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Review
. 2020 Jan;60(1):190-199.
doi: 10.1111/head.13728. Epub 2019 Dec 30.

The Headache Pipeline: Excitement and Uncertainty

Alan M Rapoport  1 , Peter McAllister  1
Affiliations
Review

The Headache Pipeline: Excitement and Uncertainty

Alan M Rapoport et al. Headache. 2020 Jan.

Abstract

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 5HT1F 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.

Keywords: calcitonin gene-related peptide antibodies; gepants; headache devices; neuromodulation; neurostimulators; treatment of cluster headache; treatment of migraine.

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References

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