However, the new year may bring a groundbreaking new approach, one even he calls "new, revolutionary."
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It is a drug that can stop migraines, and prevent them for 3 months.
The drug isn't just a painkiller, but an antibody that gets to the root of migraine.
It targets CGRP, a protein known to play a role in the pain.
Dr. Silberstein says the drug fremanezumab blocks that protein.
"They worked almost immediately to stop the migraine attack, and the effect persisted for months. In the study I reported, we show that giving the antibody every 3 months was effective in decreasing migraine attack frequency," he says.
Dr. Silberstein says the only side effect was occasional pain at the injection site.
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Like many migraine medications, it works in about half the patients.
"What we don't understand, since we know that CGRP is part of the mechanism of the migraine, why doesn't work for everybody?" says Dr. Silberstein.
"What we suspect is that there may be more than one mechanism. And new chemical entities are being developed to look at those people who do not respond to CGRP," he notes.
But when it works, it's VERY effective.
"Some people have a 75 or 100% improvement," he says.
The drug is expected to get FDA approval by mid-2018.