The title is misleading, as other medications have been used for migraine prophylaxis. This is the first drug, per the article, that has been specifically approved for migraine prophylaxis. Medications such as beta blockers and valproic acid are other medications used for migraine prophylaxis but were originally approved for other conditions.
Additionally, please note that this drug has already been approved in the US, since May.
Now, onto the meat of this. If I'm not mistaken, erenumab is a cgrp inhibitor that made much fanfare a few months ago in New England Journal of Medicine when two studies found a clinical benefit in cgrp.
Basically healthcare providers are prescribing this if you failed the aforementioned therapies for migraine prophylaxis (since those are way cheaper).
On a funnier note, medical students such as myself have started referring to all of these new biologic drugs as "what-the-f*-umabs" since they all have weird names and we can't keep up with the rapid development of them.
Valproate is far from ideal, because it's massively teratogenic. Migraine is far more prevalent in women, so erenumab could become very useful when it goes off patent.
I've been taking Feverfew extract daily (the brand is Mygrafew, I think) and it has reduced my migraines by about 80%. For the rest of the time there's sumatriptan, which works about 70% of the time. Between the two, I've got my migraines under control (maybe one a month).
I used to get at least one a week, and I know there are people who get them much more often. I'm glad there are advances being made in this area because I feel like for all the pain migraines have caused me, I'm mostly a dabbler and others have it much worse.
It's really one of the worst pains I've ever experienced. They are kind of evil. With some pain, you know "at least it's for a reason" (like your body self-healing something). With migraines, it's devoid of any purpose. The pain only exists to torture you. Nasty things.
I know two people who suffer from chronic, debilitating migraines. As someone who gets episodic clusters, I am sympathetic / empathetic to their plight. My attacks (which only happen every two years or so) can be treated pretty effectively with oxygen and/or sumatriptan injections, so it's tempting to think that sumatriptan (primarily a migraine drug in the first place) should just work.
Everyone is different, and there is so much we don't understand about migraines (and clusters, which often benefit from migraine research). If you think that ginger, cannabis, or just avoiding your triggers is all it takes, that's not always (nor probably often) the case.
I hesitate to subject a friend's personal blog to the HN effect, but if you want to learn about chronic migraine from one firsthand account, read through some of the archives at thedailyheadache.com. She has been trying desperately and relentlessly to find peace for a long time.
Interesting you mention oxygen -- this means you breath from an oxygen tank? I notice I yawn a lot when a migraine is about to occur -- I always thought this had something do with lack of oxygen.
I always have a supply of MaxAlt (rizatriptan benzoate) with me which short circuits my migraines if I take it in the correct window of time. 1 MaxAlt usually works, 2 or 3 in the worse case.
I wonder if natural ginger ale could have a prophylactic effect when drank at lunch each day. That would be a super thing if it did — and safe for pretty much anyone.
There is growing evidence that hyperinsulemia is related to migraines. Insulin-resistant individuals and/or people with metabolic syndrome who suffer migraines could try lowering their insulin levels by removing fast-digesting carbohydrates (refined sugars, starches, junk food in general) and seeing if that helps.
Along the same lines: chronic migraine sufferers can sometimes have good results at reducing frequency by lowering the blood pressure.
A low carb diet, or ketogenic diet, can cause lowered blood pressure. The only downside with diet instead of medication is that eating carbohydrates will reverse the effect.
A couple of naive (and admittedly political) questions I didn't see addressed in the article...
Is there any way to find out how much of the R&D money for the medicine came from public funding? I can understand if the information is simply not available because it comes from a larger pool of R&D monies.
> Erenumab is now expected to be considered by English and Scottish health agencies to assess whether it is appropriate for NHS use.
Curious whether it has to be approved by the EU first before its use by NHS is allowed (or if its assessment is even worth it until EU approval occurs). Also curious whether "appropriate for NHS use" means at no cost to migraine sufferers.
Some people have been able to successfully treat migraines, as well as cluster headaches, with hallucinogens such as psilocybin and LSD:
"These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives." [1]
"The authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted."[2]
I know someone who uses MDMA every few months to prevent migraines. Reportedly it works at least for a month or two after a 100mg dose.
Really wish it was legal to research around this compounds - the case of 2-Bromo-LSD suggests a successful anti-migraine drug does not have to have psychedelic effects.
I have a friend who gets regular migraines. He takes triptans to abort them, but if the frequency becomes too much he takes a low dose of psilocin and it banishes them for a couple months.
Yes, it's been found to work well on certain types of "cluster" type migranes. However, it hasn't been found to work for chronic migranes, which is what this new drug is focused on. Prevention of chronic migranes is horribly elusive, and while there's a number of "preventatives," for many people they don't work well or for very long.
you could also just avoid your migraine trigger, I have and get around 3 migraines a year max rather than having one every month or 2 or 3 a week as a teen.
Jerry Weinberg, who died yesterday, used to say that every time you hear the j-word ("just") you should replace it with "have trouble", i.e. "you could also have trouble avoiding your migraine trigger". He was talking about software projects, but the rule is general. The j-word usually indicates that difficulty is being glossed over.
