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Related Experiment Videos

New migraine preventive options: an update with pathophysiological considerations.

Marcelo E Bigal1, Alan M Rapoport, Fred D Sheftell

  • 1New England Center for Headache, Stamfor, CT, USA.

Revista Do Hospital Das Clinicas
|March 4, 2003
PubMed
Summary

This review explores newer and less common preventive migraine treatments, including anticonvulsants, natural products, and CGRP antagonists. These therapies aim to alleviate the global public health burden of frequent, severe migraines.

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Area of Science:

  • Neurology
  • Pharmacology

Background:

  • Migraine treatment includes acute and preventive strategies, with prophylaxis essential for frequent, severe attacks.
  • Current understanding suggests migraine stems from a hyperexcitable brain, potentially due to factors like low magnesium, mitochondrial issues, or nitric oxide dysregulation.
  • Advances in understanding migraine pathophysiology inform the exploration of novel therapeutic options.

Purpose of the Study:

  • To provide an evidence-based review of emerging or underutilized preventive migraine therapies.
  • To discuss new drugs and agents with potential for migraine prophylaxis.

Main Methods:

  • Review of anticonvulsants (lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam, zonisamide) with diverse mechanisms.
  • Examination of natural products (riboflavin, magnesium), botulinum toxin A, a calcitonin gene-related peptide (CGRP) antagonist, and montelukast.

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  • Pathophysiological discussion integrated with the review of therapeutic agents.

    • Main Results:

    • Anticonvulsants with various mechanisms of action were reviewed for their preventive potential in migraine.
    • Natural products, botulinum toxin A, a CGRP antagonist, and montelukast were discussed in the context of migraine pathophysiology.
    • The review highlights agents that, while available, are not commonly employed for migraine prophylaxis.

    Conclusions:

    • The study updates knowledge on newer or less frequently used preventive migraine therapies.
    • These therapies have the potential to reduce the significant burden and costs associated with migraine.
    • Migraine is recognized as a global public health concern, necessitating effective management strategies.