Could erectile dysfunction be a side effect of CGRP inhibition? A case report

Background Recently, antimigraine drugs targeting the calcitonin gene-related peptide pathway have been approved for clinical use as preventive migraine medication. Case report We present a case of a 54-year-old male migraine patient, who reported erectile dysfunction as a possible side effect of treatment with galcanezumab, a monoclonal antibody targeting calcitonin gene-related peptide. His potency recovered after treatment discontinuation. Discussion As calcitonin gene-related peptide is involved in mammalian penile erection, erectile dysfunction is a conceivable side effect associated with calcitonin gene-related peptide inhibition. Postmarketing surveillance will elucidate the actual incidence of erectile dysfunction in patients using these new antimigraine drugs, and determine whether a causal relationship between calcitonin gene-related peptide inhibition and erectile dysfunction exists. This would be relevant not only because of the direct sexual consequences of erectile dysfunction, but also considering the potential cardiovascular consequences of calcitonin gene-related peptide (receptor) blockade and the association of both migraine and erectile dysfunction with cardiovascular disease. Conclusion Erectile dysfunction might be an overlooked, but reversible side effect in male migraine patients using monoclonal antibodies that inhibit the calcitonin gene-related peptide pathway, including galcanezumab. This paper may raise clinical awareness and suggest that this potential side effect needs to be studied further.

Comparative Efficacies of Antimigraine Drugs Using Nitroglycerin Induced Migraine Rats Model

Aim: The migraine pathology is still not explained effectively. There is a common relationship between anxiety, depression, and migraine. So the aim of the study to illustrate effectively the behavioural and biomarker changes in the migraine condition. Methods: Nitroglycerin (NTG) induced migraine rats model was used the present study. Twenty-five male Wistar rats were randomly divided into five groups. Ergotamine, sumatriptan, and BIBN4096 were used as antimigraine drugs. The behavioural activity was measured by scratching head, body shaking, and social interaction task. ELISA detected biomarkers like interleukin 6 (IL-6), Substance P (SP) and 5-hydroxytryptamine (5-HT) in various rats brain regions such as cortex, brain stem, trigeminal ganglion. Results: A significant reduction in hyperalgesic response and behavioral changes like scratching head, body shaking and social interaction task. Biomarkers like 5-HT, SP and IL-6 were significantly reduced in the various brain regions such as prefrontal cortex, brain stem and trigeminal ganglia of the rats in the BIBN4096 treated groups. Conclusion: The present study showed a good antimigraine efficacy with a calcitonin gene-related peptide (CGRP) antagonistic agent BIBN4096 than ergotamine and sumatriptan but still lack of behavioural pattern, need to explore nonpharmacological intervention along with the drug treatment.

Prescription Patterns Of Antimigraine Drugs

Objetivo: Determinar los patrones de prescripción de medicamentos antimigrañosos en una población de Colombia. Métodos: Estudio de corte a partir de una base de datos poblacional que recogió todos los pacientes con diagnóstico de migraña y los medicamentos empleados para el tratamiento de crisis y profilaxis. Se hicieron análisis multivariados para identificar variables asociadas con uso de profilaxis. Resultados: Se identificaron 5973 pacientes con diagnóstico de migraña, con edad media de 37,7±14,5 años y predominio femenino (81,3%). El diagnóstico más común fue migraña sin aura (n=2207; 36,9%), seguido de migraña con aura (n=1697; 28,4%); el 7,3% fue atendido por neurología, 1,9% por medicina interna y 92,8% por medicina general. El 85,4% (n=5101) recibió tratamiento para los episodios agudos y los antiinflamatorios no esteroideos (n=3112; 52,1%) fueron los fármacos más empleados, seguidos de ergotamina (n=2513; 42,1%). El 46,3% (n=2766) estaban recibiendo medicamentos para profilaxis. Las mujeres, mayores de 35 años y aquellos atendidos por neurología tuvieron mayor probabilidad de recibir profilaxis. Conclusiones: Predominó el uso de medicamentos para manejo agudo. Pese a los importantes efectos indeseables, la ergotamina sigue empleándose con frecuencia. Los médicos deben evaluar la necesidad de profilaxis enfocados en buscar una terapia efectiva que reduzca las incapacidades. Palabras clave: acetaminofen, antiinflamatorios no esteroideos, ergotamina, Farmacoepidemiología, migraña con aura, migraña sin aura, Trastornos migrañosos

Natural Products and their (Semi-)Synthetic Forms in the Treatment of Migraine: History and Current Status

Background: Migraine may be described as a headache with moderate to extreme pain that is often accompanied by incapacitating neurological symptoms. It is estimated that 12% of the world population suffers from migraine. Although a number of drugs have been used for treatment of migraine, most of these are not effective for every patient and may have undesirable side-effects. Thus, there is an enormous unmet need in current migraine therapy for discovering safer and more effective agents. Methods: The information summarized in this review was obtained through extensive literature review and search of relevant books and articles with the use of Web of Knowledge and SciVerse Scopus databases. Results: Greater understanding of the molecular mechanisms underlying the etiopathogenesis of migraine is helpful in identifying novel targets for antimigraine drugs such as cannabinoid, histamine, and melatonin receptors. In the past, natural product-derived constituents have served as an invaluable source of numerous medicinally useful antimigraine agents and it may be expected that further promising drug candidates from natural products will be discovered for antimigraine pharmacotherapy with better efficacy and fewer adverse-effects. Conclusion: The discovery of novel targets in migraine therapy has opened new horizons for compounds that have not been clinically tested or that previously failed in clinical trials as potential antimigraine drugs. Ginkgolide B, melatonin, histamine, oxytocin, various ribosomal peptide toxins, kavalactones, devil’s claw-derived compounds, salvinorin A and petasin are among those agents that show considerable promise as novel drugs in migraine prevention and treatment. It is necessary to conduct more research to better understand their antimigraine action, to confirm their effectiveness and safety, and to introduce them into clinical practice.

An unsuspected and unrecognized cause of medication overuse headache in a chronic migraineur—essential oil-related medication overuse headache: A case report

Essential oils are widely used by people for common ailments like headache and backache. We report a case of chronic daily headache in an adolescent migraineur refractory to most antimigraine drugs secondary to topical application of essential oils containing camphor and eucalyptus. A 14-year-old boy presented with chronic daily headache of 1-year duration, refractory to four antimigraine drugs including valproate and topiramate. He was daily applying a balm called Amruthanjan (10% camphor and 14.5% eucalyptus) on his forehead to relieve headache. Patient had complete relief of headache in 2 weeks after stopping the balm application. All his antimigraine drugs were tapered and stopped over a period of 3 months. At 1-year follow-up, he is headache free. Brain-stimulant essential oils of camphor and eucalyptus may be an important unrecognized cause of medication overuse headache.