Advances in the Treatment of Acute Migraine

Jessica Ailani, MD


November 22, 2019

Several new medications have shown great potential as treatment for acute migraine. For nearly two decades, triptans, which act as agonists for 5-HT1B/1D receptors, have been the go-to therapies for patients with acute migraine. Although triptans can provide relief, they are associated with side effects like dizziness and fatigue. They are also contraindicated for several cardiovascular conditions, including uncontrolled hypertension and previous history of heart attack or stroke. Triptans have not been studied in individuals over the age of 65.

Dr Jessica Ailani, director of the Headache Center at MedStar Georgetown University Hospital, discusses two novel classes of drugs that have shown efficacy in acute migraine treatment. These new drugs include small-molecule inhibitors against calcitonin gene-related peptide (CGRP), known as gepants. Gepants have been shown to have fewer side effects and contraindications than triptans.

Lasmiditan, a serotonin receptor agonist of the ditan class, is another medication for acute migraine that is now FDA approved. Because it works on the 5-HT1F receptor, there is less concern for vasoconstriction or elevated blood pressure.

Together, gepants and ditans extend the options for effective treatment of acute migraine.


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