Delta-opioid receptors as targets for migraine therapy

Purpose of review The purpose of this review is to contrast the properties of the delta-opioid receptor with those of the mu-opioid receptor, which is the primary target of most currently available opioid analgesics. We also discuss preclinical evidence that indicates the potential efficacy of delta-opioid receptor agonists as migraine therapy. Recent findings The use of currently available opioid analgesics is highly problematic for patients with migraine. Delta-opioid receptors have key differences from mu receptors; these differences make the delta receptor an attractive therapeutic target for migraine. Delta-opioid receptors are expressed in both the peripheral and central nervous system in anatomical regions and cell types that are believed to play a role in migraine. Delta-receptor agonists have also shown promising effects in multiple migraine models, including nitroglycerin evoked hyperalgesia and conditioned place aversion, and cortical spreading depression. Evidence from animal models indicates that activation of delta receptors is less likely to cause tolerance and dependence, and less likely to cause hyperalgesia. In addition, delta receptors may have antidepressant and anxiolytic properties that are distinct from those of mu receptors. In human studies investigating other conditions, delta-receptor agonists have been generally safe and well tolerated. Summary Delta-opioid receptor agonists have promising potential as acute and/or preventive migraine therapies, without the problems associated with currently used opioid analgesics.