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Headache Disorders
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Another breakthrough in the treatment of migraine is the development of 5-HT1F receptor antagonists Particularly, this drug class binds more specifically to the serotonin 1F receptor than triptans which bind to the 5HT1b/d receptors with the potential for vasoconstriction.35 This new drug class called ditans may be highly valuable for an aging population that is no longer eligible for triptan therapy because of cardiovascular and cerebrovascular risk factors or in those with known coronary artery disease.
Recently approved and emerging drug options for migraine prophylaxis
Published in Expert Opinion on Pharmacotherapy, 2022
Enrico Bentivegna, Michelangelo Luciani, Valeria Ferrari, Silvia Galastri, Francesco Baldari, Francesco Scarso, Piera A. Lamberti, Paolo Martelletti
Based on current studies on human and animal anatomy, 5-HT1f receptors are present in structures related to migraine physiopathology, such as meninges, trigeminal nucleus caudalis, trigeminal ganglion, hypothalamus, thalamus, and cortex [96]. This receptor is the target of a new class of drugs, Ditans. Currently, lasmiditan is the only Ditan available for acute migraine attack treatment [97]. In this moment, there are several trials aimed at evaluating the effectiveness and safety of this new class of medication. In a systematic review with metanalysis where gepants versus triptans were compared for acute migraine attacks [98], the results showed a major efficacy of triptans in pain freedom at 2 hours. Regarding tolerability, lasmiditan was a drug with a major risk of adverse effects (especially dizziness, nausea, and fatigue) with respect to other ditans. All the adverse effects were mild to moderate. All these classes showed better pain relief at 2 hours with respect to placebo. It is important to underline that, unlike the triptans, ditans could be used in cardiovascular ischemic patients [99]. To the best of our knowledge, there are not systematic review or studies for comparing the efficacy of gepants and monoclonal antibodies for migraine prevention. Regarding their use in prophylaxis, a recent phase I trial of a 5-HT2B/2C receptor antagonist, XC101-D13H (NCT04104399), has shown promising tolerability during its daily use [100]. This could lead to a possible prophylactic therapy with a daily use. Further studies are needed to evaluate its effectiveness.
Atogepant: an emerging treatment for migraine
Published in Expert Opinion on Pharmacotherapy, 2022
Cecilia Rustichelli, Rossella Avallone, Anna Ferrari
Migraine can be managed by both acute and prophylactic medications. Acute treatment of migraine attacks is essential to relieve suffering and ensure that a person can quickly resume daily activities. Medications used include triptans (5-HT1B/1D/1 F receptor agonists), which are the gold standard for the acute treatment of moderate to severe migraine, and non-steroidal anti-inflammatory drugs (NSAIDs) for mild to moderate attacks. In addition, lasmiditan, a highly selective 5-HT1F receptor agonist, and ubrogepant and rimegepant, small-molecule CGRP receptor antagonists, have recently been approved for acute treatment of migraine [5]. Prophylactic treatment aims to reduce the frequency, duration, and intensity of migraine attacks; improve the efficacy and decrease the use of symptomatic drugs; and prevent chronicity. The indication for prophylactic treatment is not an absolute recommendation. Preventive treatment is initiated when the frequency of migraine attacks is around four per month, when symptomatic medications are ineffective and/or contraindicated and when the patient’s quality of life is impaired. In current practice, treatment is chosen empirically among the recommended medications based on their efficacy level in accordance with evidence-based guidelines [6,7]. Furthermore, drug choice is based on the patient’s diagnosis including other clinical conditions (comorbidities and drug–drug interactions), the physician’s knowledge and past experiences, and above all, the drug’s safety profile [5].
Unmet needs for migraine
Published in Current Medical Research and Opinion, 2021
Paolo Martelletti, Martina Curto
Facing this transversal disease with a large social, occupational and economic impact deriving from it, global health systems have generally proven to be unprepared in recent decades. The discovery of Calcitonin Gene Related Peptide (CGRP) as a molecule implicated in the pathophysiology of migraine and the appearance of new drugs targeting it or its receptor, the monoclonal antibodies and CGRP antagonists, or agonists of the 5-HT1F receptor2–7, has raised in recent years the need for a systematic approach to this vast multitude of patients following criteria shared by the scientific community. This approach, coagulated around the unmet needs of these patients, is trying to identify a stratification of the different clinical expressions and a definition of the cut-offs useful for defining the levels of application of these new molecules. It is also important to reiterate the necessity for a more widespread education in the multidisciplinary subspecialty of headache medicine, to reduce the gap between the need for seeking care and obtaining a fair, effective and safe treatment for migraine.