Top

Current Pain and Headache Reports

Published in:

01-09-2018 | Episodic Migraine (S Nahas, Section Editor)

Emerging Treatments in Episodic Migraine

Authors: Kate W. Grimsrud, Rashmi B. Halker Singh

Published in: Current Pain and Headache Reports | Issue 9/2018

Abstract

Purpose of Review

The purpose of this review is to evaluate and describe recent and emerging treatment options for episodic migraine.

Recent Findings

Recent advances have been made in better understanding the pathophysiology of migraine, which has led to further investigation of potential new pharmacologic and non-pharmacologic treatment options.

Summary

A number of new medications are emerging for the acute and preventive treatment of migraine, including CGRP monoclonal antibodies, CGRP receptor antagonists, serotonin 5-HT_1F agonists, and PACAP receptor monoclonal antibodies. Additionally, newer studies on existing non-invasive neuromodulation devices including transcranial magnetic stimulation, supraorbital transcutaneous nerve stimulation, and transcutaneous vagus nerve stimulation have recently received FDA approval for use in migraine. Neuromodulation devices including percutaneous mastoid electrical stimulation, non-painful remote electrical stimulation, and caloric vestibular stimulation are undergoing further investigation and have shown promising results thus far. These new developments are expected to contribute to better treatment and decreased disability in migraine.

GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16(11):877–97. https://doi.org/10.1016/S1474-4422(17)30299-5.CrossRef

Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800. https://doi.org/10.1016/S0140-6736(15)60692-4.CrossRefPubMedCentral

Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337–45. https://doi.org/10.1212/WNL.0b013e3182535d20. CrossRefPubMedPubMedCentral

Edvinsson L. The trigeminovascular pathway: role of CGRP and CGRP receptors in migraine. Headache. 2017;57(Suppl 2):47–55. https://doi.org/10.1111/head.13081. CrossRefPubMed

Tso AR, Goadsby PJ. Anti-CGRP monoclonal antibodies: the next era of migraine prevention? Curr Treat Options Neurol. 2017;19(27):887–98. https://doi.org/10.1177/0333102416653233. CrossRef

Voss T, Lipton RB, Dodick DW, Dupre N, Ge JY, Bachman R, et al. A phase IIb randomized, double-blind, placebo-controlled trial of ubrogepant for the acute treatment of migraine. Cephalalgia. 2016;36:887–98. https://doi.org/10.1177/0333102416653233.CrossRefPubMed

Deen M, Correnti E, Kamm K, et al. Blocking CGRP in migraine patients—a review of pros and cons. J Headache Pain. 2017;18(1):96. https://doi.org/10.1186/s10194-017-0807-1. CrossRefPubMedPubMedCentral

Hong P, Wu X, Liu Y. Calcitonin gene-related peptide monoclonal antibody for preventive treatment of episodic migraine: a meta analysis. Clin Neurol Neurosurg. 2017;154:74–8. https://doi.org/10.1016/j.clineuro.2017.01.009.CrossRefPubMed

•• Dodick DW, Ashina M, Brandes JL, et al. ARISE: a phase 3 randomized trial of erenumab for episodic migraine. Cephalalgia. 2018;1:333102418759786. https://doi.org/10.1177/0333102418759786. Recently published phase III trial examining CGRP receptor antibody erenumab. CrossRef

10.

• Skljarevski V, Oakes TM, Zhang Q, et al. Effect of different doses of galcanezumab vs placebo for episodic migraine prevention: a randomized clinical trial. JAMA Neurol. 2018;75(2):187–93. https://doi.org/10.1001/jamaneurol.2017.3859. Recently published phase IIb trial examining CGRP antibody galcanezumab. CrossRefPubMed

11.

•• 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(22):2113–22. https://doi.org/10.1056/NEJMoa1709038. Recently published phase III trial examining CGRP antibody fremanezumab. CrossRefPubMed

12.

Somerville BW. Platelet-bound and free serotonin levels in jugular and forearm venous blood during migraine. Neurology. 1976;26:41–5.CrossRefPubMed

13.

Rubio-Beltrán E, Labastida-Ramírez A, Villalón CM, MaassenVanDenBrink A. Is selective 5-HT1F receptor agonism an entity apart from that of the triptans in antimigraine therapy? Pharmacol Ther. 2018;186:88–97. https://doi.org/10.1016/j.pharmthera.2018.01.005.CrossRefPubMed

14.

Negro A, Koverech A, Martelletti P. Serotonin receptor agonists in the acute treatment of migraine: a review on their therapeutic potential. J Pain Res. 2018;11:515–26. https://doi.org/10.2147/JPR.S132833.CrossRefPubMedPubMedCentral

15.

Three doses of lasmiditan (50 mg, 100 mg and 200 mg) compared to placebo in the acute treatment of migraine (SPARTAN). 2017. Available from: https://www.clinicaltrials.gov/ct2/show/record/NCT02605174?term=lasmiditan&rank=1. https://investor.lilly.com/releasedetail.cfm?ReleaseID=1036101

16.

An open-label, long-term, safety study of lasmiditan for the acute treatment of migraine (GLADIATOR). 2017. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02565186?term=GLADIATOR&rank=3.

17.

Sundrum T, Walker CS. PACAP receptors in the trigeminovascular system: implications for migraine. Br J Pharmacol. 2017; https://doi.org/10.1111/bph.14053.

18.

Edvinsson L, Tatji J, Szalardy L, Vecsei L. PACAP and its role in primary headaches. J Headache Pain. 2018;19(1):21. https://doi.org/10.1186/s10194-018-0852-4.CrossRefPubMedPubMedCentral

19.

