Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Apr 17;20(1):37.
doi: 10.1186/s10194-019-0974-3.

Therapeutic novelties in migraine: new drugs, new hope?

Thien Phu Do  1 , Song Guo  1 , Messoud Ashina  2
Affiliations
Review

Therapeutic novelties in migraine: new drugs, new hope?

Thien Phu Do et al. J Headache Pain. .

Erratum in

Abstract

Background: In the past decade, migraine research has identified novel drug targets. In this review, we discuss recent data on emerging anti-migraine therapies.

Main body: The development of ditans, gepants and anti-calcitonin gene-related peptide monoclonal antibodies for the treatment of migraine is one of the greatest advances in the migraine field. Lasmiditan, rimegepant and ubrogepant will extend our therapeutic armamentarium for managing acute migraine attacks when triptans are not effective or contraindicated due to cardiovascular disorders. The monoclonal antibodies are migraine specific prophylactic drugs with high responder rates and favorable adverse event profiles. Furthermore, they offer convenient treatment regimens of 4- or 12-week intervals.

Conclusion: Collectively, novel migraine therapies represent a major progress in migraine treatment and will undoubtedly transform headache medicine.

Keywords: Adverse event; Antibody; Ditan; Efficacy; Gepant; Migraine; Randomized clinical trial; Tolerability.

PubMed Disclaimer

Conflict of interest statement

MA is a consultant or scientific advisor for Allergan, Amgen, Alder, Eli Lilly, Novartis and Teva, principal investigator for: Amgen 20,120,178 (Phase 2), 20,120,295 (Phase 2), 20,130,255 (Open label extension), 20,120,297 (Phase 3), 20,150,308 (Phase 2), ElectroCore GM-11 gamma-Core-R, TEVA TV48125-CNS-30068 (Phase 3), Novartis CAMG334A2301 (Phase 3) and Alder PROMISE-2. MA has no ownership interest and does not hold stock in any pharmaceutical company. MA serves as associated editor of Cephalalgia and co-editor of the Journal of Headache and Pain and is Editor for the thematic series 'The changing face of migraine'. TPD and SG report no competing interests.

Figures

Fig. 1
Fig. 1
Overview of patients (%) achieving 2-h pain freedom in lasmiditan phase III clinical trials with different doses. A darker bar indicates a higher dose. *vs. placebo, p < 0.001
Fig. 2
Fig. 2
Overview of the therapeutic gain* in 2-h pain freedom with lasmiditan. A darker bar indicates a higher dose. *Therapeutic gain is defined as the difference between percentage of responders in active group compared to percentage of responders in placebo group
Fig. 3
Fig. 3
Overview of the therapeutic novelties targeting the calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide/pituitary adenylate cyclase 1 (PACAP/PAC1) pathways developed for migraine
Fig. 4
Fig. 4
Overview of patients (%) achieving 2-h pain freedom in rimegepant phase III clinical trials. *Study 301; vs. placebo, p < 0.003. Study 302; vs. placebo, p < 0.001
Fig. 5
Fig. 5
Overview of patients (%) achieving 2-h pain freedom in ubrogepant phase III clinical trials. *ACHIEVE I; 50 mg vs. placebo, p = 0.0023; 100 mg vs. placebo, p = 0.0003. ACHIEVE II; 25 mg vs. placebo, p = 0.0285; 50 mg vs. placebo, p = 0.0129
Fig. 6
Fig. 6
Overview of the therapeutic gain* in 2-h pain freedom with gepants. A darker bar indicates a higher dose. *Therapeutic gain is defined as the difference between percentage of responders in active group compared to percentage of responders in placebo group
Fig. 7
Fig. 7
Overview of patients (%) achieving > 50% reduction in migraine days in phase III clinical trials with erenumab. A darker bar indicates a higher dose. *ARISE; 70 mg vs. placebo, p = 0.010. STRIVE; 70 mg vs. placebo, p < 0.001; 140 mg vs. placebo, p < 0.001
Fig. 8
Fig. 8
Overview of patients (%) achieving > 50% reduction in migraine days in phase III clinical trials with eptinezumab. A darker bar indicates a higher dose. *PROMISE I; 100 mg vs. placebo, p = 0.0085; 300 mg vs. placebo, p = 0.0001. PROMISE II; 100 mg vs. placebo, p < 0.0001; 300 mg vs. placebo, p < 0.0001
Fig. 9
Fig. 9
Overview of patients (%) achieving > 50% reduction in migraine days in phase III clinical trials with fremanezumab. A darker bar indicates a higher dose. *NCT02629861 (left); 225 mg vs. placebo, p < 0.001; 675 mg vs. placebo, p < 0.001. NCT02629861 (right); 225 mg vs. placebo, p < 0.001; 675 mg vs. placebo, p < 0.001
Fig. 10
Fig. 10
Overview of patients (%) achieving > 50% reduction in migraine days in phase III clinical trials with galcanezumab. A darker bar indicates a higher dose. *EVOLVE-1; 120 mg vs. placebo, p < 0.001; 240 mg vs. placebo, p < 0.001. EVOLVE-2; 120 mg vs. placebo, p < 0.001; 240 mg vs. placebo, p < 0.001
Fig. 11
Fig. 11
Overview of the therapeutic gain* in percentage of patients with > 50% reduction in migraine days with anti-calcitonin gene-related peptide monoclonal antibodies. A darker bar indicates a higher dose. *Therapeutic gain is defined as the difference between percentage of patients in active group compared to percentage of patients in placebo group
See this image and copyright information in PMC

References

    1. Ashina M, Hansen JM, BO ÁD, et al. Human models of migraine - short-term pain for long-term gain. Nat Rev Neurol. 2017;13:713–724. doi: 10.1038/nrneurol.2017.137. - DOI - PubMed
    1. Schytz HW, Schoonman GG, Ashina M. What have we learnt from triggering migraine? Curr Opin Neurol. 2010;23:259–265. doi: 10.1097/WCO.0b013e328337b884. - DOI - PubMed
    1. Goadsby P, Lipton R, Ferrari M. Migraine- current understanding and treatment. N Engl J Med. 2002;346:257–270. doi: 10.1056/NEJMra010917. - DOI - PubMed
    1. Humphrey PP, Feniuk W, Perren MJ, et al. Serotonin and migraine. Ann N Y Acad Sci. 1990;600:587–598. doi: 10.1111/j.1749-6632.1990.tb16912.x. - DOI - PubMed
    1. Goadsby PJ. The vascular theory of migraine--a great story wrecked by the facts. Brain. 2009;132:6–7. doi: 10.1093/brain/awn321. - DOI - PubMed

MeSH terms