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The Headache Pipeline: Excitement and Uncertainty
Author(s) -
Rapoport Alan M.,
McAllister Peter
Publication year - 2020
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.13728
Subject(s) - zolmitriptan , medicine , sumatriptan , migraine , triptans , calcitonin gene related peptide , tolerability , dihydroergotamine , bromocriptine , anesthesia , pharmacology , agonist , adverse effect , receptor , neuropeptide , prolactin , hormone
There are many new treatment options available for migraine and more are coming. Three calcitonin gene‐related peptide (CGRP) antagonist monoclonal antibodies have been approved and a 4th is due in early 2020. Small molecule CGRP receptor‐blocking oral compounds, both for acute care and prevention, are also coming. Four neurostimulators are available, with others on the way. New acute treatments coming soon include the 5HT 1F agonist lasmiditan, a zolmitriptan intradermal micro‐needle patch, and a nasal mist sumatriptan with a permeability enhancer. Farther out, three novel dihydroergotamine delivery systems, and a liquid‐filled capsule of celecoxib show early promise. A new, safer form of methysergide is in the works, as is a longer‐duration onabotulinumtoxinA. As always with new products, questions regarding safety, tolerability, cost, and insurance coverage will need to be addressed. Despite these concerns and uncertainties, a robust headache treatment pipeline is good for patients who are not satisfied with the results of their treatment and/or cannot tolerate existing treatments.