migraine disorders
Migraine is a debilitating neurological condition affecting approximately 1 billion people globally, ranking as the second leading cause of disability worldwide by years lived with disability. Clinical trials have transformed acute and preventive treatment, with the CGRP pathway now the most actively targeted mechanism β€” producing anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and oral CGRP receptor antagonists (rimegepant, ubrogepant, atogepant) as approved agents, with numerous successors in trials.
Current trials investigate next-generation anti-CGRP agents with extended dosing intervals, combination preventive strategies for high-frequency migraine, valrocemide and Nav1.7 inhibitors for treatment-resistant patients, and non-pharmacological approaches including non-invasive vagus nerve stimulation (nVNS), TMS devices, and digital therapeutics. Trials also address cluster headache, chronic migraine, and vestibular migraine as distinct entities.
Migraine frequency (episodic: <15 headache days/month; chronic: ≥15/month) and medication overuse history are key eligibility criteria; biomarker-based enrichment trials use CGRP blood levels.