title: New therapeutic approaches for the prevention and treatment of migraine.
abstract: The management of patients with migraine is often unsatisfactory because available acute and preventive therapies are either ineffective or poorly tolerated. The acute treatment of migraine attacks has been limited to the use of analgesics, combinations of analgesics with caffeine, ergotamines, and the triptans. Successful new approaches for the treatment of acute migraine target calcitonin gene-related peptide (CGRP) and serotonin (5-hydroxytryptamine, 5-HT1F) receptors. Other approaches targeting the transient receptor potential vanilloid (TRPV1) receptor, glutamate, GABAA receptors, or a combination of 5-HT1B/1D receptors and neuronal nitric oxide synthesis have been investigated but have not been successful in clinical trials thus far. In migraine prevention, the most promising new approaches are humanised antibodies against CGRP or the CGRP receptor. Non-invasive and invasive neuromodulation approaches also show promise as both acute and preventive therapies, although further studies are needed to define appropriate candidates for these therapies and optimum protocols for their use.
authors.affiliation: Department of Neurology and Headache Center, University of Duisburg-Essen, Essen, Germany. Electronic address: hans.diener@uk-essen.de.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Charles
authors.affiliation: NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
authors.affiliation: Department of Neurology and Headache Center, University of Duisburg-Essen, Essen, Germany.
authors.forename: Dagny
authors.initials: D
authors.lastname: Holle
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D001578:Benzopyrans / Q000627:therapeutic use*; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy* / Q000517:prevention & control*; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D052248:Nitric Oxide Synthase Type I / Q000037:antagonists & inhibitors*; D050916:TRPV Cation Channels / Q000037:antagonists & inhibitors*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*
chemical_list: D000911:Antibodies, Monoclonal; D001549:Benzamides; D001578:Benzopyrans; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D018377:Neurotransmitter Agents; D050916:TRPV Cation Channels; C494482:TRPV1 protein, human; C118706:tonabersat; D052248:Nitric Oxide Synthase Type I