片頭痛の標準的治療と新規治療

抄録

Migraine is a common and debilitating neurological disorder. Currently, triptans are used to abort migraine attacks, while medical preventive therapy is carried out using centrally–acting calcium blockers, antiepileptic agents, and tricyclic antidepressants. Nevertheless, alternative therapy is required to treat those who are intractable to these medications. Calcitonin gene–related peptide (CGRP) is abundantly expressed in trigeminal ganglion neurons. Blood CGRP concentrations are increased in some migraine patients, and intravenous administration with CGRP has been shown to induce delayed migraine–like headache attacks almost exclusively in migraineurs. Hence, attempts have been made to develop CGRP–based migraine therapy. Initially, an injectable small–molecule CGRP receptor antagonist termed BIBN 4096 BS (Olcegepant) was found to abort migraine attacks. Oral CGRP receptor antagonists are now being developed for abortive and preventive treatment. Recently, monoclonal antibodies against CGRP or its receptor have been shown to be effective in migraine prophylaxis with minimal side effects. Moreover, it has been made clear that these antibodies are able to ameliorate chronic migraine, which is extremely disabling and generally drug–resistant. In this article, recent advance in CGRP–based migraine therapy and its perspective are discussed.