Migraine Management

Dr. Stephen Shrewsbury recently left Impel Pharmaceuticals where he served as Chief Medical Officer (CMO) from March 2017 and led the development of Precision Olfactory Delivery of DHE through its clinical program and to FDA approval in September 2021. Formerly Stephen was CMO at MAP Pharmaceuticals where he conducted a successful clinical program for an inhaled version of DHE, but it never got approved due to manufacturing issues. Before MAP he was at Chiron Corporation where he was also on the International Pharmaceutical Aerosol Consortium Board of Science. Before Chiron, Stephen spent 9 years with GlaxoSmithKline (last 2 in the US) having moved into the industry in 1993 after 13 years working in the UK’s National Health Service. He has also been CMO for several other West Coast (US) biotech companies; has numerous patents; written and published a book, over 40 scientific papers and nearly 200 abstracts

Part I – Foundations and historical development on Migraine Pain Management
1. Introduction
2. Neuroanatomy
3. Historical overview of drug development and therapeutics
4. Alternative therapy development
5. Comorbidities and their impact on therapies
6. Not all Migraine attacks are the same
7. The case for nasal delivery

Part II – Druggable targets
8. CGRP
9. PACAP
10. Transient Receptor Potential Ankyrin 1 (TRPA1) Antagonists
11. Src family kinases (SFK)
12. Delta opioid receptor system
13. Piezo channels in peripheral trigeminal nociception
14. TRPM8 antagonists

Part IIIa – Drugs – Acute Management
15. Simple analgesics
16. Opioids
17. Ergots
18. Triptans
19. Lasmiditan (and the ditan class)
20. Timolol
21. Rimegepant
22. Combination therapies

Part IIIb – Drugs – Prevention
23. Tricyclic antidepressants, SNRIs, beta-blockers
24. Antiseizure and other orals – gabapentin, topiramate, candesartan, flunarizine
25. Onabotulinumtoxin
26. Gepants
27. Monoclonal antibody
28. Others: Magnesium, riboflavin, Coenzyme Q10, melatonin

Part IV – Administration routes
29. Oral
30. Upper Nasal Space vs Traditional Nasal Spray
31. Inhaled
32. Sub/trans-cutaneous
33.I V/Infusion

Part V – Alternative Management
34. The role of smartphone apps (DTx)
35. Traditional and herbal medicine
36. Chiropractic Therapy
37. Phototherapy
38. Nerve stimulators
39. Acupuncture
40 .Other "mechanical" techniques
41. Nutraceuticals
42. Mindfullness

Part VI – Summary and conclusion [Shrewsbury]
Final perspectives