PACAP pathway: a new frontier in migraine prevention

Migraine is characterised not only by headache but also by prodromal, aura, and non-pain symptoms, such as nausea, photophobia, and cognitive changes.7 There is a strong influence of sexual hormones as well as comorbidity with cardiovascular and mental health conditions on migraine.8 Addressing this multifaceted disorder might require combination therapies targeting multiple pathways. Another important question is whether PACAP-targeted treatments could benefit patients who have a partial response to inhibition of CGRP or its receptors or other preventive therapies (eg, those who have only a 50% reduction in days with a headache, rather than a higher percentage decrease). MFPP has received honoraria for speaking engagements and consulting from Eurofarma, Ache, Libbs, Teva, Abbvie, Pfizer, Lundbeck, Lilly, and Viatris; participates on data safety monitoring boards or advisory boards for Abbvie, Pfizer, Lundbeck, and Teva; has patents planned, issued, or pending for US 17/196,611 and BR202017023353; and has roles in Abraces and the Brazilian Headache Society