Blurring the Lines Between Acute and Prevention Migraine Treatment

Migraine, a common primary headache disorder, requires a comprehensive care approach involving both pharmacological and nonpharmacological therapies. Treatments for migraine typically fall into 2 main categories which are acute treatments, providing pain relief during attacks, and preventive therapies, reducing attack frequency and severity. Specific medications like triptans and ergots target migraine, while others like nonsteroidal anti-inflammatory therapies and opioids provide nonspecific relief during an attack. Preventive options include β-blockers, calcium channel blockers, antidepressants, and antiepileptic medications, which collectively provide relief from the debilitating effects of migraine.
Over the past few years, the FDA has approved several new treatments for patients with migraine which has expanded the landscape of care in headache medicine. These newer treatments include Biohaven’s rimegepant (Nurtec ODT) and Theranica’s Nerivio, a remote electrical neuromodulation (REN) device, among others. In May 2021, the FDA approved 75-mg rimegepant for the preventive treatment of migraine, adding to its prior indication for the acute treatment of the headache disorder, and marking it as the first oral calcitonin gene-related peptide (CGRP) antagonist to be approved for prevention and the first to be approved for both acute and preventive therapy. In February 2023, the FDA approved Nerivio as a dual-use acute and preventive treatment for migraine with or without aura in patients 12 years of age or older.
In a recent interview with NeurologyLive®, Andrea S. Synowiec, DO, FAAN, system vice chair for the department of neurology at Allegheny Health Network, and associate professor of neurology at Drexel University, discussed how recent advancements in migraine treatment have transformed the traditional distinctions between acute or attack and preventive therapies. Synowiec also talked about the role of innovative devices like the remote electronic neuromodulator and CGRP receptor antagonists in providing effective options for both acute and preventive migraine treatment. In addition, she spoke about how flexible strategies in the latest migraine treatments are empowering patients to take more control of their healthcare decisions.
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