Pervez Hira, Khemani Lavina, Khan Mahrukh A, Seedat Ahmed M, Roshan Fnu
Internal Medicine/Cardiology, Dow University of Health Sciences, Karachi, PAK.
Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2020 Jun 20;12(6):e8711. doi: 10.7759/cureus.8711.
Headaches due to migraine are the second leading cause of disability in the world. Migraine can be classified as episodic migraine (EM) and chronic migraine (CM). The course of the disease starts from an aura followed by 4-72 hours of bouts of throbbing, mostly unilateral headache associated with nausea, photo/phonophobia with/without neurological deficit. The pathophysiology of migraine remains debatable and many drugs are used to help control migraine attacks with little or no benefit. However, patient compliance remains a reason for over and underdosing of these medications. The calcitonin gene-related peptide (CGRP), a vasoactive peptide is known to contribute to the disease course. Much work is done on antagonizing the receptor or the molecule itself. For this purpose, genetically engineered monoclonal antibodies are being utilized for long-term reduction in morbidity and prevention of migraine headaches. The four to name are: galcanezumab, fremanezumab, eptinezumab, and erenumab. The purpose of this review is to shed light on the use of these monoclonal antibodies, completed and recruiting trials, and the role of these medications in the prevention of not only EM and CM but also in medication overuse headaches.
偏头痛引起的头痛是全球第二大致残原因。偏头痛可分为发作性偏头痛（EM）和慢性偏头痛（CM）。该病病程始于先兆，随后是4至72小时的搏动性发作，主要为单侧头痛，伴有恶心、畏光/畏声，有/无神经功能缺损。偏头痛的病理生理学仍存在争议，许多药物用于帮助控制偏头痛发作，但效果甚微或毫无益处。然而，患者的依从性仍是这些药物用药过量或不足的一个原因。降钙素基因相关肽（CGRP）是一种血管活性肽，已知其与疾病进程有关。在拮抗该受体或分子本身方面已开展了大量工作。为此，基因工程单克隆抗体正被用于长期降低发病率和预防偏头痛头痛。其中四种分别是：加卡尼单抗、夫雷西单抗、依普他单抗和erenumab。本综述的目的是阐明这些单克隆抗体的使用情况、已完成和正在招募受试者的试验，以及这些药物在预防EM和CM以及药物过量使用性头痛方面的作用。
