New Migraine Treatments 2024-2025: Revolutionary Options Changing Lives

Migraine treatment has undergone a revolution in the past few years, and 2024-2025 have brought game-changing developments. The American Headache Society now recommends that newer CGRP-targeting therapies be considered as first-line treatments, medicines that work within days rather than months are becoming available, and completely novel treatments targeting different pathways are showing extraordinary promise.

If you've struggled with migraines for years, cycling through preventive medications that take months to work (or don't work at all), or felt limited by the side effects of traditional treatments, these new developments represent genuine hope for transformative relief.

The Paradigm Shift: CGRP Therapies as First-Line Treatment

The single most important development in migraine treatment came in 2024 when the American Headache Society published a position statement that fundamentally changes how migraines should be treated. For the first time, CGRP (calcitonin gene-related peptide) targeting therapies are recommended as a first-line treatment option, not something to try only after multiple other medications have failed.

This is revolutionary because it means you may no longer need to spend months or years trying older preventive medications like beta-blockers, antidepressants, or anti-seizure drugs before accessing treatments specifically designed for migraine. The evidence supporting this change is compelling: CGRP therapies are more effective than older preventives, have significantly better side effect profiles, and were developed specifically for migraine rather than being repurposed from other conditions.

CGRP is a neuropeptide that plays a key role in migraine attacks, causing inflammation and vasodilation in the brain. By blocking CGRP or its receptors, these treatments address migraine at a fundamental level.

Atogepant: The Preventive That Works Immediately

One of the most exciting new treatments is atogepant (brand names Qulipta in the US, Aquipta in the UK), which received NICE approval for NHS use in England in April 2024 and was also approved in Scotland in October 2023.

What makes atogepant revolutionary is that it may start working right away. Research published in December 2024 in the journal Neurology showed that unlike traditional preventive medications which take weeks or months to become effective, atogepant can begin reducing migraine frequency within the first week of treatment.

This is transformative for patients. With traditional preventives like topiramate or amitriptyline, you might wait 8-12 weeks to know if the medication will work, all whilst experiencing side effects. Many people give up before reaching this point. With atogepant, you may see results within days.

Atogepant is a CGRP receptor antagonist (a "gepant") taken orally once daily. Clinical trials showed it significantly reduced migraine frequency with a low incidence of side effects. The most common side effects were mild nausea and constipation, which are far more tolerable than the cognitive impairment ("brain fog") associated with topiramate or the sedation from amitriptyline.

The NHS eligibility criteria specify atogepant may be prescribed for adults with at least four migraine days per month who have failed at least three previous preventive treatments. However, given the AHS position statement recommending CGRP therapies as first-line options, advocacy for earlier access is growing.

Zavzpret: Revolutionary Nasal Spray for Acute Treatment

Zavzpret (zavegepant) nasal spray, approved by the FDA in March 2023, represents a completely new approach to treating migraine attacks as they happen. It's the first and only intranasal CGRP receptor antagonist for acute migraine treatment.

The advantage of a nasal spray is rapid absorption and effectiveness even when you're experiencing nausea or vomiting, which often makes oral medications difficult to take during a migraine attack. Zavzpret works within one to two hours, with many patients experiencing relief even faster.

For people who can't take triptans (the previous mainstay of acute migraine treatment) due to cardiovascular contraindications, or who don't respond to triptans, Zavzpret offers a crucial alternative. Unlike triptans which constrict blood vessels and can't be used by people with heart disease, CGRP antagonists work through a different mechanism without cardiovascular effects.

The convenience of a nasal spray also means you can treat migraines wherever you are, without needing water or the ability to swallow tablets whilst feeling nauseated.

The Full Range of CGRP Therapies Now Available

Beyond atogepant and zavegepant, there's now a complete toolkit of CGRP-targeting medications offering options for different preferences and needs.

Monoclonal antibody injections for prevention include erenumab (Aimovig), which blocks the CGRP receptor, and fremanezumab (Ajovy), galcanezumab (Emgality), and eptinezumab (Vyepti), which block the CGRP molecule itself. These are administered monthly or quarterly via self-injection (or quarterly IV infusion for eptinezumab).

