Acute migraine therapy: New drugs and new approaches

Teshamae S Monteith, Peter J. Goadsby

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Opinion Statement: The conceptual shift of our understanding of migraine from a vascular disorder to a brain disorder has dramatically altered the approach to the development of new medicines in the field. Current pharmacologic treatments of acute migraine consist of nonspecific and relatively specific agents. Migraine-specific drugs comprise two classes, the ergot alkaloid derivatives and the triptans, serotonin 5-HT1B/1D receptor agonists. The ergots, consisting of ergotamine and dihydroergotamine (DHE), are the oldest specific antimigraine drugs available and are considered relatively safe and effective. Ergotamine has been used less extensively because of its adverse effects; DHE is better tolerated. The triptan era, beginning in the 1990s, was a period of considerable change, although these medicines retained vasoconstrictor actions. New methods of delivering older drugs include orally inhaled DHE and the transdermal formulation of sumatriptan, both currently under study. Novel medicines being developed are targeted at neural sites of action. Serotonin 5-HT1F receptor agonists have proven effective in phase II studies and have no vascular actions. Calcitonin gene-related peptide (CGRP) receptor antagonists are another promising nonvasoconstrictor approach to treating acute migraine. Olcegepant (BIBN4096BS) and telcagepant (MK-0974) have been shown to be safe and effective in phase I, II, and (for telcagepant) phase III clinical trials. Other targets under investigation include glutamate (AMPA/kainate), TRPV1, prostanoid EP4, and nitric oxide synthase. With new neural targets and the potential for therapeutic advances, the next era of antimigraine medications is near.

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalCurrent Treatment Options in Neurology
Volume13
Issue number1
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

Fingerprint

Dihydroergotamine
Migraine Disorders
Ergotamine
Tryptamines
Drug Therapy
Blood Vessels
Pharmaceutical Preparations
Calcitonin Gene-Related Peptide Receptors
Ergot Alkaloids
Serotonin 5-HT1 Receptor Agonists
Sumatriptan
Phase III Clinical Trials
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid
Kainic Acid
Brain Diseases
Vasoconstrictor Agents
Nitric Oxide Synthase
Prostaglandins
Glutamic Acid
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Acute migraine therapy : New drugs and new approaches. / Monteith, Teshamae S; Goadsby, Peter J.

In: Current Treatment Options in Neurology, Vol. 13, No. 1, 01.02.2011, p. 1-14.

Research output: Contribution to journalArticle

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