding food and 2. pharmaceuticals with side effects that render them permanently disabled.
Good luck with your search for health and wellbeing.