CA2953170A1 - Methods of treating or ameliorating migraine - Google Patents

Abstract

In certain embodiments, the invention relates to methods for treating migraine (e.g. episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache) by administering a peptide NMDAR partial agonist. In certain embodiments, the invention also relates to methods for treating or ameliorating long-term post migraine sequelae in a patient by administering a peptide NMDAR partial agonist. In certain other embodiments, the invention relates to methods for treating, suppressing, or preventing cortical spreading depression or a disease or condition caused by cortical spreading depression in a patient in need thereof, comprising administering a peptide NMDAR partial agonist. For example, provided herein are methods of treating epilepsy, traumatic brain injury, and/or stroke.

Description

2 METHODS OF TREATING OR AMELIORATING MIGRAINE
CROSS REFERENCE TO RELATED APPLICATIONS
[00011 This application claims the benefit and priority to United States Provisional Application No. 62/015,727, filed June 23, 2014, and United States Provisional Application No. 62/109,386, filed January 29, 2015, each of which are hereby incorporated by reference in their entirety.
BACKGROUND
100021 Migraine is a primary, episodic headache pain disorder associated with debilitating attacks that are recurring, and often poorly controlled by existing phannacotherapies that focus on vascular triggers. The onset of migraine attacks is often presaged by a scintillating scotoma, or migraine aura, caused by the phenomenon of cortical spreading depression (SD; see Ayata, Headache, 50:725-30, 2010; Eike _________________________________________ man-Haerter et al., Cum Neurol. Neurosci. Rep., 10:167-73, 2010; and Sanchez-del-Rio et al., Curr. Opin. Neurol., 17(3):289-93, 2004). SD
is a slowly propagating suppression of electrocorticographic activity triggered by a local increase in extracellular potassium and release of glutamate that produces a self-propagating wave of slow depolarization across large regions of cortex. Migraine with aura is experienced by approximately 15-30% of migraine sufferers.
[00031 The central nervous system (C,'NS) of mammals employs many neuroactive peptides to effect specialized signaling within the brain and spinal cord including the neuroactive peptides somatostatin, cholecystokinin, VIP, Substance P. enkephalin, Neuropeptide Y (NPY), Neurotensin, TRH, CCK, and dynorphin. (see generally The Biochemical Basis of Neuropharmacology, Cooper, Bloom and Roth, 5th ed.., Oxford University Press, New York, 1986). The careful elucidation of the complex signaling pathways, which operate in the C,NS, has led to identification of specific receptors modulated by these neuroactive peptides presenting important therapeutic targets for various disorders associated with the CNS.
[00041 The N-ineth,,,I-D-aspartate (NMDA) receptor (NMDAR), is one such receptor that has been implicated in neurodegenerative disorders including stroke-related brain cell death, convulsive disorders, and learning and memory. NMDAR also plays a central role in modulating normal synaptic transmission, synaptic plasticity, and ex.citotoxicity in the central nervous system. The NMDAR is further involved in long-term potentiation (L.TP). LTP is the persistent strengthening of neuronal connections that underlie learning and memory (See Bliss and Collingridge, 1993, Nature 361:31-39).
[00051 Two general classes of glutamate receptors have been characterized in the central nervous system (CNS). They are the metabotropic glutamate receptors, which belong to the G-protein coupled receptor family of signaling proteins, and the ionotropic glutamate receptors (Muir and Lees. Stroke, 1995, 26, 503-513). The ionotropic class is further subdivided into the AMPA, kainate, and NINADA receptor subtypes by the selective ligands that activate them.
[00061 NMDA-modulating small molecule agonist and antagonist compounds have been developed for potential therapeutic use. However, many of these are associated with very narrow therapeutic indices and undesirable side effects including hallucinations, ataxia, irrational behavior, and significant toxicity, all of which limit their effectiveness and/or safety.
[00071 Thus, there remains a need for improved treatments of migraine and other related diseases with compounds that provide increased efficacy and reduced undesirable side effects.
SUMMARY
[00081 In certain embodiments, the disclosure relates to a method of treating migraine, comprising administering to a patient in need thereof a pharmaceutically effective amount of a GLYX peptide. in certain embodiments, the migraine may be episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephaigic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, and/or cluster headache. In certain embodiments, the migraine is migraine without aura (common migraine). In certain embodiments, the migraine is migraine with aura (classical migraine). In certain embodiments, the migraine is accompanied by allodynia.
[00091 For example, the disclosed compounds may functionally interact with or modulate the action of the glycine site of the NMDAR for the -treatment of migraine (e.g., episodic migraine, chronic migraine, retinal migraine, ophthahnoplegic migraine, acephalg,ic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache).

3 [00101 In certain embodiments, the disclosure relates to a method of treating, suppressing and/or preventing cortical spreading depression (SD), comprising administering to a patient in need thereof a pharmaceutically effective amount of a GLYX peptide. In certain embodiments, the disclosure relates to treating or ameliorating long-term post migraine sequelae in a patient in need thereof, comprising administering to the patient a pharmaceutically effective amount of GLYX peptide.
[00111 In certain embodiments, the GLYX peptide has the following structure:
H
-1µ
H2t\kõ.õ0---, N "
_I/ Li 0 NH2 OH
Or a pharmaceutically acceptable salt thereof, Of derivative thereof having NMDAR partial agonist activity.
[0012] In one aspect, the invention relates to a method for -treating migraine in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
o 0, H

-OH
or pharmaceutically acceptable salt thereof.
[00131 In another aspect, the invention relates to a method of treating, suppressing, and/or preventing cortical spreading depression in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:

- N

je 0 NH, 'OH
or pharmaceutically acceptable salt thereof

4 [00141 In another aspect, the invention relates to a method of treating or ameliorating long-term post migraine sequelae in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
H2N' OH
0 (j:

[00151 or pharmaceutically acceptable salt thereof.
10016] As described in greater detail below, drugs that are effective when administered at aura would be beneficial to a patient, e.g., by allowing intervention at an earlier stage of migraine. it is contemplated that the methods described herein are applicable to the treatment of migraine with aura comprising administration of a GLYX peptide at aura.
BRIEF DESCRIPTION OF FIGURES
10017] Figure 1 shows focal, high [I0-induced spreading depression (SD) in field CA1 of hippocampal slices resulting in a change in luminance reflecting the spreading wave of mass depolarization of neurons and glia.
[00181 Figure 2 shows data for SD elicited in brain slices; there were no significant differences between the baseline areas of individual sequential episodes of SD
at the initiating site (Bonferroni Multiple Comparison Test, P >0.20), indicating that CiLYX-13 did not alter the initiation of SD.
[00191 Figure 3 shows data demonstrating that CiLYX-13 increases the refractory period for SD initiation. SD could be successfully evoked five minutes after a previous SD in a control slice (Control), but could not be elicited in a slice treated with GLYX-1 3 (GLYX-13 30').
100201 Figure 4A shows that an SD "aura" of increased luminance spreads from the initiating pipette and propagates across the slice, and can be used to calculate SD conduction -velocity (Figure 4B).
[0021.1 Figure 5 shows one-way analysis of variance (ANOVA) with repeated measures to analyze 6 subsequent SDs in order to test whether repeated episodes of SD
maintained a stable speed and if GLYX-13 affected SD conduction velocity.

