Unmet Medical Needs

The greatest unmet need in migraine is a broader recognition of the biological basis of the problem. It remains true after the decade of the triptans, 1995-2005, that the majority of migraine sufferers in the western world, and certainly the developing world, still do not access best-practice care. If diagnostic rates in most of the world reflect those of the US, where nearly 50% of migraine sufferers do not have the diagnosis made,65 and only a minority are treated with migraine-specific treatments, the opportunity to do good is huge. Any medicine development needs to bear this in mind. Having said that, the obvious need in acute treatment is a purely neuronally acting treatment that has no vascular side effects; this would be a major opportunity given the perceived cardiac safety issues with triptans.66 A drug with less recurrence, i.e., a greater 24-h sustained painfree response, would also be most welcome by the fully one-third of migraineurs who suffer headache recurrence: the attack is settled by treatment but reappears some hours later. For preventive medicines, a well-tolerated treatment would be a major, immediate, and welcome bonus, even if it did not help all sufferers, since the choice of side effects is daunting to patients. Lastly, the holy grail might be a medicine that would work as an acute therapy, preemptively if the patient feels an attack, and in short-term prophylaxis, for example when there will be a known trigger or an important event over some days. There is considerable opportunity.

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