People who experience frequent migraines may soon have access to a new class of drugs.
In a pair of large studies, two drugs that tweak brain circuits involved in migraine each showed they could reduce the frequency of attacks without causing side effects, researchers report in the New England Journal of Medicine.
"They offer the first migraine treatment that's actually aimed at the disorder," says Peter Goadsby, an author of one of the studies and a professor of neurology at King's College in London.
Current migraine prevention treatments consist primarily of drugs designed to treat high blood pressure, epilepsy and depression. "We give [patients] a choice between a beta blocker where they'll feel tired, or we tell them they can go on an antidepressant, which will make them sleepy and put on weight," Goadsby says.
The new drugs use special antibodies to dampen a system in the brain that modulates pain. The effect is a bit like soundproofing, says Stephen Silberstein, a study author and director of the Jefferson Headache Center in Philadelphia.
"You have a kid next door making a lot of noise, you put in soundproofing and all of a sudden you're quiet," Silberstein says. "That's what the antibodies do. They prevent the noise from aggravating the system."
The idea is to prevent the full range of migraine symptoms including headache, nausea, and sensitivity to light and sound.
Silberstein's study gave monthly or quarterly injections of an antibody called fremanezumab to more than 700 patients who have chronic migraines. "These patients are having almost daily attacks and they're greatly impaired by it," he says.
Nearly half the people who got the drug experienced fewer migraine attacks. And in some people the attacks all but vanished.
In Goadsby's study, a different antibody called erenumab produced similar results in patients who had up to 14 migraines a month. Neither drug appeared to cause more side effects than a placebo.
The results suggest a brighter future for migraine patients, who have had quite limited options until now, Goadsby says. "I hope it shows patients that this is not an impossible problem. It's a tractable problem."
But the drugs did not work for everyone, and their effectiveness was aided by a powerful placebo effect, says Andrew Hershey, who directs the headache center at Cincinnati Children's Hospital. Even people who got the placebo saw migraine attacks drop by more than 20 percent, meaning the treatment group did better than the placebo group, but not hugely better. Hershey, who was not associated with either study, wrote an editorial accompanying the research.
In it, he describes the benefit of these drugs as "modest but meaningful."
Also, "every indication is that they will be fairly expensive compounds," Hershey says, possibly costing thousands of dollars a month. That means they will probably be reserved for patients who are severely disabled by migraines and haven't been helped by other, less expensive treatments, he says.
The Food and Drug Administration is expected to review the new drugs in the next few months. One or both could reach the market in 2018.
RACHEL MARTIN, HOST:
People who get migraines may soon have access to a new type of drug. NPR's Jon Hamilton reports on the first medications designed specifically to prevent migraine attacks.
JON HAMILTON, BYLINE: More than 10 percent of us get the occasional migraine. But Dr. Stephen Silberstein says for about 1 percent of the population, the problem is a lot worse.
STEPHEN SILBERSTEIN: These patients are having an almost daily or near daily attacks of migraine. And they're greatly impaired by it.
HAMILTON: Silberstein is a professor of neurology at Thomas Jefferson University in Philadelphia. And he's the lead author of a study that tested a new approach to treating chronic migraines. Silberstein, who spoke via Skype, says more than 700 patients got monthly or quarterly injections of special antibodies. He says they act a bit like soundproofing in the brain.
SILBERSTEIN: You have a kid next door making a lot of noise. You put soundproofing, and then all of a sudden, you're quiet. That's what the antibodies do. They dampen. They prevent the noise from aggravating the system.
HAMILTON: The idea is to prevent the full range of migraine symptoms - headache, nausea and sensitivity to light and sound. And the drug helped nearly half of patients who took it. Most had fewer migraines. A few saw them all but disappear. And in a second, larger study, a different antibody produced similar results. Peter Goadsby, the study's lead author, says antibody drugs represent an important advance.
PETER GOADSBY: They offer the first migraine treatment that's actually aimed at the disorder - so a migraine treatment for migraine patients.
HAMILTON: Goadsby, a professor of neurology at King's College in London, says, until now, migraine patients have relied on drugs meant to treat epilepsy or depression or high blood pressure.
GOADSBY: We give them a choice between, like, a beta blocker where they'll feel tired, or we tell them that they can go on an antidepressant, which will make them sleepy and put on weight.
HAMILTON: Goadsby says the antibody treatments don't seem to produce side effects. And he says their success means that it's possible to develop better migraine drugs.
GOADSBY: I hope it shows patients that this is not an impossible problem. It's a tractable problem.
HAMILTON: Both studies were published in The New England Journal of Medicine, so was an editorial by Andrew Hershey, who directs the Headache Center at Cincinnati Children's Hospital. In it, Hershey describes the benefit to patients as modest but meaningful.
ANDREW HERSHEY: So the modest part is that most of them only had about a two-day improvement over placebo.
HAMILTON: In other words, they might average eight days a month with migraines instead of 10. Hershey also says use of these drugs may be limited by their cost.
HERSHEY: Every indication is they will probably be fairly expensive compounds, which means that they probably will not be first line.
HAMILTON: The Food and Drug Administration is expected to review the new drugs in the next few months. One or both could reach the market in 2018.
Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.