The major advantage of these injections is convenience – a monthly or quarterly dose rather than daily tablets. Many people find this easier to maintain long-term. Clinical trials show 50-60% of patients experience at least a 50% reduction in migraine frequency.

Oral gepants for acute and preventive treatment include rimegepant (Nurtec ODT), which is unique in being approved for both acute treatment (taken as needed when a migraine starts) and prevention (taken every other day). Ubrogepant (Ubrelvy) is approved for acute treatment and works within one hour for many patients.

The flexibility to use the same medication for both acute and preventive treatment (with rimegepant) simplifies treatment regimens and ensures you always have medication available when needed.

PACAP Inhibitors: The Next Generation

Looking ahead, one of the most promising developments is a completely new class of migraine treatments targeting PACAP (pituitary adenylate cyclase-activating polypeptide) rather than CGRP. Lu AG09222, a monoclonal antibody PACAP inhibitor from Lundbeck Therapeutics, showed highly encouraging results in Phase 2 clinical trials published in 2024.

PACAP is another neuropeptide involved in migraine, acting more broadly than CGRP by also binding to receptors in the parasympathetic nervous system. This means blocking PACAP could potentially help people who don't respond adequately to CGRP inhibitors.

The Phase 2 trial results were impressive enough that development is continuing rapidly. For the estimated 30-40% of migraine patients who don't respond adequately to CGRP therapies, PACAP inhibitors could provide the alternative they desperately need.

As Dr Jessica Ailani, a leading migraine clinician, noted: "Given that there are still millions of people with migraine and still hundreds of thousands of people with severe migraine, I think we're on a mission here to do something about this very debilitating disease." PACAP inhibitors represent the next step in that mission.

Nurtec ODT: The Dual-Action Breakthrough

Rimegepant (Nurtec ODT) deserves special mention as it's the first medication approved for both acute and preventive migraine treatment. This dual indication is revolutionary because it addresses a common patient need: treating attacks when they occur whilst also reducing their frequency.

For acute treatment, Nurtec ODT is taken at the first sign of a migraine. The orally disintegrating tablet dissolves quickly without water, making it easy to take even during nausea. Many patients experience relief within one hour.

For prevention, taking Nurtec ODT every other day reduces monthly migraine days. Clinical trials showed patients experienced an average reduction of 4.3 monthly migraine days during weeks 9-12 of treatment.

The convenience of a single medication for both purposes eliminates the need for separate acute and preventive prescriptions. It's particularly valuable for people with episodic migraines who don't have attacks frequently enough to justify daily preventive medication but still want to reduce occurrence.

The American Headache Society's Game-Changing Position

The AHS position statement published in 2024 represents decades of clinical experience and research culminating in a fundamental shift in migraine treatment philosophy. The key recommendation: CGRP-targeting therapies should be considered as a first-line option, not reserved for after other treatments fail.

This doesn't mean CGRP therapies are the only first-line option or that everyone should take them, but rather that they should be in the conversation from the start when discussing preventive treatment. The decision should be based on individual patient factors, preferences, and circumstances rather than arbitrary requirements to "fail" multiple older treatments first.

The position statement emphasises the superior safety and tolerability profile of CGRP therapies compared to traditional preventives. Side effects are generally mild, and CGRP therapies don't cause the cognitive impairment, weight gain, sedation, or other problematic effects associated with many older preventives.

For patients, this means you can advocate for access to these treatments earlier in your migraine journey rather than enduring years of trial-and-error with medications that may not work or cause unacceptable side effects.

Accessing New Migraine Treatments in the UK

NICE approval of atogepant in April 2024 means it's now available on the NHS in England for eligible patients, with Scotland having approved it even earlier. However, current eligibility criteria require having tried at least three previous preventive treatments.

CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality) have varying availability across the UK. Some areas offer them on the NHS for eligible patients, whilst others require private prescription. Access often depends on your local integrated care board's formulary decisions.

Zavzpret nasal spray availability in the UK may be limited, though it can potentially be prescribed privately. Other acute treatments like Nurtec ODT and Ubrelvy may also require private prescription.

Private neurology or headache clinics offer access to the full range of CGRP therapies without the wait times and restrictions of NHS pathways. For people whose migraines significantly impact their quality of life and work, private treatment may be a worthwhile investment.

