| Topic | Explanation |
|---|---|
| Older vs. Newer Medications | Oxford University study found that older, cheaper drugs like triptans (e.g., eletriptan) and ibuprofen are highly effective for relieving migraines compared to newer, costlier drugs like gepants. |
| Vitamin B2 (Riboflavin) | 400 mg of Vitamin B2 daily has been shown to reduce the frequency of migraine attacks. It works by supporting energy production in brain cells, helping them function more efficiently and reducing electrical irritability. |
| Coenzyme Q10 | Works alongside Vitamin B2 to support energy production in the brain. Together, they help prevent migraines by ensuring the brain has enough energy to function properly. |
| Magnesium | Magnesium helps regulate nerve function and can prevent migraines by reducing the brain's electrical excitability. It’s particularly effective when combined with Vitamin B2 and Coenzyme Q10. |
| NICE Recommendations | The National Institute for Health and Care Excellence (NICE) in the UK lists Vitamin B2, Coenzyme Q10, and magnesium as frontline treatments for migraine prevention, yet they are often overlooked in favor of drug treatments. |
| Migraine Triggers | Common triggers include dehydration, poor sleep, stress, and missed meals. Managing these triggers with supplements like Vitamin B2, magnesium, and Coenzyme Q10 can help reduce the frequency and severity of attacks. |
| Holistic Migraine Management | Combining medications (like triptans or gepants), supplements (Vitamin B2, Coenzyme Q10, magnesium), and lifestyle changes (regular sleep, hydration, balanced meals) can be more effective than relying solely on one treatment method. |
On April 11, 2023, the National Institute for Health and Care Excellence (NICE) recommended a new migraine drug, atogepant, for use in England. It’s the first oral treatment designed to prevent both chronic and episodic migraines, with hopes of benefiting up to 170,000 people who suffer from debilitating head pain. But is this new medication truly the breakthrough migraine sufferers have been waiting for, or should patients explore natural alternatives before jumping on the latest pharmaceutical bandwagon?
What Are Gepants?
Atogepant belongs to a class of drugs known as gepants, which are specifically designed to block the receptor for calcitonin gene-related peptide (CGRP), a protein believed to play a key role in migraine attacks. Unlike older migraine medications like triptans, which constrict blood vessels, gepants work by reducing inflammation in the brain without affecting the cardiovascular system, making them an attractive option for patients with heart-related concerns.
Atogepant is the latest in the gepants line of drugs, following closely on the heels of rimegepant, another CGRP antagonist. Both drugs have been lauded for their ability to provide migraine relief with fewer side effects than traditional treatments. For patients who haven’t responded well to other medications or cannot tolerate injections, atogepant is an exciting new option that may soon be available on the NHS.
How Effective Is Atogepant?
While the introduction of atogepant has been hailed as a “positive step” by migraine charities, recent research from Oxford University raises questions about whether newer drugs like atogepant and rimegepant are genuinely more effective than older, more established treatments.
A recent study suggests that older medications like triptans and ibuprofen still provide highly effective migraine relief at a fraction of the cost of newer drugs. For example, triptans, such as eletriptan, have been a mainstay of migraine treatment for years and are often just as effective as their newer, more expensive counterparts.
NICE’s guidance recommends atogepant only for patients who have unsuccessfully tried at least three other treatments, many of which are injections or infusions. This places atogepant as a secondary option, not a first-line treatment. Given that the drug will initially only be available in secondary care settings, such as hospitals, rather than from GPs, access may be delayed for many patients.
Should You Consider Natural Alternatives?
Before considering new, expensive drugs like atogepant, it may be worth exploring natural alternatives that have been proven to help prevent migraines. Supplements like vitamin B2 (riboflavin), magnesium, and Coenzyme Q10 have shown promise in reducing the frequency of migraines, and they come with virtually no side effects.
NICE even lists vitamin B2, CoQ10, and magnesium as first-line treatments for migraine prevention, yet these supplements are often overlooked in favor of pharmaceutical options. Here’s why you might want to try these alternatives for at least three months before turning to newer medications:
- Vitamin B2 (Riboflavin)
- What It Does: Research suggests that taking 400 mg of vitamin B2 daily can reduce the frequency of migraine attacks. Riboflavin supports energy production in brain cells, helping them function more efficiently and reducing electrical irritability.
- Why It’s Worth Trying: It’s safe, inexpensive, and has been recommended by NICE for migraine prevention.
- Magnesium
- What It Does: Magnesium helps regulate nerve function and can reduce the brain’s electrical excitability. Studies have shown that magnesium deficiency is common in people who suffer from migraines, and supplementing with magnesium can help prevent attacks.
- Why It’s Worth Trying: It’s particularly effective when combined with vitamin B2 and CoQ10. Plus, magnesium is safe and has other health benefits, such as supporting muscle and heart health.
- Coenzyme Q10
- What It Does: CoQ10 works alongside vitamin B2 to support energy production in the brain. Together, these supplements help prevent migraines by ensuring that the brain has the energy it needs to function properly.
- Why It’s Worth Trying: Like magnesium and riboflavin, CoQ10 is a safe and natural way to manage migraines without the risks associated with medications.
A Balanced Approach to Migraine Management
While atogepant and other gepants may offer relief for some patients, they are not a cure-all, and access to these drugs may be limited initially. Given the potential side effects, costs, and waiting times associated with new pharmaceutical treatments, many patients may find that natural supplements provide a safer, more accessible option for managing migraines.
Holistic migraine management, which includes lifestyle changes, supplements, and medication when necessary, may be the most effective approach. Addressing triggers like dehydration, poor sleep, stress, and skipped meals can also help reduce the frequency and severity of migraines.
Conclusion: Try Natural Alternatives Before New Medications
Atogepant offers a new option for those who haven’t found success with traditional migraine medications, but it should not necessarily be the first line of defense. Research continues to suggest that older, more affordable drugs like triptans are just as effective for many people, while natural supplements like vitamin B2, magnesium, and CoQ10 have proven benefits with fewer side effects.
If you’re suffering from migraines, consider giving these natural alternatives a try for at least three months. Consult with your healthcare provider, especially if you’re currently taking other medications, but don’t overlook the power of a natural approach to migraine management. Supplements and lifestyle changes can often provide significant relief and might even help you avoid the need for more expensive, newer drugs like atogepant.