A new medication by Amgen (a monoclonal antibody) has just been approved for treatment of severe chronic and episodic migraine headaches. This appears to be a truly better and different therapy. It is also, not surprisingly, rather expensive.
AIMOVIG, New Therapy for Migraine
The drug (AIMOVIG, the name of which is unexplained, so far as I can find except IG is likely for ImmunoGlobulin), is said to block a newly discovered protein, calcitonin gene-related peptide receptor (CGRP-R), which appears to be related to the occurrence of migraine headaches. For those of you who missed the last three or four decades of migraine research, the precise mechanism of occurrence of migraine headaches has bedeviled physicians, researchers and, most of all, patients who were migraine sufferers for generations. This is the first new news I have heard on this topic this millenium.
The medication is an injectable monoclonal antibody to CGRP-R, which means it is a complex protein that mimics antibodies produced by our immune system, which when injected into a person will seek out and block the working of the calcitonin gene-related peptide receptor, which now appears to play a key role in the occurrence and propagation of migraine headaches. Incidentally, calcitonin is an established hormone present in the thyroid gland that plays a role in reduction of calcium levels in the blood. (I actually did research during medical school on that hormone and demonstrated its apparent presence in chicken thyroids, of course during a summer in Paris.) Why calcitonin is related to migraines clearly requires much more explanation. But the drug appears to work.
Effects, Cost, Risk
Data presented on the FDA website Daily Med suggest roughly a 50% reduction in migraine days for those with severe episodic or chronic migraine headaches. That is an enormous improvement. The medication requires a monthly subcutaneous injection. Adverse responses so far are minor, mainly injection site inflammation. Of course, we need to see much more clinical experience to quantify the risks properly. Cost may be $70,000 annually (newspaper reports), of course subject to prior approval and such from your drug intermediary.
Appears to Be Major Improvement
Chronic severe or episodic migraine is an awful affliction. Beyond specific treatment with triptans such as Imitrex and its friends, we often have little to offer patients with migraine except pain meds with their attendant risks and limited efficacy. AIMOVIG (all caps and all) appears to be a step-improvement and a substantial one. It will be worth exploring with all migraineurs in our practice.