100221 Figure 6A shows spine shrinkage in response to two episodes of SD
in a control pyramidal neuron, while Figure 6B exemplifies the same process in the presence of 10 MM
I,YX-13; Figure 6C indicates that GLYX-13 rescued recovery of spine size following SD.
10023] Figure 7A shows spreading distance and Figure 7B shows spreading velocity of

5 spreading depression (in estrogen-treated and non-oil treated) rats indicating that spreading speed was faster as compared to oil-treated rats.
100241 Figure 8 shows that SD in slices from estrogen treated rats traveled longer than oil-treated rats.
100251 Figure 9A shows that luminance changes associated with SD in a rat experiment were delayed in the presence of GLYX-13; Figure 9B indicates SD was evoked in the presence of GLYX-13.
100261 Figure 10 shows the effect of GLYX-13 on SD propagation speed across from estrogen treated rats before and after application of GLYX-13 (F(1,8)=3.1;p<0.05); and the preexposure of GLYX-13 between the two groups (F(1,8)=4.2; p<0.05).
is [0027] Figures 11A-11B show rescue of blast-induced learning deficits by rapas-linel (3 mg/kg IV; I hour pest-blast) in PEI, tests 24 hours post-blast.. Figure I IA
shows blast recovery time (latency to normal ambulation) data. Figure I 113 shows the results of a single 3 min Positive Emotional Learning (PEL) test session conducted 24 hours post-blast using a between subjects design. N = 4-6 per group. * P < 0.05 (Figure 1 IA) ANOVA, or (Figure I1B) fisher's PLSD post hoc test, rapastinel TEl vs. vehicle + TBL
DETAILED DESCRIPTION
Migraine Classifications 100281 Migraines were first comprehensively classified in 1988. The international Headache Society most recently updated their classification of headaches in 2004. According to this classification migraines are primary headaches along with -tension-type headaches and cluster headaches, among others.
[00291 Migraines are divided into seven subclasses (some of which include further subdivisions):

6 [00301 Migraine without aura, or "common migraine", involves migraine headaches that are not accompanied by an aura.
10031] Migraine with aura, or "classic migraine", usually involves migraine headaches accompanied by an aura. Less commonly, an aura can occur without a headache, or with a nonmigraine headache. Two other varieties are familial hemiplegic migraine and sporadic hemiplegic migraine, in which a person has migraines with aura and with accompanying motor weakness. if a close relative has had the same condition, it is called "familial", otherwise it is called "sporadic". Another variety is basilar-type migraine, where a headache and aura are accompanied by difficulty speaking, world spinning, ringing in. ears, or a number of other brainstem-related symptoms, but not motor weakness. This type was initially believed to be due to spasms of the basilar artery, the artery that supplies the brains-tem.
Guidelines for diagnosis of migraine with aura are found, for example, in Eriksen. et al., European Journal of Neurology 11 :583-591, 2004 and in the international Classification of Headache Disorders, Second Edition KHD-H). Subtypes of migraine with aura include those set forth in the IdHD-ii such as typical aura with migraine headache (1HS 1.2.1), typical aura with non-migraine headache (THS 1.2.2), typical aura without headache OHS 1.2.3), familial hemiplegic migraine (IRS
1.2.4), sporadic hemiplegic migraine OHS 1.2.5), and basilar-type migraine (fliS 1.2.6).
[00321 Childhood periodic syndromes that are commonly precursors of migraine include cyclical vomiting (occasional intense periods of vomiting), abdominal migraine (abdominal pain, usually accompanied by nausea), and benign paroxysmal vertigo of childhood (occasional attacks of vertigo).
100331 Retinal migraine involves migraine headaches accompanied by visual disturbances or even temporary blindness in one eye.
[00341 Complications of migraine describe migraine headaches and/or auras that are unusually long or unusually frequent, or associated with a seizure or brain lesion.
100351 Probable migraine describes conditions that have some characteristics of migraines, but where there is not enough evidence to diagnose it as a migraine with certainty (in the presence of concurrent medication overuse).

[00361 Chronic migraine is a complication of migraines, and is a headache that fulfills diagnostic criteria for migraine headache and occurs for a greater time interval. Specifically, greater or equal to 15 days/month for longer than 3 months.
[0037] There are four possible phases to a migraine, although not all the phases are necessarily experienced: (1) The prodrome, which occurs hours or days before the headache;
(2) The aura, which immediately precedes the headache; (3) The pain phase, also known as headache phase; and (4) The postdrome, the effects experienced following the end of a migraine attack.
[0038] Prodromal or premonitory symptoms occur in ¨60% of those with migraines with an onset of two hours to two days before the start of pain or the aura. These symptoms may include a wide variety of phenomena including: altered mood, irritability, depression or euphoria, fatigue, craving for certain food, stiff muscles (especially in the neck), constipation or diarrhea, and sensitivity to smells or noise. This may occur in those with either migraine with aura or migraine without aura.
[00391 An aura is a transient focal neurological phenomenon that occurs before or during the headache. They appear gradually over a number of minutes and generally last fewer than 60 minutes. Symptoms can be visual, sensory or motor in nature and many people experience more than one. Visual effects OCCUr most frequently; they occur in up to 99?/o of cases and in more than 50% of cases are not accompanied by sensory or motor effects. Vision disturbances often consist of a scintillating scotoma (an area of partial alteration in the field of vision which flickers and may interfere with a person's ability to read or drive.) These typically start near the center of vision and then spread out to the sides with zigzagging lines which have been described as looking like fortifications or walls of a castle. Usually the lines are in black and white but some people also see colored lines. Some people lose part of their field of vision (known as hemianopsia) while others experience blurring.
[00401 Sensory aurae are the second most common type; they occur in 30-40% of people with auras. Often a feeling of pins-and-needles begins on one side in the hand and arm and spreads to the nose-mouth area on the same side. Numbness usually occurs after the tingling has passed with a loss of position sense. Other symptoms of the aura phase can include: speech or language disturbances, world spinning, and less commonly motor problems Motor symptoms indicate that this is a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras.
[0041] An aura may also occur without a subsequent headache. Acephalgic migraines, also known as silent migraines, are relatively rare and include an aura and other symptoms but without a subsequent headache (i.e., no pain phase).
[00421 During the pain phase, the headache usually is unilateral, throbbing, and moderate to severe in intensity. It usually com.es on gradually and is aggravated by physical activity. In more than 40% of cases however the pain may be bilateral, and neck pain is commonly associated. Bilateral pain is particularly common in those who have migTaines .without an aura.
Less commonly pain may occur primarily in the back of top of the head. The pain usually lasts 4 to 72 hours in adults, however in young children frequently lasts less than 1 hour. The frequency of attacks is variable, from a few in a lifetime to several a week, with the average being about one a month.
[00431 The pain is frequently accompanied by nausea, vomiting, sensitivity to light, sensitivity to sound, sensitivity to smells, fatigue and irritability. in a basilar migraine, a migraine with neurological symptoms related to the brain stem or with neurological symptoms on both sides of the body, common effects include: a sense of the world spinning, light-headedness, and confusion. Nausea occurs in almost 90% of people, and vomiting occurs in about one-third. Other symptoms may include: blurred vision, nasal stuffiness, diarrhea, frequent urination, pallor, or sweating. Swelling or tenderness of the scalp ma:yr occur as can neck stiffness.
[0044] The effects of migraine may persist for some days after the main headache has ended; this is called the migraine postdrome. Many report a sore feeling in the area where the migraine was, and some report impaired thinking for a few days after the headache has passed.
The patient may feel tired and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness.
GLYX Peptides [0045] GLYX-l3 is a newly-developed rapid-acting, long-lasting antidepressant with unprecedented modulatory actions on the activation of N-methyl-D-aspartate glutamate receptors (NMDAR). This agent, which acts at the obligatory co-agonist glycine site on the NA/IDA receptor required for it to be activated, normalizes activation of this critical receptor, increasing it when it is too low, and suppressing it when it is too high.
Through this action, GLYX-13 can enhance the induction of long-term potentiation (LTP), while suppressing LTD, of synaptic strength, and restore normal LTP in hippocampal slices from aging animals.
[00461 As used :herein, the term "GLYX peptide" refers to a peptide having NMDAR
glycine-site partial agonistlantagonist activity. GLYX peptides may be obtained by well-known recombinant or synthetic methods such as those described in US Patents 5,763,393 and 4,086,196 herein incoiporated by reference. In some embodiments, GLYX refers to a tetrape tide having the amino acid sequence Thr-Pro-Pro-Thr, or L-threonyl-L-prolyl-L-prolyl-1.0 L-threonine amide.
l00471 For example, GLYX-13 refers to the compound depicted as:
= oo, 0 H

