Current and emerging evidence-based treatment options in chronic migraine: a narrative review

Elio Clemente Agostoni, Piero Barbanti, Paolo Calabresi, Bruno Colombo, Pietro Cortelli, Fabio Frediani, Pietrangelo Geppetti, Licia Grazzi, Massimo Leone, Paolo Martelletti, Luigi Alberto Pini, Maria Pia Prudenzano, Paola Sarchielli, Gioacchino Tedeschi, Antonio Russo, Italian chronic migraine group, Elio Clemente Agostoni, Piero Barbanti, Paolo Calabresi, Bruno Colombo, Pietro Cortelli, Fabio Frediani, Pietrangelo Geppetti, Licia Grazzi, Massimo Leone, Paolo Martelletti, Luigi Alberto Pini, Maria Pia Prudenzano, Paola Sarchielli, Gioacchino Tedeschi, Antonio Russo, Italian chronic migraine group

Abstract

Background: Chronic migraine is a disabling condition that is currently underdiagnosed and undertreated. In this narrative review, we discuss the future of chronic migraine management in relation to recent progress in evidence-based pharmacological treatment.

Findings: Patients with chronic migraine require prophylactic therapy to reduce the frequency of migraine attacks, but the only currently available evidence-based prophylactic treatment options for chronic migraine are topiramate and onabotulinumtoxinA. Improved prophylactic therapy is needed to reduce the high burden of chronic migraine in Italy. Monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway of migraine pathogenesis have been specifically developed for the prophylactic treatment of chronic migraine. These anti-CGRP/R monoclonal antibodies have demonstrated good efficacy and excellent tolerability in phase II and III clinical trials, and offer new hope to patients who are currently not taking any prophylactic therapy or not benefitting from their current treatment.

Conclusions: Treatment of chronic migraine is a dynamic and rapidly advancing area of research. New developments in this field have the potential to improve the diagnosis and provide more individualised treatments for this condition. Establishing a culture of prevention is essential for reducing the personal, social and economic burden of chronic migraine.

Keywords: Anti-CGRP monoclonal antibodies; Chronic migraine; Fremanezumab; Prophylaxis; Topiramate; onabotulinumtoxinA.

Conflict of interest statement

E. C. Agostoni has no conflict of interest.

P. Barbanti has received fees for participation on advisory boards, as well as research grants and travel grants from Allergan, Allmirall, Electrocore, Eli Lilly, Lusofarmaco, Merck & Co, New Penta, Novartis, Teva and Visufarma.

P. Calabresi received/receives research support, speaker honoraria, and support to attend national and international conferences from: Abbvie, Bayer Schering, Biogen-Dompè, Biogen-Idec, Eisai, Genzyme, Lundbeck, Lusofarmaco, Merck-Serono, Novartis, Prexton, Teva, UCB Pharma, Zambon.

B. Colombo has received congress fee reimbursements from Teva and Novartis.

P. Cortelli, has received honoraria for speaking engagements or consulting activities with Allergan Italia, AbbVie srl, Chiesi Farmaceutici, Eli Lilly, Novartis, Teva, UCB Pharma S.p.A,, Zambon.

F. Frediani has received fees for participation on advisory boards, speaker honoraria or consulting activities from Allergan, Cristalfarma, Ecupharma, Novartis, Teva.

P. Geppetti received/receives research support, speaker honoraria, and support to attend national and international conferences from Novartis, TEVA, Chiesi Pharmaceuticals, Sanofi, Allergan, Eli Lilly, Electrocore, IBSA.

L. Grazzi has received consultancy and advisory fees from Allergan SpA, Electrocore LLC, Novartis, TEVA, ElyLilly.

M. Leone has received fees for participation on advisory boards from Eli Lilly and Teva.

P. Martelletti has received fees for participation on advisory boards, as well as research grants and travel grants from Allergan, Electrocore, Elythrapharma, Eli Lilly, Novartis and Teva.

L. A. Pini has received fees for participation on advisory boards, as well as research grants and travel grants from Allergan, Novartis and TEVA.

M. P. Prudenzano has received fees for participation on advisory boards, speaker and editorial honoraria, as well as congress fee reimbursements from Allergan, Almirall, Novartis and Teva.

P. Sarchielli has received fees for participation on advisory boards, as well as research grants.

from Allergan, Novartis, Teva.

G. Tedeschi, has received fees for participation on advisory boards, as well as research grants and travel grants from Allergan, Novartis, Teva, Sanofy, Biogen.

A. Russo, has received congress fee reimbursements from Novartis, Teva and Allergan.

Figures

Fig. 1
Fig. 1
Mechanisms of action of antimigraine treatments used in chronic migraine and emerging treatments in relation to calcitonin gene-related peptide (CGRP). Modified with permission from Benemei, et al. J Headache Pain 2013;14:71 [29]

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