Letter from the Editor
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In 1992 the clinical emergence of injectable sumatriptan, the first “designer drug“ developed specifically for migraine, inaugurated a revolution in public awareness of migraine, scientific investigation leading to a better understanding of migraine’s biologic origins and, best of all, new therapeutic alternatives for the migraine population. Although for a time investigators in the field of migraine appeared to be largely preoccupied with producing one oral triptan after after another via studies funded by the pharmaceutical industry, at no point did a large proportion of migraine scientists cease exploring other therapeutic avenues for helping migraineurs reduce their headache burdens.
The results from the efforts made by those scientists now are entering the limelight, and within the past 36 months new migraine therapies have debuted like eggs dropping from a particularly prolific hen. We have witnessed the emergence of no less than nine new therapies for migraine prevention, acute migraine treatment or both. As with the triptans, all of these new therapies were designed specifically for treating migraine, but all of them possess mechanisms of action that differ from those of the tripans.
This is a critical point. When it comes to treating migraine, there exists no one-size-fits-all therapy that is universally effective and well tolerated. This only makes sense. If there are dozens of genetic permutations which may produce the common endpoint of the symptom complex we name “migraine“, then there must exist multiple variations on the biologic circuitry that produces migraine. As we have discussed in a previous issue, finding the right treatment for a given for a given patient with migraine is a process of educated trial and error. The embarrassment of riches which these new therapeutic options offer us can only assist in that process.
We could have chosen any of these new therapies to feature as our “migraine treatment of the month“, and any one of them justifiably could lay claim to that place of prominence. Instead, in part to help avoid any appearance of playing favorites and in part to provide some balance between the old and new, we are featuring onabotulinumtoxinA (BotoxA)…still an important weapon in our arsenal of migraine therapies.
In a separate article in this issue we will briefly summarize these new and exciting medications available to the migraine population, and in future issues we will address each one in detail.
Having migraine myself, I realize all too well that this disorder is not one that a sane person typically would wish for. Having been in the business of migraine research and having treated migraine patients for almost 4 decades now, however, as migraineur and clinical neuroscientist I can confirm that, therapeutically speaking, there has never been a better time to have migraine.
