FAQ Episode 26: Your response to the latest migraine drugs vs. the root causes of your headaches.

FAQs for Natural Migraine Relief for Women

There is a new class of drug on the migraine market the last ~2 years, and you would have to live a screen-free life to miss hearing ads for brand names like Aimovig, Ajovy, Emgality, Vyepti, Ubrelvy, Nurtec, Qulipta or Zavzpret. (my theory is that they got these names from a list of Aztec or Klingon warlords…)  

What these medications have in common is that they minimize and modify the brain response to a molecule called CGRP (calcitonin gene-related peptide).  The first four of the drugs listed above use monoclonal antibodies which target either CGRP or the CGRP receptor. The second four listed are gepants, small molecules which can block the CGRP receptor.  Both groups are used for acute migraine therapy and/or prevention, and they are truly a breakthrough in pharmaceutical therapy for migraine.

The CGRP molecule is one of the most potent vasodilators in the body.  It is released when the brain needs more oxygen and nutrients to manage acute or chronic stress and injury.  The process of CGRP release also results in elevated amounts of pro-inflammatory neurochemicals, local tissue edema and enhanced sensitivity of nerves to pain.  In this situation, a migraine headache is to a degree the price for repairing the brain strain, stress, and inflammatory damage from what are often unidentified root cause factors. Elevated CGRP is not the root cause of a headache. It is the body’s reaction to one or more underlying causes. Always remember that symptoms or their resulting chemical pathways are not the disease. They are the body’s response to underlying functional imbalances as it’s attempt to re-establish balance and to restore normal function and health.

Let’s consider two versions of response to CGRP blocking drugs:

1) there are roughly 40-50% of migraine patients who will get at least 50% relief benefit from the CGRP medication group.

Pain relief = no pain = so, is this not a good thing? Yes, absolutely.  

But does it explain and manage the reasons that the brain thought that it needed the CGRP induced vasodilation for self-therapy?  No, it does not.  It’s somewhat like pasting a dab of duct tape over the “check engine” light.  Short term engine related anxiety may be allayed, but ignoring this signal can have significant future consequences.  

We may be able to block the CGRP related pain, but we are also to a degree blocking the role of CGRP in the cycle of repair. This process of pain management teaches us nothing new about the ‘under the surface’ root cause factors that are driving up CRGP levels. Ignoring them by “making the pain just go away” may allow for an underlying and recurrent vicious cycle that can perpetuate the migraine process for many patients.

2) then there’s the other 50-60% of patients who did not respond meaningfully to CGRP drug therapy (including the 50% or so from group #1 that were only partial responders.) For this group, CGRP blockade alone may not be enough to reduce the migraine pain cycle.  For some of these patients meds like the CGRP blocking drug could be an useful adjunct if we could also reduce or clear some of the underlying root cause factors that are driving brain stress or damage, causing the brain to push the “CGRP to the rescue” button.

So, what are the true “root cause factors” driving your migraines?

If you have been reading my FAQ Episodes, you can see that many topics address some of the expressions of the most common underlying root causes promoting migraines and the CGRP pathway, including :

• multiple sources of brain inflammation and adverse immune activation

• reduced cell energy production

• nutrient deficits that affect cell repair and function

• hormone imbalances, which can include:

• reproductive hormone levels and ratios through all four hormonal phases of life:  premenopause, peri-menopause, menopause, and post-menopause

• thyroid and parathyroid hormone imbalances

• adrenal dysfunction and pineal gland deficits.

• brain chemistry imbalances

• alteration of autonomic nervous system function

• lifestyle habits

• structural anatomical factors

The process of understanding your own profile can feel overwhelming, as there are SO MANY potential contributing factors, and the combination in play for any person with migraine is UNIQUE to their story.   Reviewing this blog’s previous FAQ Episodes that address root cause factors can provide clues that may apply to your situation.  Past FAQ Episodes 3, 9, 13, 16, 20, 22 and 24 would be a good place to start. FAQ Episode 21 talks specifically about the use of ginger, which also reduces CGRP levels as a front line migraine therapy.  It could also help patients taking CGRP blockers to get a better response from the medication.

You can also learn more about your specific migraine root cause factors by looking to www.naturalmigrainerelief.online for my online course on how to find and personally triage the best non-drug therapies to proactively manage your migraine headaches.

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