H 2N ,kk N N H 2 N N

H
Formula I
[00481 Also contemplated are polymorpbs, homologs, hydrates, solvates, free bases, and/or suitable salt forms of GLYX-13 such as, but not limited to, the acetate salt.
The peptide may be cyclized or non-cyclized form as further described in US 5,763,393. In some embodiments, an a GLYX-13 analog may include an insertion or deletion of a moiety on one or more of the Tin or Pro groups such as a deletion of CH2, OH, or NI712 moiety. in other embodiments, GLYX-13 may be optionally substituted with one or more halogens, CI-C3 alkyl (optionally substituted with halogen or amino), hydroxyl, andior amino. Glycine-site partial agonist of the NMDAR
are disclosed in US 5,763,393, US 6,107,271, and Wood et al., NeuroReport, 19, 1059-1061, 2008, the entire contents of which are herein incorporated by reference.
l00491 It may be understood that the peptides disclosed here can include both natural and unnatural amino acids, e.g., all natural amino acids (or derivatives thereof), all unnatural amino acids or derivatives thereof), or a mixture of natural and unnatural amino acids. For example, one, two, -three or more of the amino acids in GLYX-13 may each have, independently, a D- or -L-configurati on.
[0050] GLYX-13 may act predominantly at NR2B-contairting NMDARs, and may not display the classic side effects of known NMDAR modulators such as CPC-101,606 and 5 ketamine in certain embodiments, an anti-migraine or other therapeutic effect with essentially no sedation may be produced by GLYX- I 3 when administered to a subject in therapeutically effective amounts. In still other embodiments, CiLYX-13 may not have abuse potential (e.g., may not be habit-forming).
[0051] In some embodiments, GLYX-13 may increase AMPA GluRl serine-845 10 phosphorylation. In certain embodiments, glycogen synthase kinase 3 (GSK-30) may be activated by GLYX-13. In some cases, levels of 13-catenin may be altered after administration of GLYX-13.
[00521 In some embodiments, GLYX-13 or a composition comprising GLYX-13 may provide better i.v. in vivo potency and/or brain level concentration, relative to plasma levels.
[0053] Additionally, GLYX-13 may have a wide therapeutic index compared to glycine site antagonists such as L-701,324, or other gl:,,,cine site antagonists having narrow therapeutic indexes, which result in a very narrow range of dose between therapeutic effects and ataxia. For example, L-701,324 had anticonvulsant effects at doses that produced ataxia (Bristow, et al.
PET 279:492-501, 1996). Similarly, a series of Wierz compounds had anticonvuisant effects at doses that produced ataxia (Parsons, et al., JPET283:1264-1275, 1997).
Methods [00541 in one aspect, the invention relates to a method for treating migraine in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
0 y NC:

'OH
or pharmaceutically acceptable salt thereof i [00551 In certain embodiments, the compound is administered to the patient with a dose of about 0.01 inivikg to about 1000 mg/kg or about 1 mg/kg to about 500 mg/kg of the compound.
10056] In certain embodiments, the migraine is episodic migraine, chronic migraine, retinal migraine, ophthahnoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache.
[00571 In certain embodiments, the migraine is episodic migraine, chronic migraine, retinal migraine, oplithalnroplegic migraine, acephalgic migraine, or cluster headache.
10058[ In certain embodiments, the migraine is migraine with aura (classical migraine.).
[0059j in certain embodiments, the migraine is migraine without aura (common migraine.).
[00601 In certain embodiments, the migraine is accompanied by allodynia.
[00611 In certain embodiments, the method comprises administering about I
to 10 mg/kg, about 10 mg/kg to about 250 mg/kg, about 20 mg/kg to about 150 mg/kg, about 30 mg/kg to about 125 mg/kg, about 40 -mg/kg to about 110 mg/kg, about 50 mg/kg to about 100 mg/kg, about 60 mg/kg to about 90 mg/kg, or about 70 mg/kg to about 90 mg/kg, of the compound.
[00621 In certain embodiments, the method comprises administering about 1 mg/kg, about 2.5 mg/kg, about 5 mg/kg, about 10 mg/kg, about 15 -mg/kg, about 20 mg/kg, about 25 -mg/kg, about 30 mg/kg, about 50 mg/kg, about 70 mg/kg, or about 100 mg/kg of the compound.
10063] In certain embodiments, the method comprises administering the compound about twice a day, about every day, every 2 days, every 3 days, every 4 days, every 5 days, about once a week, about every two weeks, or about every four weeks.
[00641 In another aspect, the invention relates to a method of treating, suppressing, Of preventing cortical spreading depression or a disease or condition caused by cortical spreading depression in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:

OH
`eõ..
Li NH 2 'OH
or pharmaceutically acceptable salt thereof.

[00651 In another aspect, the invention relates to a method of treating Of ameliorating long-term post migraine sequel.ac in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
H

'Nts H2Nh-N,It's `^"OH

or pharmaceutically acceptable salt thereof [0066] in certain embodiments, the compound is administered to the patient with a dose of about 0.01 ing/k.g to about 1000 mg/kg of the compound. In certain embodiments, the compound is administered to the patient with a dose of about 1 mg/kg to about 500 mg/kg of the compound.
[00671 In certain embodiments, the method comprises administering about 1 mg/kg to 10 -mg/kg, about 1 mg/kg to 20 mg/kg; about 10 mg/kg to about 250 mg/kg, about 20 mg/kg to about 150 mg/kg, about 30 mg/kg to about 125 mg/kg, about 40 mg/kg to about 110 mg/kg, about 50 mg/kg to about 100 mg/kg, about 60 mg/kg to about 90 mg/kg, or about 70 mg/kg to about 90 mg/kg, of the compound.
l00681 In certain embodiments, the method comprises administering about 20 mg/kg, about 25 mg/kg, about 30 mg/kg, about 50 mg/kg, about 70 mg/kg, 1 mg/kg, 5 mg/kg, 10 mg/kg, 15 mg/kg, 20 mg/kg or about 100 mg/kg of the compound.
[00691 In certain embodiments, the method comprises administering the compound about twice a day, about every day, every 2 days, every 3 days, every 4 days, every 5 days, about once a week, or about every two weeks, or e.g., every month.
[00701 In certain embodiments, the method further comprises co-administration with an opioid, an antidepressant, an antiepileptic, a non-steroidal anti-inflammatory drug (NSAID), a serutonin 5E1T IB/1D agonist, an N-methyl-D-aspartate antagonist, or an anti-inflammatory compound.
[00711 NMDAR activation may promote or even be essential for, the phenomenon of SD in many experimental situations. Therefore, compounds that prevent over-activation of NNIDARs could be important new therapies for lessening, and even preventing, the onset of migraine attacks. For example, CiLYX-13, discussed below, suppresses the production and propagation of SD in hippocampal slices in vitro. In certain experiments, GLYX-13 may completely prevent the induction of SD by local increase in extracellular potassium concentration, and/or if not blocking it completely, may slow the rate of SD propagation. Furthermore, CILYX-13 can improve the return of dendritic spines to their original sizes following an SD. For example, provided herein are methods of treating migraine in patients prophylacticly and/or on an acute basis. Such administration may ameliorate the severity (or in some embodiments, abort) migraine attacks in patients.
[00721 In certain embodiments, the patient is a human. Contemplated patients include female patients and/or adolescent patients.
[00731 Also provided herein arc methods of treating migraine (e.g., episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache) in neatment-resistant patients or treating refractory migraines, e.g., patients suffering from a migraine that does not, andlor has not, responded to adequate courses of at least one, or at least two, other compounds or therapeutics. For example, provided herein is a method of treating migraine (e.g., episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache) in a treatment resistant patient, comprising a) optionally identifying the patient as treatment resistant and b) administering an effective dose of GLYX-13 to said patient. In certain embodiments, the migraine is migraine with aura.
[00741 Provided herein, in an embodiment, are methods of acutely treating migraine (e.g., episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache) in a patient in need thereof, comprising administering an effective amount of a GLYX peptide, for example, in a single unit dose. For example, contemplated herein in an embodiment, is a method of treating migraine in a patient in need thereof at the onset of a migraine attack comprising administering acutely (e.g., a single dose) an effective amount of GLYX-13. Such methods may relieve the patient of at least one symptom of migraine for about 2 weeks or less, 1 week or less, 1 day or less, or 1 hour or less (e.g. 15 minutes or less, half an hour or less), after said administration. In some embodiments, such methods may relieve the patient of at least one symptom of migraine for about 1 day or more, I week or more, or 2 weeks or more after said administration. For example, provided herein is a method comprising administering an. effective amount of a GLYX
peptide to a patient suffering from migraine, wherein said patient is substantially relieved of at least one symptom of migraine substantially earlier after the first administration of a GLYX peptide, as compared to the same patient administered another medicament for heating migraine. One of skill in the art will appreciate that such methods of acute administration may be advantageous in a hospital or oat-patient setting. The methods described herein can also be useful for the treatment of allodynia that occurs during migraine with aura.
[0075] The present methods may also be used in treatment of patients who have depression, suffer from traumatic brain injury, epilepsy, or are at risk of a stroke. For example, provided herein, in an. embodiment, is a method for treating traumatic brain, injury comprising administering an effective amount of a GLYX peptide, e.g., GLYX-13. In another embodiment, a method for treating epilepsy is provided, comprising administering an effective amount of a GLYX peptide, e.g., GLYX-13.
[0761 In addition to cardiovascular conditions, migraine sufferers with aura may be at increased risk for other neurological and/or psychological conditions and disorders. it has been shown., for example, that the co-occurrence of migraine with aura with major depression or a suicide attempt increased the risk of developing unprovoked seizure (Hesdorffer et al., Epilepsy Res. 75(2-3):220-223, 2007). Other conditions associated with migraine with aura include significantly higher markers of NO activity, increased incidence of depression, and genetic biomarker correlation for stroke substantially greater than that of the general population (Etminan et al., ttiv1J330(7482):63, 2005). A migraine sufferer that has, or is at risk of, any of these conditions may take medications to treat or to manage these diseases, and these medications may adversely interact with currently used medications for the treatment of migraine with aura. As shown herein, some of these conditions are contraindications for triptan therapy (e.g., stroke and sumatriptan therapy). Moreover, the FDA issued a public health advisory in 2006 regarding serotonin syndrome, a life-threatening condition that may occur when. a tripta.n is used together with certain anti-depressants that are serotonin reuptake inhibitors (SSR1s) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs).

