Prevention Of Migraine Attacks Research Articles

Experience of using Russian rizatriptan 10 mg tablets in routine clinical practice: results of a multicenter post-registration observational study “OPYT”

One of the key mediator systems involved in the pathogenesis of migraine is the serotonergic system, which led to the development and introduction of serotonin 5-HT1 receptor agonists (triptans) into clinical practice as the most important means of preventing migraine attacks. Serotonin 5-HT1 receptor agonists have a high selectivity for the 5-HT1B and 5-HT1D receptor subtypes, which ensures their effect on the pathogenesis of migraine attack development.Objective: to evaluate the efficacy of a standard dose of Relonova in the relief of four moderate to severe migraine attacks in outpatients in reallife clinical practice, including assessment of the rate of attack relief, the effect of the drug on headache intensity, concomitant symptoms and the general condition of the patient.Material and methods. The study involved 415 patients with migraine (319 women and 96 men; mean age 35.7±7.8 years). A total of 1660 migraine attacks were analyzed. The average number of migraine days per month was 6.72±3.99. Migraine attacks with aura were observed in 125 patients (30.1%). Patients stopped four migraine attacks and filled out self-monitoring diaries. Treatment efficacy was assessed according to the European Headache Federation (EHF) Consensus Algorithm for Determining Effective Treatment of a Migraine Attack.Results. After taking Relonova, pain became mild or disappeared completely in 30 minutes in 52% of patients, in 76% in 1 hour, in 93% in 2 hours, in 99% in 4 hours and in 99% of patients in 24 hours. A recurrence of the headache occurred in 8.8% of the attacks. Additional analgesic treatment after 30 minutes was required in 14% of cases, after which period the frequency did not exceed 2%. Adverse events were observed in 4% of patients and were mild. The overwhelming majority (90%) of study participants were able to successfully terminate three attacks and were responders.Conclusion. Relonova is an effective and safe agent to stop migraine attack and can be recommended for use in daily clinical practice.

Association between composite dietary antioxidant index and migraine in American young women: insights from NHANES 1999-2004 cross-sectional data.

Excessive oxidative stress is one of the key pathophysiological mechanisms underlying migraine, and increasing antioxidant intake has proven to be an effective strategy for the prevention and improvement of migraine symptoms. To explore the relationship between the composite dietary antioxidant index (CDAI) and the occurrence of migraine attacks. Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2004 were utilized. Logistic regression, stratified analysis, and restricted cubic spline (RCS) models were employed to investigate the association between CDAI and migraine attacks. A total of 8,137 adults aged ≥20 were enrolled, comprising 1,610 patients with migraine and 6,527 non-migraine individuals. After adjusting for all covariates, CDAI was negatively correlated with migraine. In the overall participants, compared with the CDAI Q1 (-5.83 to -2.14) group, the adjusted odds ratio (OR) for migraine in Q3 (-0.59 to 1.53) and Q4 (1.53-44.63) groups were 0.71 [95% confidence interval (95% CI): 0.54-0.92, p = 0.011] and 0.64 (95% CI: 0.47-0.87, p = 0.005), respectively. After stratifying by age and gender, the protective effect was more pronounced in females aged 20-50, with adjusted OR for Q3 (-0.59 to 1.53) and Q4 (1.53-44.63) groups of 0.60 (95% CI: 0.40-0.90, p = 0.013) and 0.48 (95% CI: 0.30-0.78, p = 0.003), respectively. The RCS curve indicated a nonlinear relationship between CDAI and migraine in females aged 20-50, with a threshold of 0.006. CDAI is negatively correlated with migraine attacks, and a higher CDAI may be an effective protective factor in preventing migraine attacks, especially in women aged 20-50.

