Skip to main content
SpringerLink
Log in

Taking the Negative View of Current Migraine Treatments

The Unmet Needs

  • Current Opinion
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Acute migraine treatment is given to abolish ongoing attacks, while prophylactic migraine treatment is given on a daily basis to prevent the occurrence of migraine attacks as far as possible. The majority of migraine patients do not use the specific acute anti-migraine drugs, the triptans. Thus, only 10% (Denmark) to 35% (France) of migraine patients use triptans. This is most likely due to relatively low efficacy. Thus, in randomized controlled trials (RCTs) pain freedom after 2 hours ranges from 12% (frovatriptan 2.5 mg) to 40% (rizatriptan 10 mg). For prophylactic treatment (propranolol, valproate, topiramate) a response (at least a 50% reduction in migraine frequency) is observed in 40–50%. In addition, prophylactic treatment is hampered by adverse events and withdrawals.

[There is a need for new acute anti-migraine drugs and targets are already available and there are more to come. It has been estimated that approximately 2% of the adult population need prophylactic treatment because of frequent migraine attacks. For prophylactic migraine drugs there is an even greater need for new drugs than for acute drug treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Dahlöf C, Hogenhuis L, Olesen J, et al. Early clinical experience with subcutaneous naratriptan in the acute treatment of migraine: a dose-ranging study. Eur J Neurol 1998; 5: 469–77

    Article  PubMed  Google Scholar 

  2. Tfelt-Hansen P. Parenteral versus oral sumatriptan and naratriptan: plasma levels and efficacy in migraine. A comment. J Headache Pain 2007; 8: 273–6

    Article  CAS  Google Scholar 

  3. Tfelt-Hansen P. Maximum effect of triptans? A comment. Cephalalgia 2008; 28: 767–8

    Article  PubMed  CAS  Google Scholar 

  4. Treatment of migraine attacks with sumatriptan: the Subcutaneous Sumatriptan International Study Group. N Eng J Med 1991; 325: 316–21

    Article  Google Scholar 

  5. Cady RK, Wendt JK, Kirchner JR, et al. Treatment of acute migraine with subcutaneous sumatriptan. JAMA 1991; 265: 2831–5

    Article  PubMed  CAS  Google Scholar 

  6. Tfelt-Hansen P. Excellent tolerability but relative low initial efficacy of telcagepant in the treatment of migraine. Headache 2011; 51: 118–23

    Article  PubMed  Google Scholar 

  7. Ferrari MD, Goadsby PJ, Roon KI, et al. Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Cephalalgia 2002; 22: 633–56

    Article  PubMed  CAS  Google Scholar 

  8. Saxena PR, Tfelt-Hansen P. Triptans, 5HT1B/1D agonists in the acute treatment of migraine. In: Olesen J, Goadsby PJ, Ramadan NM, et al., editors. The headaches. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2006: 469–503

    Google Scholar 

  9. Poolsup N, Leelasangaluk V, Jittangtrong J, et al. Efficacy of tolerability of frovatriptan in acute migraine treatment: systematic review of randomized controlled trials. J Clin Pharm Ther 2005; 30: 521–32

    Article  PubMed  CAS  Google Scholar 

  10. Kramer MS, Matzura-Wolf D, Polis A, et al. A placebo-controlled crossover study of rizatriptan in the treatment of multiple migraine attacks: Rizatriptan Multiple Attack Study Group. Neurology 1998; 51: 773–81

    Article  PubMed  CAS  Google Scholar 

  11. Diener H-C, Barbanti P, Dahlöf C, et al. BI 44370 TA, an oral CGRP antagonist for the treatment of acute migraine attacks: results from a phase II study. Cephalalgia 2011; 31: 573–84

    Article  PubMed  Google Scholar 

  12. Tfelt-Hansen P, Block G, Dahlöf C, et al. Guidelines for controlled trials of drugs in migraine: second edition. Cephalalgia 2000; 20: 765–86

    Article  PubMed  CAS  Google Scholar 

  13. Lipton RB, Stewart WF. Acute migraine therapy: do doctors understand what patients with migraine want from therapy? Headache 1999; 39 Suppl. 2: S20–6

