Migraines New Treatment Options

The third most common disease and the second leading cause of disability worldwide

The US Food and Drug Administration (FDA) has given approval for the use of a new type of migraine headache drug, which is in the DHE class. This approval, issued on September 3, is part of a series of treatment transformations for Migraine migraine headaches over the past few years, with the introduction of new medicines and medicines with different methods of receiving them by the patient.

New medicine in this drug is to be received as an “intranasal spray” for adults. “The past few years have seen an abundance of new options for treating migraines?” Dr. Rebecca Burch, a neurologist at Brigham and Women’s Hospital in Boston, said in her July scientific paper titled “New Migraine Therapies: Which is Right for Patients?” With drugs, recently approved by the US Food and Drug Administration, as palliative and preventive treatments. Doctors have more drug options than ever to offer patients.”

Migraine is common in the world, and is considered the third most common disease in the world. According to some statistics, about one billion people around the world suffer from it, especially females, where the percentage of infections is: three females for every one of the males. International studies also indicate that migraine is the second leading cause of disability worldwide. It affects not only adults, but about 7 percent of school-aged children also suffer from it.

And a health problem of this magnitude in the spread, and with this kind of repercussions, really needs several options in the means of treatment, in a way that ensures its suitability to the cases of different patients, and their benefit from it according to their different health conditions and response capabilities. The availability of new treatments is expected to make a significant difference in the lives of the many people who suffer from the debilitating effect of it. But the main point in helping with this remains patient education.

In this, the American Headache Society summarizes the treatment of migraine by saying: “An effective migraine management plan depends on partnering with the patient. Educating patients about the nature and mechanism of their disease will enable the patient to actively participate in their headache management program. To play an effective role, patients should be encouraged to initiate preventive behavioral strategies, which include establishing more regular sleep patterns, improving diet, adding an exercise program, stress management, and relaxation training.”

Categories of drugs

Pharmacotherapy for migraine headaches aims to stop the headache and other associated symptoms, as well as prevent future migraine attacks. Medicines are generally divided into: “Analgesic” drugs for acute headache attacks, which are received during acute migraine attacks. And “preventive” medications, which are taken regularly, to prevent the recurrence of migraine attacks or make them less severe and severe if the patient is affected.

And medical accreditation in treating migraine attacks goes beyond those general analgesics for any body pain, to advanced analgesic drugs, which are directed towards disabling the mechanisms that cause migraines from their origin, as well as the accompanying symptoms. It consists of five main categories:

> Medicines of the Triptan class. This class of drugs is most effective when taken early in an attack, while the pain is still mild. It can remove headache pain in migraines, and relieve many of the accompanying symptoms. Examples include sumatriptan and rizatriptan. And its way of working depends on stimulating serotonin (a neurotransmitter found in the brain), in order to contribute to the narrowing of the dilated blood vessels, stopping the sending of pain signals to the brain, and preventing the secretion of some natural substances that cause pain, nausea and other migraine symptoms. In scientific terms, triptans are selective serotonin receptor agonists.

It is available in the form of oral tablets, subcutaneous injections, and nasal sprays. But it may sometimes not be safe when used in certain patients who are at risk of stroke or heart attack.

> Drugs of the dihydroergotamine class DHE. It is available as a nasal spray or injection, and is most effective when taken shortly after the onset of migraine symptoms. Patients with coronary artery disease, high blood pressure, or kidney or liver disease should inform their physician before receiving dihydroergotamine.

- Improved types

> Drugs of the Ditan class. It is another new class of drugs, and it is taken as a pill by mouth. It is similar in the way it works to triptans, but it is distinguished from it by not resorting to narrowing the blood vessels in order to relieve pain, which makes it suitable for some patients who are not suitable for triptans for this reason in the blood vessels. It helps relieve headaches, nausea, and sensitivity to light and sounds. However, after taking it, it is advised not to drive the car for eight hours, because it may cause dizziness and poor concentration for some, unlike triptans and gypants.

> Medicines of the Gepants class. It is a different class of medicine than the above. It relieves pain and other symptoms of a migraine after two hours of taking the medication by mouth, such as nausea and sensitivity to light and sound.

To explain how it works: a chemical compound called CGRP is released from nerves at the beginning of the migraine process.