Comparison of the Efficacy of Propranolol Versus Valsartan in the Prevention of Migraine: A Randomized Controlled Trial

BackgroundMigraine is a prevalent episodic headache that affects approximately 14%-15% of the global population. Since valsartan is an antihypertensive drug, it is hypothesized that taking valsartan can prevent migraine attacks in patients with the condition. This study aimed to determine the efficacy of propranolol versus valsartan in preventing migraine attacks. Material and MethodsThis randomized controlled trial was conducted on 56 patients with migraine from a neurology clinic. Patients were divided into two equal groups of 28 individuals, after providing informed consent. The patients then received either propranolol or valsartan treatment. The intensity and frequency of migraines were compared before and after treatment in both study groups. ResultsThe patients’ mean age was 32.78 years old (±6.9 SD), and 64% of the patients were female. After a 1-month treatment period, the results showed that valsartan patients experienced significantly fewer severe migraine attacks compared to propranolol patients. ConclusionAccording to the results of the present study, valsartan may be at least as effective as propranolol and perhaps more effective on some measures.

Exploring the link between self-management of migraine and emotional wellbeing: a cross-sectional study of community-dwelling migraine sufferers

BackgroundGlobally, an estimated 14% of adults live with migraine disease which impacts their physical, emotional and social wellbeing. To target the disease comprehensively, research recommends a multidisciplinary approach to migraine management. Yet, at present, migraine management primarily centers around pharmaceutical treatments. The aim of this study was to investigate the extent to which emotional awareness could influence the uptake of self-care behaviours of community-dwelling adults with migraine.MethodsA cross-sectional online survey explored personal experiences with migraine disease and strategies or behaviours to manage migraine attacks. Chi-squared tests were used to investigate differences in ratings of migraine prevention and management strategies between users and non-users of the strategies. Univariable logistic regressions were used to assess the effectiveness of self-care behaviours to manage or prevent migraine attacks.ResultsWe surveyed 170 community-dwelling adults with migraine in the United Kingdom, Austria, Germany and the United States. Most (85%) respondents had experienced migraine for over five years, where 42% of attacks usually lasted several days. Whereas we did not differentiate between diagnosis by a neurologist or self-diagnosis, the most common diagnoses in the cohort were migraine without aura (38.9%) and migraine with aura (29%). Staying hydrated was the most popular preventative strategy (87%), 70.2% used prescription medication and 64.9% changed their diet and/or supplements. Almost all ( 92.4%) respondents stated that their mood or emotions could trigger their migraine attacks. Keeping a headache or mood diary was the lowest-rated prevention strategy and was rated as "probably ineffective" or causing "no change" in preventing migraine attacks. Over a third (39.7%) kept track of their physical wellbeing and symptoms. Reasons stated for tracking symptoms included to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%) or deteriorations (67.3%).ConclusionsMigraine management is dominated by pharmaceutical management for acute pain attacks and lifestyle changes for managing migraine long-term. Perception of the effectiveness of those techniques is high, whereas perception of interventions that target the emotional or psychological components of chronic pain management (keeping a mood diary, and mental health support) is mixed. There exists a gap between the recommended biopsychosocial approach and the current state of migraine management.Graphical

Efficacy of Probiotics in Prevention of Migraine Attacks in Children: A Randomized Clinical Trial Study.

Migraine is a chronic and joint disease in children. The results of previous studies on the effectiveness of probiotics in preventing migraine attacks in children have been controversial. This study aims to investigate the effect of probiotics on migraine prophylaxis in children. In this clinical trial study, 41 children aged 5 to 15 with migraine enrolled the study in two control and intervention groups. Children in the intervention group (18 children) received propranolol at a dose of 1 mg per kilogram of body weight daily in two divided doses along with a 250 mg Yomogi capsule daily for three months, and children in the control group (23 children), received propranolol along with placebo for three months. The study compared the frequency and duration of headache days, PedMIDAS criteria, and parental satisfaction between the two groups before treatment, as well as one month and three months post-treatment. The number of headache days in both groups decreased over time, but in the intervention group, this decrease was more than the control group was statistically significant (P=0.045). The average PedMIDAS scale after treatment in the intervention group was 3.9 ± 3.8; in the control group, it was 8.4 ± 8.2, which was statistically significant (P=0.047). Parents' satisfaction with the treatment was statistically significantly higher in the intervention group (94.4%) than in the control group (54.5%) (P=0.011). No significant drug complications were seen in any of the two groups. In children with migraine, adding probiotics to migraine treatment reduces the intensity and number of days of children's headaches and increases the Parents' satisfaction with the treatment.

