Acute and prophylactic treatment of migraine

Abstract

Migraine is a chronic neurological disorder that causes significant disability in patients and has a substantial economic impact in Canada. Effective treatment for migraine will improve our patients’ quality of life; additionally, it will reduce the economic burden generated by healthcare visits and employee absenteeism. The novel treatments in migraine target calcitonin gene-related peptide (CGRP), a neuropeptide which plays a role in the initiation of a migraine attack. Although our current understanding of migraine pathophysiology is incomplete, it is believed to involve the trigeminal nerve and its connections with the cerebral vasculature with nociceptive signals activated through a variety of neuropeptides including CGRP, substance P and nitric oxide. As a result of an improved understanding of migraine pathophysiology, the past several years have seen the advent of a variety of new therapeutic options in both the acute and prophylactic management of migraine. Although these agents represent additional options in the clinician’s arsenal, they have, in addition, introduced challenges in determining their cost-effectiveness. In this review, we provide an update on new acute and prophylactic migraine therapies and how they integrate into current practice from a primary care perspective.