Dr Frank Porreca On Future Areas of Focus in Migraine Research

The future of migraine research will include further investigations into understanding the pathophysiology of migraine outside of CGRP, said Frank Porreca, PhD, professor of pharmacology and anesthesiology at the University of Arizona and a member of the Department of Collaborative Research at Mayo Clinic in Arizona.

Transcript:

The American Journal of Managed Care® (AJMC®): In your opinion, what will be the next are of focus for research on migraine pathophysiology treatment?

Dr. Porreca: Well, I think that we are starting to get insights into, first of all, differences between males and females. That's an important area. It has to be validated in humans Now, of course, that is going to be an area of study that I think can be pursued and should be pursued. Secondly, though, I mentioned that CGRP is causal in migraine in many patients, but it's not causal in all patients. And so we know that anti-CGRP antibodies, and anti-CGRP small molecule receptor antagonists are effective in many patients, but not in all patients. Even in the presence of blockade of CGRP signaling, blockade of CGRP peptide or blockade of CGRP receptors, patients will still have migraine attacks. These are these sort of breakthrough migraines which not only imply, they demonstrate that there is something else other than CGRP that can drive the migraine, even in patients who have had their migraine well-controlled or improved by anti-CGRP therapies. The mechanisms that drive this type of pain that are beyond CGRP, I think is the next frontier and one that is heavily under-studied both in the preclinical level and that will have a great impact clinically as well.

Another area that I think should be mentioned is that we are advancing not only our understanding of migraine, which is a primary headache disorder, but also our understanding of post-traumatic headache. There's a tremendous number of individuals that suffer from mild traumatic brain injury, we commonly call this concussion. One of the most common consequences of concussion is headache. Post traumatic headache is a secondary headache that can be studied in the preclinical laboratory, is being studied in the preclinical laboratory with numerous groups around the country. The mechanisms of post traumatic headache may be significantly different from migraine. The patients that suffer from post traumatic headache may need different kinds of therapies than migraine patients and so that's going to be another area that I think is highly important and will affect many individuals in our society.