Migraine in the Triptan Era: Lessons From Epidemiology, Pathophysiology, and Clinical Science

Authors

  • Marcelo E. Bigal MD, PhD,

    1. From the Global Director for Scientific Affairs—Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA (M.E. Bigal); Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Centre (LUMC), Leiden, Netherlands (M. Ferrari); Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein); Departments of Neurology, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton); The Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton); Headache Group—Department of Neurology University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Michel Ferrari MD, PhD,

    1. From the Global Director for Scientific Affairs—Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA (M.E. Bigal); Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Centre (LUMC), Leiden, Netherlands (M. Ferrari); Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein); Departments of Neurology, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton); The Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton); Headache Group—Department of Neurology University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Stephen D. Silberstein MD,

    1. From the Global Director for Scientific Affairs—Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA (M.E. Bigal); Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Centre (LUMC), Leiden, Netherlands (M. Ferrari); Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein); Departments of Neurology, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton); The Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton); Headache Group—Department of Neurology University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Richard B. Lipton MD,

    1. From the Global Director for Scientific Affairs—Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA (M.E. Bigal); Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Centre (LUMC), Leiden, Netherlands (M. Ferrari); Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein); Departments of Neurology, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton); The Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton); Headache Group—Department of Neurology University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Peter J. Goadsby MD, PhD

    1. From the Global Director for Scientific Affairs—Neuroscience; Merck Research Laboratories, Whitehouse Station, NJ, USA (M.E. Bigal); Chair Leiden Centre for Translational Neuroscience, Leiden University Medical Centre (LUMC), Leiden, Netherlands (M. Ferrari); Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein); Departments of Neurology, and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton); The Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton); Headache Group—Department of Neurology University of California, San Francisco, CA, USA (P.J. Goadsby).
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  • Conflict of Interest: Dr. Lipton has received honoraria, consulting fees, and research support from many commercial entities. Dr. Silberstein is on the advisory panel, speakers bureau, or serves as a consultant for AGA, Allergan, Capnia, Endo Pharmaceuticals, GlaxoSmithKline, MAP, Medtronic, Merck, NuPathe, Pfizer, Valeant Pharmaceuticals, and Vyteris. He receives research support from AGA, Advanced NeuroModulation Systems, Allergan, Boston Scientific, Coherex, Endo Pharmaceuticals, GlaxoSmithKline, Lilly, MAP, Medtronic, Merck, NuPathe, and Valeant Pharmaceuticals. Dr. Ferrari has received grant, consultancy, or industry support from Almirall, Coherex, CoLucid, Eisai, GlaxoSmithKline, Linde, MAP, Medtronic, Menarini, Merck, Pfizer, and St. Jude and independent support from NWO, NIH, European Community FPG, Biomed EC, and the Dutch Heart Foundation.

Marcelo E. Bigal, 1 Merck Drive, Whitehouse Station, NJ 08889, USA.

Abstract

The triptan era has been a time of remarkable progress for migraine diagnosis and treatment. In this paper, we review some of the advances achieved in migraine science during this era focusing on 3 themes: lessons from clinical practice, lessons from epidemiology and lessons from pathophysiology. Science has shown that migraine is a disorder of the brain, and that the key events happen in the the trigeminal neuronal pathways, not on blood vessels. Clinical science has led to the observation that migraine sometimes progresses or remits. This in turn led to longitudinal epidemiologic studies focusing on factors that determine migraine prognosis. In addition, these studies raised questions about the mechanisms of migraine progression, including the role of allodynia, obesity, inflammation, and medications as determinants of progression. This in turn opens a new set of scientific questions about the neurobiologic determinants of migraine, as well as of its clinical course, and exciting opportunities to develop new therapies for this highly disabling brain disorder.

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