HeadacheNew targets in the acute treatment of headacheGoadsby, Peter JAuthor Information Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK Correspondence to Professor Peter J. Goadsby, Institute of Neurology, Queen Square, London WC1N 3BG UK Tel: +44 20 7829 8749; fax: +44 20 7813 0349; e-mail: [email protected] Sponsorship: P.J.G. is a Wellcome Trust Senior Research Fellow. Current Opinion in Neurology: June 2005 - Volume 18 - Issue 3 - p 283-288 doi: 10.1097/01.wco.0000169746.60029.e5 Buy Metrics Abstract Purpose of review The aim of this article is to review recently identified targets for the acute treatment of primary headache disorders. Recent findings Calcitonin gene-related peptide (CGRP) receptor blockade has been shown to be an effective acute anti-migraine strategy and is a non-vasoconstrictor in terms of the mechanism of action. It is likely that direct blockade of CGRP release by inhibition of trigeminal nerves would be similarly effective in both migraine and cluster headache. Options for acute treatment based on preclinical work and initial clinical studies include: serotonin 5HT1F and 5HT1D receptor agonists, glutamate excitatory amino acid receptor antagonists, nitric oxide synthase inhibitors and adenosine A1 receptor agonists. Proof of principle studies with octreotide, a somatostatin receptor agonist, demonstrated it to be better than placebo in the acute treatment of cluster headache but not in the acute management of migraine. Summary The prospect of a non-vasoconstrictor acute migraine therapy offers a real opportunity to patients, and perhaps more importantly, provides a therapeutic rationale to plant migraine and cluster headache firmly in the brain as neurological problems. © 2005 Lippincott Williams & Wilkins, Inc.