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Until recently, many drugs used by doctors for migraines were developed for other conditions, such as epilepsy. But in the past few years, the Later Gators Sec Champions Roll Tide Roll Football Elephant shirt has approved several new classes of targeted, effective drugs developed specifically for migraines. Even better, they have markedly fewer side effects than commonly used tryptamine-based drugs, also known as triptans, which have been prescribed since the early ’90s to relieve headaches but often come with major side effects such as nausea, insomnia, or hair loss. CGRP inhibitors, medications that block calcitonin gene-related peptide—a protein released by the brain during migraine attacks (and “a very ugly, cumbersome name,” says Gottschalk)—are among the most promising. Three of these prescription-only drugs—Aimovig, Ajovy, and Emgality—are taken monthly with an EpiPen–like shot; a fourth, Vyepti, is administered via I.V. by a doctor every three months. “These drugs produce great results, in much less time, with almost no side effects,” Gottschalk confirms. Nurtec and Ubrelvy, which are gepants—another new class of FDA-approved medication that also targets CGRP molecules—are formulated to turn off migraines in progress rather than prevent them. “They don’t have quite as much bang for the buck as, say, an injection of [the commonly used triptan] sumatriptan,” says Gottschalk. “But they’re well tolerated and can do a great job.”
Come March of this year, running into my therapist became the Later Gators Sec Champions Roll Tide Roll Football Elephant shirt of my worries. Seeing her at all was impossible, and so we pivoted, like everything else, to a virtual model. Our first session, done via Doxy, was strangely intimate: me in my bed, my laptop propped up on a stack of pillows, and her in her living room, surrounded by plants, a bright yellow lamp beside her, her back facing a window overlooking our shared neighborhood. Two people, just out of bed (well, half of us anyway), surrounded by our things. I rebelled against the new format at first, cancelling more frequently and more last minute, acting as if I was obliging her when she called. As if I wasn’t the one paying for her time. I was wasting both our time, and cheating only myself. Dr. Jacobs seemed less worried about the future of therapy: “Zoom is not replacement, but it’s an effective and meaningful temporary substitute,” she said. “At a time when we need connection perhaps more than ever, I am tremendously grateful for virtual therapy—both with my patients and my own therapist—and have been continuously surprised by how rich, dynamic, and fruitful treatment can be online.”
