Emerging treatments

Lu AG0922

Lu AG09222 is an investigational humanised monoclonal antibody which targets pituitary adenylate cyclase-activating polypeptide (PACAP). PACAP is located in sensory nerve fibres and infusion of PACAP induces a migraine.[212] In a phase 2, double-blind randomised controlled trial, a single infusion of Lu AG09222 reduced migraine frequency by an additional 2 days over the subsequent 4 weeks, compared with placebo. Adverse events were more common in the LU AG09222 group and included nasopharyngitis and fatigue.[213]

Melatonin

Pineal gland irregularity has been suggested as a cause of migraine, and its hormone, melatonin, has been found to be low in patients with migraine. Abnormal melatonin secretion may be a marker of a more general neurological disorder, or may affect calcitonin gene-related peptide (CGRP) regulation. There is some evidence that melatonin is effective for migraine prevention, with few adverse effects, but high-quality studies are required.[214] Larger clinical trials are needed to determine the efficacy of melatonin.

Greater occipital nerve block or ablation

Systematic reviews have concluded that greater occipital nerve block significantly reduces pain intensity, migraine frequency, and analgesic use in patients with migraine compared with placebo.​[215][216]​​​

Levetiracetam

There is some evidence from randomised controlled trials that the anticonvulsant levetiracetam is associated with decreased migraine frequency and severity, compared with placebo.[217]

Zonisamide

One randomised controlled trial has compared the efficacy of anticonvulsant zonisamide with topiramate for migraine prophylaxis. Zonisamide was as effective as topiramate for reducing headache frequency, severity, disability, and need for acute medication.[218]

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