A randomized, double-blind, placebo-controlled parallel trial to test the effect of inulin supplementation on migraine headache characteristics, quality of life and mental health symptoms in women with migraine.

Migraine is a complex neurovascular disorder characterized by recurrent headache attacks that are often accompanied by symptoms such as vomiting, nausea, and sensitivity to sound or light. Preventing migraine attacks is highly important. Recent research has indicated that alterations in gut microbiota may influence the underlying mechanisms of migraines. This study aimed to investigate the effects of inulin supplementation on migraine headache characteristics, quality of life (QOL), and mental health symptoms in women with migraines. In a randomized double-blind placebo-controlled trial, 80 women with migraines aged 20 to 50 years were randomly assigned to receive 10 g day-1 of inulin or a placebo supplement for 12 weeks. Severity, frequency, and duration of migraine attacks, as well as depression, anxiety, stress, QOL, and headache impact test (HIT-6) scores, were examined at the start of the study and after 12 weeks of intervention. In this study, the primary outcome focused on the frequency of headache attacks, while secondary outcomes encompassed the duration and severity of headache attacks, QOL, and mental health. There was a significant reduction in severity (-1.95 vs. -0.84, P = 0.004), duration (-6.95 vs. -2.05, P = 0.023), frequency (-2.09 vs. -0.37, P < 0.001), and HIT-6 score (-10.30 vs. -6.52, P < 0.023) in the inulin group compared with the control. Inulin supplementation improved mental health symptoms, including depression (-4.47 vs. -1.45, P < 0.001), anxiety (-4.37 vs. -0.70, P < 0.001), and stress (-4.40 vs. -1.50, P < 0.001). However, no significant difference was observed between the two groups regarding changes in QOL score. This study provides evidence supporting the beneficial effects of inulin supplement on migraine symptoms and mental health status in women with migraines. Further studies are necessary to confirm these findings. Trial registration: Iranian Registry of Clinical Trials (https://www.irct.ir) (ID: IRCT20121216011763N58).

Management of Paediatric Migraine - A Brief Review

Purpose: Paediatric migraine is a common and debilitating neurological condition that affects a significant number of children worldwide. Episodes of moderate to severely severe headaches, frequently accompanied by nausea, photophobia, and phonophobia, are the most typical indications and symptoms. Effective management of Paediatric migraines requires a comprehensive approach that includes acute treatment of individual attacks, preventive strategies, and lifestyle modifications. Acute treatment options for paediatric migraines primarily involve the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) as initial medication treating episodes that are mild to severe. In cases of severe or refractory migraines, triptans may be considered. Preventive strategies occupy a crucial part in reducing the frequency and the degree of intensity of paediatric migraines. These strategies include the use of medications such as antiepileptic drugs, beta-blockers, and tricyclic antidepressants. Lifestyle modifications are integral to the management of Paediatric migraines. Identifying and avoiding triggers, maintaining regular sleep patterns, promoting a healthy diet, and managing stress are key elements in preventing migraine attacks. Design/Methodology/Approach: All pertinent standard papers were briefly reviewed and relevant data was extracted. Findings/Result: The management of paediatric migraines requires a multidimensional approach that encompasses acute treatment, preventive strategies, lifestyle modifications, and healthcare professional involvement. By implementing evidence-based practices tailored to each child, healthcare providers can significantly improve the quality of life for paediatric headache migraine sufferers and minimize the impact of this condition on their overall well-being. Originality/Value: This review article focuses on a thorough summary of the existing research regarding the management of paediatric migraine Paper Type: Review Article

Tai Chi for the prophylaxis of episodic migraine: protocol of a non-inferiority randomized controlled trial with mechanism exploration