Waschek JA, Baca SM, Akerman S. PACAP and migraine headache: immunomodulation of neural circuits in autonomic ganglia and brain parenchyma. J Headache Pain. 2018;19(1):23. https://doi.org/10.1186/s10194-018-0850-6.CrossRefPubMedPubMedCentral

20.

Akerman S, Goadsby PJ. Neuronal PAC1 receptors mediate delayed activation and sensitization of trigeminocervical neurons: relevance to migraine. Sci Transl Med. 2015;7(308):308ra157. https://doi.org/10.1126/scitranslmed.aaa7557.CrossRefPubMed

21.

Puledda F, Goadsby PJ. An update on non-pharmacological neuromodulation for the acute and preventive treatment of migraine. Headache. 2017;57(4):685–91. https://doi.org/10.1111/head.13069.CrossRefPubMed

22.

Lipton RB, Dodick DW, Silberstein SD, Saper JR, Aurora SK, Pearlman SH, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomized, double-blind, parallel-group, sham-controlled trial. Lancet Neurol. 2010;9(4):373–80. https://doi.org/10.1016/S1474-4422(10)70054-5.CrossRefPubMed

23.

Bhola R, Kinsella E, Giffin N, Lipscombe S, Ahmed F, Weatherall M, et al. Single-pulse transcranial 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. https://doi.org/10.1186/s10194-015-0535-3. CrossRefPubMed

24.

Starling AJ, Tepper SJ, Marmura MJ, Shamim EA, Robbins MS, Hindiyeh N, et al. A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE Study). Cephalalgia. 2018;1: 333102418762525:1038–48. https://doi.org/10.1177/0333102418762525.CrossRef

25.

Riederer F, Penning S, Schoenen J. Transcutaneous supraorbital nerve stimulation (t-SNS) with the Cefaly device for migraine prevention: a review of the available data. Pain Ther. 2015;4:135–47. https://doi.org/10.1007/s40122-015-0039-5.CrossRefPubMedCentral

26.

Magis D, D’Ostilio K, Thibaut A, de Pasqua V, Gerard P, Hustinx R, et al. Cerebral metabolism before and after external trigeminal nerve stimulation in episodic migraine. Cephalalgia. 2017;37(9):881–91. https://doi.org/10.1177/0333102416656118.CrossRefPubMed

27.

Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gerard P, et al. Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial. Neurology. 2013;80:697–704. https://doi.org/10.1212/WNL.0b013e3182825055.CrossRefPubMed

28.

Magis D, Sava S, d’Elia TS, Baschi R, Schoenen J. Safety and patients’ satisfaction of transcutaneous supraorbital neurostimulation (tSNS) with the Cefaly device in headache treatment: a survey of 2,313 headache sufferers in the general population. J Headache Pain. 2013;14(95) https://doi.org/10.1186/1129-2377-14-95.

29.

Yarnitsky D, Volokh L, Ironi A, Weller B, Shor M, Shifrin A, et al. Nonpainful remote electrical stimulation alleviates episodic migraine pain. Neurology. 2017;88:1250–5. https://doi.org/10.1212/WNL.0000000000003760.CrossRefPubMed

30.

Oshinsky ML, Murphy AL, Hekierski H Jr, Cooper M, Simon BJ. Noninvasive vagus nerve stimulation as treatment for trigeminal allodynia. Pain. 2014;155(5):1037–42. https://doi.org/10.1016/j.pain.2014.02.009.CrossRefPubMedPubMedCentral

31.

Chen SP, Ay I, de Morais AL, et al. Vagus nerve stimulation inhibits cortical spreading depression. Pain. 2016;157(4):797–805. https://doi.org/10.1097/j.pain.0000000000000437.CrossRefPubMedPubMedCentral

32.

Goadsby PJ, Grosberg BM, Mauskop A, Cady R, Simmons KA. Effect of noninvasive vagus nerve stimulation on acute migraine: an open-label pilot study. Cephalalgia. 2014;34(12):986–93. https://doi.org/10.1177/0333102414524494.CrossRefPubMed

33.

Tassorelli C, Grazzi L, De Tommaso M, et al. The PRESTO Trial. Neurology 2018; 90 (15 Supplement).

34.

Juan Y, Shu O, Jinhe L, Na Y, Yushuang D, Weiwei D, et al. Migraine prevention with percutaneous mastoid electrical stimulator: a randomized double-blind controlled trial. Cephalalgia. 2017;37(13):1248–56. https://doi.org/10.1177/0333102416678623.CrossRefPubMed

35.

Wilkinson D, Ade KK, Rogers LL, Attix DK, Kuchibhatla M, Slade MD, et al. Preventing episodic migraine with caloric vestibular stimulation: a randomized controlled trial. Headache. 2017;57:1065–87. https://doi.org/10.1111/head.13120.CrossRefPubMed

Title: Emerging Treatments in Episodic Migraine
Authors: Kate W. Grimsrud
Rashmi B. Halker Singh
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Pain and Headache Reports / Issue 9/2018
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-018-0716-2

At a glance: The STEP trials

Springer Medicine

Emerging Treatments in Episodic Migraine

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 9/2018

Complexities of Perioperative Pain Management in Orthopedic Trauma

A Review of Recent Advances in Ultrasound, Placed in the Context of Pain Diagnosis and Treatment

Forecasting Migraine Attacks and the Utility of Identifying Triggers

Occipital Headaches and Neuroimaging in Children