One of those involved in the rimegepant studies, Darlene LeBlanc, 63, describes how the drug was the first treatment she had tried in more than 40 years that worked well for her debilitating symptoms
For nearly three decades, Jennifer Farrington’s life was so dominated by migraines that the doctor had to go on sick leave for nine months.
Then three months ago she got the chance to try a monthly injection of a preventative treatment called fremanezumab.
The effect was transformative: not only halving the number of days she gets migraines, but if she feels one coming on, she’s more likely to respond to painkillers like ibuprofen.
“I feel like I have my life back,” says Jennifer.
Fremanezumab is part of a wave of new drugs that have recently become available in the UK for chronic migraines – defined as having headaches for more than 15 days a month – and episodic migraines, where it occurs less than 15 days a month.
These monthly injections (the others include erenumab and galcanezumab) are administered in the stomach or thigh and block a chemical calcitonin gene-related peptide (CGRP) from being released in the brain.
They made a big difference to Jennifer, who had previously sat by her bedside for days with crippling, pulsating pain behind one eye, nausea, and vomiting, before feeling wiped out for at least two days afterward.
‘It was awful,’ says Jennifer, 42, who lives in Alsager, Cheshire, with her husband Gary, 47, a teacher, and their daughters Amy, 15, and Abigail, 14, and another was due to start in hours – it was unbearable. ‘
Jennifer was so weakened by constant pain that she reluctantly took sick leave last June.
However, in January of this year, Jennifer’s neurologist suggested fremanezumab.
She’s now starting to work again – and, most importantly, I now get very little of the aftereffects of the migraine, which was completely exhausted for at least two days. But with the injections this has almost stopped. ‘
The good news for migraine sufferers is that studies have shown that a new form of tablet targeting the same CGRP pathway can also help prevent attacks – and unusually, relieve symptoms when a migraine starts.
Three times more common in women (due to hormonal differences, it is thought), migraines occur when nerves and blood vessels at the top and front of the brain release CGRP, a chemical that carries messages between cells
One such drug, rimegepant, is licensed in the US (as Nurtec) and is considered by European regulators as both a rescue and a preventive treatment.
A study in The Lancet in December involving more than 700 migraine patients found that those who received rimegepant experienced 4.3 fewer days per month of migraines, compared with 3.5 fewer days in the placebo group.
Half said they had a 50 percent or more decrease in their severe migraine days, compared with 41 percent of the placebo group.
One of those involved in the rimegepant studies, Darlene LeBlanc, 63, describes how the drug was the first treatment she’d tried in more than 40 years that worked well for her debilitating symptoms.
Darlene, of Tampa, Florida, developed migraines at the age of 27, after giving birth to her first child, and the mother of three has since suffered between three and five attacks per month.
“It had such a big impact, not just on me, but on my whole family,” she says. “I was bedridden for 15 or 20 days a month.”
Darlene, who lives with her husband Kevin, 60, who works in insurance, tried many treatments that had no effect on her migraines and left her feeling ‘different from herself’. The only treatments that made a difference were triptans, drugs that help relieve symptoms but not prevent them.
A study in The Lancet in December involving more than 700 migraine patients found that those who received rimegepant experienced 4.3 fewer days per month of migraines, compared with 3.5 fewer days in the placebo group. [File photo]
“They reduced the migraines so that I could just get up and function, but I still had an underlying migraine, the sensitivity to light and nausea,” says Darlene.
She entered the drug trial two years ago, and after just one tablet, the crippling pain, nausea, and watery eyes were gone.
Darlene is now prescribed the medication by her doctor and takes three to five tablets a month when an attack starts. A single tablet is generally enough to stop all of her symptoms.
In studies, rimegepant is taken every two days as a tablet (which melts under the tongue) as a preventative, but it can also be taken when patients feel an attack coming.
Another tablet that works in a similar way is already licensed in the US, while others are in development. No one has yet received approval for use in the UK, but the hope is that at least one will be used soon.
They would be an easy option for the six million people in the UK who suffer from migraines.
Three times more common in women (due to hormonal differences, it is thought), migraines occur when nerves and blood vessels at the top and front of the brain release CGRP, a chemical that carries messages between cells. Research suggests that CGRP promotes pain signals in the head.
The injectable preventatives are lab-produced proteins that prevent CGRP molecules from attaching to receptors, where they would trigger and progress migraines.
Brendan Davies, a consultant neurologist and head of headache research at North Midlands NHS Foundation Trust University Hospitals, says these drugs are an important step forward in migraine treatment. “The CGRP drugs are the biggest change I’ve seen in people with migraines in the 18 years I’ve been in headache care,” he says. The new tablets could be readily prescribed by general practitioners and more widely available than preventive treatments prescribed by specialists.
About 25 percent of people with migraines respond to CGRP treatments, and “they are doing spectacularly well,” said Peter Goadsby, professor of neurology at King’s College London, who first identified the CGRP mechanism for treating migraines.
“For those who don’t, there is probably a different mechanism, and different chemicals, that trigger their migraines.”
Additionally, with studies showing that the side effects are minimal, the fact that these drugs both prevent and treat the problem is an important step forward.
“It totally changes how we look at medication,” says Professor Goadsby. With a single pack of tablets, people may be able to take the drug when they need it. If they think they are at high risk of getting migraines, they can take one tablet every day as a preventative measure. ‘
Most existing migraine treatments are designed for other conditions and have side effects that can be serious. They include beta blockers, such as propranolol, which were originally developed to treat high blood pressure and cannot be taken by people with asthma – side effects include fatigue and fatigue.
Meanwhile, tricyclic antidepressants, which block serotonin, a brain chemical that’s also believed to play a role in migraines, can make people sleepy and cause weight gain.
The CGRP tablet and injections have had fewer side effects so far – about 2 percent of patients report nausea.
Andrew Dowson, the clinical leader for East Kent Headache Service, warns that while the new injections and tablets are an exciting development, “We need to show a realistic tone that many people with migraines are not eligible for these treatments.”
The injections are only available to those who have failed on three other preventative treatments. “Even if people have access to it, they may not work,” adds Dr. Dowson. “The great hope is that they will help those who cannot take advantage of existing options.”
Jennifer has tried all the standard therapies, including Botox injections (the mechanism by which it works is not fully understood), and while they have had varying degrees of success, “the side effects are dire,” she says.
And none helped with the aftereffects of migraines. She injects herself into the stomach or thigh muscle once a month. “It has returned me to my family – and to my patients,” she says.
Bad, good, best
How to get the most from your food choices. This week: sesame seeds
Bad: sesame snaps.
These brittle wafers are half nutrient-rich sesame seeds and deliver cholesterol-lowering fats.
But each pack also contains two and a half teaspoons of sugar, 34 percent of a person’s daily recommended maximum.
Good: green beans with garlic and sesame.
Sprinkling seeds over green beans and garlic adds extra nutrients. An average sprinkle – one teaspoon per person – is relatively small, but it still provides 3 percent of your daily calcium, important for bones.
Made with ground sesame seeds, these are the most concentrated way to benefit from sesame seeds.
Two tablespoons of tahini used as a dip or topping for vegetables contains 25 percent of your daily calcium, 30 percent magnesium, and 22 percent iron.