Migraine Pain 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 of migraine pain management

1. Introduction
2. Neuroanatomy and Neurophysiology
3. Historical overview of migraine product development
4. Comorbidities and their impact on therapies
5. Not all Migraine attacks are the same
6. Challenges and Controversies; Pharmacokinetics, Linguistics, Semantics and Statistics

Part II: Druggable targets

7. CGRP
8. PACAP
9. Src family kinases (SFK) in Migraine
10. Delta opioid receptor system
11. Piezo channels in peripheral trigeminal nociception
12. TRP antagonists

Part III: Drugs – Acute Management

13. Simple analgesics and combination oral products
14. Cannabinoids & Phytochemicals
15. Ergots
16. Triptans
17. Beta blocker (timolol) eye drops
18. Lasmiditan (and the ditan class)
19. Gepants

Part IV: Drugs – Prevention

20. TCAs (Tricyclic Antidepresants), SNRIs, Beta blockers, candesartan, flunarizine
21. Antiseizure orals (gabapentin, topiramate)
22. Onabotulinumtoxin
23. Gepants (for prevention)
24. (CGRP) Monocloncal antibodies

Part V: Administration routes

25. Oral Drugs (including SMEDDS)
26. Inhaled - oral & nasal
27. Subcutaneous/IM/Transcutaneous ("Injectables")
28. IV/Infusion

Part VI: Alternative Management

29. The role of digital platforms and smartphone apps
30. Herbal Medicines
31. Phototherapy
32. Neuromodulation
33. Acupuncture (for episodic and chronic migraine)
34. Manual Therapies
35. Nutraceuticals and Diets
36. Mindfulness

Part VII: Summary & conclusion [Shrewsbury]

37. Final Perspectives: oral/non-oral pharmaceuticals; devices; Complimentary practices