Abstract
Migraine is a common and highly disabling neurological disorder associated with a high socioeconomic burden. Effective migraine management depends on adequate patient education: to avoid unrealistic expectations, the condition must be carefully explained to the patient soon as it is diagnosed. The range of available acute treatments has increased over time. At present, abortive migraine therapy can be classed as specific (ergot derivatives and triptans) or non-specific (analgesics and non-steroidal anti-inflammatory drugs). Even though acute symptomatic therapy can be optimised, migraine continues to be a chronic and potentially progressive condition. In addition to the drugs officially approved for migraine prevention by international governmental regulatory agencies, numerous different agents are commonly used for this indication, showing various levels of evidence of efficacy and tolerability. Guidelines published in recent years, based on evidence-based medicine data on migraine prophylaxis, are a useful source of guidance, especially for primary care physicians and neurologists without specific expertise in headache medicine. Although the field of pharmacological migraine prevention has seen few advances in recent years, potential novel approaches are now being developed. This review looks at emerging pharmacological strategies for acute and preventive migraine treatment that are nearing or have already entered the clinical trial phase. Specifically, it discusses preclinical and clinical data on compounds acting on calcitonin gene-related peptide or its receptor, the serotonin 5-HT1F receptor, nitric oxide synthase, and acid-sensing ion channel blockers.
Highlights
Migraine is a common and highly disabling neurological disorder associated with a high socioeconomic burden
Migraine is a common and highly disabling primary headache form associated with a high socioeconomic burden and a generally high prevalence
Eletriptan In a meta-analysis of six randomised, controlled trials of eletriptan involving 3224 patients, eletriptan at doses of 20, 40, and 80 mg performed significantly better than placebo for all the main outcomes
Summary
B B effects (most commonly nausea and vomiting, and cramps, sleepiness and transient lower limb muscle pain). Dihydroergotamine (DHE) is usually better tolerated than ergotamine, but less effective due to its poor oral bioavailability. A major problem with ergot derivatives is ergotamineinduced headache and rebound headache associated with frequent use These problems can be limited by introducing a preventive therapy as the headache becomes more frequent. Triptans Introduced nearly 25 years ago, the triptans, a class of selective and highly effective 5-HT1B/1D receptor agonists, have largely replaced the ergot derivatives. Sumatriptan As shown by the results of systematic reviews and metaanalyses (Derry et al 2012), the subcutaneous, oral and intranasal preparations of sumatriptan have shown evidence of efficacy in randomised, placebo-controlled trials of acute migraine therapies; in a single placebo-controlled trial, the novel transdermal formulation was found to be effective (Goldstein et al 2012). Subcutaneous sumatriptan (6 mg) has the fastest onset of action and is more effective than oral sumatriptan
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