Accordingly, the methods described herein may be useful for the -treatment of patients who have depression or patients who have suffered, or are at risk of, stroke.
Dosages [00771 The dosage of any compositions of the disclosure will vary depending on the symptoms, age and body weight of the patient, the nature and severity of the disorder to be 5 treated or prevented, the route of administration, and the form of the subject composition. Any of the subject formulations may be administered in a single dose or in divided doses. Dosages for the compositions of the disclosure may be readily determined by techniques known to those of skill in the art or as taught herein. In general, satisfactory results can be obtained when the compound is administered to a human at a daily dosage of, for example, between 0.05 mg and 10 3000 mg (measured as the solid form), e.g. about 10 mg to about 500 mg, or e.g., about 1 to about 200mg/kg. Dose ranges include, for example, between 10-1000 mg (e.g., 50-800 mg). In some embodiments, 50, 100, 150, 200, 225, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, or 1000 mg of the compound is administered.
Alternatively, the dosage amount can be calculated using the body weight of the patient. For example, the dose of is a compound, or pharmaceutical composition thereof, administered to a patient may range from 1-500 mg/kg (e.g., 5-250 mg/kg). In exemplary, non-limiting embodiments, the dose may range from 5-200 mg/kg (e.g., 1, 2, 2.5, 5, 10, 15, 20, 25, 30, 35, 40, 45, or 50 mg/kg) or from 15-100 mg/kg (e.g., 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg/kg). In exemplary, non-limiting embodiments, the dose may range from 1-15 mg/kg, 50-100 .mg/kg, 60-90 mg/kg, or 70-80 mg/kg.
[00781 GLYX-13 may provide a high therapeutic index. For example, GLYX-13 may be therapeutically effective with an i.v. or subcutaneous dose range of about 1 to about 10 mg/kg, about 10 to about 200 mg/kg, e.g. about 30 mg/kg, about 75 mg/kg, or about 100 mg/kg. In some embodiments, no ataxia occurs, at for example a dose of at 500 mg/kg, i.v.
[00791 A therapeutically effective amount of GLYX peptide required for use in therapy varies with the form of the condition being treated, the length of treatment time desired, the age and the condition of the patient, and is ultimately determined by the attending physician. The desired dose may be conveniently administered in a single dose that is effective for two weeks, one week, 6, 5, 4, 3, 2, or 1 day, or as multiple doses administered at appropriate intervals, for example as two, three, four or more sub-doses per day.

[00801 An effective dose or amount, and any possible effects on the timing of administration of the formulation, may need to be identified for any particular composition of the disclosure. This may be accomplished by routine experiment as described herein, using one or more groups of animals (preferably at least 5 animals per group), or in human trials if appropriate. The effectiveness of any subject composition and method of treatment or prevention may be assessed by administering the composition and assessing the effect of the administration by measuring one or more applicable indices, and comparing the post-treatment values of these indices to the values of the same indices prior to treatment.
[00811 The precise time of administration and amount of any particular subject composition that will yield the most effective treatment in a given patient will depend upon the activity, pharmacokinetics, and bioavailability of a subject composition, physiological condition of the patient (including age, sex, disease type and stage, general physical condition, responsiveness to a given dosage and type of medication), route of administration, and the like. The guidelines presented herein may be used to optimize the treatment, e.g., determining the optimum time and/or amount of administration, which will require no more than routine experimentation consisting of monitoring the subject and adjusting the dosage and/or timing.
100821 While the subject is being treated, the health of the patient may be monitored by measuring one or more of the relevant indices at predetermined times during the treatment period. Treatment, including composition, amounts, times of administration and formulation, may be optimized according to the results of such monitoring. The patient may be periodically reevaluated to determine the extent of improvement by measuring the same parameters.
Adjustments to the amount(s) of subject composition administered and possibly to the time of administration may be made based on these reevaluations.
10083] Treatment may be initiated with smaller dosages which are less than the optimum dose of the compound. Thereafter, the dosage may be increased by small increments until the optimum therapeutic effect is attained.
[00841 The use of the subject compositions may reduce the required dosage for any individual agent contained in the compositions because the onset and duration of effect of the different agents may be complimentary.

