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CGRP is an extensively studied neuropeptide that has been implicated in the pathophysiology of migraine. While a number of small molecule antagonists against the CGRP receptor have demonstrated that targeting this pathway is a valid and effective way of treating migraine, off-target hepatoxicity and formulation issues have hampered the development for regulatory approval of any therapeutic in this class. The development of monoclonal antibodies to CGRP or its receptor as therapeutic agents has allowed this pathway to be re-investigated. Herein we review why CGRP is an ideal target for the prevention of migraine and describe four monoclonal antibodies against either CGRP or its receptor that are in clinical development for the treatment of both episodic and chronic migraine. We describe what has been publically disclosed about their clinical trials and future clinical development plans.

In predisposed individuals, migraine evolves into a stage of daily or nearly daily headaches, known as chronic migraine. Although relatively prevalent and debilitating at all ages, chronic migraine is particularly aggressive in the pediatric population. Several risk factors for chronic migraine have been identified, largely due to two very large longitudinal studies, the American Migraine Prevalence and Prevention Study (AMPP) and the Attention Brazil Project (ABP). This review summarizes lessons learned from these studies that included children from 5 to 19 years of age. We start by contextualizing chronic migraine and by offering a systematic approach to diagnosis. We then discuss pre-natal and post-natal risk factors for migraine transformation, and close by reviewing treatment strategies, ultimately attempting to offer a meaningful overview of chronic migraine in pre-adults based on our experience conducting these studies. [ABSTRACT FROM AUTHOR]

Kinesiophobia is a common symptom associated with high disability, and has been observed in patients with migraine. However, the association between kinesiophobia and clinical factors in this population is unknown. To assess the fear of falling, dizziness disability, and migraine disability in patients with migraine, considering the presence of kinesiophobia. Eighty patients with migraine completed the Tampa Scale for Kinesiophobia and were divided into two groups according to the questionnaire cutoff point: migraine without kinesiophobia (MoK, n = 39) and migraine with kinesiophobia (MK, n = 41). Fear of falling, dizziness disability, and migraine disability were assessed in both groups using validated questionnaires. The MK group presented higher scores on dizziness disability, fear of falling, and migraine disability compared to the MoK (p <.05). Kinesiophobia can explain 29% of the variance in dizziness disability and 18% of migraine disability. Both kinesiophobia and the presence of dizziness can explain 14% of fear of falling variability. Also, kinesiophobia is associated with the risk of presenting fear of falling (Prevalence Ratio = 2.4, p =.012), and migraine disability (Prevalence Ratio = 2.6, p =.01). The presence of kinesiophobia should be considered in clinical practice when evaluating migraine, as it is associated with increased levels of fear of falling, dizziness disability, and migraine disability. [ABSTRACT FROM AUTHOR]

Cefaléia é uma das queixas mais freqüentes na prática médica e causa bastante comum de atendimento em unidades de emergência, implicando custos consideravelmente altos. Foram estudados retrospectivamente os casos de cefaléia atendidos na Unidade de Emergência do Hospital das Clinicas de Ribeirão Preto (UE) no ano de 1996. Neste ano, 1254 pacientes procuraram a UE com queixa de cefaléia aguda, sendo que 64 necessitaram de internação. O custo estimado com o atendimento, investigação e tratamento clínico das cefaléias agudas foi da ordem de R$ 138,573.31 (US$ 76,985.17). Os gastos apenas com exames laboratoriais foram R$ 23,801.54 (US$ 13,223.07). Os custos cirúrgicos foram R$ 5,817.90 (US$ 3,232.17). Os custos totais foram RS$ 144,391.21 (US$ 80,217.34), o que equivale a R$ 115,14 (US$ 63.97) por paciente. Tais cálculos estimulam discussão adicional acerca de custos e eficácia do modelo de saúde vigente, em que os recursos financeiros são precários e as necessidades da população dependente do estado são proporcionalmente maiores.