New strategies for migraine treatment and prevention
1 The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
2 Department of Neurology, St. Lukas Specialist Hospital in Końskie, Końskie, Poland
3 Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Poland
Correspondence: Dr hab. n. med. Waldemar Brola, Wydział Lekarski i Nauk o Zdrowiu, Uniwersytet Jana Kochanowskiego w Kielcach, ul. IX Wieków Kielc 19, 25-317 Kielce, tel.: +48 41 390 22 59, 601 313 415, e-mail: wbrola@wp.pl
Aktualn Neurol 2019, 19 (3), p. 132–140
DOI: 10.15557/AN.2019.0018
ABSTRACT

Migraine is a neurological disorder characterised by recurrent attacks of headache accompanied by vegetative symptoms. It is estimated that 11–12% of the world’s population suffers from migraine. Triptans are the drugs of choice for emergency treatment, but they are ineffective in 30–35% of patients. Triptans also have serious contraindications, mainly from the cardiovascular system. Hence the need to look for new, more effective therapeutic methods for both interrupting and preventing migraine attacks. Studies on the pathogenesis of migraine have shown that the dominant role during an attack is played by the trigeminovascular system and release of a number of peptides, of which the calcitonin gene-related peptide (CGRP) is the strongest. Great hopes are associated with the use of CGRP receptor antagonists (gepants) and monoclonal antibodies directed against CGRP and its receptors. Selective 5-HT1F receptor agonists (ditans) may also make some progress. Studies are ongoing on antagonists of other neuropeptides associated with migraine pathogenesis – pituitary adenylate cyclase-activating polypeptide (PACAP), nitric oxide synthase (NOS), glutamate, a vasoactive intestinal peptide (VIP), and neurokinin A (NKA). The results of studies assessing the efficacy and safety of CGRP antagonists are promising. Some of them have already been registered for the prevention of migraine attacks and there is hope that in the near future they will expand the possibilities of effective emergency and preventive treatment.

Keywords: migraine, CGRP, monoclonal antibodies, gepants, ditans