Current and Investigational Drugs for the Prevention of Migraine in Adults and Children

Abstract

There are only a handful of drugs that have been submitted for and received an indication for the preventative treatment of migraine by the US Food and Drug Administration, as well as international governmental regulatory agencies. However, there are a wide variety of agents that are used for this indication with different levels of evidence for efficacy and tolerability. Several guidelines have been published in recent years examining the evidence-based medicine of migraine preventative therapy and these provide guidance especially for the primary care clinician, but also for neurologists whose primary focus is not headache medicine. Some of the therapies are used in children and adolescents while others are used more commonly in adults. In the adult population, an evolutive state of migraine is more commonly seen than in young persons, that is chronic migraine. There is a paucity of evidence for medications for this stage of migraine but there is a single agent that is approved for this use but not for use in the treatment of episodic migraine. There have been few advances in the field of migraine-preventative medications in recent years but potential novel approaches are in development.

Cycling Through Migraine Preventive Treatments: Implications for All-Cause Total Direct Costs and Disease-Specific Costs

“…More research is needed to understand what drives the selection of the first and second PMM classes in patients with migraine, how that influences subsequent HCRU and cost burden, and whether or not treating both migraine and a concomitant condition with one drug intervention is in the best interest of patients, clinicians, and the health care system. 3,20 Despite the use of PMMs, breakthrough migraine attacks often require acute treatment. 21 Not surprisingly, use of acute medications during the 12-month post-index period was common (e.g., more than one fourth of our patients received an acute medication).…”

Recent advances in migraine therapy

“…Drugs should be started at a low dose and slowly up-titrated until a therapeutic effect is seen, the maximum dose is achieved, or side effects become intolerable. All drugs should be trialled at an adequate dose for at least 6–8 weeks before being deemed ineffective (Freitag and Shumate 2014 ). Most patients need to be treated for at least 6 months in order to control their migraines; thereafter the drug can be gradually withdrawn.…”

Recent developments in the treatment of migraine in children and adolescents

“…While preventive treatment is a part the multidisciplinary approach to migraine management, it is important to continue to screen for issues of lifestyle, diet, sleep, medication-overuse, and concomitant psychosocial stressors or coexist medical and psychiatric disorders that can influence migraine [30][31][32]. The use of a headache diary or journal can provide a helpful method of communication as well as documenting the various treatment issues being considered including avoidance of specific migraine triggering factors.…”