The first significant attack Michelle Tracy experienced took place in August 2004. It was the summer between her freshman and sophomore year at The University of Massachusetts Amherst. The pain, which radiated from the left side of her forehead to the base of her skull in throbbing waves, began early in the day. As the minutes and hours ticked by, the pain swelled into an excruciating force.

Her parents’ living room, where she was riding out the episode, became nightmarishly amplified. Everything was too bright, too noisy, too smelly. “It was all too much,” says Tracy. She grew dizzy. When she began vomiting uncontrollably, her mom drove her to the emergency room. Tracy sobbed the entire 20-minute ride there.

At the hospital, a CAT scan and blood tests ruled out an aneurysm or meningitis. Given her symptoms, the attending physician on duty suspected Tracy was having a migraine — a headache that lasts between four and 72 hours, is severe enough to impact a person’s daily routine, and is accompanied by symptoms such as nausea and sensory sensitivity. Tracy was admitted to the hospital overnight and given saline fluid and a cocktail of medication administered via IV for the nausea and pain; she left the hospital the next day feeling loopy, but better. “I didn’t realize that was the beginning,” she says. In retrospect, this first attack “was a demarcation,” Tracy says. There was life before the migraine attacks, and then there was life after.

Chronic migraine disorder, which a neurologist diagnosed Tracy with shortly after her initial ER visit, is defined as having 15 or more days with a headache that lasts four hours or more, in a given month. While migraine attacks are common — an estimated 20% of women and 6% to 10% of men in the U.S. suffer from them — the chronic form of the condition is more rare, afflicting an estimated 10% of people with migraine.

“You go through this trial and error with medication. You never know, ‘Is this going to help? Is it not going to help?’”

Over the next decade and a half, Tracy dealt with migraine attack symptoms that fluctuated in their severity, frequency, and length — lasting anywhere from a couple hours to three days (a common experience for people with migraine disorder). At times, her pain was near-constant. To quell it, she tried dozens of medications that are used off-label to treat migraine, including nerve blockers, Botox injections, anti-seizure medications, an array of blood pressure drugs and antidepressants, cannabis, steroids, and much more. None of them worked particularly well for her, and even when there was a benefit, the effects usually faded over time. There were also side effects like anxiety, forgetfulness, a tingling in her arms and legs, and insomnia. “You go through this trial and error with medication,” Tracy says. “You never know, ‘Is this going to help? Is it not going to help? Or is it going to make things worse?’ You start to have this loop in your head: ‘Is this worth it?’” Her migraine disorder got so bad she took a leave of absence from school, graduating three years after her freshman-year classmates. After college, she worked as a preschool teacher but the attacks worsened again; in 2011, she was let go for missing too much work.

Then, in the summer of 2015, Tracy’s neurologist told her that a new targeted therapy for migraine — the first developed specifically to treat the condition — was being developed.

In May 2018, the first drug in this class, Aimovig, was approved by the U.S. Food and Drug Administration (FDA) for episodic and chronic migraine. Brought to market by the pharmaceutical company Amgen, Aimovig is a calcitonin gene-related peptide (CGRP) inhibitor. It prevents migraines by stopping a protein fragment called CGRP — which is involved in the formation of migraine attacks — from binding to CGRP receptors in the brain, effectively blocking the migraine from developing.