BackgroundMigraine is a complex neurovascular disorder with considerable clinical, social and economic issues. Tai chi has the potential to be an alternative prophylactic treatment for migraine with high safety since the adverse effects and limited efficacy of available medications.AimsThe proposed study aims to compare the prophylaxis efficacy of 24-week Tai Chi training on migraine attacks with the standard prophylactic medication; and to explore the mechanism of Tai Chi in preventing migraine attacks by analyzing the associations between changes of migraine attacks and changes of neurovascular functions and inflammatory makers.MethodThis is a two-arm parallel non-inferiority randomized controlled trial. In total 220 Hong Kong Chinese women aged 18–65 years with diagnosis of episodic migraine will be recruited and randomized to either the Tai Chi training group or the standard prophylactic medication group with 1:1 ratio, and receive the 24 weeks of modified 33-short form Yang-style Tai Chi training and the standard prophylactic medications, respectively. A 24-week follow-up will be implemented for both groups. For efficacy examination, the primary outcome was the frequency of migraine attacks measured by the migraine diary; and for the mechanism exploration, the primary outcome was the volume and number of white matter hyperintensity (WMH) measured by magnetic resonance imaging (MRI). The measurements will be conducted at the baseline, 24th weeks, and 48th weeks. Linear mixed model will be adopted to comprehensively analyze the changes of variables within and between groups.DiscussionGiven the importance of reducing disease burden and financial cost of migraine attacks, the findings of this study will provide new insights regarding the role of Tai Chi in alleviating migraine burden and further shed light on the mechanism action of Tai Chi on preventing headache attacks.Trial registrationClinicalTrials.gov NCT05690737. Registered on January 28, 2023.

Auriculotherapy in prevention of migraine attacks: an open randomized trial.

Use of auriculotherapy to prevent episodic migraine pain has seldom been reported. The aim of this open study was to show that three sessions of auriculotherapy, 1 month apart, using semi-permanent needles decrease frequency and intensity of an attack in patients presenting episodic migraine. A total of 90 patients were randomized to the treatment group (AUR group, n = 58) or the control group (C group, n = 32). Four patients dropped out during the study (three in the AUR group and one in the C group). The number of days with migraine and non-migraine headache was similar when the analysis focused on the 3 months of the study or on the difference in each group of this number between the 3 months preceding the inclusion and the 3 months of the study (p = 0.123). AUR group patients had fewer days with non-migraine headache (p = 0.011) and took less Triptans (p = 0.045) than group C. Number of days with migraine, sum of the pain intensities of all migraines and non-migraine headaches, and total number of analgesics taken, other than triptan, were similar between groups. MIDAS score decreased with time in the AUR group while it increased in the C group whether in absolute values (p = 0.035) or as categories (p = 0.037). These contrasted results should lead to further study of the effectiveness of auriculotherapy for the prevention of migraine. Clinical trail registration: Protocol registered on the Clinicaltrials.gov, website (January 30, 2017, NCT03036761).

Migraine drugs

According to recent studies, migraine affects more than 1 billion people worldwide, making it one of the world’s most prevalent diseases. Although this highly debilitating illness has been known since ancient times, the first therapeutic drugs to treat migraine, ergotamine (Gynergen) and dihydroergotamine (Dihydergot), did not appear on the market until 1921 and 1946, respectively. Both drugs originated from Sandoz, the world’s leading pharmaceutical company in ergot alkaloid research at the time. Historically, ergot alkaloids had been primarily used in obstetrics, but with methysergide (1-methyl-lysergic acid 1′-hydroxy-butyl-(2S)-amide), it became apparent that they also held some potential in migraine treatment. Methysergide was the first effective prophylactic drug developed specifically to prevent migraine attacks in 1959. On the basis of significantly improved knowledge of migraine pathophysiology and the discovery of serotonin and its receptors, Glaxo was able to launch sumatriptan in 1992. It was the first member from the class of triptans, which are selective 5-HT1B/1D receptor agonists. Recent innovations in acute and preventive migraine therapy include lasmiditan, a selective 5-HT1F receptor agonist from Eli Lilly, the gepants, which are calcitonin gene-related peptide (CGRP) receptor antagonists discovered at Merck & Co and BMS, and anti-CGRP/receptor monoclonal antibodies from Amgen, Pfizer, Eli Lilly, and others.Graphical abstract

Propranolol: A migraine prophylactic since the 1960s

IntroductionPropranolol was the first non-selective beta-adrenergic blocker to be developed. Initially it was used in the treatment of cardiovascular diseases, but since the 60's it has been used in the prevention of migraine.ObjectiveThe objective of this study was to know the history of propranolol and its use as a migraine prophylactic.MethodsThis study was an integrative literature review using articles with historical data on propranolol, from its origin in cardiology to its indication in the preventive treatment of migraine.ResultsPropranolol was described in 1962 for the treatment of cardiovascular diseases. In the same decade, it was prescribed for the preventive treatment of migraine and, recently, included in the consensus of the Brazilian Headache Society.ConclusionAlthough propranolol was initially synthesized for the treatment of heart disease, it has proved to be an effective drug in preventing migraine attacks.

