Current Opinion in Pharmacological and Non-Pharmacological Treatment of Migraine: A Focus on Calcitonin Gene-Related Peptide
DOI:
https://doi.org/10.17140/NOJ-8-136Keywords:
Migraine treatment; CGRP antagonists; Neuromodulation; Nerve stimulation; Trigeminal activation; Cortical spreading depression.Abstract
The most common neurologic disorder is migraines. Migraine is defined as throbbing headaches that can be associated with auras.
The headaches are episodic and can be debilitating in quality. Migraines can be triggered by emotional stress, lack of sleep, bright
lights, loud noise, certain foods, and other environmental factors. The most effective way of preventing migraines is to avoid
these triggers. A migraine can begin with prodromes or warning signs such as loss of vision, loss of motor reflexes or sensation.
In this review, the types of migraine, signs and symptoms, pathways leading up to auras, and detailed pathophysiology will be
discussed. The pathophysiology of a migraine consists of three different mechanisms: 1) cortical spreading depression, 2) the
trigemino vascular system, and 3) sensitization. Three different treatment methods for a migraine will be discussed: 1) pharmacological, 2) non-pharmacological and 3) lifestyle modifications. Lifestyle modifications include eating a healthy diet, exercising, and
maintaining proper sleep hygiene. Pharmacological treatments can be preventative or abortive. The latest migraine treatment of
calcitonin gene-related peptide (CGRP) antagonist use will be discussed in this review and compared to other treatments such as
nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and Triptans. Future research methods to prevent and better
treat migraine headaches are considered a hot topic in medicine and these novel methods will be discussed.
References
Creeney H. CGRP pathway monoclonal antibodies. Web site. https://www.migrainetrust.org/living-with-migraine/treatments/ calcitonin-gene- related-peptide-pathway-monoclonal-antibodies/. Accessed December 4, 2020.
Swanson JW, Riggin EA. “Migraine.” Mayo Clinic, Mayo Foundation for Medical Education and Research. Web site. www.mayoclinic.org/diseases-conditions/migraine-headache/ symptoms-causes/syc-20360201. Accessed December 4, 2020.
Karatas H, Erdener SE, Gursoy-Ozdemir Y, Lule S, Eren-Koçak E, Sen ZD, Dalkara T. Spreading depression triggers headache by activating neuronal panx1 channels. Science. 2013; 339(6123): 1092- 1095. doi: 10.1126/science.1231897
Cutrer M. Pathophysiology of migraine. Semin Neurol. 2006; 26(2): 171-180. doi: 10.1055/s-2006-939917
Sprenger T. Goadsby PJ. Migraine pathogenesis and state of pharmacological treatment options. BMC Med. 2009; 16: 71. doi: 10.1186/1741-7015-7-71 Review | Volume 8 | Issue 1 | Mirza B et al
Silberstein SD. Treatment recommendations for migraine. Nat Clin Pract Neurol. 2008; 4(9): 482-489. doi: 10.1038/ncpneu-ro0861
Dodick DW, Silberstein SD, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T. Effect of fremanezumab vs placebo on prevention of episodic migraine. JAMA. 2018; 319(19): 1999-2008. doi: 10.1001/jama.2018.4853
Samsam M. Central nervous system acting drugs in treatment of migraine headache. Cent Nerv Syst Agents Med Chem. 2012; 12: 158- 172. doi: 10.2174/187152412802430147
Saper JR, Dodick DW, Silberstein SD, McCarville S, Sun M, Goadsby PJ, ONSTIM Investigators. Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia. 2011; 3 1(3): 271-285 . doi :
1177/0333102410381142 10. Stanton-Hicks M, Salamon J. Stimulation of the central and peripheral nervous system for the control of pain. J Clin Neurophysiol. 1997; 14(1): 46-62. doi: 10.1097/00004691-199701000-00004
Bhola R, Kinsella E, Giffin N, Lipscombe S, Ahmed F, Weatherall M, et al. Single-pulsetranscranial magnetic stimulation (sTMS) for the acute treatment of migraine: Evaluation of outcome data for the UK post market pilot program. J Headache Pain. 2015; 16: 535. doi: 10.1186/ s10194-015-0535-3
Stubberud A, Varkey E, McCrory DC, Pedersen SA, Linde M. Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis. Pediatrics. 2016; 138(2): pii: e20160675. doi: 10.1542/ peds.2016-0675
Wells RE, Loder E. Mind/Body and behavioral treatments: The evidence and approach. Headache. 2012; 52 Suppl 2: 70-75. doi: 10.1111/j.1526-4610.2012.02238.x
Sun Y, Gan TJ. Acupuncture for the management of chronic headache: A systematic review. Anesth Analg. 2008; 107(6): 2038- 2047. doi: 10.1213/ane.0b013e318187c76a
Henry TR, Bakay RA, Votaw JR, Pennell PB, Epstein CM, Faber TL, et al. Brain blood flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: I. Acute effects at high and low levels of stimulation. Epilepsia. 1998; 39(9): 983-990. doi: 10.1111/j.1528-1157.1998.tb01448.x
Stojanovic MP. Stimulation methods for neuropathic pain control. Curr Pain Headache Rep. 2001; 5(2): 130-137. doi: 10.1007/ s11916-001-0081-3
Rhee TG, Harris IM. Gender differences in the use of complementary and alternative medicine and their association with moderate mental distress in U.S. adults with migraines/severe headaches. Headache. 2017; 57(1): 97-108. doi: 10.1111/head.12986
Tepper SJ, Cleves C. Telcagepant, a calcitoningene related peptide antagonist for the treatment of migraine. Curr Opin Investig Drugs. 2009; 10: 711-720.
