Section Review—Central & Peripheral Nervous Systems: Current and Future Therapies for Migraine

Abstract

Although migraine has been recognised and described over many centuries, effective therapy has only recently become available. Historically, ergotamine was the first acute treatment, introduced over seventy years ago, followed by aspirin and, more recently, non-steroidal anti-inflammatory drugs. Over the past twenty years, the role of prophylactic medication in migraine treatment has also become established. In recent years, interest in migraine has increased, including scientific perspective into the aetiology of this condition, clinical evaluation of existing and new migraine treatments and pharmaceutical activity in developing effective therapies. In this context, sumatriptan represents the first of a novel class of drugs (5-HT_1D agonists) specifically developed from an understanding of the pathophysiology of migraine. This drug is an acute treatment for migraine and clinical experience with sumatriptan is extensive. Currently, other 5-HT_1D drugs are in clinical development and a further class of agents being investigated (the neurokinin antagonists) are considered to have potential as migraine treatments. Furthermore, in this innovative field, existing migraine therapies are being re-formulated to improve their clinical profiles and, in the future, an understanding of the role of nitric oxide in migraine and also application of genetic approaches may become a reality, leading to further new therapies. The objective of this review is to consider the above issues in a clinical context and attempt to evaluate the clinical significance of such developments in the current and future treatment of migraine.