April 22nd, 2010
03:30 PM ET
By Caitlin Hagan
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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