New drugs for migraine

Abstract

After the triptans, a calcitonin gene-related peptide blocker (telcagepant) is the first acute medicine that has been developed primarily for treatment of acute migraine. Otherwise, the new drugs have been developed first for other purposes, like anticonvulsants, antihypertensives and antidepressants used for migraine prophylaxis. For acute attacks, a new way to administer a traditional drug like dihydroergotamine is under way, and documentation of efficacy in migraine has been gained for some commonly used painkillers and anti-inflammatory drugs, and for some herbal extracts. Based on insights into the basic pathophysiological mechanisms of the disorder, some drugs have been developed which seem promising in early phase II studies (NOS inhibitors and 5HT1F-receptor agonists). In the future, development and enhancements of existing medicines must be accompanied by increased efforts to develop truly new migraine drugs based on knowledge of the pathophysiology if one wishes to reduce substantially the great burden migraine poses on patients and society.

Chronic migraine: comorbidities, risk factors, and rehabilitation

“…The study reports no particular differences among treatments in terms of efficacy, but there is a significant difference for what concerns safety profiles, which is definitely in favor of OnabotulinumtoxinA. In fact, adverse events due to Topiramate therapy result more often in abandoning the treatment itself [52].…”

“…The majority of AEs appears during the titration period, generally within 6 weeks. These data suggest that if patients do not present AEs by the end of such period, they will be safe from such events [52].…”

“…The use of topiramate in preventing migraine's chronicization process or in reverting consolidated CM is well known [51,52]. In migraine, topiramate acts by reducing nociceptive transmission at the central system level through trigeminovascular modulation and inhibition of the cortical spreading depression [53].…”

Rehabilitating chronic migraine complicated by medication overuse headaches: how can we prevent migraine relapse?

“…The future in relapse prevention of CM complicated by MOH consists in considering how drugs currently used such as triptans and emerging therapies present responsivity profiles related to well-defined genetic polymorphisms [40][41][42][43].…”

Meningeal Afferent Signaling and the Pathophysiology of Migraine

“…Triptans alone account for up to 80% of medications prescribed for migraine. 2,19,20 Despite the high propensity of their use, triptans are not always effective. For example, the percentage of patients that report being completely pain-free 2 h after dosing ranges from 12% (frovatriptan 2.5 mg) to 40% (rizatriptan 10 mg).…”