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Author: Admin | 2025-04-28
The understanding of concepts such as vasoconstriction not being necessary for therapeutic effect, the central mechanisms of medication overuse and sensitisation and how to avoid drug central effects that may drive this, as well as the quantum between acute and preventive migraine treatment, are paving the way for further innovative research in this area.The future needs to involve the development of acute treatments that do not cause medication overuse nor vasoconstriction and are safe with long-term use, with sustained response with time. The ability to use different agents, such as a triptan and a gepant, and a gepant and a monoclonal antibody, together safely are important concepts that will increase treatment options for patients. Some patients develop a plateau or weaning of response to currently used oral migraine preventives, and there is a need to address this with novel therapies, if possible, to avoid periods of treatment failure, switching treatments and patient and physician dissatisfaction. Ideally, acute and preventive strategies should be migraine-specific, but increasing understanding of migraine neurobiology may continue to produce ideas of how other non-specific drugs used for other conditions may provide benefit in migraine, and these can only increase the treatment options we have for our patients.Taking advantage of the quantum between acute and preventive treatment is likely to be attractive to patients, where their daily preventive treatment could also have an acute effect on headache. Moreover, an active question in research is perhaps the apogee of treatment during the premonitory phase: the tantalizing concept of eliminating pain altogether may not be Panglossian.For the foreseeable future, there will be a need for more treatments, particularly for specific underserved groups of patients such as pregnant women, children and adolescents and the elderly. The ongoing trials of oral lasmiditan and rimegepant in children may provide a useful therapeutic avenue for our younger patients in the future. For many patients, migraine affects them for decades during the prime of their working lives, and there is a constant need for therapies that can be used long term without significant drug interactions and with sustained response. Migraine spares no gender, age group or demographic, and the availability of several acute and preventive options, with different modes of administration, is important in tailoring treatment to our individual patients.5 ConclusionsMuch has been achieved in migraine therapeutics of late, and translational research and pharmaceutical collaboration has led to a hopeful and promising time for headache physicians and their patients. Well tolerated specific drugs with good long-term safety profiles have proven to be an attractive therapeutic strategy with the now widely used CGRP antibodies. Real-world use of the oral ditans and gepants will reveal whether these drugs follow suit and change the landscape of acute treatment for many sufferers, by providing an even more logistically simple means of administering such treatments. The once-daily dosing of even preventive doses of the gepants is attractive in terms of feasibility and compliance. Ongoing clinical use of non-migraine-specific available drugs used in other disorders, such as melatonin and memantine,
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