Online GP services can prescribe some acute migraine treatments and provide referrals to specialist headache clinics. They can also prescribe traditional preventives whilst you're waiting for specialist appointments.

What About Traditional Migraine Medications?

Triptans like sumatriptan remain valuable acute treatments, particularly for people who respond well to them and don't have contraindications. They're inexpensive, well-understood, and effective for many patients.

Traditional preventives including propranolol, topiramate, and amitriptyline still have a role, particularly for people with specific comorbidities that these medications also address (like propranolol for anxiety or amitriptyline for insomnia). They remain first-line options for many patients.

However, the key change is that CGRP therapies should now also be considered as first-line options, with the choice based on individual patient factors rather than automatically requiring months or years of trying older medications first.

Creating Your Modern Migraine Treatment Plan

An optimal migraine treatment strategy in 2024-2025 typically includes both acute treatment (for when migraines occur) and preventive treatment (to reduce frequency). The specific combination depends on your migraine pattern, frequency, and individual circumstances.

For someone with frequent migraines (more than four days per month), a comprehensive approach might include a CGRP preventive like atogepant or a monoclonal antibody taken daily or monthly. An acute treatment like zavegepant nasal spray, Nurtec ODT, or a triptan kept available for breakthrough attacks. Identification and management of migraine triggers. Lifestyle measures including regular sleep, hydration, and stress management.

For episodic migraines (fewer attacks per month), you might focus on effective acute treatment with a CGRP antagonist or triptan and consider Nurtec ODT every-other-day for mild prevention without daily medication.

The beauty of current treatment options is the flexibility to tailor your regimen to your specific needs rather than following a rigid one-size-fits-all protocol.

The Reality of Migraine Treatment Costs

CGRP therapies are significantly more expensive than traditional treatments. In the UK, NHS access depends on meeting eligibility criteria and local formulary decisions. Private treatment costs vary but can range from £200-£600+ monthly for monoclonal antibodies or oral gepants.

However, for many people, the cost must be weighed against the impact of inadequately treated migraines. Lost work days, reduced quality of life, and the cumulative cost of multiple failed treatments all factor into the value equation.

Some manufacturers offer patient assistance programmes. Health insurance through employers may cover CGRP therapies where NHS access is limited. For some patients, switching to private treatment for a period whilst advocating for NHS access may be worthwhile.

What to Expect from Your Doctor

Whether you see an NHS GP, private GP, or specialist, you should expect a thorough assessment of your migraine pattern, frequency, impact on quality of life, previous treatments tried, and other relevant health conditions.

Your doctor should discuss both acute and preventive treatment options, including newer CGRP therapies if appropriate. They should explain expected timelines for effectiveness – atogepant may work within days, whilst monoclonal antibodies typically take 2-3 months to show full effect.

If your GP isn't familiar with newer treatments or says you must try multiple older treatments first despite the AHS position statement, you can request referral to a headache specialist or seek a second opinion through an online GP service.

Hope for the Future

Beyond current treatments, research continues on additional PACAP inhibitors, novel neuromodulation devices (magnetic, electrical, or mechanical stimulation of specific brain areas), and refinements to existing CGRP therapies. Personalised medicine approaches to predict which treatment will work best for individual patients based on genetic or biomarker testing.

The pace of progress in migraine treatment is unprecedented. If you've been suffering with migraines for years, now is an especially hopeful time.

Taking Control of Your Migraine Treatment

You don't have to accept years of suffering whilst slowly working through multiple failed treatments. The American Headache Society's position statement supports considering CGRP therapies as first-line options. New treatments work faster, have better side effect profiles, and were designed specifically for migraine.

If your current treatment isn't working well or causes unacceptable side effects, ask about newer options. If NHS access is limited in your area, consider private consultation to access a wider range of treatments. Advocate for yourself – you deserve effective migraine treatment, not just whatever happens to be cheapest or "next in line."

Modern migraine treatment should mean substantial reduction in attack frequency, effective relief when attacks do occur, and the ability to live your life without constant fear of the next migraine. With treatments now available, this is an achievable goal for most people.

Frequently Asked Questions

What's the difference between CGRP monoclonal antibodies and gepants?

