Migraine 偏头痛: I Prevention

choi

Jonathan D Rockoff, Treatments to Prevent Migraines Show Positive Results. Wall Street Journal, Nov 30, 2017.
https://www.wsj.com/articles/new ... eatments-1511994639

Two consecutive paragraphs:

"Pain Medicines like ibuprofen as well as so called triptan drugs, now sold in general versions, are approved [by FDA and regulators in foreign countries] to treat attacks already underway. But to ward off attacks, patients mostly relies on drugs approved for other uses, like epilepsy or depression.

"The experimental drugs [meaning FDA has not approved them, except for clinical trials] belong to an emerging class mostly injectable biological treatments to prevent migraine. These drugs target a chemical, known by its initials CGRP, involved in the brain's pain signaling during migraines.

Note:
(a) This is a concise report, with the quotations constituting about a third of its length. The quotation is all you need to read in this report.
(b)
(i) The WSJ report says
(A) Teva Pharmaceuticals Industries Ltd (1901- ; based in Israel; Teva is Hebrew noun for "nature")
and (B) Amgen Inc and Novartis AG
publishes phase 3 of clinical trials of their own drugs in New England Journal of Medicine, Wednesday (Nov 29).
(ii) The publications are
(A) from Teva:
Silberstein SD et al, Fremanezumab for the Preventive Treatment of Chronic Migraine. New England Journal of Medicine, 377: 2113-2122 (Oct 30, 2017).
www.nejm.org/doi/full/10.1056/NEJMoa1709038
(B) from Amgen and Novartis:
Goadsby PJ et al, A Controlled Trial of Erenumab for Episodic Migraine. N Engl J Med, 377: 2123-2132 (Nov 30, 2017).
www.nejm.org/doi/full/10.1056/NEJMoa1705848

Each publication tests a different monoclonal antibody that inhibits the CGRP receptor (name of the monoclonal antibody appears in the title of publication).
(iii) These two, like any other antibody, must be injected -- because oral ingestion may cause them to be digested (and invalidated).
(c)
(i) The WSJ report in print includes a table that lists, among other experimental drugs to prevent migraine, ubrogepant from Dublin, Ireland-based Allergan. The ubrogepant is a small chemical taken orally as an antagonist to CGRP receptor. CGRP stands for "calcitonin gene-related peptide."
(ii) In summary, the two monoclonal antibodies, along with ubrogepant, hopefully may PREVENT migraine, as opposed to "triptan drugs" that specifically treat migraine AFTER the headache has started.
(d) CGRP stands for "calcitonin gene-related peptide."
(i) calcitonin gene-related peptide
https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptide
(ii) Russell FA et al, Calcitonin Gene-Related Peptide: Physiology and Pathophysiology. Physiological Reviews, 94: 1099–1142
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187032/
("CGRP is a highly potent vasodilator * * * CGRP is primarily released from sensory nerves * * * The primary association of CGRP with sensory neurons * * * is clear. * * * CGRP is also coexpressed with ACh [acetylcholine] in motor neurons. Of importance for the vasodilator activity of CGRP is the finding that CGRP is contained in perivascular nerves, providing a major link with the cardiovascular system [citation omitted]. Immunohistochemical localization of CGRP indicates * * * The localization of CGRP in perivascular neurons is common to all vascular beds, with perhaps a higher localization in arterial than venous tissues")
(e) In the next posting, I will talk about treatment of headache after migraine starts -- that is, triptan drugs.