1 '7 [00851 Toxicity and therapeutic efficacy of subject compositions may be determined by standard pharmaceutical procedures in c;. 11 cultures or experimental animals, e.g., for determining the LD50 and the ED50.
100861 The data obtained from the cell culture assays and animal studies may be used in formulating a range of dosage for use in humans. The dosage of any subject composition lies preferably within a range of circulating concentrations that include the ED50 with little or no toxicity. The dosage may vary within this range depending upon the dosage form employed and the route of administration utilized. For compositions of the disclosure, the therapeutically effective dose may be estimated initially from cell culture assays.
100871 in certain embodiments, the GLYX peptide is administered as a preventative measure (i.e., before the prodrome phase). -hi certain embodiments, the GLYX
peptide is administered during prodrome. in certain embodiments, the GLYX peptide is administered at aura. By "at aura" is meant any time after the onset of aura and prior to the onset of migraine pain. In certain embodiments, the GLYX peptide is administered after the onset of migraine pain. -hi certain embodiments, the (JINX peptide is administered during the postdrome, e.g. to lessen the symptoms thereof.
[00881 The term "prevent," as used herein, refers to prophylactic treatment or treatment that prevents one or more symptoms or conditions of a disease, disorder, or conditions described herein (e.g., pain or migraine with aura and with or without allodynia).
Preventative treatment can be initiated, for example, prior to ("preexposure prophylaxis") or following ("post-exposure prophylaxis") an event that precedes the onset of the disease, disorder, or conditions (e.g., at migraine aura). Preventive treatment that includes administration of a GLYX peptide described herein, or a pharmaceutically acceptable salt or solvate -thereof, or a pharmaceutical composition thereof, can be acute, short-term, or chronic. The doses administered may be varied during the course of preventative treatment. See also: Kaniecki et al., "Treatment of Primary Headache: Preventive Treatment of Migraine." In: Standards of Care for Headache Diagnosis and Treatment. Chicago (IL): National Headache Foundation; 2004, p.
40-52.
Formulations 100891 The GLYX peptides of the disclosure may be administered by various means, depending on their intended use, as is well known in the art. For example, if compositions of the disclosure are to be administered orally, they may be formulated as tablets, capsules, granules, powders or syrups. Alternatively, formulations of the disclosure may be administered parenterally as injections (intravenous, intramuscular or subcutaneous), drop infusion preparations, or suppositories. For application by the ophthalmic mucous membrane route, compositions of the disclosure may be formulated as eyedrops or eye ointments.
These formulations may be prepared by conventional means, and, if desired, the compositions may be mixed with any conventional additive, such as an excipient, a binder, a disintegrating agent, a lubricant, a corrigent, a solubilizing agent, a suspension aid, an.
emulsifying agent or a coating agent.
[00901 DNA encoding the GLYX peptides, incorporated into an expression vector, can also be administered, using any of the known administration methods, to express of the GLYX
peptides in vivo.
100911 in formulations of the subject invention, wetting agents, emulsifiers and lubricants, such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives and antioxidants may be present in the formulated agents.
[0092] Subject compositions may be suitable for oral, topical (including buccal and sublingual), rectal, vaginal, aerosol and/or parenteral administration. The formulations may conveniently be presented in unit dosage form and may be prepared by any methods well known in the art of pharmacy. The amount of composition that may be combined with a carrier material to produce a single dose vary depending upon the subject being treated, and the particular mode of administration.
10093] Methods of preparing these formulations include the step of bringing into association compositions of the disclosure with the carrier and, optionally, one or more accessory ingredients. In general, the formulations are prepared by uniformly and intimately bringing into association agents with liquid carriers, or finely divided solid carriers, or both, and then, if necessary, shaping the product.
[00941 Formulations suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution or a suspension in an aqueous or non-aqueous liquid, or as an oil-in-water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pasfilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia), each containing a predetermined amount of a subject composition thereof as an active ingredient.
Compositions of the disclosure may also be administered as a 'bolus, eleetuary, or paste.
[0095] In solid dosage forms for oral administration (capsules, tablets, pills, dragees, powders, granules and the like), the subject composition is mixed with one or more pharmaceutically acceptable carriers, such as sodium citrate or dicalcium phosphate, and/or any of the following: (1) fillers or extenders, such as starches, lactose, sucrose, glucose, marmitol, and/or silicic acid; (2) binders, such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone, sucrose and/or acacia; (3) humectants, such as glycerol; (4) disintegrating agents, such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; (5) solution retarding agents, such as paraffin; (6) absorption accelerators, such as quaternary ammonium compounds; (7) wetting agents, such as, for example, acetyl alcohol and glycerol monostearate; (8) absorbents, such as kaolin and bentonhe clay; (9) lubricants, such a talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate, and mixtures thereof: and (10) coloring agents. In the case of capsules, tablets and pills, the compositions may also comprise buffering agents.
Solid compositions of a similar type may also be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugars, as well as high molecular weight polyethylene glycols and the like.
[00961 A. tablet may be made by compression or molding, optionally with one or more accessory ingredients. Compressed tablets may be prepared using binder (for example, gelatin or hydroxypropyimethyl cellulose), lubricant, inert diluent, preservative, disintegrant (for example, sodium starch glycolate or cross-linked sodium carboxymethyl cellulose), surface-active or dispersing agent. Molded tablets may be made by molding in a suitable machine a mixture of the subject composition moistened with an inert liquid diluent.
Tablets, and other solid dosage forms, such as dragees, capsules, pills and granules, may optionally be scored or prepared with coatings and shells, such as enteric coatings and other coatings well known in the pharmaceutical-formulating art.
[00971 Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs. in addition to the subject composition, the liquid dosage forms may contain inert diluents commonly used in the art, such as, for example, water or other solvents, solubilizing agents and emulsifiers, such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor and sesame oils), glycerol, tetrahydrofinyl alcohol, polyethylene glycols and fatty acid esters of sorbitan, cyclodextrins and mixtures thereof 5 [00981 Suspensions, in addition to the subject composition, may contain. suspending agents as, for example, ethoxylated i.sostearyi alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, and mixtures thereof 10099] Formulations for rectal or vaginal administration may be presented as a suppository, 10 which rna,,, be prepared by mixing a subject composition with one or more suitable non--irritating excipients or carriers comprising, for example, cocoa butter, polyethylene glycol, a suppository wax or a salicylate, and which is solid at room temperature, but liquid at body temperature and, therefore, will melt in the body cavity and release the active agent Formulations which are suitable for vaginal administration also include pessaries, tampons, 15 creams, gels, pastes, foams or spray formulations containing such carriers as are known in the art to be appropriate.
[001001 Dosage forms for transdermal administration of a subject composition includes powders, sprays, ointments, pastes, creams, lotions, gels, solutions, and patches.
[001011 For topical ocular administration compositions of this invention may take the form 20 of solutions, gels, ointments, suspensions or solid inserts, formulated so that a unit dosage comprises a therapeutically effective amount of the active component or some multiple thereof in the case of a combination therapy.
[001021 Pharmaceutical compositions of this invention suitable for parenteral administration comprise a subject composition in combination with one or more pharmaceutically-acceptable sterile isotonic aqueous or non-aqueous solutions, dispersions, suspensions Of emulsions, or sterile powders which may be reconstituted into sterile injectable solutions or dispersions just prior to use, which may contain antioxidants, buffers, bacteriostats, solutes which render the formulation isotonic with the blood of the intended recipient or suspending or thickening agents.

1001031 Examples of suitable aqueous and nun-aqueous carriers which may be employed in the pharmaceutical compositions of the invention include water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), and suitable mixtures thereof, vegetable oils, such as olive oil, and injectable organic esters, such as ethyl oleate and cyclodextrins. Proper fluidity may be maintained, for example, by the use of coating materials, such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
Combination Therapy 1001041 Any of the GLYX peptides described herein (e.g., GLYX-13) can be used alone or in combination with other agents to treat or prevent any of the diseases or conditions discussed herein. For example, in some combination treatments, the dosages of one or more of the therapeutic compounds may be reduced from standard dosages when administered alone.
1001051 The methods of the invention also comprise co-administration of a GLYX
peptide with an opioid, an antidepressant, an antiepileptie, a non-steroidal anti-inflammatory drug (MAID), a serotonin 5HT1 B/1 D agonist, an N-methyl-D-aspartate antagonist, or an anti-inflammatory compound.
1001061 The disclosure relates in certain embodiments to the use of a GLYX
peptide or peptides alone or in combination with one or more other antidepressant treatments, such as tricyclic antidepressants, MAO-I's, SSR1's, and double and triple uptake inhibitors and/or anxiolytic drugs for manufacturing a medicament for treating migraine (e.g., episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic, migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or cluster headache). Exemplary drugs that may be used in combination with a GLYX peptide include Anafranil, Adapin, Aventyl, Elavil, Norpramin, Pamelor, Pertofrane, Sinequan., Surmontil, Tofranil, Vivactil, Parnate, Nardil, Marplan, Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft, Welibutrin, Effexor, Remeron, Cymbalta, Desyrel (trazodone), and Ludiomill.
1001071 in certain embodiments, the opioid is selected from the group consisting of alfentanil, butorphanol, buprenoiphine, dextromoramide, dezocine, dextropropoxyphene, codeine, dihydrocodeine, diphenoxylate, etorphine, fentanyl, hydrocodone, hydromorphone, ketobemidorie, loperami d.e, levorphanol, levomethadone, meptazinol, methadone, morphine, morphine-6-g1ucuronide, nalbuphitte, naloxone, oxycodone, oxymowhone, pentazocine, pethidine, piritramide, propoxyphene, remifentanil, sulferitanyl, tilidine, and tram.adol.
[001081 In certain embodiments, the antidepressant is selected from the group consisting of adinazolam, ataproclate, amineptine, amitriptyline/chlordiazepoxide combination, atiparnezole, azainian.serin, bazinaprine, beforatinc, bifeitnelane, binodaline, bipenamol, brofaromine, caroxazorte, cerielamine, cianopramine, cimoxatone, citalopram, clemeprol, clovoxamine, dazepinil, deanol, demexiptiline, dibenzepin, dothiepin, dr oxidopa, enefexine, estazolam, etoperidone, femoxetinc, fengabine, fezolamine, fluo.tracen, ida.zoxan, indalpine, indeloxazine, iprindo1e, levoprofiline, lithium. litoxetine, lofepraTiline, medifoxamine, metapramine, metralindole, rnianserin, milnacipran, minaprine, mirtazapine, montirelin, nebracetarn, nefopam, nialamide, notnifensine, norfluo.xetine, orotirelin, oxaflozane, pinazepain, pirlindole, pizotyline, ritanserin, rolipram, sercloremine, setiptiline, sibutramine, sulbutiamine, sulphide, teniloxazirte, thozalinone, thyroliberin, tianeptine, tiflucarbine, trazodone, tofenacin, tofisopam, toloxatone, tomoxetine, veralipride, viloxazine, viqualine, zimelidine, and zometapine.
[001091 In certain embodiments, the antiepileptic is selected from the group consisting of carbamazepine, flupirtine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, retigabine, topiramate, and vaiproate.
[001101 in certain embodiments, the NSAID is selected from the group consisting of acemetacin, aspirin, cele,coxib, deracoxib, diclofenac, diflunisal, ethenzamide, etofenarnate, etoricoxib, fenoprofen, .flufenainic acid, .flurbiprofen, lonazolac, lornoxicam, ibuprofen, indomethacin, isoxicam, kebuzone, ketoprofen, ketorolac, naproxen, naburnetone, niflurnic acid, sulindac, tolmetin, piroxicam, mec,lofenarnic acid, mefenamic acid, meloxicarn, metamizol, mofebutazone, oxyphenbutazone, parecoxib, phenidone, phertylbutazone, piroxicarn, propacetamol, propyphenazone, rofecoxib, salicylainide, suprofen, tiaprofenic acid, t enox ic am, valdecoxib, 4-(4-cyclohexy1-2-methyloxazol-5-y1)-2 -fl u o rob en zene sulfonami de, N-[2-(cyclohexyloxy)-4-n itr op he n yl] rn e th a ne s ulfo narnide, 2-(3,4-d iflu o ro p h e ny1)-4-( 3 -hydroxy-3 -met hy lb utoxy)-5- [4- ( met 111õ,ls ulfo nyl)r) henyl] -3(2H)-pyrid az inone, and 2-(3,5-di fluor op h e,n.y1)-3- [4- (me thy Is ulfon yl)p e I] -2-cycl op ent en -ne.
[001111 In certain embodiments, the serotonin 5fITIB/ID agonist is selected from the group consisting of eletriptan, frovairiptan, naratriptan, rizatTiptan, s LI
inatriptan, and zoimitriptan.