Both target CGRP but through different mechanisms and delivery. Monoclonal antibodies (Aimovig, Ajovy, Emgality, Vyepti) are large protein molecules given by injection monthly or quarterly, primarily for prevention. Gepants (atogepant, rimegepant, ubrogepant, zavegepant) are small molecules taken orally or as nasal spray, used for both acute treatment and prevention depending on the specific medication. Gepants work faster but monoclonal antibodies may provide more consistent prevention for some people.

Can I get CGRP treatments on the NHS?

Atogepant is NICE-approved for NHS use in England for patients with at least four migraine days monthly who've failed three previous preventives. Some CGRP monoclonal antibodies are available on NHS in some areas but access varies by local integrated care board. Your GP or neurologist can advise on local availability. Private prescription is an alternative if NHS access is limited, though costs are significant (£200-£600+ monthly).

How quickly will I know if atogepant works?

Unlike traditional preventives which take 8-12 weeks, research shows atogepant may start reducing migraine frequency within the first week. Most people see significant results within 2-4 weeks. If you've not seen any improvement after 4-6 weeks, discuss with your doctor whether to continue or try a different option. The rapid onset means less time spent wondering if a medication will work.

Can I still use triptans if I'm taking a CGRP preventive?

Yes, it's safe to use triptans for acute treatment whilst taking CGRP preventives like atogepant or monoclonal antibodies. Many patients use this combination. However, some people find that CGRP preventives reduce their need for acute medications. If using CGRP gepants for acute treatment (like rimegepant or ubrogepant), you shouldn't combine them with another CGRP medication on the same day.

What if CGRP treatments don't work for me?

Approximately 30-40% of people don't respond adequately to CGRP therapies. If you've tried multiple CGRP options without success, traditional preventives like topiramate, propranolol, or amitriptyline remain valuable alternatives. The upcoming PACAP inhibitors may provide another option. Combination approaches using both CGRP therapy and traditional preventives are sometimes effective. Neuromodulation devices offer non-medication alternatives.

Are there side effects from CGRP treatments?

CGRP therapies generally have fewer and milder side effects than traditional preventives. Common side effects include mild constipation or nausea with oral gepants, injection site reactions with monoclonal antibodies. Crucially, they don't cause the cognitive impairment, weight gain, fatigue, or mood changes associated with many traditional preventives. This superior tolerability is a key reason they're now recommended as first-line options.

Can I take CGRP medications if I'm pregnant or planning pregnancy?

CGRP therapies aren't recommended during pregnancy as safety data is limited. If you're planning pregnancy or become pregnant, you should discuss options with your doctor. Some traditional preventives are safer in pregnancy. Acute treatments like paracetamol or specific triptans may be used during pregnancy. Always inform your doctor if you're pregnant, planning pregnancy, or breastfeeding.

How long do I need to take preventive migraine medication?

This varies by individual. Some people take preventives for 6-12 months, then gradually taper to see if the migraine pattern has improved. Others need long-term prevention. With CGRP therapies' excellent safety profiles, longer-term use is more feasible than with traditional preventives. Your doctor should regularly review whether continuing prevention is necessary based on your migraine frequency and impact on life.

Can children and teenagers use the new migraine treatments?

Some CGRP therapies are approved for adolescents. Ajovy is approved for episodic migraine prevention in patients aged 6-17 years who weigh 45kg or more. Research on other CGRP therapies in paediatric populations is ongoing. Traditional preventives and acute treatments remain important for younger patients. A paediatric neurologist can advise on the most appropriate options.

How can The Online GP help with migraine treatment?

Online GP consultations can assess your migraine pattern, prescribe acute treatments, prescribe some preventive medications, and provide specialist referrals to headache clinics. For treatments requiring specialist prescribing (like some CGRP therapies), your online GP can fast-track referrals to private headache specialists, avoiding long NHS waiting lists. Same-day consultations mean you can start treatment quickly when experiencing frequent attacks.

Struggling with migraines and want to explore the latest treatment options? The Online GP offers consultations with doctors experienced in migraine management who can prescribe appropriate treatments and arrange specialist referrals when needed.

Message us on WhatsApp to discuss your migraines – we typically respond within 15 minutes and offer same-day appointments. Get the migraine relief you deserve with modern, evidence-based treatment.