title: New migraine preventive options: an update with pathophysiological considerations.
abstract: BACKGROUND
  The pharmacological treatment of migraine may be acute or preventive. Frequent, severe and long-lasting migraine attacks require prophylaxis. Multiple threads of research over the last 15 years have led to the concept that migraine is generated from a hyperexcitable brain. A variety of causes for hyperexcitability of the brain in migraine have been suggested. These causes include low cerebral magnesium levels, mitochondrial abnormalities, dysfunctions related to increased nitric oxide or the existence of a P/Q type calcium channelopathy. The better knowledge about migraine pathophisiology led us to discuss new treatment options.
  
  
  OBJECTIVE
  The aim of the present study is to present an evidence-based review of some new drugs or some agents that even though available for a long time, are not frequently used.
  
  
  RESULTS
  We present a review of anticonvulsants with various mechanisms of action such as lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam and zonisamide. We also review natural products, like riboflavin and magnesium, botulinum toxin A, a specific CGRP antagonist and the anti-asthma medication montelukast, with pathophysiological discussion.
  
  
  CONCLUSIONS
  We aimed to present an update of newer or less frequently used preventive migraine therapies, drugs that might reduce the burden and the costs of a disease that should be considered as a public health problem all around the world.
authors.affiliation: New England Center for Headache, Stamfor, CT, USA.
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Bigal
authors.forename: Alan M
authors.initials: AM
authors.lastname: Rapoport
authors.forename: Fred D
authors.initials: FD
authors.lastname: Sheftell
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Tepper
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D006801:Humans; D008274:Magnesium / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy / Q000517:prevention & control*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017319:Photosensitizing Agents / Q000627:therapeutic use
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000927:Anticonvulsants; D009465:Neuromuscular Agents; D017319:Photosensitizing Agents; D008274:Magnesium