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Pharmacological strategies to treat attacks of episodic migraine in adults

Research output: Contribution to journalReviewResearchpeer-review

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INTRODUCTION: Migraine patients prioritize early complete relief of headache and associated symptoms, sustained freedom of pain, and good tolerability. One major obstacle for the successful use of drug treatment of migraine attack is that the speed of action of triptans, 5-HT1B/1D receptor agonists, is delayed.

AREAS COVERED: In this review, the author discusses the following features of acute migraine drugs: pharmacology; pharmacokinetics, and absorption of drugs during migraine attacks. Next, dose-response curves for effect; and the delayed onset of action is reviewed. In the more clinical part of the review, the following items are discussed: overall clinical judgments; comparison of triptans; comparison of triptans with NSAIDs; early intervention with triptans; medication-overuse headache; comments on the effect of gepants; and the general principle of acute migraine therapy.

EXPERT OPINION: The delay in the onset of effect of acute migraine drugs is likely due to a complex antimigraine system involving more than one site of action. Investigations into the mechanisms of the delay should have a high priority, both in studies with animals, migraine models, and in migraine patients during attacks. Non-oral administration of antimigraine drugs resulting in early absorption of drugs should be developed as they possibly also can increase Emax.

Original languageEnglish
JournalExpert Opinion on Pharmacotherapy
Volume22
Issue number3
Pages (from-to)305-316
Number of pages12
ISSN1465-6566
DOIs
Publication statusPublished - 2021

    Research areas

  • Adult, Animals, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use, Humans, Migraine Disorders/drug therapy, Serotonin Receptor Agonists/therapeutic use, Tryptamines/therapeutic use, Acute migraine therapy, triptans, gepants, lasmiditan, NSAIDs, tolerability, delayed onset

ID: 66965943