Monoclonal antibodies may represent the future of headache treatment. Molecules are being studied that would be periodically given to patients with chronic forms of migraine headache, or episodic but refractory forms to standard treatments as well as cluster headaches. We talk about this topic with Dr. Vincenzo Tullo, neurologist and head of the Humanitas Headache Outpatient Clinic.
Path towards new drugs?
Several research groups have evaluated the efficacy of monoclonal antibodies for the treatment of headache. Monoclonal antibodies are highly specialized molecules that target a certain antigen. In this case, the antigen is CGRP (Calcitonin Gene Related Peptide), a vasodilator peptide involved in the transmission of pain and headache when a migraine crisis is ongoing.
Several studies at different stages have provided important results on the action and usefulness of these monoclonal antibodies. These molecules target peptide directly or act against its receptors present in the nervous system and neutralize pain transmission. Migraine crises would thus be defused.
It could be a preventative therapy that would reduce the frequency of attacks and the intensity of pain by administering intravenous or subcutaneous medications periodically, for example every month or every two months.
Potential beneficiaries
Two recent studies published in the New England Journal of Medicine have achieved some very interesting results. One evaluated the action of hermnumab, a monoclonal antibody injected in doses of 70 or 140 milligrams once a month. It has been seen how the molecule helped to significantly reduce the number of crises and therefore to contain the impact of migraine on everyday life. However, researchers conclude that the long-term safety and efficacy of antibody requires further evidence.
The other study, which tested fremanezumab monoclonal antibody, also came to similar conclusions. Patients who had received injections within twelve weeks benefited from a greater reduction in migraine-related seizures.
These drugs are indicated in patients with chronic migraine headache (headache lasting for more than fifteen days a month for more than three months) and chronic cluster headaches (almost daily attacks without remission periods for at least one year or with remission periods of less than one month a year),” Dr. Tullo points out.
As of today – he continues – it is not possible to say whether monoclonal antibodies will also be a first-line therapy for episodic headaches or will remain a viable treatment only for chronic headaches refractory to common prevention treatments. We can certainly say that this is a new and valid therapy in the difficult fight against migraine headache and cluster headache,” the specialist concludes.
