Looking Back on the Latest Advancements in Acute Migraine Treatment: Andrea S. Synowiec, DO, FAAN

WATCH TIME: 3 minutes

"The CGRP-modulating drugs have really changed the landscape of what we can offer patients over the last 5 years. I think there are still, somehow, patients who have been in migraine care for a long time who have drifted out of acute, or active, following because they've had adverse effects or bad experiences or they're not aware. We're still seeing a lot of patients who come in who haven't been exposed to things that are not brand new anymore.”

Migraine, a prevalent and highly disabling neurological disorder, has a complex neurobiology involving various central and peripheral nervous system components. Advances in understanding the pathophysiology of migraine have led to the development of several novel treatments in recent years. Some of these treatments are now accessible to patients worldwide, marking a significant shift in the clinical approach to managing the condition.¹

One of the newer treatments, zavegepant (Zavzpret; Pfizer), a calcitonin gene-related peptide (CGRP) receptor antagonist nasal spray, received FDA approval in March 2023 for the acute treatment of migraine with or without aura in adults.² This third-generation, high-affinity, selective and structurally unique agent became the first and only CGRP nasal spray available for patients with migraine. The treatment had its new drug application (NDA) backed by 2 pivotal double-blind, placebo-controlled studies. In both trials, the medication demonstrated statistically significant differences relative to placebo on the coprimary end points of superiority at 2 hours for pain freedom and freedom from the most bothersome symptom.³

Recently, Andrea S. Synowiec, DO, FAAN, system vice chair for the department of neurology at Allegheny Health Network, and associate professor of neurology at Drexel University, sat down in an interview with NeurologyLive® to discuss some updates in the field of headache medicine in terms of treatment. She talked about how CGRP-modulating therapies have revolutionized migraine care over the past 5 years, and also spoke about the significance of the newly approved CGRP small-molecule receptor antagonist, zavegepant, in acute migraine treatment. Additionally, she explained how recent research publications shed light on the association between a history of trauma or adverse childhood experiences and severe migraine disorders.⁴

REFERENCES
1. Puledda F, Silva EM, Suwanlaong K, et al. Migraine: from pathophysiology to treatment. J Neurol 270, 3654–3666 (2023). https://doi.org/10.1007/s00415-023-11706-1
2. Pfizer’s Zavzpret (zavegepant) migraine nasal spray receives FDA approval. News release. Pfizer. March 10, 2023. Accessed December 6, 2023. https://www.businesswire.com/news/home/20230309005795/en/Pfizer%E2%80%99s-ZAVZPRET%E2%84%A2-zavegepant-Migraine-Nasal-Spray-Receives-FDA-Approval
3. FDA accepts for review Biohaven’s new drug application (NDA) filing of intranasal zavegepant for the acute treatment of migraine. News release. Biohaven Pharmaceuticals. May 23, 2022. Accessed December 6, 2022. https://www.prnewswire.com/news-releases/us-fda-accepts-for-review-biohavens-new-drug-application-nda-filing-of-intranasal-zavegepant-for-the-acute-treatment-of-migraine-301552566.html
4. Trauma in childhood may increase risk of adult headache disorders. News Release. Harvard. Published October 27, 2023. Accessed December 6, 2023. https://www.hsph.harvard.edu/news/hsph-in-the-news/trauma-in-childhood-may-increase-risk-of-adult-headache-disorders/#:~:text=Different%20types%20of%20trauma%20also,to%20a%2035%25%20increased%20risk.