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Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space

1
University of Cincinnati Headache and Facial Pain Center, Cincinnati, OH 45219, USA
2
Research & Development, Impel NeuroPharma, Seattle, WA 98119, USA
3
Medical Affairs, Impel NeuroPharma, Seattle, WA 98119, USA
4
Clinical Development, Impel NeuroPharma, Seattle, WA 98119, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Antonio Russo
J. Clin. Med. 2021, 10(11), 2468; https://doi.org/10.3390/jcm10112468
Received: 28 April 2021 / Revised: 26 May 2021 / Accepted: 27 May 2021 / Published: 2 June 2021
(This article belongs to the Special Issue Prevention and Acute Treatment of Migraine)
The acute treatment of migraine requires effective drugs that are well tolerated and provide rapid and consistent pain relief. Oral tablets are the most commonly used acute treatment for migraine; however, their effectiveness is limited by the rate of gastrointestinal (GI) tract absorption and first-pass hepatic metabolism, and they may not be ideal for patients experiencing GI motility issues. Nasal delivery is an attractive alternative route as it may circumvent GI tract absorption, avoid first-pass metabolism in the liver, and potentially reduce the frequency of GI adverse events. The large surface area and high vascularity within the nose may permit rapid absorption of therapeutics into the systemic circulation, allowing for rapid onset of action. However, the site of drug deposition (upper versus lower nasal cavity) may influence drug pharmacokinetics. Most approved nasal migraine therapies target the lower nasal space where the epithelium is less permeable, and they may be quickly cleared away due to increased ciliary function or dripping from the nose or swallowing, resulting in variable absorption and limited bioavailability. Together with its abundant vascularization, relative mucosal thickness stability, and low clearance rates, the upper nasal space harnesses the benefits of nasal delivery to potentially maximize drug efficacy. View Full-Text
Keywords: migraine; headache; acute treatment; therapy; nasal delivery; drug delivery; bioavailability; upper nasal space; olfactory region migraine; headache; acute treatment; therapy; nasal delivery; drug delivery; bioavailability; upper nasal space; olfactory region
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MDPI and ACS Style

Martin, V.; Hoekman, J.; Aurora, S.K.; Shrewsbury, S.B. Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space. J. Clin. Med. 2021, 10, 2468. https://doi.org/10.3390/jcm10112468

AMA Style

Martin V, Hoekman J, Aurora SK, Shrewsbury SB. Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space. Journal of Clinical Medicine. 2021; 10(11):2468. https://doi.org/10.3390/jcm10112468

Chicago/Turabian Style

Martin, Vincent, John Hoekman, Sheena K. Aurora, and Stephen B. Shrewsbury 2021. "Nasal Delivery of Acute Medications for Migraine: The Upper Versus Lower Nasal Space" Journal of Clinical Medicine 10, no. 11: 2468. https://doi.org/10.3390/jcm10112468

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