Migraine: Emerging treatments offer new hope

For the 40 million Americans living with migraine episodes, they are far more than just a headache. Migraine is a complex neurological disorder that can disrupt work, family life and daily activities yet often remains undiagnosed.

Fortunately, significant advances in recent years have expanded treatment options, providing new hope for patients who previously struggled to find relief.

Dr. Crystal Jicha, a UCI Health neurologist who specializes in migraine, headache and facial pain disorders, says that understanding the difference between a migraine and a typical headache is the first step toward effective treatment.

Headache versus migraine

Many people think all headaches are the same, but migraine episodes are a completely different experience, she says.

“A tension headache often feels like pressure or tightness, and people can usually continue functioning,” Jicha notes. “Migraine attacks are much more severe and can last for hours or even days with associated symptoms.”

These may include:

• Nausea
• Vomiting
• Sensitivity to light, noise and smell
• Visual aura (i.e. shimmering zigzag lines, blind spots, temporary loss of vision)
• Sensory aura (i.e. a "pins and needles" sensation that commonly starts in the fingers or hand)

"People can experience migraine pain differently; other less common symptoms include dizziness, brain fog, trouble speaking and blurry vision," Jicha says.

Because symptoms vary widely from person to person, diagnosis is based on careful clinical evaluation and relies heavily on a patient’s medical history and symptoms over time, she adds.

“Currently, there’s no blood test, biomarker or brain scan that can definitively diagnose migraine.”

Tracking symptoms

Migraine management often begins with understanding an individual’s triggers and patterns. Jicha encourages patients to keep a headache journal to help identify factors that may be contributing to the attacks.

“I recommend tracking headaches in whatever format works best for you — an app, a calendar or even a simple notebook,” she says. “Record when headaches occur, how severe they are, what treatments you used and whether there were possible triggers, such as stress, dehydration, poor sleep, foods eaten or environmental factors.”

This information can help patients and healthcare providers determine which treatments are working and what lifestyle factors may be contributing to migraine frequency.

Early intervention

Jicha emphasizes that people should seek treatment before migraine episodes become disabling, meaning they are:

• Frequent
• Persisting despite medical treatment
• Severe enough to limit day-to-day functioning including work and social interactions

“Early intervention is critical,” she says. “The longer migraine remains uncontrolled, the more difficult it can become to manage and the greater the risk of disability.”

Patients who experience recurring migraine episodes should begin by speaking with their primary care physician, especially if over-the-counter medications such as ibuprofen, naproxen, acetaminophen and combination formulas are no longer providing relief.

“Depending on the severity and frequency, they may refer you to a neurologist,” says Jicha.

The CGRP revolution

The most significant advancement in migraine treatment over the past decade has been the development of therapies that target calcitonin gene-related peptide (CGRP), a naturally occurring protein that acts as a neurotransmitter in the nervous system.

During a migraine episode, CGRP is released from nerve endings in the head and neck, triggering intense pain, inflammation of the blood vessels and the dilation of cranial arteries.

The new medications work by blocking this pathway, reducing migraine frequency and severity.

“CGRP-targeting therapies have been game changers,” Jicha says. “For the first time, we have targeted preventive treatments designed specifically for migraine rather than medications used for other medical conditions.”

They are available in multiple forms, including daily pills, self-administered injections, nasal sprays and intravenous infusions.

Some are used to stop migraine attacks, while others are designed to prevent attacks from occurring. They also are well tolerated and often produce fewer side effects than traditional migraine medications.

“The American Headache Society now recommends CGRP-inhibitors as a first-line option for migraine prevention,” Jicha notes. “This suggests that patients should be able to access these treatments without failing older therapies first".

Most insurance companies haven’t quite caught up to this recommendation, but it may help improve insurance coverage for these drugs in the future.

Beyond medication

While medications remain an important part of migraine care, Jicha says other non-drug treatments are increasingly recognized as valuable tools for both prevention and symptom management.

Lifestyle modifications such as improving sleep habits, staying hydrated, maintaining regular meals, managing stress and avoiding other triggers can play a significant role in reducing migraine attacks.

Cognitive behavioral therapy and mindfulness techniques may help patients better manage symptoms while neuromodulation devices also have emerged as innovative treatment options.

“These devices use electrical or magnetic stimulation to influence nerve pathways involved in migraine,” says Jicha. “They offer an important alternative for patients who prefer non-drug approaches or who cannot tolerate certain medications.”

Some are available by prescription, while others can be purchased over the counter. Many are cleared by the U.S. Food and Drug Administration for both acute treatment and migraine prevention, but most are not covered by insurance, she notes.

Individualized treatment options

“Migraine is a very heterogeneous disorder,” Jicha explains. “Genetics, hormones, environmental factors, stress and even prior injuries can all contribute. That’s why treatment decisions need to be individualized."

Despite the growing number of options, there is no one-size-fits-all migraine treatment.

"At UCI Health, we collaborate with our patients and consider a variety of factors, including previous medication responses, side effect concerns, patient preferences and preferred methods of medication,” she says.

Looking ahead

Migraine research continues to evolve.

“Researchers are exploring new targets beyond CGRP, including a molecule called pituitary adenylate cyclase-activating polypeptide or PACAP,” says Jicha. “This could lead to the next generation of migraine therapies.”

While no cure currently exists, the expanding range of treatment options offers renewed optimism for patients living with migraine.

“For patients who have struggled for years with debilitating symptoms, this progress represents something invaluable: hope,” says Jicha.

Whether you have migraine, tension or cluster headaches or facial pain, one of our headache specialists can help. Call 714-456-7720 to make an appointment.er you have a tension headache, migraine, cluster headaches or facial pain, we can help. 

Call 714-456-7720 now to make an appointment with a headache specialist.