Optimising migraine treatment: from drug-drug interactions to personalized medicine

Abstract

Migraine is the most disabling and expensive chronic disorders, the etiology of which is still not fully known. The neuronal systems, (glutammatergic, dopaminergic, serotoninergic and GABA-ergic) whose functionality is partly attributable to genetically determined factors, has been suggested to play an important role. The treatment of acute attacks and the prophylactic management of chronic forms include the use of different category of drugs, and it is demonstrated that not each subject has the same clinical answer to them. The reason of this is to be searched in different functional capacity and quantity of phase I enzymes (such as different isoforms of CYP P450), phase II enzymes (such as UDP-glucuronosyltransferases), receptors (such as OPRM1 for opioids) and transporters (such as ABCB1) involved in the metabolic destiny of each drug, all of these dictated by DNA and RNA variations. The general picture is further exacerbated by the need for polytherapies, often also to treat comorbidities, which may interfere with the pharmacological action of anti-migraine drugs. Personalized medicine has the objective of setting the optimal therapies in the light of the functional biochemical asset and of the comorbidities of the individual patient, in order to obtain the best clinical response. Novel therapeutic perspectives in migraine includes biotechnological drugs directed against molecules (such as CGRP and its receptor) that cause vasodilatation at the peripheral level of the meningeal blood vessels and reflex stimulation of the parasympathetic system. Drug-drug interactions and the possible competitive metabolic destiny should be studied by the application of pharmacogenomics in large scale. Drug-drug interactions and their possible competitive metabolic destiny should be studied by the application of pharmacogenomics in large scale.

Headache medication and the COVID-19 pandemic

“…Apart from the usual considerations, such as drugdrug interactions or gastrointestinal safety the NSAIDs [7], in view of the suggested increased risk for COVID-19 infection by RAS inhibitors and ibuprofen, many clinicians now need to know what to advice their patients: continue treatment or not. The relation between RAS blockade and the COVID-19 pandemic in hypertensive patients has recently been discussed, and the advice was to continue RAS blocker treatment in such patients [4].…”

Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons

“…In both cases (PPTH and MO), the possibility that the treatments are ineffective and induce chronicity associated with an overuse of medicaments could be sought in a non-optimal choice of the drug. The target of this therapeutic failure to date seems to be the personalized approach [14]. This review points to evaluate similarities and differences between migraine and PPTH, mainly considering the pathophysiology and the pharmacological treatment.…”

Migraine Literacy and Treatment in a University Sample

“…Migraine is a disorder associated with considerable disability, suffering, and cost [10]. While promising new drugs are being developed [11], these do not address the substantial problems surrounding appropriate diagnosis and treatment of migraine that still remain.…”