    Article  Google Scholar 

  14. Lantéri-Minet M, Massiou H, Romatet S, et al. An instrument to assess patient perception of satisfaction with acute migraine treatment (EXPERT Study). Headache 2011; 51: 590–601

    Article  PubMed  Google Scholar 

  15. Tfelt-Hansen P, Steiner TJ. Over-the-counter triptans for migraine: what are the implications? CNS Drugs 2007; 21: 877–83

    Article  PubMed  CAS  Google Scholar 

  16. Bigal ME, Borucho S, Serrano D, et al. The acute treatment of episodic and chronic migraine in the US. Cephalalgia 2009; 29: 891–7

    Article  PubMed  CAS  Google Scholar 

  17. Mathew NT, Kailasam J, Meadors L. Early treatment of migraine with rizatriptan: a placebo controlled study. Headache 2004; 44: 669–73

    Article  PubMed  Google Scholar 

  18. Goadsby PJ, Zanchin G, Geraud G, et al. Early vs. non-early intervention in acute migraine: ‘act when mild (AwM)’. A double-blind, placebo-controlled trial of almotriptan. Cephalalgia 2008; 28: 383–91

    CAS  Google Scholar 

  19. Silberstein SD, Mannix LX, Goldstein J, et al. Multi-mechanism (sumatriptan-naproxen) early intervention for the acute treatment of migraine. Neurology 2008; 71: 114–21

    Article  PubMed  CAS  Google Scholar 

  20. Tfelt-Hansen P, Rolan P. b-Adrenoceptor blocking drugs in migraine prophylaxis. In: Olesen J, Goadsby PJ, Ramadan NM, et al., editors. The headaches. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2006: 519–28

    Google Scholar 

  21. Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic review. Headache 1991; 31: 333–40

    Article  PubMed  CAS  Google Scholar 

  22. Diener HC, Tfelt-Hansen P, Dahlöf C. Topiramate in migraine prophylaxis: results from a placebo-controlled trial with propranolol as an active control. Eur Neurol 2004; 251: 943–50

    CAS  Google Scholar 

  23. Toda N, Tfelt-Hansen P. Calcium antagonists in migraine prophylaxis. In: Olesen J, Goadsby PJ, Ramadan NM, et al., editors. The headaches. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2006: 539–44

    Google Scholar 

  24. Celano CM, Freudenreich O, Fernandez-Robles C, et al. Depressogenic effects of medications: a review. Dialogues Clin Neurosci 2011; 13: 109–25

    PubMed  Google Scholar 

  25. Silberstein SD, Tfelt-Hansen P. Antiepileptic drugs in migraine prophylaxis. In: Olesen J, Tfelt-Hansen P, Goadsby PJ, et al., editors. The headaches. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2006: 545–51

    Google Scholar 

  26. Mathew NT, Saper JR, Silberstein SD, et al. Migraine prophylaxis with divalproex. Arch Neurol 1995; 52: 281–6

    Article  PubMed  CAS  Google Scholar 

  27. Klapper JA. Divalproex sodium in migraine prophylaxis: a dose-controlled study. Cephalalgia 1997; 17: 103–8

    Article  PubMed  CAS  Google Scholar 

  28. Freitag FG, Collins SD, Carlson HA, et al. A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis. Neurology 2003; 58: 1652–9

    Article  Google Scholar 

  29. McNamara JO. Drugs effective in the therapy of the epilepsies. In: Hardman JG, Limbird LE, Molinoff PB, et al., editors. Goodman and Gilman’s: the pharmacological basis of therapeutics. 9th ed. New York (NY): McGraw Hill, 1996: 461–80

    Google Scholar 

  30. Edvinsson L, Linde M. New drugs in migraine treatment and prophylaxis: telcagepant and topiramate. Lancet 2010; 376: 645–55

    Article  PubMed  CAS  Google Scholar 

  31. Adelman J, Freitag FG, Lainez M, et al. Analysis of safety and tolerability data obtained from over 1,500 patients receiving topiramate for migraine prevention in controlled trials. Pain Med 2008; 9: 175–85