Anecdotally, over the years I've tried identifying my triggers by keeping logs of food, drink, sleep, stress, travel, etc, and correlating the data. After all that, I've identified a few specific foods, but even those were unreliable triggers, and avoiding them didn't cause a significant decrease overall. Medication gave me my life back.
You state that as if it's simple and anyone can do it.
What if something common like changes in atmospheric pressure trigger it? What if you have multiple common triggers? What if you don't know all your triggers?
I was under the impression that identifying the trigger can be quite difficult, to the point where some folks who suffer from Chronic migraines can spend years trying to figure out the combination of factors that act as the trigger?
With the variety of triggers that are possible and the possibility of there being multiple triggers with complex interactions, that is much easier said than done for many. After keeping meticulous logs of anything that might be a trigger, I've managed to reduce my migraines to 1 a month from 3-4 per weeks over a period of about 4 years, eventually identifying 7 or 8 causes. Even then, when I do get one, which combination of pain drugs to take is a huge gamble. CBD oil seems to be the only thing that always works, but that's unfeasible for me. So I'm not going to complain about a new drug for it.
Not all migraines have triggers. This drug in particular is for chronic migraines, and while the definition of chronic is 15 days or more, the people who will qualify for this drug (and who it was really designed for) are the people who have them 24 hours a day, 7 days a week non-stop. So living is their trigger. Nice advice.
For a lot of people cannabis works great for their migraines, but I guess it is difficult for pharma to make money off of it so it is still a gray area in the EU. I am only pointing this out because the hype coming from the article makes the situation grotesque.
1. It isn't so difficult. "Pharma" makes drugs from plants all the time. It isn't hard to imagine having strains specifically for treatment, packaged in prepackaged dosages with the right strains with different strengths. Or inhalers and things. "Pharma" also makes things like aspirin, after all. Besides, "Pharma" isn't the only one with an interest here - alcohol and tobacco companies would surely jump in to fill the niche. Not to mention that many countries have taxpayer-funded health care and have a vested interest to provide lower-cost treatments that work.
2. It depends on what is causing your migraines. I have a family member that will smoke occasionally if the migraines get bad enough. But they also have allergies, and sometimes smoking irritates them. That means that she has a small chance of the headache changing forms. One type of pain traded for another.
3. The situation is pretty horrible. I don't have them, but they run in my family. I've had to pick a person up because they got an aura while driving. I've known another that goes literally months with headaches. The pain gets bad enough that folks near "If I overdose, at least the pain stops". It can literally disable folks for hours. Cannabis doesn't always work well enough and doesn't prevent them. Most things that help with the pain still disable folks enough that they can't drive nor do their work.
Does cannabis actually prevent migraines or help after they started? I would be interested in reading the peer reviewed studies on the effectiveness of cannabis in preventing migraines.
I am skeptical of anecdote because half of my family is Mexican and the grandmothers on that side of the family are convinced that being cold causes colds or that homeopathy actually works. But in reality it’s just quite literally old wives tales not backed by any reputable, reproducible studies.
To be clear, I am not disputing that cannabis could have some beneficial effects, but the science should be there before we start suggesting that government is up to some conspiracy to boost pharma profits.
Am marijuana is still illegal in most EU countries — so don’t blame pharma for not manufacturing and testing cannabis medications, blame the democratically elected EU governments for trying to “protect” people from making their own decisions about what to ingest.
[+] [-] epmaybe|7 years ago|reply
Additionally, please note that this drug has already been approved in the US, since May.
Now, onto the meat of this. If I'm not mistaken, erenumab is a cgrp inhibitor that made much fanfare a few months ago in New England Journal of Medicine when two studies found a clinical benefit in cgrp.
Basically healthcare providers are prescribing this if you failed the aforementioned therapies for migraine prophylaxis (since those are way cheaper).
On a funnier note, medical students such as myself have started referring to all of these new biologic drugs as "what-the-f*-umabs" since they all have weird names and we can't keep up with the rapid development of them.
[+] [-] jensvdh|7 years ago|reply
I'm currently taking Cosentyx and it's been life-changing.
More and more the treatment goal of my condition is becoming sustained drug-induced remission.
[+] [-] Someone|7 years ago|reply
They have similar name endings because of naming conventions. umab indicates a human monoclonal antibody. See https://en.wikipedia.org/wiki/Nomenclature_of_monoclonal_ant..., https://en.wikipedia.org/wiki/Drug_nomenclature#List_of_drug...
[+] [-] jdietrich|7 years ago|reply
[+] [-] orthecreedence|7 years ago|reply
I used to get at least one a week, and I know there are people who get them much more often. I'm glad there are advances being made in this area because I feel like for all the pain migraines have caused me, I'm mostly a dabbler and others have it much worse.
It's really one of the worst pains I've ever experienced. They are kind of evil. With some pain, you know "at least it's for a reason" (like your body self-healing something). With migraines, it's devoid of any purpose. The pain only exists to torture you. Nasty things.
