As we approach an exciting time in migraine therapeutics, my Editor’s Pick for this edition of EMJ Neurology is an article by Karsan et al., detailing the emerging treatment options to reduce the burden of migraine; an under-appreciated, debilitating condition. Recent improvements in our understanding of this condition have led to the trialling of new therapeutic avenues. As such, I highly recommend this thorough review to all those interested in the most recent advances in this field of neurology. Prof Lászlo Vécsei
Nazia Karsan,1,2 Jonathan Jia Yuan Ong,1,2,3 *Peter James Goadsby1,2
1. Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
2. NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, London, UK
3. National University Hospital, Singapore
*Correspondence to firstname.lastname@example.org
Disclosure: Dr Karsan is an Association of British Neurologists/Guarantors of Brain Clinical Research Training Fellow. Dr Ong has no conflicts of interest to declare. Dr Goadsby reports personal fees from Allergan, Amgen, Eli-Lilly and Company, Akita Biomedical, Alder Biopharmaceuticals, Autonomic Technologies Inc., Avanir Pharma, Cipla Ltd., Colucid Pharmaceuticals Ltd., Dr. Reddy’s Laboratories, eNeura, Electrocore LLC, Novartis, Pfizer Inc., Promius Pharma, Quest Diagnostics, Scion, Teva Pharmaceuticals, Trigemina Inc., Scion, MedicoLegal work, Journal Watch, Up-to-Date, and Oxford University Press. Dr Goadsby has a patent for Magnetic stimulation for headache pending, which is assigned to eNeura.
Received: 20.03.17 Accepted: 03.07.17
Citation: EMJ Neurol. 2017;5:50-58.
Migraine is a leading cause of disability worldwide. Despite increasing knowledge about its pathophysiology and neurobiology over recent times, treatment options for both acute attacks and longer-term attack prevention were largely developed for other conditions. This has led to treatment often being complicated by side effects and compliance issues, in addition to at best only between 40 and 50% of patients having good responses to daily preventive treatment.
There is a pressing need to reduce the burden of migraine, in an era where there have been no substantial breakthroughs in treatment approved and licensed for migraine since triptans in the early 1990s. Over recent times, preclinical migraine models, clinical human migraine models, and functional neuroimaging have provided novel insights into the underlying neurochemical systems at play in migraine and have enabled more targeted research into particular molecules or receptors of particular interest.
There have been several targeted therapeutic avenues explored recently through preclinical research and clinical trials, both for abortive and preventive treatment of migraine. These have largely focussed on targeting the calcitonin gene-related peptide receptor, with small agent antagonists and monoclonal antibodies, targeting the serotonin 5-HT1F receptor by way of preventing pain without causing vascular side effects, and emerging neuromodulatory options for acute and preventive treatment. These new and emerging treatment options will be the focus of this review.
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