Migraine is generally managed with triptans, which however present the disadvantage of being poorly tolerated (precordial pain, dizziness, pharyngeal constriction) and of being contraindicated in patients with coronary artery disease. A new product has been recently experimented, telcagepant, which seems to be promising for this invalidating disease. In a randomized, case-control, double-blind trial, sponsored by pharmaceutical industry, telcagepant (a calcitonin gene-related peptide receptor antagonist) was experimented on 1380 adults (averagely 42; 85% women) affected by events of acute migraine in a design implying the use of these drugs: telcagepant 160-300 mg, zolmitriptan 5 mg or placebo. The trial was performed in 81 centers of primary care and in centers for the study of headache, in Europe and USA. Patients with heart disease or non-controlled hypertension or under SSRIs, anti-MAOs or propanolol treatment for at least one month were excluded from the trial. All the subjects were invited to keep a migraine diary, recording pain intensity (absent, mild, moderate, severe) and the presence or the lack of associated symptoms (phonophobia, photophobia, nausea). The recording had to be made at the beginning of the painful event, then every 30 minutes for the first three hours. Afterwards, after 4, 6, 8 and 24 hours. 300-mg telcagepant and 5-mg zolmitriptan showed themselves to be equally effective and both better than 150-mg telcagepant and placebo in reducing pain and related symptoms. The only severe side effect occurred in a subject taking placebo. Moderate side effects were much more frequent with zolmitriptan than in the other three groups.In effects, telcagepant seems to be a new promise in the treatment of migraine, given its good efficacy and the lack of side effects. We are waiting for its marketing.
