New Treatment Options for Migraine Prevention

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Migraines are a common disorder, effecting almost 10% of men and 20% of women.  While significant effort is focused on treating an acute migraine episode, upto 40% of individuals with migraines, especially those with frequent and/or severe migraines, are candidates for preventive therapy. Commonly used medications for migraine prevention include beta blockers (metoprolol, propranolol, timolol), antidepressants (amitriptyline, venlafaxine) and anticonvulsants (valproate, topiramate). 

Calcitonin-gene-related peptide (CGRP) antagonists are a new therapeutic class for preventing migraines, and thought to work via mediating trigeminovascular pain transmission and the vasodilatory component of neurogenic inflammation.  Erenumab was approved in May of 2018 and fremanezumab-vfrm was approved last week based on the HALO-CM trial.  In this study, patients who received fremanezumab had significantly reduced number of headache days (4.6 versus 4.3) compared to placebo.  

With two other anti-CGRP treatments expected to file with the FDA approval in 2018 and no head to head comparisons of any of the medications, choice of agent is likely to be made on convenience and cost.  Fremanezumab is currently the winner in convenience with an IM dose delivered once every three months compared to erenumab which is administered as a monthly injection.  Cost is equivalent as the average wholesale price of erenumab is listed at $575 a month, while fremanzemab is $1725 every 3 months.  


Additional information about metoprolol, venlafaxine, amitriptyline,  can be found in the Top 300 Pharmacy Drug Cards.  If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to the Top 300 Pharmacy Drug Cards.  If your institution does not provide access, ask your medical librarian about subscribing.

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Go to the profile of Jill M. Kolesar

Jill M. Kolesar

Professor , University of Kentucky

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