The Therapeutic Impact of New Migraine Discoveries.

László Vécsei, Melinda Lukács, János Tajti, Ferenc Fülöp, József Toldi, Lars Edvinsson

Journal: Current medicinal chemistry 2019;26(34):6261-6281

PMID: 29848264

Abstract

BACKGROUND

Migraine is one of the most disabling neurological conditions and associated with high socio-economic costs. Though certain aspects of the pathomechanism of migraine are still incompletely understood, the leading hypothesis implicates the role of the activation of the trigeminovascular system. Triptans are considered to be the current gold standard therapy for migraine attacks; however, their use in clinical practice is limited. Prophylactic treatment includes non-specific approaches for migraine prevention. All these support the need for future studies in order to develop innovative anti-migraine drugs.

OBJECTIVE

The present study is a review of the current literature regarding new therapeutic lines in migraine research.

METHODS

A systematic literature search in the database of PUBMED was conducted concerning therapeutic strategies in a migraine published until July 2017.

RESULTS

Ongoing clinical trials with 5-HT1F receptor agonists and glutamate receptor antagonists offer promising new aspects for acute migraine treatment. Monoclonal antibodies against CGRP and the CGRP receptor are revolutionary in preventive treatment; however, further long-term studies are needed to test their tolerability. Preclinical studies show positive results with PACAP- and kynurenic acid-related treatments. Other promising therapeutic strategies (such as those targeting TRPV1, substance P, NOS, or orexin) have failed to show efficacy in clinical trials.

CONCLUSION

Due to their side-effects, current therapeutic approaches are not suitable for all migraine patients. Especially frequent episodic and chronic migraine represents a therapeutic challenge for researchers. Clinical and preclinical studies are needed to untangle the pathophysiology of migraine in order to develop new and migraine-specific therapies.

Address: Department of Neurology, University of Szeged, Szeged, Hungary.; MTASZTE Neuroscience Research Group, Szeged, Hungary.; Department of Neurology, University of Szeged, Szeged, Hungary.; Institute of Pharmaceutical Chemistry and MTA-SZTE Research Group for Stereochemistry, University of Szeged, Szeged, Hungary.; Department of Physiology, Anatomy and Neuroscience, University of Szeged, Szeged, Hungary.; Department of Clinical Sciences, Division of Experimental Vascular Research, Lund University, Lund, Sweden.; Department of Clinical Experimental Research, Copenhagen University, Glostrup Hospital, Copenhagen, Denmark.

DOI: 10.2174/0929867325666180530114534