Newer treatments that are changing migraine care

Migraines can be incredibly disruptive — and for a long time, treatment felt like a frustrating cycle of “try this older med and hope.” That’s changed. Over the last few years, we’ve gotten migraine-specific therapies that target the biology of migraine more precisely, often with better tolerability and stronger results. Here’s what’s new and worth knowing. The biggest shift: treatments that target CGRP

One of the most important discoveries in migraine science is the role of CGRP (calcitonin gene-related peptide) — a molecule that rises during migraine attacks and helps drive pain and inflammation. Newer medications block CGRP or its receptor directly, and major headache societies now recognize these as first-line options for many patients, not just a last resort.

1) CGRP monoclonal antibodies (preventive injections or IV)

These are designed to reduce migraine frequency over time. They’re typically taken once a month or every 3 months.

Examples

• Erenumab (Aimovig)

• Fremanezumab (Ajovy)

• Galcanezumab (Emgality)

• Eptinezumab (Vyepti – IV infusion)
  

Why they’re a game-changer

• Migraine-specific prevention (not repurposed blood pressure/seizure meds)

• Often fewer side effects than older preventives

• Can be used earlier if migraines are frequent or disabling
  

Notable recent expansion

• In 2025, fremanezumab gained approval for prevention in certain pediatric patients, showing how this class is broadening across age groups.
  

2) Gepants (oral CGRP blockers)

Gepants block CGRP through pills (or nasal spray) and come in acute and preventive forms.

Acute gepants (take at onset)

• Ubrogepant (Ubrelvy)

• Rimegepant (Nurtec ODT)

• Zavegepant nasal spray (Zavzpret)
  

Preventive gepants

• Atogepant (Qulipta)

• Rimegepant (Nurtec ODT) (every-other-day prevention)
  

Why patients like these

• Fast, targeted relief without the “heavy” feel of some older meds

• A strong option if triptans don’t work or aren’t safe for you

• Less risk of medication-overuse headache for many people compared to older rescue drugs (still needs smart use)
  

Newer clinical approachSome patients benefit from using a gepant preventively plus a gepant acutely under guidance — a flexibility we didn’t have before.

A new acute class: Ditans

Lasmiditan (Reyvow) is the first “ditan.”It treats migraine pain through serotonin receptors without constricting blood vessels, making it an option for some patients who can’t take triptans due to cardiovascular risk.

Important practical noteIt can cause sleepiness/dizziness, so there are driving restrictions after dosing.

Non-medication neuromodulation devices

For people who want fewer meds, have side effects, are pregnant/trying to conceive, or want a strong add-on option, several FDA-cleared neuromodulation devices can help both acutely and preventively.

Examples

• Cefaly (forehead trigeminal nerve stimulation)

• Nerivio (arm-worn remote electrical neuromodulation)

• gammaCore (vagus nerve stimulation)

• Relivion MG / other multi-nerve systems
  

Why they’re worth considering

• No systemic medication side effects

• Can be paired with CGRP meds or triptans

• Useful for patients with frequent attacks or special circumstances
  

Better rescue options for “fast and severe” migraines

If migraines escalate quickly or cause nausea/vomiting, non-oral routes matter more than most people realize.

Newer and improved non-oral options

• Zavegepant nasal spray for fast CGRP-based acute relief

• Self-administered acute auto-injector options continue to expand; one was newly approved in 2025 (Brekiya), giving more at-home rescue flexibility.
  

Where older therapies still fit (briefly)

Even with these advances, older tools like triptans, Botox for chronic migraine, and select preventives still help many people. The difference now is you’re not stuck there if they fail — we have migraine-specific next steps earlier in the journey.

The bottom line

Migraine treatment has entered a new era:

• CGRP preventives reduce attack frequency with precision

• CGRP acute meds (gepants, nasal options) stop attacks without triptan limitations

• Ditans provide another non-vascular acute choice

• Neuromodulation devices offer effective non-drug or add-on relief
  

If you’re still suffering despite older therapies — or you avoided treatment because of side effects in the past — it’s worth re-visiting your options. The menu is dramatically better than it was even 3–5 years ago.

We’re happy to build a personalized migraine plan with you — including trigger strategy, acute rescue, and modern prevention tailored to your health history. Contact us for more information.

Disclaimer: This article is for general educational purposes only and is not a substitute for personalized medical advice, diagnosis, or treatment. Migraine symptoms and appropriate therapies vary from person to person. If you have new, severe, or changing headaches, or if you think you may be experiencing a medical emergency, seek urgent care immediately. Please contact our office to discuss the best plan for your individual needs.