Category Archives: Migraine treatment


Migraine with Aura as explained by Dr Audrey Halpern

Aura, often referred to as the “warning sign” of migraine can be a variety of sensory disturbances that occur prior to a migraine attack. Aura usually last 20-60 minutes and only affects approximately 25-30 % of people with migraine.

Aura can consist of visual disturbances such as seeing spots, flashes, zig zags, stars, or loss of vision. Aura can also present as sensory changes including tingling or numbness in the face, body, hands, and fingers. Speech or language disturbances can also be a form of aura. For example, being unable to produce the right words, slurring or mumbling words.

Aura is a result of hyper-excited nerves in the brain. When these excited nerves are activated in the visual processing areas of the brain, the patient experiences the visual symptoms of aura. When these excited nerves are activated in other areas of the brain, other symptoms may occur.

The majority of migraines with aura are not due to a worrisome underlying problem but be cautious and aware of certain “red flag” that may indicated seeking additional medical attention. Red flags include an immediate onset of symptoms or symptoms lasting longer than 60 minutes. Additional warning signs include weakness on one side of the body, change in consciousness or level of alertness.

It is also important to be aware of the fact that migraine with aura can increases the risk of stroke. As a result, treating other stroke risk factors and avoiding certain medications (such as estrogen containing birth control) is important and should be discussed with a physician.

Fun Fact: Lewis Carroll the author of Alice in Wonderland had migraine with aura. His aura consisted of visual disturbances which inspired his writing.

– Caroline Pruski, NP

FDA approves new CGRP monoclonal antibodies!

On September 14th, the FDA approved Ajovy for migraine prevention, and now Emgality has been approved as well. These are the 2nd and 3rd monoclonal antibodies to be approved specifically for the prevention of migraine. A very exciting time for migraine research, migraine treatment, for migraine patients and care providers!

While each of these treatments, Aimovig, Ajovy, and Emgality, all have their differences, they have some similarities too. They are all intended for migraine prevention, they are all monthly injections, or in the case of Ajovy, there is a once every 3 month protocol that was approved as well. Also, tolerability is very good across all of these treatments.

One of these might be the right medication for you. Make an appointment to see a headache specialist to talk about migraine treatment options.

New observational study shows migraine patients skipping recommended treatments

A recently published observational study states that even when a headache specialist refers migraine patients for proven behavioral treatments like biofeedback, relaxation training or cognitive behavioral therapy, barely half of the patients follow through.

In the study, a group of 69 migraine sufferers treated at a large academic headache practice were referred for behavioral therapy, but just 57 percent got as far as making an appointment with the behavioral practitioner, researchers found.

The patients who ignored their doctor’s recommendation cited time limitations as the main barrier to treatment. Concerns about cost and insurance coverage were also an issue. And some were skeptical about whether the treatment would work; others worried about the potential stigma of seeing a psychologist, the study team reports in the journal Pain Medicine.

Evidence shows that behavioral therapy is more effective and safer in treating migraines as opposed to opioids, which are often being prescribed as the first line of treatment for migraines. To learn more about the benefits of behavioral therapy, click here to read the full coverage of this story.

FDA approves novel preventive treatment for migraine

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.

“Aimovig provides patients with a novel option for reducing the number of days with migraine,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We need new treatments for this painful and often debilitating condition.”

Patients often describe migraine headache pain as an intense pulsing or throbbing pain in one area of the head. Additional symptoms include nausea and/or vomiting and sensitivity to light and sound. Approximately one-third of affected individuals can predict the onset of a migraine because it is preceded by an aura – transient sensory or visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision. People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, hormonal changes, bright or flashing lights, lack of food or sleep and diet. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide.

The effectiveness of Aimovig for the preventive treatment of migraine was evaluated in three clinical trials. The first study included 955 participants with a history of episodic migraine and compared Aimovig to placebo. Over the course of six months, Aimovig-treated patients experienced, on average, one to two fewer monthly migraine days than those on placebo. The second study included 577 patients with a history of episodic migraine and compared Aimovig to placebo. Over the course of three months, Aimovig-treated patients experienced, on average, one fewer migraine day per month than those on placebo. The third study evaluated 667 patients with a history of chronic migraine and compared Aimovig to placebo. In that study, over the course of three months, patients treated with Aimovig experienced, on average, 2 ½ fewer monthly migraine days than those receiving placebo.

The most common side effects that patients in the clinical trials reported were injection site reactions and constipation.

The FDA granted the approval of Aimovig to Amgen Inc.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.