New Migraine Medication in Australia by Docto Online Neurologist – Rob Henderson

For those wondering how to get rid of a migraine, there is a new and exciting group of therapies now available.

To begin with, how do you know if a headache is a migraine? Migraine symptoms can include nausea, sensitivity to light or sound and/or severe headache which causes throbbing in a particular area varying in intensity.

What causes these Migraine headaches? The calcitonin-gene related peptide (henceforth CGRP) has a key role in the mechanism underlying migraine, and monoclonal antibodies that target this molecule are now available on the PBS.

Consult quickly and easily with a Docto:

Man sitting on a bed holding his eyes looking like he is in pain.

What about this new Migraine treatment? In the clinical trials 50-60 % of those with migraine reported at least a 30% improvement over the first 3 months. In addition to their novel mechanism of action, what makes these medications different is their relatively long biological half-life, they are administered either monthly or quarterly usually by subcutaneous injection, require minimal or no dose-titration and have the potential for a rapid onset of effect compared to conventional oral preventive drugs.

The therapies for migraine relief have been studied in clinical trials for acute and preventive migraine, in addition to analgesic rebound headache, with the evidence for migraine prevention leading to PBS approval for Emgality (Galcanezumab) and Ajovy (Fremanezumab), as discussed below.

A pair of hands- one holding a glass of water and the other a tablet on their open palm.

Current clinical experience is that their tolerability and side effect profile is highly favourable. Thus there are significant advantages over existing migraine therapies. There remain some questions e.g. use in pregnancy and for “cluster migraine” but migraine sufferers have a reason to be very excited, and it seems clear further CGRP receptor antagonists are on their way.

Wondering if this may provide you with migraine relief?
Consult with a neurologist near me today.

In general to write continuing scripts for these migraine medications, there is a need for a greater than 50% reduction in migraine days per month. A headache diary is the best way to document headache/migraine – the example available from Headache Australia is a helpful and practical one to use, but there are also apps available that are preferred by many patients.

Migraine is common, debilitating and treatable and there is real hope for those who have not achieved adequate control of their pain

A person lays in bed holding their head.

The PBS criteria for use are the requirement for an average of 15 or more headache days per month with at least 8 days of migraine, over a period of at least 6 months, prior to commencement of treatment; and patients must have experienced an inadequate response, intolerance or a contraindication to at least three prophylactic migraine medications prior to commencement of treatment with this drug for this condition.

To discuss treatment options for severe migraine with a neurologist:

A female pharmacist standing behind a counter holding out a sheet of medication.

The migraine medication is available for those over 18 years of age and the medication cannot be used concurrently with botulinum toxin. Both Emgality and Ajovy are now on the PBS with a streamlined authority code, and it seems likely that other CGRP based therapies will be available in the near future.

The differences between Emgality and Ajovy are relatively subtle– Ajovy is given by an auto-injector, has a slightly longer half-life and is given 3 monthly, Emgality is given via a pre-filled syringe with monthly injections. The efficacy seems similar but in my experience some patients have reported benefit from one drug over the other. For both medications injection site and allergic reactions are the main (and uncommon) side-effect.

Migraine is common, debilitating and treatable and there is real hope for those who have not achieved adequate control of their pain – it is certainly the right time to seek a referral to a neurologist. Wondering what is a neurologist?

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