Migraine treatment: the doors for the future are open, but with caution and prudence

Abstract

Migraine is a burdensome disorder. Current treatments are far from ideal. Recent knowledge has been indicating targets whose antagonism may improve efficacy. It is particularly true with the calcitonin gene-related peptide (CGRP) and the monoclonal antibodies anti-CGRP can interfere with this pathway and decrease the frequency of migraine attacks. Erenumab, fremanezumab and galcanezumab have recently been approved and eptinezumab is likely to be, soon. Although efficacy figures were not spectacular, tolerability and potential higher adherence were noteworthy. However, caution must be exercised. The time frame after the studies was limited to three years and dose administration was restricted to three-monthly doses. The CGRP is present throughout the human body and migraine is a life-long disease, often requiring treatment for decades. It is not known whether this favorable profile can be maintained or will be safe in pregnant women or adolescents. In addition, there were deaths during the studies, which may have happened without a clear relationship. New treatments are welcome, but caution is warranted.

Gel-forming antagonist provides a lasting effect on CGRP-induced vasodilation

“…In the meta-analysis, small molecule antagonists were shown to provide 2 h pain freedom in ~20% of Frontiers in Pharmacology frontiersin.org patients and pain relief in ~60% (Zhang et al, 2021;Altamura et al, 2022). Because these anti-CGRP therapies have an efficacy comparable to the currently used drugs, migraine headaches remain a life-long burden for many patients (Krymchantowski et al, 2019). New therapeutic approaches that can fully explore the CLR/RAMP-mediated pain pathways may provide an alternative strategy to reduce the medical burden on migraine patients.…”

Schwann cells and trigeminal neuralgia

“…43 However, some studies have advised caution in migraine treatment using CGRP monoclonal antibodies. 89…”

“…43 However, some studies have advised caution in migraine treatment using CGRP monoclonal antibodies. 89 The drug treatment is just pain relief. Compared with drug treatment, the advantage of transplantation of SCs is that it can repair the damaged nerve more quickly and treat TN etiologically.…”

Ferramentas Da Biologia Molecular No Estudo Das Doenças Emergentes E Reemergentes Como a Covid-19

“…Em consonância à isso, as Diretrizes Curriculares Nacionais (DCNs) dos cursos de Medicina, no Brasil, valorizam as atividades práticas (FERREIRA et al, 2019). Contudo, o grande dilema consiste em: até que ponto essa relação pacientegraduando, na qual de um lado se encontra a inexperiência acadêmica e em cujo outro lado está a necessidade de se integrar a Academia aos cenários de prática, pode ser harmoniosa (WECHT, 1994).…”

“…Dentre as orientações destas diretrizes, categorizadas em atenção à saúde, gestão em saúde e educação em saúde, destacam-se o foco dado aos aspectos humanísticos da formação médica, a fomentação dos aspectos reflexivos da prática, o desenvolvimento de habilidades para a atuação em todos os níveis de atenção à saúde, bem como o incentivo aos métodos de ensino-aprendizagem centrados no aluno e a oferta de cenários de prática reais. Por conseguinte, coloca em relevo a aprendizagem em Saúde Coletiva, em conformidade com os princípios estabelecidos pelo Sistema Único de Saúde (SUS), reafirmando a relevância de uma atuação pautada nos determinantes sociais de saúde(FERREIRA et al, 2019).O Projeto Pedagógico do Curso de Medicina (PPCM) apresenta um programa de ensino o qual abrange, de maneira evidente, parâmetros mais atuais estabelecidos pela DCN. Observou-se mudança curricular evidente, com mais destaque para o método ativo de aprendizado, a partir da segunda década dos anos 2010 (PROJETO PEDAGÓGICO DO CURSO DE MEDICINA, 2012).…”