[0011.21 In certain embodiments, the N-methyl-D-aspartate antagonist is selected from the group consisting of ama.nta.dine, aptiganel, besonprodik budipine, conantokin G, delucemine, dexanabinol, dextromethorphan, dextropropoxyphene, felbamate, fluorofelbamate, gacyclidinc, glycine, ipenoxazone, kaitocephalin, ketamine, ketobemidone, lanicemine, licosiinel, midafotel, -me-mantine, fl-methadone. D-morphine, milnacipran, neramexane, orphenadrine, remacemide, sulfazocine, FPL-12,495 (racemide metabolite), topiramate, (aR)-a-amino-5-chloro-1-(ph o sphonomethyl)- I H-b en zi midazole-2-propanoi c acid, 1 -aminocycl op entane-carbox.ylic acid, [5 -(arn int) me thyl)-2 - [ [ [.(5 S)-9-chl oro-2,3,6,7-te trahydro-2,3-dioxo- 1 H- EI-pyrido [1,2,3 -de] quinoxalin-5-yll a.c etyl] amino] p he noxy ] -acetic acid, a- a mino -2-(2-pho sp hono e thyl)-cycluhexanepropanoic acid, a-amino-4-(phosphonomethyl.)-benzeneacefic acid, (3E)-2-amino-4 -(ph o sp h 0110/11 ethyl)-3 - h eptenoic, acid, 3 - [(iE)-2-earb oxy-2 -p h enyletneri yli -4 ,6-dichloro- 1H-indote-2-carboxylie acid, 8-chloro-2,3-dihydropyridazino14,5-b]quino.1ine-1,4-dione 5-oxide salt with 2-hydroxy-N,N,N-trimethyl-ethanaminium, N '42-chloro-5-(m.ethylthio)phen:µ,71]-N-methyl-N- [3 -(rn eth y ith io )ph eny I] -guanidine, N'42-chloro-5-(methylthio)phertyll -N-methy l-N-[3-[(R)-methylsulfiny1iphenyl]-guanidine, 6-ehloro-2,3,4,9-tetrahydro-9-methyl-2,3-dioxo-1H -indeno[1,2-b]pyrazine-9-acetic acid, 7-chlorothiokynurenic acid, (3S,4aR,6S,8aR)-decahydro-6-(phosphonoMC thyl)-3-isoquinolinecarboxylic acid, (¨)6,7-dichlo ro- 1,4 - d ihydro-5 - [3 -(tri ethoxym eth yl)-5-(3-pyri d iny1)-4- H-1 ,2,4-triazol -4 -2,3 -cin inox alinedione, 4,6-di ehl oro-3 -[(E)-(2-oxo- 1 - p he ny1-3 -pyrrol id inylid ene)methyt] 1H- ind o.le-2 -carboxylic acid, (2R,4 S)-re 5,7 -dich ro - 1,2,3 ,4-tet ra.hydro -4 - apheny kunino)carb onyl] amino.] - 2-citi i no linecarbox.ylic acid, (3R,4 ihydro-344-h ydroxy-4-(phen y ethy1)- 1 -pip eri d iny11-2H- I -benzopyran.-4,7-diol, 2- [(2,3 -dihydro- 1 H- inden-2-yDaminol-acetam ide, 1,4-dihydro-6-methy1-5-V me thy la mino)me thyll -7-nitro-2,3-quinoxalinedione, [2-(8,9-dioxo-2,6-diazabicyclo[5.2.0]noa-1(7)-en-2-Aethyl]-phosphonie acid, (2R.,6S)-1,2,3,4,5,6-hexahydro-3-[(2 S)-2-methoxypropy11-6,11 , 11 -tri methy1-2,6-met hano-3 -benzazocin-9-ol., 2-hydroxy-5-[ [(pent afluo rophe ri yprne thyl]am ino] -benzoic acid, 1 -12--(4-hydroxyph enoxy)ethy11-4 - [(4-methylphenyl)me thy I] - 4 -p eridinol, 1-[4 - ( 1H-imida zoi-4 y1)-3 -b Mynyi] -4 -( phe ny lmethyl)-piperidine, 2-triethyl-6-phenylethyny1)-pyridine, 3-(phosphoriomethyl)-L-phenylalanine, and 3,6,7-tetrahy dro-2,3-dioxo-N-p henyl- 111,5 -pyri do [1,2,3 -de] quinoxaline-5-acetamide.
:-30 [001131 la certain embodiments, the anti-inflammatory compound is selected from the group consisting of aspirin, celecoxib, cortisone, deracoxib, diflunisak etoricoxib, ferioprofen, ibuprofen, ketoproferi, riaproxen, prednisolone, sulindac, tolmetin, piroxicam, mefenamie acid, meloxicam, phenylbutazone, rofecoxib, suprofen, valdecoxib, 4-(4-cyclohexy1-2-methyloxazol-5-y1)-2-fluorobenzenesulfonamide, N- [2-(cyclahexyloxy)-4- trophenyl]
methanesu tfon amide, 2-(3,4-di fitioropheny1)-4-(3-hydroxy-3-methy b u tox.y)-5- [4-(methy sulfony Opheny11-3 (2H)-pyri daz ino neõ and 2-(3,5-difluoropheny1)-3- [44 methy s ulfonyl)p heny1]-2-cyclop enten-l-one.
[001141 The disclosure has multiple aspects, illustrated by the following non-limiting Examples.
EXAMPLES
Examolel [001.151 The studies described, herein utilized extracellular multi-site electrophysiological monitoring of SD rate of propagation, and two-pholon laser scanning microscopy for real-time imaging of SD-evoked changes in dendritic spine size, in in vitro hippocampal slices. The effect of a novel NMDAR. receptor functional glycine site partial agonist, GLYX-13 was examined on the threshold and rate of propagation of SD, and real-time effects of SD on dendritic spine mutphology. GLYX-13 occasionally completely prevented the induction of SD
by a local increase in extracellular potassium concentration, and consistently slowed its propagation rate. The passage of SD through the hippocampal CA1 region produced a rapid retraction of dendritic spines which reversed after neuronal depolarization had recovered.
GLYX-13 improved the rate and extent of return of dendritic spines to their original sizes and locations following SD, indicating that the drug and others that modulate NIVIDA receptor activity could protect synaptic connections in the brain from possible damage from repeated migraine attacks.
General Methods Drugs [001161 All external and patch pipette solutions were made with deionized distilled water (resistance > 18 mn cm 2; Milli-Q system), The chemicals for making extra- and intracellular solutions were purchased from Sigma-Aldrich (St. Louis, MO, -USA).
Alex.aFittor 594 was purchased from Molecular Probes.

