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Curr Med Chem. 2018 May 29. doi: 10.2174/0929867325666180530114534. [Epub ahead of print]

The therapeutic impact of new migraine discoveries.

Author information

1
University of Szeged, Hungary - Department of Neurology Szeged Hungary Szeged, Hungary
2
Szegedi Tudomanyegyetem Ringgold standard institution - Department of Neurology Szeged Hungary Szeged, Hungary
3
Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Szeged Szeged Hungary Szeged, Hungary
4
Lund University, Lund, Sweden - Department of Clinical Sciences, Division of Experimental Vascular Research Lund Sweden Lund, Sweden

Abstract

BACKGROUND:

Migraine is one the most disabling neurological conditions and associates 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 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.

METHOD:

A systematic literature search in the database of PUBMED was conducted concerning therapeutic strategies in 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.

KEYWORDS:

5-HT1F receptor agonist; Calcitonin gene-related peptide; glutamate; kynurenic acid; pituitary adenylate cyclase-activating polypeptide; trigeminovascular system.

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