New frontiers in headache therapy
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There are numerous headache therapies available for our patients, more for migraine than for any of the other primary headache disorders. Only four medications have been approved for migraine prevention in the last few decades in the US and onabotulinumtoxinA was recently approved in the UK and the US for chronic migraine. We have been more fortunate in the acute care arena where in the US we have had seven triptans and one nonsteroidal anti-inflammatory medication approved by the FDA and currently available. There are several other acute care medications in various stages of development and there are two new methods of administering a triptan and others under investigation. We are always looking for faster, easier and more efficient administration of medications with fewer adverse events, as optimal migraine therapy requires these characteristics. What follows is a brief review of the progress in development for four of the many new acute care medications being investigated: the CGRP antagonist tablet telcagepant, the sumatriptan iontophoretic patch, sumatriptan powder for use in the OptiNose apparatus and the dihydroergotamine oral inhaler. I will not include transcranial magnetic stimulation, a 5-HT1F agonist, large conductance calcium-activated potassium channel openers, glial modulators or other medications and devices in early stages of development .
KeywordsMigraine treatment Migraine pipeline CGRP antagonists Sumatriptan Dihydroergotamine
Conflict of interest
A. Rapoport is on the Advisory Boards of NuPathe and MAP, an author of the Phase IIB study on telcagepant, and on the speakers bureau for Merck.
- 6.Ho TW, Ferrari MD, Dodick DW et al (2008) Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. Lancet 372:2089–2090CrossRefGoogle Scholar
- 7.Pierce M, Marbury T, O’Neill C et al (2008) A novel patch formulation of sumatriptan succinate utilizing SmartReliefTM transdermal technology. In: Data presented at the 50th annual scientific meeting of the American Headache Society, 28 June 2008Google Scholar
- 12.Djupesland PG, Docˇekal P, the Czech Migraine Investigators Group (2010) Intranasal sumatriptan powder delivered by a novel breath-actuated bi-directional device for the acute treatment of migraine: a randomised, placebo-controlled study. Cephalalgia 30(8):933–942 (Cephalalgia online first, published on March 17, 2010 as doi: 10.1177/0333102409359314)Google Scholar