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April 22nd, 2010
03:30 PM ET

Migraine relief on the horizon?

By Caitlin Hagan
CNN Medical News associate producer

A cutting-edge treatment for migraines is in the final stages of development and may be on track for regulatory approval within the next few years. Telcagepant, a drug manufactured by the Merck Corp., seems to relieve headache pain without causing vasoconstriction, or the narrowing of blood vessels.


The current class of medications used to treat acute migraine pain causes blood vessels to narrow – vasoconstriction - as a means of relieving the headache. Because of that, the drugs, known as triptans, are not recommended for any patient with a history of coronary heart disease or risk factors such as hypertension.

Telcagepant would be the first safe therapy for migraine suffers who also have risk factors for cardiovascular disease.

"Imagine patients who are 45 or 50 years old who have had a single heart attack in the past so I can't give them anything for their migraines," says Dr. Timothy A. Collins, a neurologist at the Duke University Medical Center who is not affiliated with the development of Telcagepant.

"[This medication] would allow us to treat a previously poorly treated population."

Telcagepant has performed well in clinical trials when used as an acute treatment. But early last year Merck abruptly ended a clinical trial testing Telcagepant as a preventive medication because some trial participants developed liver problems. The company is currently establishing protocols for another safety study that will look at whether there are underlying issues when the drug is taken to relieve pain. The results of that study will determine whether Merck begins the regulatory approval process to get the drug approved for general use. There is no guarantee that Telcagepant will be approved.

Experts agree that if the drug were to be put on the market, it wouldn't replace triptans as a migraine therapy, just add to the list of available medications already on the market.

"For acute therapy of migraine in patients with coronary heart disease, we have anti-inflammatory, we have narcotics - which no one likes to use - and we have older drugs that cause worse vasoconstriction than triptans," says Collins.

"So for there to be a non-narcotic that doesn't cause vasoconstriction, this would be very significant change in the market for what we have to give patients." Collins advises migraine sufferers not to wait for Telcagepant to get approved before making an appointment with their doctor.

"Only half of all people with migraines talk with their doctors and only half of them get prescriptions for their headaches," he says.

"Ask your doctor for something to stop headaches that isn't a narcotic and if you have more than two headachse days a week, talk about migraine headache prevention medication."

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soundoff (8 Responses)
  1. Mary Ellen Secula

    I am one of those migraine sufferers that cannot take the popular triptan medications and nothing else I have tried works. The migraine attacks keep me in bed for 3 days and really interfere with my life. I can only hope and pray that this medication is approved and made available soon!

    April 22, 2010 at 23:47 | Report abuse | Reply
  2. DollParts

    Medical Marijuana has helped me control the migrainous pain I've experienced since a double-aneurysm and stroke almost 3 years ago.

    I would recommend it to anyone for serious, acute, migraine headaches.

    April 23, 2010 at 16:16 | Report abuse | Reply
  3. Angela from Charlotte, NC

    Several years ago I had a migraine headache and was going to have my eyes tested. After the doctor dilated my eyes to examine the retina, the migraine had completely gone.
    As the pupils tend to get smaller during migraines, I wondered wether the drug relaxing the muscles around the eyes stopped the migraine somehow? I think it is worth some research.

    April 24, 2010 at 11:29 | Report abuse | Reply
  4. Barry Spencer

    Dr. Gupta, vascular dilation associated with migraine is a symptom of migraine, not a cause of migraine symptoms. Triptans relieve migraine episodes not by constricting blood vessels but by substituting for serotonin at particular types (5-HT1B and 1D) of serotonin receptors. Caffeine indeed constricts blood vessels in the head, but caffeine doesn't relieve headache by constricting blood vessels. Rather, caffeine relieves headache by blocking adenosine.

    April 25, 2010 at 15:38 | Report abuse | Reply
  5. Natalie Kramer

    Barry, caffeine does not relieve migraines in everyone. It is totally useless for me, for example. The triptans help me, but in addition to the side effects I see listed everywhere, they are extremely sedating, to the point of being debilitating. I am wondering whether there is a way to speed up the trials of Telcagepant by Merk or have them work on developing of more effective preventatives. The ones that exists don't work!

    June 9, 2010 at 18:05 | Report abuse | Reply
  6. Lauren crain

    Dr. Gupta, I have had "atypical"migraines for 30 years, and I am also an Rn. My medical knowledge and access to the medical system has been invaluable in seeking care, but for the past 5 years I have become increasingly debilitated. I have always had a medication "resistance" and numerous allergies.My Dr.s have always said my migraines were not "just Migraines'. So I went the homeopathic way, $10,000 later, including a chronic pain therapist, I am getting increasingly worse. I have basically spent the last 3 years bedridden. What has worked, was a sphenoganglion block (intranasal w/ lidocaine) and magnesium infusions. Now they aren't working. I went to John Hopkins recently, I had laid out my expectations and Dr.'s concerns prior to visit with medical concierge, as the visit was a financial burden at this time. They blew me off and gave me a Rx for depakote. Refused any type of infusion trial, etc... They did rule out low CSF leak after much insistence on my part, althought I am still baffled by this. At Shepherd in Atlanta, I was told my closing pressure was 0 , and 2 blood patches failed to eliminate the headache, that lead me to Boston, they said my closing pressure was csf 21. I live in Atlanta, I am 47, I really want my life back, I have done everything I can, My current headache has been since September, I am using no pain meds, so it is not rebound. I have a good friend who knows you professionally and recommended I contacted you, he had planned on doing so on my behalf, but had a traumatic accident 10/31, and thankfully is recovering, but I did not want to trouble him about myself at this time. I have had at least 15 procedures done by an excellent local pain specialist, allergy sensitivity testing, 5 chiropractors, bio-identical hormones, hundreds of dollars of vitamins, medical meditation, chronic pain therapy, craniosacral massage, trigger point masssage, the only medical majiuana legal in ga.,& intergrative medicine with a fellow of Andrew Weils. I am desperate, but relentless to find an answer, my husband , children, and elderly parents need me back, and our family needs my income. I am sorry for the length of this email, but I hope others may gain help through my journey, and the information I have shared. Thank-you for your time, respectfully awaiting your reply

    January 6, 2011 at 10:41 | Report abuse | Reply
  7. wuffe

    Lauren ,
    I am shocked by the lack of response to your email. As an RN with migraines as well, I can only hope that the high number of americans suffering with migraines, 30 million, puts research in high gear. Such a high number , is a complete section of our economy.

    January 15, 2011 at 12:44 | Report abuse | Reply
  8. Brad C.

    Great Post. I am a heart patient and a migraineur. I don't use triptans, as a matter of fact, I don't use anything, because what I have tried just won't work. Believe me, I have spent a ton of money on prescriptions from doctors, homeopathic meds, magnesium sprays and supplements and many more. None of them worked, they didn't put a dent in the pain. So, like many of us out here in the real world, we suffer in dark rooms with cold washclothes on our heads, not being able to live our life with our families. Maybe someday someone will stumble on a cure or at least something that will relieve the pain.

    August 24, 2011 at 16:16 | Report abuse | Reply

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