New Treatments Are Changing the Way Migraine Is Managed

“As people, particularly females, get older and hormones change after menopause, they may drop the headache altogether and their migraine may be aura-only,” says Barbara L. Nye, M.D.,

clinical associate professor in neurology at Wake Forest University School of Medicine. “Aura” refers to visual changes — flashes, bright spots, shapes, blind spots, or blurred or lost

vision — that typically precede a headache. “You may be driving down your street and see a shimmer in your vision or partially blocked vision,” Nye says. Imagine the panic, since these can

also be signs of a stroke. (See “When to See the Doctor”)  POWERFUL NEW TREATMENT OPTIONS More than half of those with migraine say they’re constantly juggling treatments in search of the

right one, according to 2021 data from the National Headache Foundation. Over the past five years, however, new therapies have emerged that are changing the way migraine is managed.

Historically, the only therapies available were medications used for other diseases, such as seizure disorder, depression or high blood pressure, Nye says.  Though these remain viable and

effective options, some are not safe for older adults with conditions such as heart disease. So it’s a relief that a number of new therapies, including drugs and devices, have been designed

specifically to prevent and treat migraine — and many have proven to be better suited for older adults. ORAL MEDICATIONS​ The new generation of migraine drugs is called CGRP antagonists

(or “gepants”). These drugs — rimegepant (Nurtec), ubrogepant (Ubrelvy) and atogepant (Qulipta) — block the action of a pathway, or connection of brain cells, involved in triggering

migraine attacks. Typically, these are used “as needed” to treat a migraine in progress, but the Food and Drug Administration expanded the approval of Qulipta, allowing it to be used as a

daily preventative for people who experience at least 15 headache days a month (called chronic migraine). Clinical trials on this group found that 41 percent of patients experienced at least

a 50 percent reduction in their headache days every month when given one of three dosage levels, compared with 29 percent of those taking a placebo.  Gepants are an especially useful

alternative for people who don’t respond to triptans, a more traditional migraine medication, and a safer type of drug for those with heart disease, a 2022 review suggests.  NASAL SPRAY

​Zavegepant (Zavzpret), a gepant nasal spray used to treat migraine, can bring relief within 30 minutes. Approved by the FDA last year and launched over the summer, “the spray provides a

quicker onset of action compared to oral rescue medications, which is good for ​patients whose migraines come on fast and severe,” Carroll says. (If you experience nausea and vomiting, this

is a good option should you have trouble keeping down a pill.)