title: Treatment of migraine: update on new therapies.
abstract: OBJECTIVE
  This review provides a comprehensive selection of the latest clinical trial results in antimigraine treatment.
  
  
  RESULTS
  The oral calcitonine gene-related peptide antagonist telcagepant is efficacious in acute treatment. Compared to triptans, its efficacy is almost comparable but its tolerance is superior. The same is true for the 5HT-1F agonist lasmiditan, another agent devoid of vascular effects. Triptans, as other drugs, are more efficient if taken early but nonsteroidal anti-inflammatory drugs and analgesics remain useful for acute treatment, according to several meta-analyses. Single-pulse transcranial magnetic stimulation during the aura rendered more patients pain-free (39%) than sham stimulation (22%) in one study. Topiramate could be effective for migrainous vertigo, but it did not prevent transformation to chronic migraine in patients with high attack frequency. Onabotulinumtoxin A was effective for chronic migraine and well tolerated, but the therapeutic gain over placebo was modest; the clinical profile of responders remains to be determined before widespread use. Occipital nerve stimulation was effective in intractable chronic migraine with 39% of responders compared to 6% after sham stimulation. This and other neuromodulation techniques, such as sphenopalatine ganglion stimulation, are promising treatments for medically refractory patients but large controlled trials are necessary. One study suggests that outcome of patent foramen ovale closure in migraine might depend on anatomic and functional characteristics.
  
  
  CONCLUSIONS
  Drugs with a better efficacy or side-effect profile than triptans may soon become available for acute treatment. The future may also look brighter for some of the very disabled chronic migraineurs thanks to novel drug and neuromodulation therapies.
authors.affiliation: Headache Research Unit - University Department of Neurology, CHR Citadelle, University of Liège, Liège, Belgium.
authors.forename: Delphine
authors.initials: D
authors.lastname: Magis
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001381:Azepines / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D002986:Clinical Trials as Topic; D004558:Electric Stimulation; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D008881:Migraine Disorders / Q000628:therapy*; D010070:Oxalates; D050781:Transcranial Magnetic Stimulation; D014363:Tryptamines / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001381:Azepines; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D007093:Imidazoles; D010070:Oxalates; C121034:Pain-Free; D014363:Tryptamines; C525458:telcagepant