Andreou AP, Holland PR, Akerman S, Summ O, Fredrick J, Goadsby PJ. Transcranial magnetic stimulation and potential cortical and trigeminothalamic mechanisms in migraine. Brain. 2016; 139(Pt 7): 2002-2014. doi: 10.1093/brain/aww118
Samsam M., Targeting calcitonin gene related peptide and its receptor by monocolonal antibody, new developments in the treatment of migraine. Neuro Open J. 2015; 2: e6-e10. doi.: 10.17140/NOJ-2-e004
Gokani T. Ayurveda--the science of healing. Headache. 2014; 54(6): 1103-1106. doi: 10.1111/head.12363
McBean DE, Sharkey J, Ritchie IM, Kelly PA. Evidence for a possible role for serotonergic systems in the control of cerebral blood flow. Brain Res. 1990; 537: 307-310. doi: 10.1016/0006- 8993(90)90374-K
Merison K, Jacobs H. Diagnosis and treatment of childhood migraine. Curr Treat Options Neurol. 2016; 18(11): 48. doi: 10.1007/ s11940-016-0431-4
Happe S, Peikert A, Siegert R, Evers S. The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: A randomized, controlled parallel group study. Neurol Sci. 2016; 37(10): 1627-1632. doi: 10.1007/s10072-016-2645-3
Foroughipour M, Golchian AR, Kalhor M, Akhlaghi S, Farzadfard MT, Azizi H. A sham-controlled trial of acupuncture as an adjunct in migraine prophylaxis. Acupunct Med. 2014; 32(1): 12-16. doi: 10.1136/acupmed-2013-010362
Ramadan NM, Skljarevski V, Phebus LA, Johnson KW. 5-HT1F receptor agonists in acute migraine treatment: a hypothesis. Cephalalgia. 2003; 23: 776-785. doi: 10.1046/j.1468- 2982.2003.00525.x
Tottene A, Urbani A, Pietrobon D. Role of different voltagegated Ca2+ channels in cortical spreading depression: specific requirement of P/Q-type Ca2+ channels. Channels (Austin). 2011; 5: 110-114. doi: 10.4161/chan.5.2.14149
Knyihár-Csillik E, Tajti J, Samsam M, Sáry G, Buzás P, Vécsei L. Effect of a serotonin agonist (Sumatriptan) on the peptidergic innervation of the rat cerebral dura mater and on the expression of c-fos in the caudal trigeminal nucleus in an experimental migraine model. J Neurosci Res. 1997; 48: 449-464.
Matharu MS, Bartsch T, Ward N, Frackwiak RS, Weiner R, Goadsby PJ. Central neuromodulation in chronic migraine patients with suboccipital stimulators: A PET study. Brain. 2004; 127: 220- Submit your article to this journal | https://openventio.org/submit-manuscript/ 230. doi: 10.1093/brain/awh022
Bahra A, Walsh M, Menon S, Goadsby PJ. Does chronic daily headache arise de novo in association with regular use of analgesics? Headache. 2003; 43: 179-190. doi: 10.1046/j.1526- 4610.2003.03041.x
Radat F, Creac’h C, Guegan-Massardier E, Mick G, Guy N, Fabre N, et al. Behavioral dependence in patients with medication overuse headache: A cross-sectional study in consulting patients using the DSM-IV criteria. Headache. 2008; 48: 1026-1036. doi: 10.1111/j.1526-4610.2007.00999.x
Gallai V, Sarchielli P, Floridi A, Franceschini M, Codini M, Glioti G, et al. Vasoactive peptide levels in the plasma of young migraine patients with and without aura assessed both interictally and ictally. Cephalalgia. 1995; 15(5): 384-390. doi: 10.1046/j.1468- 2982.1995.1505384.x
Robbins L. New Migraine Treatments: Oral Gepants, Ditan Tablet, and More. Web site. https://www.practicalpainmanagement. com/treatments/pharmacological/new-migraine-medications-oral-gepants-ditan-tablet-more. May 14, 2020.
Bigal ME, Walter S, Rapoport AM. Therapeutic antibodies against CGRP or its receptor. Br J Clin Pharmacol. 2015; 79(6): 886- 895. doi: 10.1111/bcp.12591
Bangs ME, Kudrow D, Wang S, Oakes TM, Terwindt GM, Magis D, et al. Safety and tolerability of monthly galcanezumab injections in patients with migraine: integrated results from migraine clinical studies. BMC Neurology. 2020; 20: 25. doi: 10.1186/s12883-020- 1609-7
Silberstein SD, Dodick DW, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017; 377: 2113-2122. doi: 10.1056/NEJMoa1709038
Dodick DW, Silberstein SD, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Effect of fremanezumab compared with placebo for prevention of episodic migraine. JAMA. 2018; 319(19): 5-14. doi: 10.1001/jama.2018.4853
Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur. J Neurol. 2009; 16: 968-981. doi: 10.1111/j. 14681331.2009.02748.x
Spindler BL, Ryan M. Medications approved for preventing migraine headaches. Am J Med. 2020; 133: 664-667. doi: 10.1016/j. amjmed.2020.01.031
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