Medication overuse headache: Divergent effects of new acute antimigraine drugs

Holland, Philip R.; Saengjaroentham, Chonlawan; Sureda-Gibert, Paula; Strother, Lauren C

doi:10.1177/0333102420938655

Cited by 7 publications

(7 citation statements)

References 20 publications

(25 reference statements)

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“…Ditans (the novel class of anti-migraine medication targeting the 5-HT1F receptor) seem to induce cutaneous allodynia (66). The preclinical data are in agreement with preliminary clinical results, which show no evidence of MOH development after exposure to gepants (67).…”

Section: Resultssupporting

confidence: 89%

Preventive CGRP-targeted therapies for chronic migraine with and without medication-overuse headache

2023

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Background: Calcitonin gene-related peptide (CGRP) targeted therapies are an important breakthrough in migraine prevention. Randomized clinical trials, post-hoc analyses, and phase IV studies have demonstrated their efficacy and safety in chronic migraine patients, including those with concomitant medication-overuse and medication-overuse headache. Real world evidence studies support these findings and provide realistic endpoints for estimation of effect. Methods and results We have performed a narrative review including results from double-blind placebo-controlled randomized clinical trials and real-world evidence studies regarding efficacy of the CGRP(-receptor) monoclonal antibodies and CGRP-receptor antagonists (gepants) in patients with chronic migraine with concomitant medication overuse (headache). We have included patient profiles and main efficacy endpoints (monthly migraine days, monthly headache days, monthly acute medication days and percentage responder rates). Conclusion The results of this review show that CGRP monoclonal antibodies are effective in chronic migraine patients, also in those with medication overuse (headache). At the time of this review, atogepant clinical trials in chronic migraine have not been communicated. Direct comparative studies are needed for comparison with other treatment options.

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Section: Resultssupporting

confidence: 89%

Preventive CGRP-targeted therapies for chronic migraine with and without medication-overuse headache

2023

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“…Opposite results were found for triptans or the novel class of anti-migraine medication targeting the 5-HT 1F receptor called ditans, which induce cutaneous allodynia [52][53][54]. The preclinical data are in agreement with preliminary clinical results, which show no evidence of MOH development after exposure to gepants [55].…”

Section: Expert Opinionsupporting

confidence: 65%

Evaluating rimegepant for the treatment of migraine

Vries

Al-Hassany

MaassenVanDenBrink

2021

Expert Opinion on Pharmacotherapy

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IntroductionCalcitonin gene-related peptide (CGRP) is a vasodilatory neuropeptide involved in the pathophysiology of migraine, a highly disabling neurovascular disorder characterized by severe headache attacks. Rimegepant is a small-molecule CGRP receptor antagonist approved by the FDA for acute treatment of migraine and currently under investigation for migraine prophylaxis. Areas coveredThe authors summarize available data on safety and tolerability of rimegepant and provide insights on its use for acute migraine treatment. Expert opinion Rimegepant seems to be well tolerated and superior to placebo for two-hour pain freedom. Moreover, rimegepant does not induce vasoconstriction, and is therefore not contraindicated in patients with cardiovascular disease, nor does it seem to induce medication-overuse headache. However, the therapeutic gain of rimegepant is only small, and since CGRP is a vital rescue molecule during ischemia, blocking the CGRP pathway might be detrimental. Although current evidence on CGRP receptor blockade has shown no cardiovascular adverse events, clinicians should remain critical about the use of rimegepant, as well as other CGRP (receptor)-inhibiting drugs. Further research should focus on determining the consequences of long-term CGRP blockade, especially during ischemia or cardiovascular disease, the exact receptors antagonized by rimegepant, and potential effects of combining rimegepant with other antimigraine treatments.

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“…A side-note to developing G i -targeted receptors is the risk of hyperalgesic priming [55], which is typically seen with several pain-preventing medications. Although the mechanisms are not fully known, G i -coupled activation could be linked to medication overuse headache [56], and must be considered with this approach.…”

Section: Serotonergic Receptorsmentioning

confidence: 99%