title: Management of acute and chronic migraine.
abstract: OBJECTIVE
  We highlight the recent clinical trials for the management of acute and chronic migraine.
  
  
  RESULTS
  In women with menstrual migraine, triptans seem to be well tolerated irrespective of whether or not patients are taking oestrogen-containing contraceptives or have comorbidities that indicate increased cardiovascular risk. The new acute drug, telcagepant, a calcitonin gene-related peptide (CGRP) antagonist, is safe for long-term use (up to 18 months) in migraine patients with stable coronary artery disease in whom the use of triptans is not advisable. From the pooled analysis of the two Phase III Research Evaluating Migraine Prophylaxis Therapy studies of onabotulinumtoxinA (BOTOX) in chronic migraineurs, it clearly emerged that efficacy increases overtime (up to 56 weeks) and paralleled self-perceived improvement in quality of life. Effectiveness was also observed in patients with severely disabling headaches, who met criteria for triptan abuse and were refractory to several prophylactic treatments. Finally, combination of preventive pharmacological agents with different action mechanisms may be the next frontier in therapeutic advancements for treating migraine.
  
  
  CONCLUSIONS
  Although triptans are safe and well tolerated, CGRP antagonists may be an option for nonresponsive patients or those in whom the use of triptans is not advisable. New drugs and combinations of old therapeutic options may help patients with severe forms of headache.
authors.affiliation: Department of Neurophysiology of Vision and Neuro-ophthalmology, G.B. Bietti Eye Foundation-IRCCS, Rome, Italy. gianluca.coppola@gmail.com
authors.forename: Gianluca
authors.initials: G
authors.lastname: Coppola
authors.forename: Jean
authors.initials: J
authors.lastname: Schoenen
mesh_terms: D000208:Acute Disease; D001381:Azepines / Q000494:pharmacology / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D002908:Chronic Disease; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014363:Tryptamines / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001381:Azepines; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D007093:Imidazoles; D014363:Tryptamines; C525458:telcagepant; D019274:Botulinum Toxins, Type A