Slice Preparation and Evil-aceIlular Recordings [001171 Experiments were performed on hippocampal slices from 14 to 21 day old Sprague-Dawley0 rats (Taconic Farms, Hudson, NY). Rats were deeply anaesthetized with isofluorane, sacrificed, and the brains quickly removed and placed in oxygenated (95% 02 5%
CO2), ice-cold artificial cerebrospinal fluid (ACSF) containing (in rnM): 126 NaCl, 2.5 KC1, 2.6 CaC12, 5 1.3 MgC12, 1.25 NaH2PO4, 26 NaHCO3, and 11 Glucose. The brain was hemisected, the frontal lobes cut off, and individual hemispheres glued using cyanoacrylate adhesive to a stage immersed in ice-cold ACSF oxygenated continuously during slicing. 400 um thick coronal slices containing the hippocampas were cut using a -vibratome (Leica 1200s), and transferred to an interface holding chamber for incubation at room temperature for a minimum of I hour 10 before transfer to a Haas-style interface chamber for recording at 32 'C. Slices were perfused with ACSF (4mIlmin; ACSF mM: NaCI 126; KC1 3; NaH2PO4 1.25; MgCI 1.3; CaCl2 2.5;
NaHCO3 26; glucose 10) saturated with 95% 02/5% CO2 prior to start of the experiment, and all drugs were bath-applied.
[001181 Extracellular recordings were carried out using a MultiClamp 700B
(Axon 15 instruments) with Clampex (v. 9), filtered at J. kHz and digitized at 3 kHz. Low resistance (1-2 Mc2 after filled with ACSF) recording electrodes were made from thin-walled borosilicate glass inserted into the apical dendri-tic region of the Schaffer collateral termination field in stratum radiatum of the CA.1 region, at approximately 150 rum distance intervals from the SD initiating pipette, to monitor the spread of S.D. The submerged recording chamber was mounted on a 20 Zeiss Axioskop 2FS upright microscope equipped with infrared differential interference contrast (DIC) optics. A 10x objective was used to image slice luminance change caused by SD. Luminance changes were imaged every 100 ms with a cooled CCD camera (CoolSNAP
HQ) controlled by a PIT master system. Electrophysiological data were analyzed with Clampfit 9. Imaging data were digitized and reconstructed with ImageJ
25 [001.191 A bipolar stainless steel stimulating electrode (PHC, Bowdoin, ME) was placed in Schaffer collateral-commissural fibers in the CA3 region, and current pulses were applied with stimulus intensity adjusted to evoke approximately 50% of maximal fEPSPs once each 30 s (50 to 100 pA; 100 ps duration). Electrical stimulation from an ISO-Flex isolator was controlled by a Master eight-pulse generator (AMPI, Jerusalem, Israel) and triggered by a Multielamp 700B
(Molecular Devices, Sunnyvale, CA). Signals were digitized with a Digidata 1322 and recorded using a Multiclamp 700B amplifier. fEPSP slope was measured by linear interpolation from 20-80% of maximum negative deflection, and slopes confirmed to be stable to within 10% for at least 15 min before commencing an experiment. Data were analyzed using Clampfit (Version 9; Axon Instrument) on an IBM-compatible personal computer. Evoked fEPSPs (50%
of maximum amplitude, 2-4 mV) were recorded in the apical dendritic field in stratum radiatum for a stable baseline period of at least 30 min.
Induction of Hippocampal Spreading Depression [001201 Acute coronal slices of hippocampus were transferred to a submerged recording chamber on a microscope stage and perfused with warmed ACSIF (32 C) where extraeellular [K] was raised to 8 niM at a perfusion rate of 3 mlimin. Spreading depression was initiated by pressure-injecting puffs of 3M KC1 through a glass pipette. Pressure pulses of 8-10 psi that lasted 50-100 ms were driven by a Picospritzer TT (Parker Hannifin, Hollis, NH) Pipette resistances were 2 0.2 Mil when filled with 3 M KO.
Dynamic imaging analysis of dendritic spine retraction/recovery [001211 After loading a CA1 pyramidal neuron in a hippocampal slice with Alexa Fluor 594 (100 1,1\4) for 15 minutes, tertiary dendrites were imaged using a using a customized two-photon. laser-scanning Olympus BX61W1 microscope equipped with a 60x11.1 nA
water immersion infrared objective plus 4x digital zoom, as described previously (Zhang et al., 2008).
XYZ scanning mode in a range of +1- 3 um from focused layer was used to avoid movement bias, with a z step interval of 0.5 um, and each image took 0.45 second to finish, for a single depth profile time of 7 seconds. Great care was taken to avoid both saturation of fluorescence and any signs of phototoxicity to small dendritic spines from too much excitation light. Depth profiles were repeated at 5 min intervals to reduce possible dye photobleaching and phototoxicity. A. .MailTai laser (Solid-State Laser, Mountain View, CA) tuned to 810 nm was used for excitation, and image acquisition controlled by Olympus FluoviewFV300 software (Olympus America, Melville, NY) Epifluorescence was detected with photomultiplier tubes of the confocal laser scan head with pinhole maximally opened and emission spectral window optimized for signal over background. in the rransfluorescence pathway, a 565 nm dichroic mirror was used to separate green and red fluorescence, and passed through HQ525/50 and HQ605150 emission filters, respectively, to eliminate transmitted or reflected excitation light (Chroma Technology, Rockingham, VT), and detected simultaneously by two photomultiplier tubes. The figures show collapsed images from the entire 6 um Z-profile, and these projections were used to calculate intensity as an index of spine volume.
Data Analyses [001.221 Recording signals were filtered through an. eight-pole Bessel low-pass filter with a kHz cutoff frequency and sampled by Clampex (V. 9) with an interval of 100 irs. After fEPSP
slopes were calculated with Clampfit (V.9), the data were further processed with Origin 6.1 (Microcal Software, MA) and presented with CordDraw 10 (Core!, Ottawa, Ontario, Canada).
All data were analyzed by one-way analysis of variance (ANOVA), or Student's t-test using SPSS software (SPSS Inc., Chicago, IL). Significance level was preset to P <
0.05. Data are presented as mean + SEM across experiments.
Results Focal, high [K+j-indueed spreading depression in field CAI of hippocarnpal slices [001231 in artificial cerebrospinal fluid (ACSF) where [1(10 was elevated to 8 niM at 32 'V, a single local puff (100 ms) of 3 M [Kb o onto a field in CA.1 stratum radiatum (Figure 1, top left) reliably induced. SDs which spread at propagation rates of 9 71: 5.4 mm/min (n = 16) over the entire CA1 region of the hippocampus. SD characterized as a negative field potential shift (Figure 1, top right) showed a maximum shift of -8 1.5 niV (n=30) in the stratum radiatum synaptic layer of the hippocampal CA1 region which typically lasted more than 45 seconds.
[001241 SD was induced every 10 minutes to test whether the area of the negative potential shift (Figure 1, top right, hatched area), a measure of the effective magnitude and duration of extracellular space conduction of K.+, was stable with repeated SDs. While the areas of negative potential shifts recorded from the initiating electrode were larger than at the distal recording electrode 600 um away (Figure 1, bottom), there were no significant differences in amplitude or propagation speed of the individual episodes of repeated sequential SDs elicited at 10 minute intervals at either site (Bonferroni Multiple Comparison Test, P> 0.20). These results indicate that reproducible SD negative potential shifts can be stably, repeatedly evoked in field CA.1 of the hippocampus, at least for the first ten.

