CGRP Inhibitors and Holding on to Hope
Hope in the face of challenge
Hopefully, you’ve had a chance to read my last article, “CGRP Inhibitors and Realistic Expectations.” As with any other chronic disease, having realistic expectations for living with migraine is SO important. However, the question I hear so often, and which I also keep asking, is this: How can I possibly keep hope alive in the face of an unpredictable disease, failed medications, stigma, and what often seems like insurmountable challenges dealing with insurance? How can we hold on to hope while bearing in mind realistic expectations? Is this even possible? It seems a strange thing to say, but now more than ever this is an exciting time if you live with migraine. I realize that the words “excitement” and “migraine” aren’t often used in the same sentence! Hopefully, the thoughts below will explain why.
Five reasons for hope
- Surge of new research: There is a new surge of research focused on understanding, treating, and preventing migraine. That research means hope for the future and many new options down the road!
- Physician training: There are increasing numbers of certified headache specialists. There is also a push to make instruction on headache disorders a mandatory part of the medical school curriculum. This will hopefully help improve timely and effective treatment of migraine early on.
- New medications: 2018 saw FDA approval of three new migraine medications (Aimovig, Ajovy, Emgality). We expect to see another one or two FDA approved by the end of 2019 (Lasmiditan, Ubrogepant), and hopefully three more in 2020 (Eptinezumab, Rimegepant, Atogepant). There is even a new nasal spray in phase 2/3 clinical trials (Vazegepant). If that sounds like a lot of new options to you, then it does to me too!
- Interest in neuromodulators: There is increasing interest in the use of noninvasive devices both to prevent and abort migraine attacks. There are three already on the market (sTMS, Cefaly, GammaCore), one more which was recently FDA approved and expected to be available by the end of 2019 (Nerivio Migra), and a fifth following close behind (Neurolief). Having a multi-modal management approach can help improve outcomes. In addition, while insurance is often more challenging with medical devices than medications or invasive surgery, there is movement on that front also.
- Clinical pipeline: There are many more options at various stages of the pipeline. These range from pre-clinical research through different phases of clinical trials. The options include research and study on PACAP38/PAC1, Psilocybin, Cannabidiol, NOS inhibitors, Delta opioid receptor agonists, Kappa opioid receptor antagonists, NK1 receptor antagonists, and an exploration of dural stimulation. If there is nothing that helps you right now, there is still hope. If even those in the immediate future are ineffective or intolerable, there is STILL hope!
Information feeds hope
Taking the step towards educating ourselves as much as we can about the disease we live with feeds hope! Staying on the cutting edge of developments feeds hope! There are so many potential future options now and in the near future. Options that are bringing much-needed change to the migraine community. If ever there was a time to actually have hope for migraine…this would be it!
Realistically I have to face that maybe there won’t be any breakthrough that transforms my own life after decades of living with migraine. However, my hopes are high for my children and grandchildren. And who knows, maybe, just maybe, I’ll have the opportunity to experience a “new normal” too! A new normal that isn’t lived around avoiding all triggers, fear of the next “big one”, and reluctance to face tomorrow. Maybe, just maybe, you will also have the opportunity to experience a “new normal” and a brighter future. I’m choosing to hold on to hope! What about you?
Do you have a hard time holding on to hope? What is the most exciting development that you know of for migraine disease?
Have you shared your migraine story with us yet?