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 Cowan

Robert P. Cowan, MD

Professor of Neurology & Neurosciences, Chief, Division of Headache Medicine
Stanford University School of Medicine

Dr. Robert Cowan is a professor of neurology and director of the Headache and Facial Pain Program at Stanford University. He is board-certified in neurology and pain medicine with a subspecialty certification in headache medicine. Dr. Cowan holds several nationally elected positions, including chair of the section on chronic daily headache for the American Headache Society.

He is President of the Headache Cooperative of the Pacific and a fellow of both the American Academy of Neurology and the American Headache Society. He sits on the board of the Alliance for Headache Diseases Advocacy and the American Headache and Migraine Association. He has published over 50 articles and is the author of The Keeler Migraine Method.

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The Association of Migraine Disorders (AMD) is devoted to expanding the understanding of migraine disease and its true scope. Migraine is a full body condition with a broad spectrum of symptoms, AMD is focused on including many medical specialties in the management of this disease.

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