Review article
https://doi.org/10.20471/acc.2023.62.s4.6
Novel Approaches in Drug Treatment of Migraines
Davor Jančuljak
; Department of Neurology, Osijek Clinical Hospital Center, Osijek, Croatia; Faculty of Medicine, University of Osijek “J.J. Strossmayer”, Osijek, Croatia
*
Zvonimir Popović
; Department of Neurology, Osijek Clinical Hospital Center, Osijek, Croatia; Faculty of Medicine, University of Osijek “J.J. Strossmayer”, Osijek, Croatia
* Corresponding author.
Abstract
Migraine treatment can be aimed at the acute treatment of pain attacks and accompanying
symptoms and at preventing the recurrence of headaches. The choice of drug depends on clinical
effectiveness based on scientific evidence. If general analgesics are not appropriate for the acute treatment
of migraines, the first choice are specific drug agonists of serotonin receptors class 1B and 1D triptans.
Since triptans are contraindicated in patients with vascular diseases due to their vasoconstrictor effects,
lasmiditan, a class 1 F agonist that does not have such an effect, was developed. A revolution in the treatment
of migraine was achieved through the use of antagonist molecules against calcitonin gene-related
peptide (CGRP) and its receptor. There are two types of such molecules: large molecules of monoclonal
antibodies (Mabs) that are exclusively used as prophylaxis for migraines, and small molecules called gepants
that can be used in acute treatment as well as for prophylaxis in migraines. Due to the pharmacological
profile of Mabs, they are suitable for treatment in the parenteral form at longer application intervals (4
weeks / 1 month, or 3 months). They have an excellent clinical effect on reducing the frequency of frequent
episodic and chronic migraines, which ca be achieved in a few weeks with good tolerability, in contrast to
non-specific prophylactics that have lower effectiveness and tolerability. According to the latest European
guidelines, CGRP Mabs may be given as the first choice in migraine prophylaxis.
Keywords
migraine; drugs; acute treatment; prophylaxis
Hrčak ID:
315816
URI
Publication date:
1.11.2023.
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