Migraine is a chronic paroxysmal neurological disorder characterized by multiphase attacks of head pain and a myriad of neurological symptoms. Chronic migraine causes a great personal and societal burden. Many patients are poorly responsive to, or non-compliant with, conventional migraine preventive therapies. For this reason, physicians are constantly looking for effective migraine prevention strategies. The recent introduction of an innovative pharmacological class useful for migraine prevention, namely monoclonal antibodies towards calcitonin gene-related peptide or its receptors, opens a new, immense therapeutic scenario. In this commentary, the development and efficacy of this novel class of preventive anti-migraine therapy have been discussed and compared with the conventional therapies of migraine prevention.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
References and Recommended Reading
Disease GBD, Injury I, Prevalence C. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of Disease study 2016. Lancet. 2017;390(10100):1211–59.
Durham PL. Calcitonin gene-related peptide (CGRP) and migraine. Headache. 2006;46(Suppl 1):S3–8.
Edvinsson L. The trigeminovascular pathway: role of CGRP and CGRP receptors in migraine. Headache. 2017;57(Suppl 2):47–55.
Goadsby PJ, Reuter U, Hallstrom Y, Broessner G, Bonner JH, Zhang F, et al. A controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–32.
Dodick DW, Ashina M, Brandes JL, Kudrow D, Lanteri-Minet M, Osipova V, et al. ARISE: a phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018;38(6):1026–37 333102418759786.
Tepper S, Ashina M, Reuter U, Brandes JL, Dolezil D, Silberstein S, et al. Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2017;16(6):425–34.
Jain S, Yuan H, Spare N, Silberstein SD. Erenumab in the treatment of migraine. Pain Manag. 2018;8(6):415–26.
Dodick DW, Silberstein SD, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Effect of fremanezumab compared with placebo for prevention of episodic migraine: a randomized clinical trial. JAMA. 2018;319(19):1999–2008.
Silberstein SD, Dodick DW, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017;377(22):2113–22.
Stauffer VL, Dodick DW, Zhang Q, Carter JN, Ailani J, Conley RR. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial. JAMA Neurol. 2018;75(9):1080–8.
Skljarevski V, Matharu M, Millen BA, Ossipov MH, Kim BK, Yang JY. Efficacy and safety of galcanezumab for the prevention of episodic migraine: results of the EVOLVE-2 phase 3 randomized controlled clinical trial. Cephalalgia. 2018;38(8):1442–54.
Detke HC, Goadsby PJ, Wang S, Friedman DI, Selzler KJ, Aurora SK. Galcanezumab in chronic migraine: the randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211–e21.
Ju MS, Jung ST. Aglycosylated full-length IgG antibodies: steps toward next-generation immunotherapeutics. Curr Opin Biotechnol. 2014;30:128–39.
Silberstein S, McAllister P, Berman G, et al. Eptinezumab reduced migraine frequency, duration, and pain intensity through week 24: results from the phase 3 PROMISE-1 trial. Neurology. 2018;90(15):P4.091.
Lipton R, Saper J, Ashina M. A phase 3, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of eptinezumab for the preventive treatment of chronic migraine: results of the PROMISE-2 (prevention of migraine via intravenous eptinezumab safety and efficacy–2) trial InPlenary Presentation. Am Acad Neurol Conf 2018. 2018.
Estemalik E, Tepper S. Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat. 2013;9:709–20.
Conflict of Interest
Stephen D. Silberstein reports personal fees from Alder Biopharmaceuticals, Allergan, Inc., Amgen, Avanir Pharmaceuticals, Inc., Curelator, Inc., Dr. Reddy’s Laboratories, eNeura Inc., electroCore Medical, LLC, Lilly USA, LLC, Supernus Pharmaceuticals, Inc., Teva Pharmaceuticals, Theranica, Trigemina, Inc., Medscape, LLC, Abide Therapeutics, Biohaven Pharmaceuticals, Cefaly, Egalet, and GlaxoSmithKline, outside the submitted work. Sameer Jain reports no potential conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Headache
About this article
Cite this article
Jain, S., Silberstein, S.D. Invited Commentary on Preventive Anti-Migraine Therapy (PAMT). Curr Treat Options Neurol 21, 14 (2019). https://doi.org/10.1007/s11940-019-0555-4
- CGRP monoclonal antibody
- Migraine prevention
- CGRP receptor
- New migraine treatments
- Migraine prophylaxis