Features of cerebral circulation in patients with chronic migraine

The relevance of differential diagnosis and treatment of primary and secondary headaches remains an important problem for physicians of various specialties. Migraine is a maladaptive disease, which necessitates further study of new pathogenetic mechanisms, symptomatic treatment improvement of migraine, as well as the development of more effective non-drug and drug methods for preventing migraine attacks. It is also important to determine the predictors of the chronic migraine development, which will prevent the episodic migraine transformation into a chronic form. The team of authors conducted a study to assess the degree of cerebral circulatory disorders in patients suffering from chronic migraine. The obtained results of the study made it possible to improve the diagnosis of both chronic and episodic migraine, to clarify the pathogenetic mechanisms of the formation of migraine attacks and the transformation possibility into chronic migraine. Practical recommendations have been developed to improve the effectiveness of ongoing symptomatic and preventive treatment, which improves patient’s quality of life. This article will be useful for doctors – neurologists, algologists, cephalgologists, GPs, doctors of functional and radiation diagnostics and doctors of other specialties, both for beginners and with experience

Comparing Pregabalin and Sodium Valproate in Pediatric Migraine Prophylaxis: A Randomized Clinical Trial.

Migraine is a common disorder in children, and its prophylaxis with minimal side effects is momentous. This study aimed to compare the efficacy of Pregabalin and Sodium Valproate in preventing migraine attacks. Sixty-four children (aged 6-18) with migraines were recruited, as defined by Internation Headache Criteria (ICHD-III). They were randomly assigned to two groups: Sodium Valproate (n=32) and Pregabalin (n=32). The minimum dosage of drugs was prescribed in both groups. The patients were followed for four months. The parameters such as frequency, intensity, duration of migraine attacks, and the number of painkillers that the patients used monthly were recorded. The Spence Children's anxiety scale was also used to evaluate medications' effect on patients' anxiety levels. Two medications were equally effective in reducing the intensity and duration of attacks. Additionally, their effect on reducing the anxiety level of patients was equal. There was a significant difference between the effect of drugs on the frequency of migraine attacks at the end of the first and fourth months and the number of painkillers used at the end of the fourth month. The frequency of attacks was decreased by more than 50% in twenty-eight patients (90%) of Pregabalin recipients and twenty-one patients (84%) of Sodium Valproate recipients. Considering the better effect of Pregabalin in the reduction of frequency of migraine attacks and pain-reducing medications consumption, Pregabalin could be a proper substitute for Sodium Valproate for prophylactic migraine treatment in children.

Potentially Remediable Shortcomings in the Contemporary Drug Treatment of Migraine

Despite the availability over the past decade of a number of new pharmaceutical agents with different mechanisms of action from those of the drugs used previously, the contemporary drug therapy of migraine attacks falls rather short of what would be desirable, while the pharmacological attempt to prevent further attacks appears to prove unsatisfactory about as often as it is successful. The present paper explores reasons for these shortcomings in both the earlier and the current drug therapy of the disorder. Significant major contributory factors appear to be an incomplete understanding of the underlying pathogenic mechanisms of the various stages of the migraine attack, less than optimal pharmacokinetic characteristics of many of the drugs used, and migraine sufferers failing to employ the available drugs to their best advantage. New drugs developed in the light of a more complete understanding of the molecular basis of migraine pathogenesis, together with awareness of pharmacokinetic desiderata in relation to treating and preventing migraine attacks, may go some way towards remedying the situation, but patient decision making may prove more difficult to modify.

Different dosage regimens of erenumab for the treatment of migraine: A systematic review and meta-analysis of the efficacy and safety of randomized controlled trials.

