Pharmacogenetic considerations for migraine therapies

ABSTRACT

Introduction: Migraine is a common neurological disorder with a complex pathophysiology. It has been estimated that incidence between adults of current headache disorder is about 50%. Different studies show that this condition has an important and complex genetic component in response to drug therapy.

Areas covered: This review shows and summarizes the importance of the polymorphisms associated with the major antimigraine drug metabolizing enzymes. The research of bibliographic databases has involved only published peer-reviewed articles from indexed journals.

Expert opinion: Pharmacogenetics is based on the identification of polymorphism and promises personalized therapy with efficacy and reduction of adverse events. The association between genotype and an altered metabolizer status could guide clinical decision to evade concomitant treatments and adverse events. The introduction of routine genetic testing could help to choose the efficacy drug on the individual and genetic profile.

KEYWORDS:

• Migraine
• pharmacogenetics
• polymorphisms
• CYP
• drug response

Article highlights

• Migraine is a multi-factorial disease with high prevalence in the total population. This disorder is characterized by different response to the drugs used for migraine therapy.

• The acute or preventive treatment of migraine includes different classes of drugs. Each molecule is metabolized by different enzymes. The ineffective response and the presence of adverse events are very common conditions in patients.

• In the last years, various studies have analyzed many polymorphisms of genes involved on the drugs metabolism.

• These studies show many gene variations especially on CYP450 (which metabolizes 90% of drugs) and represent the most proper marker for the migraine therapy.

• Pharmacogenetics through the genetic studies promises to find a pharmacological therapy based on the patient’s unique genetic characteristics.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.