No more migraines, here are the new oral medications that eliminate attacks in 7 out of 10 patients.

There are people who have built their lives around pain: missed appointments, missed days, lights out, nausea, silence. For millions of Italians, migraines aren't just "headaches," but a condition that disrupts work, productivity, relationships, and normalcy. Today, however, everything is changing. With new-generation medications, seven out of 10 patients are finally able to control their attacks. And, when pharmacological therapy isn't enough, supplementation with non-pharmacological treatments increases effectiveness in up to 85% of cases. A possibility that until a few years ago seemed unattainable.

From “unexplained pain” to the scientific revolution

Migraine affects approximately 6 million people, or 12% of the population, with a prevalence three times higher in women than in men. For decades, it was thought to be an elusive disorder. The revolution came when research clarified the role of CGRP, a key peptide in the mechanisms that trigger inflammation and pain. From this discovery, targeted drugs were developed that could intercept or block this process at its root: first triptans and ditans, then monoclonal antibodies, and, more recently, gepants. "We are witnessing the concrete results of a true evolutionary leap in migraine therapies," explained Marina De Tommaso, president of SISC and Professor of Neurology at the University of Bari, on the sidelines of the 39th National Congress of the Italian Society for the Study of Headaches (SISC), which recently took place in Parma.

Oral medications to prevent migraine attacks

The most significant innovation is represented by two molecules, atogepant and rimegepant, which can be taken orally at home. They not only relieve pain, but also prevent it, reducing the frequency and intensity of attacks. Specifically, rimegepant is the first oral anti-CGRP drug approved in Italy for a dual indication: acute treatment of migraine with or without aura in adults, and preventive treatment of episodic migraine in adults experiencing at least four migraine episodes per month. A study in the Lancet demonstrated that a single dose of rimegepant achieved a reduction in pain and migraine-related symptoms as early as two hours after ingestion compared to a placebo, with lasting efficacy for up to 24-48 hours.

The prevention study, also published in the Lancet , shows that the drug, when taken every other day, reduces the number of migraine days per month compared to a placebo. A single dose of rimegepant can therefore rapidly relieve migraine and associated symptoms, while taking it every other day can significantly reduce attacks.

For which patients are they indicated?

Both atogepant and rimegepant are already available in pharmacies and reimbursed by the National Health Service. "Gepants," continues the SISC president, "can be prescribed at regionally authorized Headache Centers, but the scientific community is working to ensure they can also be prescribed by family doctors or local neurologists, especially for patients who need them in the acute phase." But who are eligible for reimbursement for these new drugs? "These gepants," responds De Tommaso, "are indicated for those suffering from episodic or chronic migraines with at least eight days of pain per month and who have not seen results from traditional treatments such as beta-blockers, antidepressants, and antiepileptics. But there is also the option of a white prescription: those who are not eligible for reimbursement can purchase these molecules independently."

Menstrual migraines and migraines during pregnancy

The effect lasts up to 48 hours and can be useful, for example, for menstrual attacks. "Rimegepant can also be prescribed acutely to patients who experience less frequent migraine attacks; for example, for menstrual migraines, they simply need to take it before their period," explains De Tommaso. Managing migraines during pregnancy is more challenging because many effective therapies cannot be used for safety reasons.

"Monoclonal antibodies," continues the SISC president, "are contraindicated, and gepants must be discontinued in the months preceding conception." The scientific community is producing new evidence on this very issue: according to SISC specialists, pregnant women can be effectively treated with a combination of amitriptyline and beta-blockers, a therapy considered safe and capable of significantly reducing attacks without risk to the mother or child. This allows expectant mothers with migraines to face pregnancy with better symptom control, avoiding days spent in bed and the compromised quality of life that the disease can bring.

When drugs aren't enough: the effectiveness of non-pharmacological therapies

A segment of patients remains less fortunate: approximately 30% do not respond to standard treatments. However, medicine offers new avenues for them too. Botulinum toxin, injected into specific areas of the head, neck, and shoulders, can halve the number and intensity of seizures, with a simple procedure already recognized by the Italian Medicines Agency. Transcranial neuromodulation uses electromagnetic fields to modulate brain activity and reduce seizures by approximately 50%. Targeted physiotherapy and mindfulness techniques can also contribute, with tangible results.

"By combining pharmacological and non-pharmacological treatments, we can now guarantee a normal life for a very high percentage of patients," observes Innocenzo Rainero , president-elect of the SISC and Professor of Neurology at the University of Turin. "The goal is no longer just to manage an attack, but to restore continuity to daily life: work, relationships, social activities."