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0:00
I'm Dr. Allen Rapoport and
I'm going to be talking
to you today for an update on
the treatment of migraine.
I'm a Clinical Professor
of Neurology at
the David Geffen
School of Medicine
at UCLA in Los Angeles
and a past president of
the International
Headache Society.
0:22
Here are my disclosures.
0:27
I will be talking
first about GRP,
calcitonin gene-related peptide.
Why block it, and what
happens when we do?
I will talk next
about the gepants,
the small molecule CGRP
receptor antagonist
both for acute care and
prevention of migraine.
I'll talk about Zavegepant,
which is a new nasal spray.
It is also a gepant for the
acute care of migraine.
I'll only show one
slide on the monoclonal
antibodies against
CGRP or its receptor.
I'll talk about a ditan
called lasmiditan.
I'm only going to really
delve into two devices.
Here are many devices,
I'll mention some of them,
but I'm only going
to really go into
remote upper arm
neuromodulation, or REN,
and non-invasive vagal
nerve stimulation, or nVNS.
1:31
Here is a picture of the
neuroanatomy of migraine.
I want to point out the
trigeminovascular system.
The trigeminal nerve is
composed of three
separate nerves.
The upper one which we call VI or 5
1, fifth cranial nerve first division
is the one we see
here in yellow,
stretching from the
trigeminal ganglion just
sitting outside of the brain
stem to the lower left,
which is what we
call the meninges
or the covering of
the brain where
there are other nerves and
blood vessels as well.
It's here in the
trigeminal nerve,
especially at the end of
the trigeminal nerve,
where certain chemicals are
released during migraine,
one of them being CGRP,
and I'll show you where it is
and why we would like
to block the CGRP.
