A History of Migraine Treatments Over The Years

Nearly a century ago, a neurologist in New York wrote: “Practically every known form of therapy has been tried by clinicians in the attempt to remove the causative factors of migraine or to alleviate the symptoms.”¹ This statement may still feel true to people with migraine today! Yet a look back shows how far migraine treatment has come.

How far has migraine treatment come?

In general, migraine treatment has evolved from non-specific to migraine-specific drugs. Doctors once treated migraine mostly with drugs developed for other conditions. Some of these are still used. But many of today’s drugs were made specifically to treat the causes of migraine. The field has also moved from treating attacks to preventing them.

What causes migraine disease?

Ideas about the cause of migraine have changed over time. Is it a blood vessel problem? Is it a nerve problem? Maybe it’s both! This debate continues today.² Each theory has led to migraine treatments. Some of these treatments are effective, even if the theory about what makes them work is later disproven.

What non-specific treatments were used?

Non-specific treatments that have been used for decades include:

• Caffeine
• Pain relievers such as acetaminophen, aspirin, and other NSAIDs and opioids
• Anti-nausea medications
• Anti-anxiety and antidepressants
• Beta-blockers

Ergotamine and dihydroergotamine were developed in the 1930s.² For many decades, they were the only migraine-specific medications.² Effective treatments with fewer side effects were clearly needed.

Why were triptans and Botox breakthroughs?

The approval of the first triptan in 1992 for acute migraine was considered a breakthrough.² Since then, six additional triptans have been approved. Today they come in a wide variety of formulations.

Early treatments that specifically target nerve dysfunction were Botox and the Cerena TMS device. Botox had previously been used for reducing wrinkles, neck spasms, and excessive sweating. In 2010, it was approved for migraine prevention in people with chronic migraine.³ Three years later, Cerena TMS was approved to relieve migraine pain. This device was the first of several to use magnetic or electrical energy to change the function of nerves in the pain pathway.

Are CGRPs a new era of treatment?

Migraine treatment has entered a new era with the recent development of treatments that target CGRP. The first anti-CGRP drugs were approved in 2018. CGRP transmits pain signals in the brain.⁴ Blocking CGRP can prevent or treat migraine.

Four of the new drugs are anti-CGRP antibodies. These drugs are taken to reduce the number or severity of migraine days. The other two new drugs are acute treatments taken at the start of a migraine attack. Because they work differently from the triptans, they have different side effects.