An estimated 39 million Americans live with migraine, and for decades the drugs on offer often caused trouble of their own: weight gain, cognitive dulling, cardiovascular effects. Two newer routes now exist. One is a family of drugs aimed at a protein called calcitonin gene-related peptide, or CGRP. The other is a wearable device that uses no drugs at all.
Drugs aimed at CGRP
CGRP causes blood vessel dilation and carries pain signals in the brain, and its levels surge during an attack. Four monoclonal antibodies for prevention target it: erenumab (Aimovig), fremanezumab (Ajovy), galcanezumab (Emgality) and eptinezumab (Vyepti). They are given monthly or quarterly by injection or infusion. In trials they cut monthly migraine days by 50% or more in many patients, and injection site reactions were the most common side effect. Full effect can take 4 to 12 weeks, though some patients notice change within the first month.
For attacks already under way, the gepants, including ubrogepant (Ubrelvy) and rimegepant (Nurtec ODT), block CGRP receptors. They do not constrict blood vessels, so they suit people with cardiovascular conditions who cannot take triptans. With ubrogepant, approximately 20% of patients were completely free of pain at two hours. Gepants typically work within one to two hours.
A third option, lasmiditan (Reyvow), is a ditan that acts on serotonin receptors involved in migraine without affecting blood vessels. It can cause dizziness and fatigue, and patients must avoid driving for at least eight hours after a dose.
Cost is the sticking point. Without insurance these drugs often run $600-800 per month. Insurers often require proof that patients have failed several traditional treatments first, and patient assistance programs from manufacturers aim to ease the burden.
A wearable alternative
In the UK, where approximately 10 million people live with migraines according to The Migraine Trust, a device called Nerivio launched in July 2025. It is worn on the upper arm and controlled by a smartphone app. Using Remote Electrical Neuromodulation, it stimulates the body’s own pain control system in a 45-minute session, which can be used within 60 minutes of the onset of headache or aura, or on alternate days for prevention.
The makers cite trial results: two in three users had relief within two hours, up to 51.6% saw at least a 50% reduction in headache days, and almost 80% of attacks were managed without prescription medication. Professor Peter Goadsby of King’s College London said that “Selecting the right medication tailored to each patient is our primary concern,” and called neuromodulation “a non-pharmacological alternative to traditional therapies.”
Nerivio is not routinely available on the NHS. It is prescription-only and is available through private prescriptions, Pharmacy2U or nerivio.co.uk, at an RRP of £249 for 18 sessions.
Anyone considering one of these options should talk with a doctor first, particularly about heart conditions and other medicines being taken.
