DOCTORS' BLOG

Outpatient Treatments for RCM

New Technologies and Pharmacotherapies

There are a number of therapeutic options for RCM (Refractory Chronic Migraine), including inpatient treatment. New approaches such as transcranial brain stimulation (TMS), are in various stages of development and will come along. TMS has the potential to alleviate RCM without side effects. There is currently one newer type of TMS machine in use in the US, The Neurostar machine. It is FDA-indicated for the treatment of depression. There is another type of TMS unit in development by the company Neuralieve, which will be primarily used as a migraine abortive. It has the advantage of being readily available in a patient’s home.

Occipital nerve stimulation has been beneficial for a small number of RCM patients. Techniques of implantation have improved but the technical challenges need to be overcome; the leads tend to migrate away from the occipital nerve, for example. Other implantable stimulators are being studied, such as the Bion microstimulator and the Precision Implantable Stimulator for Migraine. It is too early to know what, if any, role these will play.

In pharmacology, there are a number of emerging compounds that may eventually come to market. These include newer abortives, such as 5-HT   drugs.  These work on the 5-HT F receptor, while the current triptans target B and D. CGRP antagonists, such as olcagepant and telcagepant, may be very useful. Gap junction blockers at the neural-glial level are being assessed. Finally, glutamate receptor antagonists are currently in Phase III trials.