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Clinical & Research News
Published Online: 21 August 2009

Tonabersat Suppresses Aura but not Migraine Pain

Publication: Psychiatric News
Volume 44, Number 16
https://doi.org/10.1176/pn.44.16.0026a
The aura in migraine has been shown to be caused primarily by cortical spreading depression (CSD), a progression of depolarization in neurons and glial cells that spreads slowly across the cortex. The neurological process of CSD is accompanied by vascular fluctuations in the brain, which is considered a part of the mechanisms that cause inflammation and pain.
Tonabersat is a neuronal gap-junction blocker that inhibits CSD and was once considered a promising new compound to prevent migraine attacks. Several clinical trials sponsored by Minster Pharmaceuticals, however, have yielded disappointing results so far. In a study published online in the Lancet Neurology on June 30, tonabersat was tested in a double-blind, placebo-controlled, crossover study.
Thirty-one patients with migraine with aura received once-daily tonabersat or placebo for three months each (in random order) with a one-month washout between treatment crossover. Tonabersat significantly reduced the frequency of aura with or without pain, compared with placebo. It also significantly reduced the number of attacks of aura followed by headache. However, the drug did not significantly reduce the total number of migraine headache days with or without aura.
Previous phase 2 clinical trials also produced equivocal evidence to support efficacy of tonabersat in preventing migraines. The ambiguity in tonabersat efficacy raises new questions about the pathophysiology of migraine and rational strategies to develop new drugs that prevent migraine attacks, especially for migraine without aura.
An abstract of “Effects of Tonabersat on Migraine With Aura: A Randomised, Double-Blind, Placebo-Controlled Crossover Study” is posted at<www.thelancet.com/journals/laneur/article/PIIS1474-4422(09)70135-8/abstract>.▪

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Psychiatric News
Volume 44 • Number 16 • August 21, 2009
Pages: 26

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Published online: 21 August 2009
Published in print: August 21, 2009

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