AAN 2019 Annual Meeting Coverage

During the Hot Topics in Headaches and Related Disorders II: Migraine Pathophysiology, Brain Imaging and Therapeutic Advances at the AAN 2019 Annual Meeting in Philadelphia, Prof. Peter Goadsby (UCSF Medical Center) presented the latest advances in migraine therapy.

Prof. Goadsby started his presentation by reminding the audience that until recently, triptans— a class of serotonin 5-HT1B/1D receptor agonists—were the mainstay of the management of acute migraine attacks.1-3

Prof. Goadsby proceeded to review Gepants, small-molecule CGRP receptor antagonists developed for acute migraine therapy.4 He presented data from a set of clinical trials demonstrating the efficacy and favorable safety profile of gepants in acute migraine management. Prof. Goadsby further outlined promising data on non-invasive neuromodulations techniques, such as single pulse transcranial magnetic stimulation (sTMS) and non-invasive vagal nerve stimulation (nVNS).

In Prof. Goadsby’s opinion, when migraine occurs frequently, prophylactic therapy is preferred over acute treatment. The majority of available prophylactic treatment options are borrowed from alternate indications—e.g. beta-blockers and antidepressants—which limits their specificity, efficacy, and gives rise to a variety of adverse effects.2 Among the new classes of migraine-specific drugs in development are monoclonal antibodies targeting either CGRP or its receptor. Prof. Goadsby presented encouraging data from clinical trials with these antibodies, and emphasized the favorable safety profile of this drug class.

Prof. Goadsby concluded his presentation by stating that although there is still a lot to learn in the field of migraine, the armamentarium of preventive treatment options for migraine is currently experiencing a promising evolution. In this context, Prof. Goadsby encouraged young researchers to study the field of migraine and tackle its many unanswered questions.

“There are remaining questions on how triptans work that will not be solved anytime soon”

– Professor Peter Goadsby

References

  1. GDB 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-1858.
  2. Goadsby PJ, et al. Migraine therapy: Current approaches and new horizons. Neurotherapeutics. 2018;15:271-273.
  3. Vila-Pueyo M. Targeted 5-HT1F therapies for migraine. Neurotherapeutics. 2018;15:291-303.
  4. Holland PR, et al. Targeted CGRP small molecule antagonists for acute migraine therapy. Neurotherapeutics. 2018;15:304-312.