If you have migraine, you have probably been handed a medicine that was designed for something else. Blood pressure pills. Antidepressants. Epilepsy drugs. Botox. For decades, that was the prevention toolbox, and it worked for some people some of the time. In 2018 the first medicine ever built specifically to prevent migraine was approved, and in the eight years since, the field has moved faster than in the fifty before it.
Migraine affects about 1 in 7 people worldwide and is the second leading cause of years lived with disability worldwide. This article covers what treatment looks like today, who still falls through the gaps, what researchers are testing right now, and where clinical trials fit in.
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What migraine treatment includes today
Treatment has two jobs: stopping an attack once it starts, and cutting down how often attacks happen in the first place. Most people with frequent migraine need both.
Medicines for an attack in progress. Over the counter pain relievers work for mild attacks. Triptans, around since the 1990s, are the classic migraine specific medicine, though they narrow blood vessels, so they are not recommended for people with heart disease. Newer drugs called gepants, pills like ubrogepant and rimegepant plus a nasal spray called zavegepant, block CGRP signaling instead and do not carry that heart concern.
Older preventive medicines. Beta blockers, topiramate, amitriptyline, and similar drugs are still widely used and still help a lot of people. Their weak point is that people often stop taking them: real world studies show roughly a quarter to a third of people are still on an oral preventive after a year.
The CGRP era. CGRP is a molecule the brain releases during a migraine attack, and blocking it turned out to prevent attacks from happening. Four antibody medicines given by injection or IV (erenumab, fremanezumab, galcanezumab, eptinezumab) arrived starting in 2018, and the pill atogepant became a daily preventive option too. In a 2025 real world study of about 2,400 people, 47 percent of those on galcanezumab saw a meaningful improvement at three months, compared with 35 percent on older preventives.
Botox. OnabotulinumtoxinA (Botox) has been approved for chronic migraine since 2010 and is still a standard option for people with 15 or more headache days a month.
What researchers are studying now
The next target after CGRP. About a third of people still are not seeing improvement after a year on CGRP medicines. The leading next idea for them is PACAP, another molecule involved in migraine attacks. Antibodies that block PACAP or its receptor are being tested in people who have already failed several preventive medicines, including CGRP treatments, exactly the group with the fewest options left.
Head to head comparisons doctors actually need. With so many preventive medicines available now, the real question is which one works best for which patient. The APT comparison study is directly comparing migraine preventive medicines against each other, the kind of trial drug companies rarely pay for since there is no new product being sold.
Botox for both types of migraine. Two trials on our platform are testing incobotulinumtoxinA (Xeomin) for chronic migraine and for episodic migraine, which could extend botulinum toxin treatment beyond the chronic migraine group it is approved for today.
Menstrual migraine is finally getting its own studies. Migraine linked to the menstrual cycle is common, often worse than usual, and has historically been left out of research. A study testing rimegepant in women to prevent migraine around their period is one of several now designed specifically for this.
When nothing else has worked. For people whose chronic migraine has not responded to anything, a study of a procedure called middle meningeal artery embolization is testing a minimally invasive way to block a small artery near the brain, a completely different approach from taking medicine.
Unusual approaches, and a group most trials skip. A cocoa extract trial is testing a dietary approach, a study of psilocybin is looking into why some people report feeling better for a long time after just one dose, and a study in children with headaches covers a group that almost every adult migraine trial leaves out. New drug candidates keep showing up too, like EVO756, now being tested in adults with migraine.
Why migraine research takes time
The diary problem. There is no scan or blood test that shows migraine. Trials measure success by counting migraine days in a diary, usually over 12 weeks after a 4 week starting period. That means every trial needs months just to get a baseline, and it all depends on people logging their attacks honestly and consistently.
The placebo problem. Migraine has one of the strongest placebo effects in medicine. In prevention trials, people taking placebo often still lose two or three migraine days a month on their own. A real drug has to beat that, which means trials need hundreds of people to prove it actually works.
