11 research outputs found

    Current and prospective pharmacological targets in relation to antimigraine action

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    Migraine is a recurrent incapacitating neurovascular disorder characterized by unilateral and throbbing headaches associated with photophobia, phonophobia, nausea, and vomiting. Current specific drugs used in the acute treatment of migraine interact with vascular receptors, a fact that has raised concerns about their cardiovascular safety. In the past, α-adrenoceptor agonists (ergotamine, dihydroergotamine, isometheptene) were used. The last two decades have witnessed the advent of 5-HT1B/1D receptor agonists (sumatriptan and second-generation triptans), which have a well-established efficacy in the acute treatment of migraine. Moreover, current prophylactic treatments of migraine include 5-HT2 receptor antagonists, Ca2+ channel blockers, and β-adrenoceptor antagonists. Despite the progress in migraine research and in view of its complex etiology, this disease still remains underdiagnosed, and available therapies are underused. In this review, we have discussed pharmacological targets in migraine, with special emphasis on compounds acting on 5-HT (5-HT1-7), adrenergic (α1, α2, and β), calcitonin gene-related peptide (CGRP 1 and CGRP2), adenosine (A1, A2, and A3), glutamate (NMDA, AMPA, kainate, and metabotropic), dopamine, endothelin, and female hormone (estrogen and progesterone) receptors. In addition, we have considered some other targets, including gamma-aminobutyric acid, angiotensin, bradykinin, histamine, and ionotropic receptors, in relation to antimigraine therapy. Finally, the cardiovascular safety of current and prospective antimigraine therapies is touched upon

    Comparison of Transcatheter Aortic Valve Implantation to Medical Therapy in Prohibitive-Risk Patients

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    Aortic stenosis is the most common primary valve disease needing surgical treatment in Europe and North America. The prevalence of this disease increases over years due to the ageing population. Age and comorbidities often represent an obstacle to surgical aortic valve replacement (AVR) for those patients considered at high and prohibitive risk. In this scenario, transcatheter aortic valve replacement (TAVR) has become an appealing therapeutic option for prohibitive-risk patients with severe symptomatic aortic stenosis who were previously only medically managed and considered unsuitable for AVR. However, the delicate balance between feasibility and appropriateness needs to be accurately defined. This chapter analyzes, basing on available literature, the outcome of such a challenging prohibitive population whether medically managed or undergoing TAVR. Recent findings from both controlled trials and registries suggest that more stringent guidelines for the older and frail population are emerging as a burning issue for health systems and caregivers

    Hypervigilance, Allostatic Load, and Migraine Prevention: Antibodies to CGRP or Receptor

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