Neue Substanzen in der Akuttherapie der Migräne

Zusammenfassung

Dieser Übersichtsartikel beschreibt die wichtigsten neuen, in der Mehrzahl experimentellen Substanzen in der Akuttherapie der Migräne. Calcitonin gene-related Peptid (CGRP) Rezeptorantagonisten erwiesen sich als wirksam in der Therapie der Migräneattacke, ohne einen vasokonstriktiven Mechanismus zu besitzen. Die Annahme einer primär nicht vaskulär bedingten Genese der Migräneattacke konnte durch erfolgreiche Therapiestudien mit dem 5-HT_1F- Rezeptoragonist, LY344370, unterstrichen werden. Weitere therapeutische Optionen, in der Mehrzahl noch basierend auf präklinischen Untersuchungen oder Phase-I- und IIStudien der Serotonin 5-HT_1D-and 5-HT_1F- Rezeptoragonisten, der Glutamatrezeptorantagonisten, der Stickoxid (NO) Synthaseinhibitoren, der Adenosin-A1-Rezeptoragonisten und des Somatostatins werden diskutiert. Darüber hinaus werden die Ergebnisse der klinischen Studien mit intravenöser Valproinsäure und parenteralem Metoclopramid vorgestellt.

Der Nachweis einer erfolgreichen nicht-vasokonstriktiven Therapie der Migräne bedeutet für die Patienten, insbesondere mit kardiovaskulären Erkrankungen, neue Perspektiven, andererseits unterstreichen diese Ergebnisse die Bedeutung der zentralen neuronalen Genese im Gegensatz zur vaskulären Theorie.

Summary

The aim of this article is to review recently identified targets for the acute treatment of migraine. Calcitonin gene-related peptide (CGRP) receptor antagonists seem to be effective in the acute treatment of migraine. Interestingly, the mechanism of action is not vasoconstrictive. The prospect of a non-vasoconstricting therapy is emphasized by a successful study of the 5-HT_1F receptor agonist, LY344370, in migraine. Further therapeutic options are based on preclinical work and the first clinical studies of serotonin 5-HT_1D and 5-HT_1F receptor agonists, glutamate excitatory amino acid receptor antagonists, nitiric oxide synthase inhibitors, adenosine A1 receptor agonists and somatostatin analoga. Secondly, the clinical data of intravenous valproate acid and of parenteral metoclopramide for acute migraine are presented.

The prospect of a non-vasoconstricting therapy for acute migraine offers new opportunities for patients especially with cardiovascular diseases and migraine and, additionally, it providesa therapeutic rational to define migraine as a neurological disorder.

Schlüsselwörter

Migräne - Akuttherapie - Calcitonin gene-related Peptid - Serotonin

Keywords

Migraine - acute treatment - calcitonin gene-related peptide - serotonin

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