The Latest Drug – Erenumab
Erenumab is one of several very exciting new drugs to prevent migraine attacks. It is made by Novartis and is also called Aimovig. We are pleased to be one of the very first clinics in the country to offer it. If you would like to make an appointment to discuss your migraines and whether it might be the right treatment for you then please phone us on 020 7929 4883
You may well have learnt in the news about Erenumab, an injection that you give yourself at home every month. It work by blocking the effects of CGRP on blood vessels in the meninges, the covering tissue that protects the brain. CGRP is a brain transmitter involved in pain and inflammatory pathways around blood vessels The blood vessels in this layer are full of pain fibres which are triggered by the inflammatory pathways cause during a migraine. It can work extremely well, helping with many cases of migraines that have not been helped before.
There have been some spectacular improvements in patients who have failed all other treatments, but it is not a panacea and it is important not to have over-expectations:-
– It doesn’t work for everybody – around 10-20% get no benefit. The reasons for this are complex and not fully understood
– It doesn’t always stop all headaches. It may only reduce them.
– It is very expensive, and privately will cost about £5000 a year for the injections alone
– It is not yet available on the NHS and the cost will limit the availability very greatly. It is at present being assessed by NICE (National Institute for Clinical Excellence) on who will be eligible
Migraines are an illness of the function of the brain with an enormous genetic element. There are no structural changes caused by migraines. As doctors, we cannot cure migraines. We aim to control them, hopefully so well that they disappear. There are other treatments that can be equally as, or more effective than, Erenumab, and these include Botox and Daith Ear Piercing as well as the preventative drugs.
Botox has been used for migraines for over 10 years and can be very effective when injected correctly. The method used by the NHS is called the PREEMPT Protocol, but it is not the only method, and it has failings because it does not inject the Glabella properly. It is used by neurologists because it is the only method of injection that has been validated in Randomised Controlled Trials (RCTs). There is evidence that has not been validated by RCTs that ensuring that the glabella is properly injected raises the success rate, both in reduction of frequency and severity of headache and other migraine symptoms. I use a method that injects the muscles and nerves within the Glabella properly.
Unlike Erenumab which does not cross over into the brain, Botox has a direct effect on the pathways in the brain that cause migraines. Depending on the specific type of headache it can control headache equally as well or better than Erenumab, and is considerably cheaper
Daith Ear Piercing
Daith Ear Piercing is another new kid on the block. Its effect on migraines was first noticed 20 years ago and it went viral on social media 3 years ago, and since then many thousands of people have had it done at piercing parlours. Most doctors have dismissed it as having no proven effect, suggesting that it is only placebo, so until we started researching it there was no medical research at all!
Our research suggests that there is a real effect and that it is mediated by stimulation of the vagus nerve (a treatment already used in other more expensive ways for both epilepsy and migraines). It is inexpensive to have and our research suggests that it can be both very effective and long-lasting. you can read more about our research on our research page
Traditional Preventative Drugs
Preventative drugs include:-
- Beta-blockers such as propranolol
- Anti-depressants such as amitryptiline
- Anti-epileptics such as topiramate
They all work by a general effect on the brain that changes brain function, so often have side effects that cause people to stop using them. However they can be effective and are inexpensive, so generally they are the first line of treatment. You would generally get them from your GP.