Update on treatment of migraine

Published on March 31, 2024   48 min
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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.
Here are my disclosures.
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.
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.