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Acute therapy of the migraine attack has vastly improved over the past 16 years. The major advance has been in the development of triptan medications which target selected serotonin receptors. The triptans are effective and have significantly broadened the treatment options for migraine sufferers. Although a breakthrough, triptans are not effective for all migraine sufferers. In addition, the triptans have inherent vasoconstrictor effects which, although infrequently seen when used in appropriate clinical settings, limit their utility in certain patient populations.
In order to broaden treatment options for patients with migraine, several therapeutic targets have been identified. With a greater understanding of the role of calcitonin gene related peptide (CGRP) in the process of migraine, CGRP antagonists have been identified as targets for acute migraine therapy. CGRP is released from the trigeminal nerves and is involved in the pathophysiology of migraine. Multiple factors indicate that suppression or blockade of CGRP may be beneficial in migraine therapy. CGRP is a potent cranial vasodilator. During migraine attacks, CGRP levels have been shown to be elevated in external jugular blood. Infusion of CGRP induced headaches in susceptible persons. In migraine attacks elicited by nitroglycerin, serum levels of CGRP have been shown to rise and subsequently to decline after effective therapy. Effective relief of acute migraine attacks with a treatment mechanism that does not involve vasoconstriction would open treatment opportunities to a wider range of migraine sufferers.
Learning Objectives
After completing this activity, the participant will be able to:
- Be familiar with calcitonin gene-related peptide, its localization within the trigeminal system, and preclinical data suggesting its role in the migraine process
- Discuss the role of CGRP in migraine pathophysiology and the clinical data indicating the potential utility of CGRP antagonists as therapeutic tools in migraine treatment
- Be familiar with the emerging clinical studies with CGRP antagonists and understand the potential utility of these agents in clinical practice
Primary Care Network designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Target Audience:
This activity is targeted to all physicians and other healthcare professionals who treat patients with headaches.
Release date: March 1, 2008
Expiration date: February 28, 2009
Medium: Podcast
Acknowledgement of Commercial Support:
This activity is supported through an educational grant from Merck & Co., Inc.
Method of Participation:
This activity was developed from a symposia delivered at the 2007 AHS Convention in Chicago on June 8, 2007. This symposium is not part of the official American Headache Society Program.
Those registrants who attended the live program are not eligible to apply for CME credit with this online CME program.
IIn order to receive CME credit for this activity, you need to review program. Upon finishing the online CME, complete the post-test, evaluation, and fill out all required personal information. To receive your CME certificate you will need to pass the post-test with 70% accuracy or better.
Post-test and Evaluation:
After completing this activity, click on the Post-test button at the end of the program. If you receive less than 70% on the post-test, you will be returned to the beginning of the activity to review the presentation again. Upon successful completion of the post-test, you will be asked to fill out a program evaluation form and prompted to print your CME certificate.
PCN Disclosure Policy:
It is the policy of Primary Care Network, Inc. to ensure fair balance, independence, objectivity, scientific rigor, and integrity in all of its CME activities. All Primary Care Network staff, faculty, or any other individual who is in a position to control the content of the CME activities sponsored by PCN are required to disclose to the participants any real or apparent conflict of interest related to the activity. Primary Care Network’s resolution of conflict of interest policy aims to ensure that all financial relationships with any commercial interests do not bias the design and delivery of this continuing medical education activity.
Content/Faculty Providers & Disclosures
Paul L. Durham, PhD
Associate Professor of Biology
Director of Center for Biomedical and Life Sciences
Missouri State University
Springfield, MO
Disclosures: Dr. Durham is on the advisory board for GlaxoSmithKline and Merck. He is a consultant for CoLucid and Merck. He has received research grants from Capnia.
Peter J. Goadsby, MD, PhD
Department of Neurology
University of California San Francisco
San Francisco, CA and
Institute of Neurology
Queen Square, United Kingdom
Disclosures: Dr. Goadsby is on the advisory board for Merck. He is consultant for AstraZeneca, Ortho-McNeil, and Pfizer. He has received research grants from Advanced Bionics, Allergan, and Medtronic.
Stewart J. Tepper, MD
Associate Clinical Professor of Neurology, Yale University School of Medicine
Director, The New England Center for Headache
Stamford, CT
Disclosures: Dr. Tepper is on the advisory board/consultant for Allergan, AstraZeneca, Elan, Endo, GlaxoSmithKline, Merck, NMT, Ortho-McNeil, and Vernalis. He has received grants for research from Allergan, Alexsa, ANS/Advanced Bionics, AstraZeneca, Eisai, Endo, Forest, GlaxoSmithKline, Merck, Medtronix, Neurochem, NMT, Novartis, Ortho-McNeil, Pfizer, Pozen, Proethic, Winston, and Vernalis. He is on the speaker’s bureau for Allergan, AstraZeneca, Elan, Endo, GlaxoSmithKline, Merck, NMT, Ortho-McNeil, Pfizer, and Vernalis.
Paul Winner, DO
Director of the Palm Beach Headache Center
Attending Neurologis, Palm Beach Neurology
West Palm Beach, FL
Disclosures: Dr. Winner is on the advisory board for GlaxoSmithKline, Merck, Ortho-McNeil, and Pfizer. He is a consultant for GlaxoSmithKline, Ortho-McNeil, and Pfizer. He has received research grants from Allergan, GlaxoSmithKline, and Ortho-McNeil. He is on the speaker’s bureau with GlaxoSmithKline, Merck, and Ortho-McNeil; and he has also received honoraria from Allergan, GlaxoSmithKline, Merck, Ortho-McNeil, and Pfizer.
Unlabeled Use Declaration:
During this activity, speakers may discuss an unlabeled use or an investigational use not approved for a commercial support. Each author is required to disclose this information to the participants when referring to an unlabeled or investigational use.
PCN Staff Disclosures:
The Employees of Primary Care Network have no financial relationships to disclose.
When finished, click here to take the Post-test
Take the post-test to receive your CME certificate
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