The many kinds of migraine problem. Episodic and chronic migraine are studied as separate groups, menstrual migraine gets its own studies too, and people who take too much pain medicine are usually left out entirely. Each group needs its own trial, which multiplies both the work and the time it takes.
The representation problem. Migraine affects women about three times as often as men, is common in Black and Hispanic Americans, and is underdiagnosed in both groups, yet the people in trials skew white and well insured, and headache specialists are concentrated in only a handful of states. Several current studies name better access and diverse enrollment as goals. Here's why diversity in clinical trials matters so much.
Episodic and chronic migraine, and what care usually looks like
Episodic migraine means fewer than 15 headache days a month. It is usually treated with a medicine for the attack itself, plus a preventive medicine if attacks happen often or get in the way of daily life. Chronic migraine means 15 or more headache days a month for more than three months, and at that point a preventive medicine becomes essential, with CGRP drugs, Botox, or the older traditional drugs as the main choices. Care often also includes treating depression, anxiety, or sleep problems, since these commonly show up alongside chronic migraine. This describes usual practice, not a recommendation, your plan belongs to you and your doctor.
For trials, your monthly headache count is what matters most. Study titles say episodic or chronic right up front, and screening almost always includes a diary period to confirm which one you have. Knowing your numbers lets you filter studies in minutes.
Common myths about migraine
"It's just a headache."
Migraine is a neurological disease with a genetic basis, and the Global Burden of Disease study ranks it the second leading cause of years lived with disability worldwide. A headache is one symptom of it.
"You can just take a painkiller."
Frequent painkiller use can actually make migraine worse, a condition called medication overuse headache. People with more than a few attacks a month usually do better with prevention.
"Migraine is caused by stress."
Stress can trigger an attack in someone who already has migraine, but it does not cause the disease. Genes do most of that work, which is why migraine runs so strongly in families.
"Nothing new has come out in years."
The opposite. Since 2018, four antibodies and four gepants designed specifically for migraine have been approved, and the next target after CGRP is already in trials.
How to find a migraine clinical trial
AllClinicalTrials.com lists migraine studies recruiting across the US, from new preventives to menstrual migraine research and pediatric studies. Right now that includes a study testing rimegepant for menstrual migraine prevention, and a study on headaches in children.
The application takes about 5 minutes: you answer questions about your attack frequency, type, and treatment history, and if a study near you looks like a match, the research team contacts you. Nothing is decided until you have gone through informed consent, and participation is voluntary at every step.
Three things to have ready: your average migraine days per month, whether you have been told your migraine is episodic or chronic, and the list of preventives you have tried. Those three answers decide eligibility for most migraine studies.
Common questions
What is the best treatment for migraine? There is no single best. For attacks, triptans and gepants are the migraine specific options. For prevention, CGRP antibodies and gepants have the strongest recent evidence and the best adherence, but traditional preventives and botulinum toxin still work well for many people. The right choice depends on frequency, other health conditions, and what you have tried.
What is the newest migraine medication? The most recent additions are in the gepant class, including a nasal spray for attacks and a daily pill for prevention. The next wave, antibodies against PACAP, is designed for people who do not respond to CGRP medicines and is currently in trials.
How is chronic migraine treated? Usually with a preventive medicine as the foundation, most often a CGRP antibody, botulinum toxin injections, or a traditional oral preventive, plus an acute medicine for attacks and attention to sleep, mood, and medication overuse. Most new prevention trials enroll people with chronic migraine.
Do migraine trials use placebo? Often, yes, especially in prevention trials, because a placebo comparison is how researchers separate a drug's effect from migraine's famously strong placebo response. Participants can usually keep their acute medicines, and many trials offer the active drug afterward.
See migraine clinical trials recruiting now
Browse open studies, filter by location, and apply in about 5 minutes: Migraine Clinical Trials