    Article  PubMed  Google Scholar 

  32. Holroyd KA, Cottrell C, O’Donnel FJ, et al. Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimized acute treatment in frequent migraine: randomised controlled trial. BMJ 2010; 341: c4871

    Article  PubMed  Google Scholar 

  33. Shuhendler AJ, Lee S, Siu M, et al. Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trials. Pharmacotherapy 2009; 29: 784–91

    Article  PubMed  CAS  Google Scholar 

  34. Lipton RB, Hamelsky SW, Dayno JM. What do patients with migraine want from acute migraine treatment? Headache 2002; 42 Suppl. 1: S3–9

    Article  Google Scholar 

  35. International Headache Society Committee on Clinical Trials in Migraine (Tfelt-Hansen P, Chairman). Guidelines for controlled trials of drugs in migraine: first edition. Cephalalgia 1991; 11: 1–12

    Article  Google Scholar 

  36. Andlin-Sobocki P, Jonsson B, Wittchen HU, et al. Cost of disorders of the brain in Europe. Eur J Neurol 2005; 12 Suppl. 1: 1–27

    Article  Google Scholar 

  37. Linde M, Gustavsson A, Stovner LJ, et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol. Epub 2011 Dec 5

  38. Lyngberg AC, Rasmussen BK, Jørgensen T, et al. Secular changes in health care utilization and work absence for migraine and tension-type headache: a population based study. Eur J Epidemiol 2005; 20: 1007–14

    Article  PubMed  CAS  Google Scholar 

  39. Durham PL, Vause CV. Calcitonin gene-related peptide (CGRP) receptor antagonists in the treatment of migraine. CNS Drugs 2010; 24: 539–48

    Article  PubMed  CAS  Google Scholar 

  40. Ferrari MD, Färkkilä M, Reuter U; European COL-144 Investigators. Acute treatment of migraine with the selective 5-HT1F receptor agonist lasmiditan: a randomised proof-of-concept trial. Cephalalgia 2010; 30: 1170–8

    Article  PubMed  Google Scholar 

  41. Lipton RB, Bigal ME, Diamond M, et al.AMPP Advisory Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68: 343–9

    Article  PubMed  CAS  Google Scholar 

  42. Olesen J, Tfelt-Hansen P, Ashina M. Finding new drug targets for the treatment of migraine attacks. Cephalalgia 2009; 29: 909–20

    Article  PubMed  CAS  Google Scholar 

  43. Wienecke T, Olesen J, Oturai PS, et al. Prostaglandin E2(PGE2) induces headache in healthy subjects. Cephalalgia 2009; 29: 509–19

    Article  PubMed  CAS  Google Scholar 

  44. Antonova M, Wienicke T, Maubach K, et al. The pharmacological effect of BGC-1531, a novel prostanoid EP (4) receptor antagonist, in the prostaglandin E (2) human model of headache. J Headache Pain 2011; 12: 551–9

    Article  PubMed  CAS  Google Scholar 

  45. Ploug KB, Baun M, Hay-Schmidt A. Presence and vascular pharmacology of KATP channel subtypes in rat central and peripheral tissues. Eur J Pharmacol 2010; 637: 109–17

    Article  PubMed  CAS  Google Scholar 

  46. Anttila V, Stefansson H, Kallela M, et al.; International Headache Genetic Consortium. Genome-wide association study of migraine implicates a common susceptibility variant on 8q22. 1. Nat Genet 2010; 42: 869–73

    Article  CAS  Google Scholar 

  47. Goadsby PJ, Charbit AR, Andreou AP, et al. Neurobiology of migraine. Neuroscience 2009; 161: 327–41

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to prepare this article. The authors have no conflicts of interest that are directly relevant to the content of this article.

Author information

Authors and Affiliations

  1. Danish Headache Center, Health Science Faculty, University of Copenhagen, Denmark

    Peer Tfelt-Hansen (MD, DMSc) & Jes Olesen

Authors
  1. Peer Tfelt-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jes Olesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peer Tfelt-Hansen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tfelt-Hansen, P., Olesen, J. Taking the Negative View of Current Migraine Treatments. CNS Drugs 26, 375–382 (2012). https://doi.org/10.2165/11630590-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11630590-000000000-00000

Keywords

Search

Navigation