Tuesday 5 May 2020

The Migraine World Summit: Day 7

*This post is not sponsored by the Migraine World Summit but I am a participant in the Migraine World Summit affiliate program. This means I earn a commission from any qualifying purchases of the summit made through my link. http://www.migraineworldsummit.com/?afmc=1k

CGRP: Calcitonin gene related peptide

-        37 amino acid peptides

-        Very specific target

What excites me is the biology is giving credibility to the field”

This step forward in research and knowledge about migraine will bring new people into the field.


-        Aimovig – monoclonal antibodies – binds to receptor
-        Ajovy & Emgality –  goes directly to peptide itself (mops it up)
Block pathway and just that pathway.

Side effects – limits?

“It’s a marker of how disabling migraine is. The fact doctors will inform patients of side effects and patients still say.. .oh ill take one of those. The disorder is still worse than the horrible side effect symptoms."


-        Some super responders
-        Some high expectations – show no response
-        Some failed 7-8 treatments and now doing so much better.

Eptinezumab (IV drug)
-         Targets the peptide, not receptor (mops up the receptor)
-        Onset of action is key

-        Think twice for cardiovascular patients and those with hemiplegic/basilar migraine. Caution rather than specific data telling us it’s not safe.

-        CGRP is fine to use with other drugs such as Botox and topiramate.

Neuromodulation devices?

-        Devices that don’t interfere with reproductive process is a good idea
-        Migraine demographic – women – peaks at age of 40 – escalating migraine in 20’s and 30’s
-        Very helpful tools to use

Cefaly: Branches of trigeminal nerve

Gammacore:  vagus nerve – inputs into pain – cluster headache patients

Stms:  Cortex- brain matter how it interreacts with the thalamus

Treatment works directly for attack and no MOH. Might as well use it daily as a preventative.

Nerivio:  new device to be worn on the arm (acute). Distraction from pain.
-        Body ignores the fact you’re wearing clothes
-        Brain selecting what to attend to and filters out signals such as that you are wearing shoes for example.
-        Stimulate arm via the Nerivio – filter out other signals – pain in head is perceived as less.

Acute meds?
-        Ditans
-        Reyvow (Lasmiditan): serotonin 1F receptor antagonist (only on nerves. Turn off pain nerves, no vasal constriction). Side effects – dizzy but no chest tightness like some experience on triptans.

-        Antagonist
-        CGRP receptor blocker. Small molecule. They come on and off and compete with CGRP.

      Gepant VS triptan for acute therapy?

-        Gepant: 20% pain free within 2 hours (<2% side effects)
-        Triptan: 30% pain free within 2 hours (30% experience some side effects)
-        Gepant appears to be very well tolerated so far

-        Prevention with Gepant? Potential to use daily as shouldn’t be a problem with MOH.

“What sort of month is it when you don’t know what you can do because of triptan days. Moving towards an era when you can do what you want to do.”

Final thoughts from Professor Goadsby

-        Maintain a new optimism. “if someone says you have tried everything, it might be true today but next week or in a month or two that’s almost certainly going to be incorrect”.

      Never give up hope. Its not just a word to use. The science and the effort that’s going on is turning hope into reality. It will change, just stick with it.

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