Basal studies have shown that
calcitonin gene-related peptide (CGRP) is a major sensory neuronal messenger in the trigeminovascular system, the pathway conveying intracranial
pain. In
migraine and
cluster headache attacks, CGRP is released in parallel with the
pain and successful treatment of the attacks abort both the associated
pain and the CGRP release. The search for a potent small molecule CGRP antagonist has been successful and such an agent has been tested in preclinical and clinical studies. The aim of the present study was to examine current knowledge on the clinical pharmacology of systemic
BIBN4096BS, which has been shown in man to abort acute
migraine attacks as well or better than oral
sumatriptan.
BIBN4096BS is a specific and potent
CGRP receptor antagonist in humans. In safety and tolerability studies the substance is well tolerated with no or only mild side effects. In acute
migraine attacks the overall response was 66% with the
drug and 27% with placebo. A difference as compared to placebo was seen at 30 min; the response was still rising at 4 h suggesting a long duration of action. At 24 h the
pain-free rate was better than that with
triptans, suggesting a lower grade of rebound and perhaps even a prophylactic possibility.