, Volume 10, Issue 6, pp 393-394

Is there an inherent limit to acute migraine treatment efficacy?

This is an excerpt from the content

In the current issue of Journal of Headache and Pain, Tfelt-Hansen [1] suggests that calcitonin gene-related peptide (CGRP) receptor antagonists (CGRP-RA) offer relief to only a fraction of patients. To support his hypothesis, he points out that only around two-thirds of migraineurs receiving intravenous (IV) olcegepant achieved pain relief in 2 h, and 46% of patients had pain relief in 1 h [2], figures that are lower than previously reported values for subcutaneous sumatriptan [3]. He also considers that the therapeutic gain for oral telcagepant 300 mg [4, 5] was modest. He concludes by saying that “…there is most likely an inherent limit to the response one can expect from CGRP receptor antagonists, such as olcegepant and telcagepant, in the acute treatment of migraineurs as a group.”

The issues raised by Dr. Tfelt-Hansen are certainly of interest and may be expanded outside the CGRP-RA class. In other words, is there an inherent limit to acute migraine treatment efficacy overall? Bef