[+] [-] SloopJon|7 years ago|reply
Everyone is different, and there is so much we don't understand about migraines (and clusters, which often benefit from migraine research). If you think that ginger, cannabis, or just avoiding your triggers is all it takes, that's not always (nor probably often) the case.
I hesitate to subject a friend's personal blog to the HN effect, but if you want to learn about chronic migraine from one firsthand account, read through some of the archives at thedailyheadache.com. She has been trying desperately and relentlessly to find peace for a long time.
[+] [-] waynecochran|7 years ago|reply
I always have a supply of MaxAlt (rizatriptan benzoate) with me which short circuits my migraines if I take it in the correct window of time. 1 MaxAlt usually works, 2 or 3 in the worse case.
[+] [-] ianai|7 years ago|reply
[+] [-] bodhibyte|7 years ago|reply
[+] [-] nharada|7 years ago|reply
https://www.ncbi.nlm.nih.gov/pubmed/15257686
[+] [-] orthecreedence|7 years ago|reply
[+] [-] raverbashing|7 years ago|reply
[+] [-] al_ramich|7 years ago|reply
[+] [-] briandear|7 years ago|reply
[+] [-] cgh|7 years ago|reply
[+] [-] bonesss|7 years ago|reply
A low carb diet, or ketogenic diet, can cause lowered blood pressure. The only downside with diet instead of medication is that eating carbohydrates will reverse the effect.
[+] [-] kodablah|7 years ago|reply
Is there any way to find out how much of the R&D money for the medicine came from public funding? I can understand if the information is simply not available because it comes from a larger pool of R&D monies.
> Erenumab is now expected to be considered by English and Scottish health agencies to assess whether it is appropriate for NHS use.
Curious whether it has to be approved by the EU first before its use by NHS is allowed (or if its assessment is even worth it until EU approval occurs). Also curious whether "appropriate for NHS use" means at no cost to migraine sufferers.
[+] [-] xchaotic|7 years ago|reply
[+] [-] okmokmz|7 years ago|reply
"These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives." [1]
"The authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted."[2]
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584001/
[2] https://www.ncbi.nlm.nih.gov/pubmed/16801660
https://clinicaltrials.gov/ct2/show/NCT03341689
[+] [-] tpm|7 years ago|reply
Really wish it was legal to research around this compounds - the case of 2-Bromo-LSD suggests a successful anti-migraine drug does not have to have psychedelic effects.
[+] [-] jacob019|7 years ago|reply
[+] [-] heyyyouu|7 years ago|reply
[+] [-] sibeliuss|7 years ago|reply
[+] [-] jlebrech|7 years ago|reply
[+] [-] gruseom|7 years ago|reply
Jerry Weinberg, who died yesterday, used to say that every time you hear the j-word ("just") you should replace it with "have trouble", i.e. "you could also have trouble avoiding your migraine trigger". He was talking about software projects, but the rule is general. The j-word usually indicates that difficulty is being glossed over.
[+] [-] happytoexplain|7 years ago|reply
[+] [-] driverdan|7 years ago|reply
What if something common like changes in atmospheric pressure trigger it? What if you have multiple common triggers? What if you don't know all your triggers?
[+] [-] rrdharan|7 years ago|reply
[+] [-] TallGuyShort|7 years ago|reply
[+] [-] tsomctl|7 years ago|reply
[+] [-] heyyyouu|7 years ago|reply
[+] [-] ryanianian|7 years ago|reply
[+] [-] merinowool|7 years ago|reply
[+] [-] pygy_|7 years ago|reply
Preventive migraine treatments are not painkillers (beta blockers, anti-epileptics, and more, among which the CGRP blocker described in the article).
https://www.ichd-3.org/8-headache-attributed-to-a-substance-...
[+] [-] Broken_Hippo|7 years ago|reply
2. It depends on what is causing your migraines. I have a family member that will smoke occasionally if the migraines get bad enough. But they also have allergies, and sometimes smoking irritates them. That means that she has a small chance of the headache changing forms. One type of pain traded for another.
3. The situation is pretty horrible. I don't have them, but they run in my family. I've had to pick a person up because they got an aura while driving. I've known another that goes literally months with headaches. The pain gets bad enough that folks near "If I overdose, at least the pain stops". It can literally disable folks for hours. Cannabis doesn't always work well enough and doesn't prevent them. Most things that help with the pain still disable folks enough that they can't drive nor do their work.
[+] [-] briandear|7 years ago|reply
I am skeptical of anecdote because half of my family is Mexican and the grandmothers on that side of the family are convinced that being cold causes colds or that homeopathy actually works. But in reality it’s just quite literally old wives tales not backed by any reputable, reproducible studies.
To be clear, I am not disputing that cannabis could have some beneficial effects, but the science should be there before we start suggesting that government is up to some conspiracy to boost pharma profits.
Am marijuana is still illegal in most EU countries — so don’t blame pharma for not manufacturing and testing cannabis medications, blame the democratically elected EU governments for trying to “protect” people from making their own decisions about what to ingest.
[+] [-] soperj|7 years ago|reply