Dr. Timothy A. Collins

Dr. Collins is the Division Chief of Headache and Pain for the Duke University Department of Neurology as well as the Medical Director of Duke Neurology’s Morreene Road Clinic. He is board certified in neurology and headache medicine.

Dr. Jaskiran Vidwan

Dr. Vidwan did her fellowship in headache medicine at the University of Michigan. She is an American Osteopathic Board-certified neurologist treating headache and facial pain at the Morreene Road Clinic.

Dr. Gary Jay

Dr. Jay is a professor of headache medicine in the UNC Department of Neurology and a neurologist at the UNC Headache Clinic. He has been treating headache and pain for 42 years and is a founding member of the American Academy of Pain Medicine.

Dr. A. Laine Green

Dr. Green is a headache specialist working at the Mayo Clinic’s neurology department in Phoenix, Arizona. He engages in both research and clinical practice.

CGRP Antagonists: A Sea Change in Migraine Treatment

“Until a few years ago, we didn’t have any treatments that were specifically designed for migraine prevention,” Dr. Vidwan said. That all changed with the discovery of CGRP receptors. Researchers realized that the receptors are part of migraine genesis, although their function is still not fully understood. The result was an explosion of new drugs called CGRP antagonists which block CGRP receptors. Some of these new medications are preventatives and some stop migraine attacks.

CGRP antagonists tend to have fewer side effects than other medications used for migraine. Dr. Jay explained that they are also safe for people who are unable to take triptans, the long-standing go-to drugs for migraine attacks. “With these new medications, I have patients that come to me and say, ‘This medication changed my life,’” said Dr. Collins.

Barriers to Treatment That Remain

Just because new treatments are available doesn’t always mean they reach patients, however. “One of the issues is diagnosis is poor,” Dr. Jay said. He explained that migraine is only one of many headache disorders, and a patient can’t receive the best course of treatment without a proper diagnosis. Dr. Collins highlighted the severe shortage of headache specialists. Most people only have access to primary care or emergency medicine. “I think it’s important that education increases for those people who are the point of first contact,” Dr. Green recommended.

Even with a correct diagnosis and a prescription in hand, patients aren’t out of the woods yet. “The biggest barrier with all of the new treatments that have come out is probably the insurance,” Dr. Vidwan said. Insurance companies usually require prior authorization for CGRP antagonists, a process which can take a long time with no guarantee of approval.

Where Is Migraine Treatment Headed Next?

All our experts agreed that neuromodulation is on the rise. Neuromodulation is a treatment in which a device electrically stimulates a patient’s nerves to change the electrical activity in the brain. According to Dr. Jay, it is a popular choice among people who are hesitant about medication. Pediatric migraine is also an area that is likely to see new treatment options soon. “A lot of these things haven’t been well-tested in the child or adolescent age group,” Dr. Green said. Once they have been, children with migraines should have more treatment options available to them.