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The Pipeline in Headache Therapy

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Abstract

Migraine is a common, disabling, neurovascular disorder characterized by episodic attacks of head pain and associated disability plus systemic autonomic and neurologic symptoms. The advent of the triptan class of medication in the 1990s revolutionized the acute treatment of migraine, but many migraineurs do not respond optimally or at all to triptans, have intolerable adverse effects, or have contraindications to their use. Preventive pharmacotherapy has advanced mostly through serendipity, with new drugs being found effective while being used for other indications. There remains a significant need for new medications and devices that can provide effective, rapid, and sustained pain relief without adverse effects or recurrence. Several new acute and preventive therapies for the treatment of migraine and cluster headaches have shown promise and are currently under investigation. This article covers innovative delivery mechanisms, calcitonin gene-related peptide receptor antagonists, antibodies to calcitonin gene-related peptide and its receptor, 5-HT1F receptor agonists, transient receptor potential vanilloid receptor modulators, orexin receptor antagonists, glial cell modulators, and neurostimulation.

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Acknowledgments

AM Rapoport serves on the speaker’s bureau of Allergan, Impax, and Nautilus Neurosciences and serves on the advisory board of Impax, Merck, Nautilus Neurosciences, NuPathe Inc, and Winston Laboratories Inc. The authors have no other conflicts of interest that are directly relevant to the content of this review. No sources of funding were used to assist in the preparation of this review.

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Authors and Affiliations

  1. Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, 1575 Blondell Avenue, Ste 225, Bronx, NY, 10461, USA

    Sarah Vollbracht

  2. Director-Emeritus, New England Center for Headache, Stamford, CT, USA

    Alan M. Rapoport

  3. The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Alan M. Rapoport

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Correspondence to Sarah Vollbracht.

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Vollbracht, S., Rapoport, A.M. The Pipeline in Headache Therapy. CNS Drugs 27, 717–729 (2013). https://doi.org/10.1007/s40263-013-0090-x

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