PURPOSE OF REVIEW: To review 5 new areas in primary headache disorders, 
especially migraine and cluster headache.
RECENT FINDINGS: Calcitonin gene-related peptide (CGRP) receptor antagonists 
(gepants-rimegepant and ubrogepant) and serotonin 5-HT1F receptor agonists 
(ditans-lasmiditan) have completed phase 3 clinical trials and will soon offer 
novel, effective, well-tolerated nonvasoconstrictor options to treat acute 
migraine. CGRP preventive treatment is being revolutionized after the licensing 
of 3 monoclonal antibodies (MABs), erenumab, fremanezumab, and galcanezumab, 
with eptinezumab to follow, especially designed for migraine; they are effective 
and well tolerated. For patients seeking a nondrug therapy, neuromodulation 
approaches, single-pulse transcranial magnetic stimulation, noninvasive vagus 
nerve stimulation (nVNS), and external trigeminal nerve stimulation, represent 
licensed, well-tolerated approaches to migraine treatment. For the acute 
treatment of episodic cluster headache, nVNS is effective, well tolerated, and 
licensed; nVNS is effective and well tolerated in preventive treatment of 
cluster headache. The CGRP MAB galcanezumab was effective and well tolerated in 
a placebo-controlled trial in the preventive treatment of episodic cluster 
headache. Sphenopalatine ganglion stimulation has been shown to be effective and 
well tolerated in 2 randomized sham-controlled studies on chronic cluster 
headache. Understanding the premonitory (prodromal) phase of migraine during 
which patients experience symptoms such as yawning, tiredness, cognitive 
dysfunction, and food cravings may help explain apparent migraine triggers in 
some patients, thus offering better self-management.
SUMMARY: Headache medicine has made remarkable strides, particularly in 
understanding migraine and cluster headache in the past 5 years. For the most 
common reason to visit a neurologist, therapeutic advances offer patients 
reduced disability and neurologists a rewarding, key role in improving the lives 
of those with migraine and cluster headache.