Headache and preventive medicine

Abstract

Migraine is one of the most disabling diseases with a significant socioeconomic impact. In Japan, five types of triptans have been approved since 2000. Furthermore, the development of lomerizine and the approval of valproic acid and propranolol for migraine prophylaxis have greatly improved the treatment of the patients with migraine. Clinical Practice Guideline for Chronic Headache 2013 was published by the Japanese Headache Society, which had prompted evidence–based migraine treatment. However, we cannot get the enough effects. Calcitonin gene–related peptide (CGRP) is a neuropeptide that has an important role in migraine pathophysiology and is a target for migraine preventive therapies. Monoclonal antibodies targeting CGRP (galcanezumab, fremanezumab and eptinezumab) and its receptor (erenumab) showed consistent efficacy for migraine prophylaxis with excellent safety profiles. The effects on refractory cases have also been reported, and it is expected to bring the good news to many patients who have not been effective with existing migraine prophylaxis, and a paradigm shift in migraine treatment is expected.