New migraine drug shows promise

An experimental migraine drug seems to work just as well as migraine medicines currently on the market, a new study has found. The new drug, called telcagepant, also seems to cause fewer side effects than current medications.

What do we know already?

Roughly 6 million people in the UK get migraines. The pain of these headaches can last for several days, often accompanied by nausea and unpleasant sensitivity to light or sound. Research by the World Health Organization found that migraines are one of the most disabling long-term conditions you can have.

Ordinary painkillers such as aspirin and ibuprofen can help with the pain of a migraine. But you can also take specialised migraine drugs, called triptans. You can get these from your doctor, and one, called sumatriptan, is available over the counter.

Although triptans work well for many people, they're not suitable for everyone. You can't take them if you have a heart condition, as there's a risk they could make it worse. A few people get chest pain as a side effect.

Researchers have been looking at new migraine drugs that work in a different way to triptans. A medicine called telcagepant has just been tested in a large trial of over 1,300 patients.

What does the new study say?

During the study, when people got their first migraine, they were given either telcagepant, a medication for migraine called zolmitriptan or a dummy (placebo) treatment. They then kept a diary of how much pain they got.

Telcagepant worked better than a dummy treatment, and just as well as zolmitriptan. It also had fewer side effects than zolmitriptan.

The study looked at both high and low doses of telcagepant. The high dose worked best, and helped 38 in 100 people have less pain. For 18 in 100 people, their migraine cleared up completely. This was about the same as zolmitriptan, which helped 36 in 100 people and got rid of the migraine for 13 in 100. Both drugs worked far better than the placebo. Only 15 in 100 people taking a placebo got less pain, and only 4 in 100 found their migraine went away.

The high dose of telcagepant caused side effects for about a third of people. Half the people taking zolmitriptan got at least one side effect. However, people were given the maximum recommended dose of zolmitriptan, which is double the usual starting dose. People taking a normal dose might get fewer problems.

Common side effects from the new drug included a dry mouth, feeling sleepy, feeling dizzy or feeling sick. Chest pain was less common for people taking telcagepant than for people taking zolmitriptan.

How reliable are the findings?

The study was large and carefully done. However, there are a few things to notice. The researchers believe that telcagepant will be safer for people with heart conditions than triptan drugs because it works in a different way. But people with heart problems weren't allowed to take part in the study, as there was a chance they'd have been put in the group taking zolmitriptan. So, the study can't tell us whether the new drug is really safe for people with heart disease.

Over 8 in 10 of the patients in the study were women. So, there's not much information about how well telcagepant works for men.

Some people taking telcagepant had the option of taking a second dose if they wanted to. People taking zolmitriptan couldn't do this, as they'd already been given the maximum dose. So, people taking telcagepant might have ended up taking a higher dose, which might make the drug appear more effective.

The study only looked at how well telcagepant worked for one migraine attack. There's no information about how well it works or how safe it is in the long term.

Where does the study come from?

The study looked at people in the US and the UK. It was published in a journal called The Lancet, which is owned by a company called Elsevier. The study was paid for by Merck, which hopes to market telcagepant. It's quite common for manufacturers to fund research of their own products. In this case, Merck also helped to design the study, and most of the researchers work for the company.

What does this mean for me?

At present, telcagepant is not approved for use in the UK or elsewhere in the world. A drug can't be used in the UK until it's been approved by either the British or European drug safety watchdog. So, we don't know yet whether or when telcagepant will become available.

The study of telcagepant was a phase 3 trial. These are late-stage studies looking at how well a drug works in a large number of people. If a drug company wants to get a new product approved, it submits information from this type of trial to the drug safety regulators

What should I do now?

Ordinary painkillers and triptans are the main treatments for migraines at the moment. Learning to recognise the signs of a migraine and taking treatment early might mean your medicines work better. For people who get migraines a lot, there are drugs that can help to stop them happening so often.

Some people find particular things trigger migraines, like being hungry or not getting enough sleep. Keeping a migraine diary can help you spot these triggers and avoid them.

Some migraine treatments are available over the counter, and others can only be prescribed by a doctor. Talk to your pharmacist or make an appointment with your GP to find out about your options.

From:

Ho TW, Ferrari MD, Dodick DW, et al. Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. The Lancet. Published online 25 November 2008.

To read more, see our information on migraines in adults and migraines in children.