New Migraine Drug Promising

New migraine pain relief may be on the way for the 28 million American sufferers, shows a promising new study.

A new migraine drug under study that works differently than medications currently on the market provided pain relief for more than two-thirds of those who tried it, says Tony Ho, M.D., senior director of clinical neuroscience at Merck Research Laboratories in North Wales, Pa., who presented the findings at this week's annual meeting of the American Headache Society in Chicago.

"It also had a very good duration of action," he tells WebMD. "This effect lasted over 24 hours."

The new drug, for now called MK-0974, may eventually help the 30 percent of migraine sufferers who don't get relief from — or can't take — triptans, a current mainstay of migraine treatment to stop migraine pain and disability.

Other experts not involved in the study agreed the new drug looks promising. It's not expected on the market, however, until at least 2009.

MK-0974 In A New Class

MK-0974 is one of a new type of medications with a tongue-twisting name: It's an oral calcitonin-gene-related peptide receptor antagonist, or CGRP receptor antagonist.

CGRP is a type of brain chemical called a peptide that experts now know plays a role in migraines. ''The CGRP peptide was discovered in 1982, and in the early 1990s researchers started speculating about its role," Ho says.

Experts know that CGRP levels are elevated during a migraine. And in studies, when CGRP is given to migraine sufferers, it can produce a migraine headache, Ho says.

"When the neuropeptide CGRP gets released, the migraine pain gets worse," Ho tells WebMD. "We think it's involved in the majority of patients."

The new drug works by blocking CGRP. Triptans, in contrast, work on another brain chemical called serotonin. Triptan-type migraine medications constrict blood vessels during a migraine and help relieve related migraine symptoms including pain. However, because of their effects on blood vessels, triptans can't be taken by those who have had heart disease and certain other health problems.

Study Details

Ho and his team studied the safety and effectiveness of MK-0974 in 420 migraine patients, mostly women, whose average age was 41. Women are more likely than men to suffer from migraines. The participants typically had one to six migraines every month. The participants were given either the new drug (MK-0974), a commonly used triptan called Maxalt, or a placebo pill.

Participants were told to take the medication one time only, when they developed moderate to severe migraine pain. They were also asked to keep a diary, noting a timeline of how their symptoms and pain were affected after taking their medication. Various doses of the new medication were tried, from 25 milligrams to 600 milligrams. "We found the 300 or 600 milligrams of MK-0974 was effective at stopping the headache at two hours," Ho says.

Overall, about two-thirds of those who took MK-0974 or who took Maxalt for migraine pain relief reported a reduction in pain at two hours.

However, nearly 50 percent of patients taking MK-0974 at the 300-milligram dose reported being pain-free at two hours, compared with only 33 percent of those who took Maxalt and 14 percent of those who took a placebo.

The study also showed that nearly 40 percent of those who took the new drug were still pain-free at 24 hours, but Ho's team says only about 20 percent of Maxalt users were.

Second Opinions

"I'm enthused," says Seymour Diamond, M.D., a headache specialist and founder of the Diamond Headache Clinic in Chicago, when told of the new study findings.

If approved, the new medication may eventually prove beneficial for patients who don't respond to the triptans as well as those who can't take them, he says. "Not every (migraine) drug is for everybody."
By Kathleen Doheny
Reviewed by Louise Chang
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