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  • Review Article
  • Published:

Emerging therapies for migraine

Nature Clinical Practice Neurology volume 3, pages 610–619 (2007)Cite this article

Abstract

Migraine is a common disabling brain disorder that—considering its clinical and economic impact—is understudied and in need of additional management options. Currently, treatments are classified as preventive or acute-attack therapies, although it is expected that this distinction will become blurred over time. The gap-junction blocker tonabersat, an inducible nitric oxide synthase (NOS) inhibitor and botulinum toxin A are all being investigated in clinical trials as preventive therapies. Device-based approaches using neurostimulation of the occipital nerve have provided promising results, whereas the first study of patent foramen ovale closure for migraine prevention produced disappointing results. Calcitonin gene-related peptide receptor antagonists, vanilloid TRPV1 receptor antagonists and NOS inhibitors are all being investigated in clinical trials for acute migraine. There is much cause for optimism in this area of neurology and considerable benefit awaits our patients.

Key Points

  • Migraine is a common, disabling, inherited brain disorder that affects 12% of the US population; it is treated with medicines described as being either preventive or acute-attack therapies

  • Preventive medicines currently in development include the gap-junction blocker tonabersat, an inducible nitric oxide synthase inhibitor and botulinum toxin A; the first study of patent foramen ovale closure for migraine prevention failed; neurostimulation of the occipital nerve is currently being explored as an alternative device-based preventive approach

  • For acute-attack treatment two calcitonin gene-related peptide receptor antagonists have now been studied, and both were effective in the treatment of acute migraine

  • Vanilloid TRPV1 receptor antagonists, nitric oxide synthase inhibitors and serotonin receptor 5-HT1F agonists are all being investigated in clinical trials for acute migraine, each of which is exploring a new mechanism of action and offering the possibility of avoiding the cardiovascular side effects that limit the use of triptans

  • The future of neurological therapeutics seems bright and no more so than in the field of migraine where neuroscience and clinical neurology practice meet to advance the management of our patients

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Author notes

  1. Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK peterg@ion.ucl.ac.uk

Authors and Affiliations

  1. UK. He is visiting Professor of Neurology in the Department of Neurology, PJ Goadsby is Professor of Clinical Neurology and Honorary Consultant Neurologist at the National Hospital for Neurology and Neurosurgery, and at Great Ormond Street Hospital for Children, London, University of California, San Francisco, CA, USA.,

    Peter J Goadsby

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  1. Peter J Goadsby
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Competing interests

In the last twelve months the author has been consulted by, lectured in meetings arranged by, or conducted clinical or basic science research with Advanced Bionics, Allergan, Almirall, AstraZeneca, Capnia, CoLucid, Medtronic, Minster and MSD.

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Goadsby, P. Emerging therapies for migraine. Nat Rev Neurol 3, 610–619 (2007). https://doi.org/10.1038/ncpneuro0639

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