What efficacy measures are clinically relevant and should be used in Cochrane Reviews of acute migraine trials? A viewpoint

Background Cochrane Reviews are methodologically of high quality but the clinical relevance of analysed efficacy measures (EMs) should also be assessed. Methods The clinical relevance of EMs used in one systematic Cochrane review of oral zolmitriptan for migraine headache was evaluated. Results The following EMs were used: pain free at two hours (30%), headache relief at two hours (60%), sustained pain free for 24 hours (19%) and sustained headache relief for 24 hours (39%). These EMs were also used in four other Cochrane reviews of acute migraine treatment. Of these EMs sustained headache relief for 24 h is not judged clinically relevant. Conclusion Pain free and sustained pain free are clinically relevant, but the responses are rather low, demonstrating that there is a need for improvement of acute drug treatment in migraine.

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Rimegepant: acute treatment for migraine headaches

Pain Management ◽

10.2217/pmt-2020-0090 ◽

2021 ◽

Author(s):

Golden L Peters ◽

Erin K Hennessey

Keyword(s):

Migraine Headache ◽

Acute Treatment ◽

Treatment Options ◽

Migraine Treatment ◽

Acute Migraine ◽

The Past ◽

Vasoactive Peptides ◽

Migraine Headaches ◽

Calcitonin Gene ◽

Acute Migraine Treatment

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

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Targeted Review: Medications for Acute Migraine Treatment

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100017832 ◽

2013 ◽

Vol 40 (S3) ◽

pp. S10-S32 ◽

Cited By ~ 2

Author(s):

Irene Worthington ◽

Tamara Pringsheim ◽

Marek J. Gawel ◽

Jonathan Gladstone ◽

Paul Cooper ◽

...

Keyword(s):

Migraine Treatment ◽

Acute Migraine ◽

Acute Migraine Treatment

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Effect of Calcitonin Gene-Related Peptide Receptor Antagonists on Migraine Treatment: A Meta-Analysis

10.21203/rs.3.rs-603934/v1 ◽

2021 ◽

Author(s):

Jiyoung Kim ◽

Kyoungjune Pak ◽

Gha-Hyun Lee ◽

Jae Wook Cho ◽

Hyun-Woo kim

Keyword(s):

Meta Analysis ◽

Calcitonin Gene Related Peptide ◽

Migraine Treatment ◽

Acute Migraine ◽

Cgrp Receptor ◽

Receptor Antagonists ◽

Related Peptide ◽

Calcitonin Gene ◽

Cgrp Receptor Antagonists ◽

Acute Migraine Treatment

Abstract Background: The pathophysiology of migraine has been researched incessantly, and it has been suggested that calcitonin gene-related peptide (CGRP) is associated with migraine attacks. CGRP receptor blockers are attracting attention for migraine prevention and treatment of acute episodes, and CGRP receptor antagonists have been shown to be effective in treating acute migraine headaches. This meta-analysis aimed to assess the effect of available CGRP receptor antagonists, focusing on their therapeutic doses for acute migraine treatment.Methods: We performed a systematic search of MEDLINE (from inception to March 2021) and EMBASE (from inception to March 2021) for English publications using the keywords “migraine” and “Calcitonin gene-related peptide,” limited to human studies.Results: Five studies that focused on examining the effects of CGRP receptor antagonists on acute migraine treatment met the eligibility criteria for this meta-analysis. The pooled analysis demonstrated that the CGRP receptor antagonist improved freedom from pain (OR=2.066, 95% confidence interval [CI] 1.766–2.418, I2=0%), absence of bothersome symptoms (OR=1.606, 95% CI=1.408–1.830, I2=0%), pain relief (OR=1.791, 95% CI=1.598–2.008, I2=0%), and freedom from nausea (OR=1.361, 95% CI=1.196–1.548, I2=0%), significantly more than the placebo. Conclusions: CGRP receptor antagonists are effective for acute migraine treatment and are expected to be used clinically as emerging therapeutic agents.

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