New therapy option for the treatment of migraines

New therapy option for the treatment of migraines

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Extended range of therapies for patients with migraines

Migraine is one of the most common neurological diseases. The range of therapies for affected patients has expanded significantly in recent years. However, due to their vasoconstricting effects, many of the medicines available must not be taken by many people. Now, new substances also offer these patients a therapy option.

As the German Society for Neurology (DGN) reports in a communication, the therapeutic spectrum for patients with migraines has expanded significantly in recent years. New antibodies help to effectively prevent migraine attacks or to reduce the frequency of attacks. However, if a serious seizure nevertheless occurs, only triptans have been available to reduce the duration and intensity of the seizure. However, many patients are not allowed to take these drugs because of their vasoconstricting effects. However, new substances now also offer these people a therapy option.

One of the most common forms of headache

Migraine is one of the most common forms of headache. As explained on the information portal "Neurologists and Psychiatrists on the Net", about 12 to 14% of all women and 6 to 8% of all men in Germany suffer from migraines. The seizure-like headache returns at irregular intervals. “Some people only have a migraine once or twice a year. Others suffer from migraines several times a month or almost every day, ”the experts write. Migraine attacks last from a few hours to three days.

In some cases, home remedies for migraines can help. But those affected often take medication. As the DGN explains, pain relievers such as acetylsalicylic acid and paracetamol and non-steroidal anti-inflammatory drugs are available for the treatment of mild to moderate migraine attacks. According to a DGN guideline, patients who do not respond to this therapy or who suffer from severe migraine attacks for which they do not work are treated with triptans.

Triptans can be life-threatening in some patients

According to the DGN, triptans are very effective and, if taken in good time at the start of a migraine attack, can significantly reduce pain severity and duration. These preparations are a blessing for many sufferers and have proven themselves in everyday clinical practice for years and decades.

Although they are generally very low in side effects, they have a property that prevents some patients from taking them: triptans bind to the so-called 5-HT1 receptors, thereby preventing “pain stimulus transmission” (so-called inhibition of nociceptive transmission) and, moreover, that Release of inflammatory neuropeptides is reduced, which also contributes to pain relief. However, they also have a vasoconstrictive effect, i.e. they narrow the vessels.

This is the reason why triptans are contraindicated in different patient groups, among other things if there are serious vascular diseases such as angina pectoris or different vascular risk factors and of course also in patients who already have a heart attack, stroke or a so-called "mini-stroke" (TIA ) suffered. Taking these triptans can be life-threatening for these people.

Two new therapeutic approaches

Because people with migraines, who also belong to this patient group, have so far not had effective therapy options, there was a need to develop new drugs for acute migraine therapy that have no vasoconstrictive properties. In the meantime, two classes of substances have been developed and are in clinical trials, the so-called “Ditane” and “Gepante” groups.

As the DGN explains, Lasmiditan belongs to the first group. Like a triptan, this substance is an agonist at the serotonin 5 HT1F receptor, but in contrast to this conventional class of active substances it has no vasoconstrictive properties. In two large phase 3 studies, lasmiditan was more effective than placebo in the acute therapy of a migraine attack. However, the substance has unpleasant central side effects such as drowsiness and dizziness, which restrict its practical use. The range of indications for lasmiditan will therefore very likely be limited to patients who have contraindications to taking triptans.

The second new approach to treating migraine attacks are small molecules that act as antagonists to the CGRP receptor, the so-called "cheetahs". Ubrogepant and rimegepant were examined in larger, randomized, placebo-controlled studies for the treatment of acute migraine attacks. Both are said to be more effective than placebo and, unlike lasmiditan, have few side effects.

To date, there have been no direct comparative studies with triptans, but according to the DGN it can be said that both lasmiditan and the CGRP receptor antagonists appear to be less effective than triptans. “But they are still a long-awaited and important treatment option for patients with severe migraines for whom triptans are contraindicated. It should not be forgotten that there has been no acute migraine therapy for these patients. Anyone who knows how painful and severely debilitating a severe migraine attack can be will understand that in this situation, therapies that are somewhat less effective than hoped for can significantly improve the quality of life, ”says Professor Dr. Hans-Christoph Diener, press spokesman for the DGN. (ad)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

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