The presence of these compounds causes “prolongation of the migraine attack” and the continuation of suffering from it. This class of drugs inhibits the release of these chemical compounds. Even if they are released, they chase them and block the action of these chemical compounds and prevent their effect on the nerves, thus relieving the pain of a migraine attack and reducing its duration. It also does not narrow blood vessels to relieve headache pain, which makes it safer for people with heart problems, and can be used for people with cardiovascular disease.

> Monoclonal antibodies to the calcitonin gene related peptide CGRPmAbs. It is a new and advanced type of migraine attack treatment, and for the primary prevention of migraine attacks. It is given by injection under the skin, either monthly or every few months. The most common side effect is sensitivity at the injection site. Research has found that these medications are safe and effective in reducing the frequency and severity of migraine headaches. If a person has four or more migraines per month, it may be worth considering preventive treatment to avoid attacks.

- New Therapeutic

Nasal Spray > The US Food and Drug Administration's approval of DHE, in the form of a nasal spray, was based on the encouraging results of a study of its use by migraine patients. It is the STOP 301 study in its third stage, which was published in the current September issue of Headache Journal, issued by the American Headache Society AHS.

The STOP 301 Phase III study (the pivotal safety study for patients who suffer from migraine attacks at least twice a month) was conducted to test the efficacy and safety of this new drug in the way it is administered to the patient. Its results showed a high therapeutic feasibility in the body's tolerance of this drug, and in providing rapid, continuous and consistent relief from migraine symptoms. By eliminating pain in 93 percent of patients for 24 hours, and 86 percent over the two days after receiving a dose of this drug.

Through advanced pharmaceutical technology, this drug is received at a dose of 0.725 (zero point seven two five) milligrams, in the form of a mist that is sprayed on the upper cavity inside the nose, an area rich in capillaries. The researchers reported: “Dihydroergotamine (DHE) has long been used to treat migraine headaches, but by intravenous injection, it is not suitable for home administration. That's why the Precision Olfactory Delivery Technology was developed to receive this treatment through the nose. Which makes it suitable for use outside the hospital.” Importantly, the drug, which will be available in October, provided consistent efficacy even when taken as late as two hours after the onset of a migraine attack. This is a benefit not often seen with some oral treatments, which are most effective when taken within one hour of a migraine onset. Multiple migraine triggers Although the causes of migraines are not fully understood, genetics and environmental factors seem to play a role. Another key role in migraine pain is an imbalance of brain chemicals, including serotonin (which helps regulate pain in the nervous system) and neurotransmitters (particularly the calcitonin gene-related peptide CGRP).

There are a number of triggers for the emergence of a migraine attack, including:

> In women, estrogen hormone fluctuations, such as before or during menstrual periods, pregnancy and menopause. As well as taking hormonal medications, such as oral contraceptives and female hormone replacement therapy.

> Excessive smoking and excessive consumption of caffeinated beverages.

> Stressful stress at home or at work.

> Exposure to bright lights or sunlight.

> Exposure to loud noises.

> Kinds of perfumes, smoke odors, or the odors of some industrial materials.

> Sleep disorders, of all kinds.

> Exerting physical exertion or excessive sexual process.

> Eating disorders such as hunger when not eating some meals or eating types of old cheeses and salty foods.

General Principles for Acute Migraine Care

The American Headache Society explains: “General principles for acute migraine care include:

> Treat the headache as early as possible during the onset of the attack, to reduce the intensity and duration of the attack, as well as associated symptoms.

> Adapting the treatment of the attack to suit each patient individually, (because the triggers, general health status, comorbidities, age and gender differ among the general migraine patients). As well as appropriate to the condition of the seizure itself in the same patient (because it may differ from previous seizures in severity, accompanying symptoms and triggering factors).

> Use the correct dosage and formula. The method of administration is especially important for patients with severe nausea and vomiting.

> In general, some acute treatments should be used for a maximum of 2 to 3 days a week, to avoid a rebound headache.

> Everyone needs acute treatment as well as patient education. And in many cases, to a non-pharmacological intervention (everyday behaviours).

> Consider adding prophylactic drug therapy in selected patients.

> For patients who receive preventive treatment, they must also have medicines for acute seizures.

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