Novel Approaches in Drug Treatment of Migraines

Abstract

Migraine treatment can be aimed at the acute treatment of pain attacks and accompanying symptoms and at preventing the recurrence of headaches. The choice of drug depends on clinical effectiveness based on scientific evidence. If general analgesics are not appropriate for the acute treatment of migraines, the first choice are specific drug agonists of serotonin receptors class 1B and 1D triptans. Since triptans are contraindicated in patients with vascular diseases due to their vasoconstrictor effects, lasmiditan, a class 1 F agonist that does not have such an effect, was developed. A revolution in the treatment of migraine was achieved through the use of antagonist molecules against calcitonin gene-related peptide (CGRP) and its receptor. There are two types of such molecules: large molecules of monoclonal antibodies (Mabs) that are exclusively used as prophylaxis for migraines, and small molecules called gepants that can be used in acute treatment as well as for prophylaxis in migraines. Due to the pharmacological profile of Mabs, they are suitable for treatment in the parenteral form at longer application intervals (4 weeks / 1 month, or 3 months). They have an excellent clinical effect on reducing the frequency of frequent episodic and chronic migraines, which ca be achieved in a few weeks with good tolerability, in contrast to non-specific prophylactics that have lower effectiveness and tolerability. According to the latest European guidelines, CGRP Mabs may be given as the first choice in migraine prophylaxis.

Keywords

• migraine
• drugs
• acute treatment
• prophylaxis