New strategies in migraine therapy

作者：Keidel M^*

来源：Nervenheilkunde, 2011, 30(12): 972-+.

• Chronic migraine
• migraine attack
• comorbidity
• aura
• therapy

Currently there are no clinical investigations of novel triptans. However, innovative delivery systems of triptans are under study. In the USA a novel formulation of sumatriptan which is delivered using an iontophoretic transdermal patch is submitted to approval. A needle-free drug delivery system to subcutaneously administer sumatriptan for the acute treatment of migraine is approved. A fixed-dose tablet of sumatriptan and naproxen sodium is approved by the FDA. Other fixed combinations of triptans with NSAIDs or caffeine or acetaminophen are being tested. Amitriptyline is effective in chronic migraine; levetiracetame is not. The combination of topiramate and propranolol is not superior to a monotherapy of chronic migraine with topiramate. For treatment of acute migraine attacks valproate given intravenously is just as well effective as acetylsalicylic acid. Calcitonin gene-related peptide (CGRP) receptor antagonists, 5-HT 1F receptor agonists, glutamate receptor antagonists, nitric oxide syntase inhibitors and gap junction modulators, which do not have direct vasoconstrictor effects, are targets for acute antimigraine drugs. Oral inhalation of dihydroergotamine as a novel route of administration improving pulmonary systemic absorption is under investigation. Targeting the cortical spreading depression and neuromodulatory brainstem structures transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) or the application of drugs inhibiting neuronal-glial gap junctions are analysed in clinical trials and animal experiments. Intramuscular injections of OnabotulinumtoxinA across seven specific head/neck muscle areas are approved to treat chronic migraine refractory to oral medication. The significance of neuromodulatory techniques (e. g. occipital nerve block) in the treatment of chronic migraine is a matter of debate. This therapeutic option should be restricted to special centers. To prevent chronic migraine possible comorbidities should be diagnosed and treated.

• 出版日期2011