Long-Term Effects of New Migraine Medications

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Key Questions
  • What kinds of studies are done to test the safety of new medications? How do new medications make it to market?
  • What is the role of the FDA in the development of new drugs?
  • What do the different phases of getting a drug to the market entail?
  • Are there aspects of clinical trials that might ensure the success of a drug but that also could be harmful to patients in the long run?
  • How long does it take for a new drug to be developed?
  • What’s the difference between an adverse event and a side effect?
  • When is it a good idea to try a medication for which we don’t yet know the long-term risks?
  • How do patients and clinicians weigh the tolerability and side effects of  a medication?
  • How do clinicians find out whether migraine medications cause complications or interact with a patient’s other medical conditions, such as thyroid issues?
  • What have recent studies shown about some of the newer CGRP medications?
  • Have studies been conducted on the long-term effects and possible dependency issues of CGRP medications?
  • What do recent studies show about Aimovig, the first CGRP medication to be introduced and therefore used the longest?
  • Can these findings be applied to other similar drugs?
  • Why was the label for Aimovig revised after it was introduced?
  • Why do CGRPs potentially affect the GI tract?
  • How are side effects of a drug monitored after clinical trials are over and it’s on the market?
  • Have any migraine medications ever been pulled from the market because of safety issues with long-term use?
  • Which types of migraine medications are contraindicated for patients with heart risk?
  • When would a CGRP medication be preferable to a triptan?
  • Why is it important to let your doctor know about all medications you’re taking?
  • What recommendations are there for people who might be afraid to try some of the newer targeted medications and are instead relying only on their standard ones?
  • What is a claims data analysis and what does it show?
  • What is the best way to find out if a medication has long-term side effects, and then to determine if the benefit outweighs any risks?
Interview Notes

Find more about Robert Cowan, MD and his work here:

Treatments Mentioned
  • Aimovig (erenumab)
  • Ajovy
  • CGRP monoclonal antibodies
  • DHE
  • DHE IV
  • Emgality
  • Gepants
  • Lasmiditan
  • Methysergide
  • MAO (monoamine oxidase) inhibitors
  • Nurtec ODT
  • Propranolol
  • Qulipta
  • Triptans
  • Ubrelvy
  • Vyepti
  • Zomig

Please note: The Migraine World Summit’s aim is to bring you a variety of perspectives and expertise, independent of bias or judgment. Alternative theories presented in this video have not been medically reviewed. Views expressed in this interview do not necessarily represent the views of the Migraine World Summit. Please always consult your health care professional and do your own research before making changes to your treatment plan.

Robert P. Cowan, MD

Professor of Neurology & Director of Research in Headache and Facial Pain
Stanford University School of Medicine

Dr. Robert P. Cowan is a clinical professor of neurology and director of the Stanford Headache and Facial Pain Program Research division at Stanford University. He is board certified in neurology and pain medicine with a subspecialty certification in headache medicine. Dr. Cowan has held several nationally elected positions, including chair of multiple sections for the American Headache Society (AHS).

He is the past president of the Headache Cooperative of the Pacific and was the founding chief of the headache division in the Department of Neurology at Stanford, and before that, at the Keck School of Medicine of USC. He is a fellow of the American Academy of Neurology and the American Headache Society. He has served on the boards of the Alliance for Headache Disorders Advocacy and the now-defunct American Headache and Migraine Association. He has published over 200 articles, chapters, abstracts, and posters and is the author of The Keeler Migraine Method.

Interviews from Robert P. Cowan, MD

Unofficial Side Effects of CGRP Monoclonal Antibodies
Long-Term Effects of New Migraine Medications
Why Most Doctors Get the Diagnosis Wrong
Best Natural, Affordable and Free Treatments
Migraine Causes & Triggers

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