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HEADACHE IN 2018

Getting closer to a cure for migraine

Nature Reviews Neurology volume 15, pages 64–65 (2019)Cite this article

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In the past few years the scientific community has witnessed a prodigious surge in research activity, publication of data and progress in understanding the mechanistic components of migraine. This renaissance is the result of efforts initiated decades ago that are finally being translated into benefits for individuals affected by this disease.

Key advances

  • Trials have demonstrated that monoclonal antibodies that target calcitonin gene-related peptide 1 induce marked improvements (>75%) among a small but meaningful proportion of patients with chronic migraine1 or episodic migraine2.

  • Noninvasive vagal nerve stimulation delivered with two short-duration stimulations at the neck level has proved effective in the treatment of migraine attacks: one-third of patients achieved pain-free status at 2 h (ref.4).

  • Preclinical data support the idea that pituitary adenylate cyclase-activating polypeptide and its G-protein-coupled receptors are viable targets for new migraine treatments8.

  • Intriguing findings obtained in a migraine-specific animal model point to another potential pathway implicated in migraine pain: inhibition of acid-sensing ion channels prevents cephalic allodynia10.

In a large randomized controlled trial, Ashina et al.1 showed that nearly 22% of individuals with chronic migraine who had previously failed to respond to two or more preventive medications experienced a ≥75% reduction in monthly migraine days (a ≥75% response) by month 3 of treatment with subcutaneous erenumab 140 mg. By contrast, in the placebo group, only 3% of patients reported a ≥75% response. Similarly, in a study by Stauffer et al.2, more than one-third of patients with episodic migraine who received subcutaneous galcanezumab (either 120 mg or 240 mg, once per month) experienced a ≥75% response in ≥1 month during the 6-month observation period. By contrast, in the placebo group, only 19% of patients had a ≥75% response. Even more impressive is that ~15% of the patients receiving galcanezumab became migraine-free (a 100% response) for at least 1 month during the study, compared with just 6% of patients in the placebo group (P < 0.001). Halker Singh et al.3 directly examined 100% response rates to fremanezumab 900 mg by evaluating the percentages of stable responders over 3 months. In this study, 13% of patients with chronic migraine had a stable 100% response versus 3% of patients in the placebo group (P < 0.02).

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Fig. 1: Mechanism of action of monoclonal antibodies that target calcitonin gene-related peptide 1.

References

  1. Ashina, M. et al. Efficacy and safety of erenumab (AMG334) in chronic migraine patients with prior preventive treatment failure: a subgroup analysis of a randomized, double-blind, placebo-controlled study. Cephalalgia 38, 1611–1621 (2018).

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  2. Stauffer, V. L. et al. Evaluation of galcanezumab for the prevention of episodic migraine: the EVOLVE-1 randomized clinical trial. JAMA Neurol. 75, 1080–1088 (2018).

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  4. Tassorelli, C. et al. Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study. Neurology 91, e364–e373 (2018).

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Authors and Affiliations

  1. Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy

    Cristina Tassorelli & Roberto De Icco

  2. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Cristina Tassorelli & Roberto De Icco

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  1. Cristina Tassorelli
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  2. Roberto De Icco
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Corresponding author

Correspondence to Cristina Tassorelli.

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Competing interests

C.T. declares that she has received fees for serving on scientific advisory boards for Allergan, ElectroCore, Eli Lilly, Novartis and Teva. R.D.I. declares no competing interests.

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Tassorelli, C., De Icco, R. Getting closer to a cure for migraine. Nat Rev Neurol 15, 64–65 (2019). https://doi.org/10.1038/s41582-019-0134-z

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