New migraine prophylactic drug options.

Abstract

The review article published in this issue, concerning new options for preventive drug treatment of migraine, deals with a subject that always draws the attention of both general practitioners and neurologists because of the high frequency with which they are confronted with doubts related to treatment in everyday practice. Several drugs are reported to be useful and consequently are used for both acute and preventive treatment of migraine attacks, with a wide range of efficacy between them that probably arises from different individual responses, which arise from different pathophysiologic factors that may be involved in each case. Several drugs have been tested for their therapeutic efficacy in wellconducted, double-blind, placebo-controlled clinical trials. Nevertheless, patients often have a disappointing clinical response. From time to time, review articles are published on the subject, and although they suggest that several drugs are efficient in decreasing migraine frequency and/or intensity, they also show that we are far from identifying the ideal drug. This failure is most certainly related to our poor understanding of the basic disease mechanisms. Perhaps it would be more appropriate to address migraine as a group of closely related entities, since there are different types of migraine (with differences in the intensity, triggering, and associated factors, presence or absence of the different types of aura, etc.), probably with different pathophysiologic etiologies. Even the mechanisms of action of the various drugs that are used in preventive migraine treatment are not fully understood. The placebo effect is particularly high, not only in preventive therapy, but also in the acute phase, ranging from 20% to 70%, according to reports in the literature. This fact only adds to the difficulties in studying drug efficacy in a disease in which psychosomatic or other environmental factors seem to play such an important role in its symptomatic expression. Therefore, even studies that adhere to the strict rules of scientific research must be interpreted with caution when they test a new drug option. Other investigators must retest these drugs before they can be accepted as really useful. The review article reports on the efficacy of