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Printable Handouts
Navigable Slide Index
- Introduction
- Prof. Rapoport’s disclosures
- Agenda
- The neuroanatomy of migraine
- The Calcitonin Gene-Related Peptide (CGRP) receptor
- Where do medications work?
- Where do medications work? - monoclonal antibodies
- Four injectable monoclonal antibodies to CGRP
- Gepants
- First clinical paper on CGRP-R blocker
- Ubrogepant co-primary endpoints
- Ubrogepant
- Ubrogepant adverse events
- Atogepant prevention trial
- Atogepant for migraine prevention
- Atogepant adverse events
- Rimegepant acute care endpoints
- Rimegepant meaningful relief
- Rapid return to normal function
- Rimegepant one and done
- Rimegepant preventive study
- Significant reduction in MMD
- Prevention works in week 1
- Rimegepant adverse events
- Zavzpret (zavegepant)
- Study design for the acute treatment of migraine attacks
- One spray to rapidly reclaim patients’ moments
- Rapid pain relief observed at 2 hours vs. placebo
- Return to normal function was observed at 2 hours vs. placebo
- Zavzpret safety profile
- A new class of “ditans”
- Lasmiditan primary endpoints
- Lasmiditan adverse effects
- Celecoxib liquid
- Neuromodulation and medications for migraine & cluster
- gammaCore
- gammaCore indications
- Novel remote electrical neuromodulation (REN)
- REN mechanism of action in alleviating pain and associated migraine symptoms
- Nerivio for the acute treatment of migraine
- Summary and conclusions
- Acknowledgements
Topics Covered
- Calcitonin Gene-Related Peptide (CGRP)
- Gepants
- Zavegepant nasal spray
- Monoclonal antibodies
- Ditans
- Remote upper arm neuromodulation (REN)
- Non-invasive vagal nerve stimulation
- Clinical trials
- Trigeminovascular system
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Rapoport, A.M. (2024, March 31). Update on treatment of migraine [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 10, 2024, from https://doi.org/10.69645/KHWM1371.Export Citation (RIS)
Publication History
Financial Disclosures
- Alan M. Rapoport M.D. serves as an advisor for AbbVie, Biohaven, Cala Health, Dr. Reddy’s, Pfizer, Satsuma, Teva Pharmaceutical Industries and Theranica; he is on the Speakers Bureau of AbbVie, Dr. Reddy’s, Impel, Pfizer and Teva Pharmaceutical Industries. He is Editor-in-Chief of Neurology Reviews and on the Editorial Board of CNS Drugs.
Other Talks in the Series: Toward a Deeper Understanding of Headache and Migraine
Transcript
Please wait while the transcript is being prepared...
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.