Migraine is a worldwide epidemic neurological disorder that has a significant influence on the quality of life. Migraine attacks are considered to be related to a calcitonin gene-related peptide (CGRP) signaling molecule, and anti-CGRP medications are used to abort and prevent migraine attacks. Erenumab, a monoclonal antibody that targets the CGRP receptor, is the first migraine preventive medication approved by the US Food and Drug Administration. In the present study, we evaluate the efficacy and safety of erenumab. This study aims to systematically assess the efficacy and safety of erenumab as a migraine preventive treatment compared to a placebo. Randomized, placebo-controlled, single or double-blind trials were searched through MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov up to May 2022. The efficacy outcomes we collected include changes from baseline on monthly migraine days, monthly acute migraine-specific medication days, ≥50% responder rate, ≥75% responder rate, and 100% responder rate at week 12. Safety outcomes include treatment emergent adverse events, serious adverse events, and any adverse event that leads to discontinuation of treatment. The study was registered with PROSPERO (Registry number: CRD42022338861). In all eight included trials, we found that erenumab (28, 70, and 140 mg) is very effective and has a significantly greater reduction in baseline monthly migraine days (28 mg: mean difference [MD]=-1.1, 95% confidence interval [CI]: -2.0 to -0.2, p=0.020; 70 mg: MD=-1.4, 95% CI: -1.8 to -1.1, p < 0.001, I2 =26%; 140 mg: MD=-1.8, 95% CI: -2.1 to -1.4, p < 0.001, I2 =0%) than placebo at week 12, especially with 140 mg. Otherwise, we found that there were no statistical differences in the occurrence of adverse events (7mg: risk ratio [RR]=0.9, 95% CI: 0.7 to 1.2, p=0.570; 21 mg: RR=1.0, 95% CI: 0.8 to 1.2, p=0.730; 28 mg: RR=0.9, 95% CI: 0.7 to 1.1, p=0.340; 70 mg: RR=1.0, 95% CI: 0.9 to 1.0, p=0.230, I2 =0%; 140 mg: RR=1.0, 95% CI: 0.9 to 1.1, p=0.880, I2 =40%) between the erenumab and placebo groups. In our study, we found that erenumab, especially at the dose of 140 mg, is an effective and well-tolerated preventive treatment for migraine.

Petasites for Migraine Prevention: New Data on Mode of Action, Pharmacology and Safety. A Narrative Review.

Petasins are the pharmacologically active ingredients of butterbur and of therapeutic benefit in the treatment of migraine and tension headaches. Here, we summarize the pharmacology, safety and clinical efficacy of butterbur in the prevention of migraine attacks and present new data on its mode of action. We review published literature and study reports on the safety and clinical efficacy of the butterbur root extract Petadolex® and report new findings on petasins in dampening nociception by desensitizing calcium-conducting TRP ion channels of primary sensory neurons. Importantly, butterbur diminishes the production of inflammatory mediators by inhibiting activities of cyclooxygenases, lipoxygenases and phospholipase A2 and desensitizes nociception by acting on TRPA1 and TRPPV1 ion channels. It inhibits the release of calcitonin-gene related peptide (CGRP) of meningeal afferents during migraine attacks. We also evaluated the safety of a butterbur root extract in repeated dose studies for up to 6 months. A no-observable-adverse-effect-level at 15-fold of the maximal clinical dose (3 mg/kg/day MCD) was established for rats. At supratherapeutic doses, i.e., 45–90-fold MCD, we observed bile duct hyperplasia, and mechanistic studies revealed regulations of solute carriers to likely account for bile duct proliferations. Additionally, liver function tests were performed in cultures of primary human hepatocytes and did not evidence hepatotoxicity at therapeutic butterbur level and with migraine co-medications. Lastly, in randomized, double-blinded and placebo-controlled trials with Petadolex® migraine attack frequency was reduced significantly at 150 mg/day, and no relevant abnormal liver function was reported. Together, butterbur is effective in the prevention of migraine attacks by blocking CGRP signaling.

Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine-From Theory to Practice.

