Our Pharmacists Offer Guidance on Newest Migraine Meds

Muhaimin Id'Deen, PharmD
Specialty Pharmacist
ChristianaCare Specialty Pharmacy
833-570-2697

”Moving CGRP targeting therapies to a first-line treatment will help people receive the most appropriate treatment to prevent migraines as soon as possible,” says Muhaimin Id’Deen, PharmD, specialty pharmacist at ChristianaCare. “Approximately 40% of patients with migraines could benefit from preventative therapy, yet only a minority of patients are using such therapies.”

The data for CGRP inhibitors indicates that their convenience and effectiveness are equal to or greater than other available migraine therapies. Studies show that CGRP inhibitors are more tolerable than older medications. Now, more patients can try them without going through a long process of trying multiple other medications first.

The ChristianaCare Specialty Pharmacy helps patients get through whatever process is needed to get on an effective treatment plan.  

Migraines are common, but they can be tricky to diagnose. There is no test to tell if a headache is a migraine. Symptoms can vary from patient to patient. Other conditions (like high blood pressure, tension headaches and sinus headaches) mimic migraines.

Migraine symptoms, triggers and frequency vary from person to person. Migraines may even have more than one trigger. Genetics, brain chemicals, hormones, stress, diet and sleep deprivation may cause migraines, as well as the weather, bright lights or strong smells.

Doctors can help patients identify and manage migraine triggers, but it’s not easy. Some migraine triggers, like stress and the weather, may be hard to avoid. Others, such as bright lights, may be impossible to escape.

Migraines that come back four or more times a month are chronic. People with these headaches need treatment to prevent them. Some people go back and forth between having episodic and chronic migraine, further complicating the path to a treatment plan.

ChristianaCare's Specialty Pharmacy works with primary care physicians, neurologists and other providers to help patients with migraines.

Even with new medications, some patients need to use more than one medication to treat migraines. Information on how different medications may interact is another way specialty pharmacists help patients.

Over-the-counter medications may help with mild or infrequent migraines. These include acetaminophen and NSAIDs like ibuprofen, naproxen and aspirin. Some versions include caffeine. NSAIDs are acute treatments. They can stop pain if taken when a migraine starts. But, if taken often, they can cause rebound headaches. When the medication wears off, the pain comes back. It can feel worse.

If NSAIDs do not work well or migraines become more frequent, triptans may help, and it is safe to take them with NSAIDs. Patients take triptans at the onset of a migraine attack. Triptans work by changing how blood circulates in the brain. They come in the form of pills, nasal sprays or injections. But triptans can have side effects like dizziness and nausea. Also, people with heart conditions, high blood pressure or people who have had a stroke should not take triptans.

Preventative daily medications can block some migraines or make others hurt less. Older options include beta-blockers (like propranolol) and anticonvulsants (like topiramate). Although these medications were initially developed to treat other conditions like hypertension and seizures, clinical trials showed that they also help stop migraine pain.

Beta-blockers and anticonvulsants may cause side effects like fatigue, weight, and mood changes.

CGRP inhibitors can help patients have fewer migraines, and the headaches may hurt less. People may be able to do things without worrying about pain. ChristianaCare’s Specialty Pharmacy offers several CGRP inhibitors including medications that can be taken orally as well as medications taken by injection or transfusion.  

Studies show that CGRP inhibitors are more tolerable than older medications. Some patients may have injection-site reactions; others may experience some nausea, constipation or fatigue. However, because CGRP inhibitors come in different forms, patients have multiple options to try if one version does not work for them.

When clinicians and patients work with the ChristianaCare Specialty Pharmacy, they have 24-hour access to a clinical pharmacist,

Migraines are tough. But, with the proper treatment and support, patients can lead whole lives.

To learn more about the ChristianaCare Specialty Pharmacy and the primary conditions we treat, contact us [Link to: https://christianacare.org/us/en/care/specialty-care/pharmacy/specialty-pharmacy] or call 833-570-2697 [Link to 833-570-2697].

*Source: Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update

– 11 March 2024. [Link to: https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.14692]

Disclaimer: Information about the medications mentioned in this article including their availability and potential efficacy, is intended for informational purposes only and is not a substitute for professional medical advice. The information provided is not intended to promote the use of any drug for any condition other than those approved by the FDA.

·       Individual results may vary, and the effectiveness of these drugs may depend on various factors, including the specific health condition and other treatments the patient is receiving.

• These drugs may have side effects or interactions with other medications which should be reviewed. For more information, you can consult the manufacturer’s claims/guide for each medication or a qualified pharmacist.
• Availability of any drug is subject to change, and coverage by insurance or reimbursement options may vary.