There are many categories and individual types of
headache and most have a variety of treatment protocols, while a few are best treated by just one medication. This paper will concentrate on acute care medications for
migraine and discuss some new and future acute care treatments. There is not much to discuss about prevention, except that
onabotulinumtoxinA has been approved for prevention of chronic
migraine.
Cluster headache will also be discussed, as there are some future treatments for acute care and prevention being studied at present. For the acute care of
migraine in the US, we have seven
triptans by
tablet plus other routes and one non steroidal anti-inflammatory medication approved by the FDA that is currently available (Cambia brand of buffered
diclofenac potassium for oral
solution). There are several other acute care medications in various stages of development and there are three new methods of administering a
triptan and others under investigation. The optimal acute care
therapy for
migraine should be faster, easier to use and more efficient with fewer adverse events than what is currently available. What follows is a brief review of the status in development for five of the many new acute care medications being investigated: the CGRP antagonist
tablet telcagepant, the
sumatriptan iontophoretic patch Zelrix,
sumatriptan powder for use in the OptiNose apparatus,
dihydroergotamine for oral inhalation (Levadex),
civamide nasal
solution for prevention of
episodic cluster headache (Civanex) and sphenopalatine
ganglion stimulation for acute cluster attacks in
chronic cluster headaches. Other future treatments that will not be discussed include
transcranial magnetic stimulation, a 5-HT(1F) agonist named
alniditan,
large conductance calcium-activated potassium channel openers, glial modulators or other medications and devices in early stages of development.