So far, no coherent and convincing theory has been developed to fully explain the pathogenesis of migraine, although many researchers and experts emphasize its association with spreading cortical depression, oxidative stress, vascular changes, nervous excitement, neurotransmitter release, and electrolyte disturbances. The contribution of magnesium deficiency to the induction of cortical depression or abnormal glutamatergic neurotransmission is a likely mechanism of the magnesium–migraine relationship. Hence, there is interest in various methods of assessing magnesium ion deficiency and attempts to study the relationship of its intra- and extracellular levels with the induction of migraine attacks. At the same time, many clinicians believe that magnesium supplementation in the right dose and form can be a treatment to prevent migraine attacks, especially in those patients who have identified contraindications to standard medications or their different preferences. However, there are no reliable publications confirming the role of magnesium deficiency in the diet as a factor causing migraine attacks. It also seems interesting to deepen the research on the administration of high doses of magnesium intravenously during migraine attacks. The aim of the study was to discuss the probable mechanisms of correlation of magnesium deficiency with migraine, as well as to present the current clinical proposals for the use of various magnesium preparations in complementary or substitute pharmacotherapy of migraine. The summary of the results of research and clinical observations to date gives hope of finding a trigger for migraine attacks (especially migraine with aura), which may turn out to be easy to diagnose and eliminate with pharmacological and dietary supplementation.

Current status of calcitonin gene-related peptide-based therapies in migraine: a scoping review

A significant proportion of patients exhibit sub-optimal response to the standard treatment of acute migraine such as triptans and NSAIDs. Even the conventional preventive therapies (e.g. beta-blockers) indicated for patients with frequent migraine attacks have varying responses. Moreover, evidence from animal studies elucidated the role of calcitonin gene-related peptide (CGRP) in the pathophysiology of migraine. Currently two classes are drug, the small molecule CGRP receptor antagonist or the ‘gepants’ (Ubrogepant, Rimegepant, Atogepant, Zavegepant) and CGRP monoclonal antibodies (Erenumab, Galcanezumab, Fremanezumab, Eptinezumab) have been found efficacious and safe in various clinical trials for the treatment and prevention of migraine. While the small molecule CGRP receptor antagonists are given orally, the monoclonal antibodies are injectable drugs. Ubrogepant and Rimegepant are the second-generation gepants approved for treatment of migraine. Zavegepant is a third generation gepant which has proven efficacy for acute treatment of migraine in a phase III trial. Atogepant has been approved for prevention of migraine. Rimegepant has also proven to be efficacious for preventing migraine attacks but has not yet been approved for this indication. Erenumab is the only monoclonal antibody which neutralizes the CGRP receptor. The latter three monoclonal antibodies target the CGRP peptide. The monoclonal antibodies have been approved for the prevention of migraine as a subcutaneously or intravenous infusion (Eptinezumab) given once a month or quarterly. Both the classes of drugs were well-tolerated in the clinical trials. Nausea was the most common adverse effect with gepants while injection-site pain was commonly reported with the antibodies.

Calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide in migraine treatment.

To review the latest advances in migraine management with a focus on medications specifically developed for the treatment of migraine. Randomized clinical trials demonstrated the efficacy of calcitonin gene-related peptide (CGRP) mAbs for the preventive treatment of migraine and the small molecule CGRP receptor antagonist gepants for acute abortion and prevention of migraine attacks. Pituitary adenylate cyclase-activating polypeptide (PACAP) is another signaling molecule of interest and represents a potential new drug class of mechanism-based migraine medications. Drugs targeting PACAP are currently undergoing clinical trials, and the coming years will reveal whether this class of drugs will expand our therapeutic armamentarium. Here, we summarize the role of CGRP and PACAP in migraine pathophysiology and discuss novel therapies targeting the CGRP and PACAP signaling pathways.

Galcanezumab (Emgality)

&#x0D; CADTH recommends that Emgality should be reimbursed by public drug plans for the prevention of migraine if certain conditions are met.&#x0D; Emgality should only be covered to prevent migraine attacks in adult patients who have tried at least 2 other types of oral preventive medications.&#x0D; Emgality should only be reimbursed if the patient is being cared for by a physician who has experience managing migraine headaches. Emgality will only be reimbursed for 6 months at a time. Emgality should not be more than the least costly drug of the same class used to prevent migraine.&#x0D;