Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland.
Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
Naunyn Schmiedebergs Arch Pharmacol. 2023 Jul;396(7):1371-1398. doi: 10.1007/s00210-023-02444-2. Epub 2023 Mar 4.
Migraine is a debilitating disorder affecting females more frequently than males. There is some evidence that drugs targeting glutamate receptors: memantine and ketamine might be beneficial in the therapy of this entity. Therefore, the purpose of this work is to present NMDA receptor antagonists, memantine and ketamine, as potential anti-migraine agents. We searched PubMed/MEDLINE, Embase, and clinical trials submitted to ClinicalTrials.gov to find publications describing eligible trials published between database inception and December 31, 2021. This comprehensive literature review summarizes data on the use of the NMDA receptor antagonists memantine and ketamine in the pharmacotherapy of migraine. Results from 20 previous and recent preclinical experiments are discussed and correlated with 19 clinical trials (including case series, open-label, and randomized placebo-controlled trials). For the purposes of this review, the authors hypothesized that the propagation of SD is a major mechanism in the pathophysiology of migraine. In several animal studies and in vitro studies, memantine and ketamine inhibited or reduced propagation of the SD. In addition, the results of clinical trials suggest that memantine or ketamine may be an effective treatment option for migraine. However, most studies on these agents lack control group. Although further clinical trials are needed, the results suggest that ketamine or memantine may be promising molecules for the treatment of severe migraine. Particular attention should be paid to people who have a treatment-resistant form of migraine with aura or have exhausted existing treatment options. For them, the drugs under discussion could represent an interesting alternative in the future.
偏头痛是一种使人虚弱的疾病，女性比男性更常受到影响。有一些证据表明，靶向谷氨酸受体的药物：美金刚和氯胺酮可能对这种疾病的治疗有益。因此，本研究的目的是将 NMDA 受体拮抗剂美金刚和氯胺酮作为潜在的抗偏头痛药物进行介绍。我们检索了 PubMed/MEDLINE、Embase 和 ClinicalTrials.gov 上提交的临床试验，以查找描述数据库建立至 2021 年 12 月 31 日期间发表的合格试验的出版物。这篇全面的文献综述总结了 NMDA 受体拮抗剂美金刚和氯胺酮在偏头痛药物治疗中的应用数据。讨论了 20 项以前和最近的临床前实验的结果，并与 19 项临床试验（包括病例系列、开放标签和随机安慰剂对照试验）进行了关联。为了进行本次综述，作者假设 SD 的传播是偏头痛病理生理学中的一个主要机制。在几项动物研究和体外研究中，美金刚和氯胺酮抑制或减少了 SD 的传播。此外，临床试验的结果表明，美金刚或氯胺酮可能是偏头痛的有效治疗选择。然而，大多数关于这些药物的研究缺乏对照组。尽管需要进一步的临床试验，但结果表明，氯胺酮或美金刚可能是治疗严重偏头痛的有前途的分子。特别需要关注那些有难治性先兆偏头痛或已经用尽现有治疗选择的患者。对于他们来说，正在讨论的这些药物在未来可能代表一种有趣的替代选择。