GLYX-13 suppresses the propagation and increases the refractory period of hippocarnpal spreading depression [001251 To test the hypothesis that the novel NMDA receptor glycine coagonist site partial agonist GLYX-13 could raise the threshold for or prevent SD by regulating NMDA
receptor activation within a physiological range and preventing excess activation, GLYX-13 was bath--applied at 1, 10, or 50 um to hippocampal slices for 30 min prior to brief ejection of high [K+]
(1 miN4 in patch pipette) into stratum radiatum of the CAI region and attempted to elicit SD. A
dose-response relation was constructed based on time of high [K-1-I ejection first in naive slices, and then after a 30 minute bath application of GLYX-13 at each of the three test concentrations (1,10, or 50 M), while recording DC potential to detect SD.
[001261 After at least three SDs were initially evoked in drug-free ACSF, slices were perfused with GLYX-13 and continued to elicit SDs every ten minutes. As illustrated in Figure 2, top, for 10 t.tM GLYX-13, there were no significant differences between the baseline areas of individual sequential episodes of SD at the initiating site (Bonferroni Multiple Comparison Test, P >0.20), indicating that GLYX-13 did not alter the initiation of SD.
[001271 GLYX-13 was next tested to ascertain whether affected the relationship of SD
amplitudes at near (proximal) and far (distal) recording sites with repeated SDs. The slice was perfused with 10 uM GLYX-13 and continued to elicit SDs every ten minutes (Figure 2, bottom). Bonferroni Multiple Comparison Test (P >0.20) again showed no significant difference between the areas of individual sequential episodes of SD in control slices. CiLYX-13 did not affect the initiation of -the negative potential shift of SD at the proximal recording site.
[001281 SD amplitudes at the initiating site were con-elated with areas of negative potential shifts of SD at the remote recording (Figure 2, bottom). Therefore, proximal/distal area ratio in absence and presence of GLYX-13 was compared. As illustrated in Figure 2, bottom, the area ratio between remote and initiating sites was dramatically reduced in the presence of 10 it M
GLYX-13 by the application of the sixth SD (6th SD). A two way ANOVA indicated three significant effects: 1) time effects repeated SDs in the same slices (F(1, 12)=5.17, p <0.05) over all observations; 2) effects from drug treatment (F(1,12)=5.07, p <0.05); and 3) an interaction of time with treatment (F(1,12)=30.91, p <0.01). These results indicate that recurrent negative potential shifts of SD alter the amplitude ratio between remote and initiating sites; and that this reduction was markedly enhanced by GLYX-13. These findings show that GLYX-13 can significantly suppress the propagation of SD through the brain, particularly after multiple SD
events.
[001291 In the preceding studies, it was demonstrated that GLYX-13 can limit the propagation of SD by reducing the amplitude of the negative field potential shift and slowing the conduction speed, effects that were largest after multiple SDs. By shortening the interval between each SD initiation, it was discovered that each SD in control slices had an absolute refractory period of 3-4 minutes for the next successful SD = 7).
10 1,t1\4 GLYX-13 prolonged this refractory period to 5-6 minutes (n = 6). A.s shown in Figure 3, SD could be successfully evoked five minutes after a previous SD in a control slice (Control), but could not be elicited in a slice treated with GUYX-13 (GUY-X-13 30').
Measuring SD propagation using intrinsic changes in optical density produced by SD-induced extracellular space volume shifts [001301 SD elicits profound shrinkage of the extracellular space volume as fluid rushes in to depolarized cells and they swell, and this can. be seen as changes in intrinsic optical density in vivo. Such luminance intensity changes could also be readily detected in brain slices using transmitted light DIC microscopy. Figure 4A shows that an SD "aura" of increased luminance spreads from the initiating pipette and propagates across the slice, and can be used to calculate SD conduction velocity (Figure 4B). The time course of increased luminance correlated well with maximal negative potential shift of SD using electrophysiological recordings. Therefore, calculating the time course of luminance changes with distance provides an accurate and convenient way to measure SD conduction velocity.
[001.311 To determine if repeated SDs show the same conduction velocity, the luminance changes were monitored over 5 points separated by 150 um as diagrammed at the top of Figure 4A. A one way ANOVA with repeated measures indicated that SD maintained a steady transmitting speed from P1 to P5 (F(5, 35)=2.42, p >0.05) within an individual slice. Therefore, the transmitting speed could be used from PI to P5 to test SD stability over successive episodes. The average propagating speed of SD was 9.07 0.55 inn 'mm, ranging from 7,54 to 11.14 mm/mmn (n=16).
[001321 To test whether repeated episodes of SD maintained a stable speed and if GLYX-13 affected SD conduction velocity, a ANOVA test was used with repeated measures to analyze 6 subsequent SDs as illustrated in Figure 5. Analysis revealed a significant difference between control and GLYX-13 treated slices (F(1,50)=3.66, p <0.01). SD sequence accounted for 38.5%
of total variance, indicating that SD propagation speed significantly slowed with increasing SD
number (F(5,50)=14.01, p <0.01). Although the GLYX-13 effect on SD propagation speed 5 over all repeated SDs did not reach significance in the two-way ANOVA, there was a significant interaction between number of SD and GLYX-13 treatment (F(5,50)=2.53, P
<0.05), reflecting that GLYX-1 3 (filled circles) significantly decreased SD
propagation speed only by the seventh SD.
Spreading depression causes CA1 pyramidal neuron dendritic spines to reversibly shrink in volume [001331 The anatomical microarchitecture of pyramidal neuron dendrites in the brain is 1.0 surprisingly labile in response to a variety of stimuli.
Depolarization, oxygen/glucose deprivation and N-methyl-D-aspartate have all been shown to produce retraction of dendritic spines in hippocampal CA1 pyramidal neurons in vitro. To examine the response of spines to SD, single CA1 pyramidal neurons were filled with the fluorescent dye Alexafluor-594 and imaged dendritic spine shape using serial z-stack sections (0.2 urn steps spanning 5 lim) 15 collected from 2-photon laser scanning microscopy. Thirty minutes after loading of Alex.aFluror-594 into CAI pyramidal had reached equilibrium distribution within the neuron, SDs were initiated by brief ejection of high [K+] (1M in the patch pipette) into stratum radiatum of the CA1 region of hippocampal slices where Schaffer collateral axons synapse on the apical dendrites of CAI pyramidal neurons. As illustrated in Figure 6A and 6B, the 20 depolarization produced by SD did elicit substantial spine shrinkage as measured by collapsed z-stack fluorescence amplitude, with spine volume completely recovering 20-30 minutes after the first SD. This confirms that one of the sequelae of SD-induced depolarization is alteration in dendritic spine morphology.
GLYX-13 improves dendritic spine recovery following spreading depression [001341 Finally, the effects of GLYX-13 were examined on the dynamic morphological 25 responses of dendritic spines to SDs. GLYX-13 was investigated whether it could either lessen the shrinkage of spines in response to SD, or improve their recovery. Figure 6A illustrates spine shrinkage in response to two episodes of SD in a control pyramidal neuron, while Figure 6B
exemplifies the same process in the presence of 10 m.1%.1 GLYX-13. ANOVA. for repeated measures reached significance (F(8,64)=17.53, p<0.001) for fluorescent intensity measured from dendritic spines like the one illustrated at the top of Figure 6C, and that this significance mainly came from the post-SD time courses (F(8,64)=6,18, p<0.01), revealing that, while GLYX-13 (filled circles) did not alter the shrinkage caused by SD, it did rescue the recovery of spine size following SD (F(8,64)=2.81, p<0.05).
Example 2 [00135] Hippocampal Slice Preparation: Experiments were performed using Sprague-Dawley0 rats (Taconic Farms) .14 to 21 days of age. Rats were deeply anaesthetized with isofluorane, sacrificed, and the brains quickly removed and placed in oxygenated (95% 02 ---5% CO2), iced-cold artificial cerebrospinal fluid (ACSF) containing (in miv1):
126 NaC1, 2.5 KCl, 2.6 CaC12, 1.3 MgC12, 1.25 Na.H2PO4, 26 NaHCO3, and 11 Glucose. The brain was hemisected., the frontal lobes cut off, and individual hemispheres glued using cyanoacrylate adhesive to a stage immersed in ice-cold ACSF oxygenated continuously during slicing. 400m thick coronal slices containing the hippocampus were cut using a Vibratome (Leica. I200s), and transferred to an interface holding chamber for incubation at room temperature for a minimum of 1 hour before commencing the experiment.
[001361 induction of Hippocampal Spreading Depression: Acute corona! slices of hippocampus were transferred to a submerged recording chamber on a microscope stage and perfused with warmed ACSF (32 degree centigrade) where extracellular [K+1 was raised to 8 inM at a perfusion rate of 3 milmin. Spreading depression was initiated by pressure-injecting puffs of 3M l(C1 through a glass pipette. Pressure pulses of 8-10 psi that usually lasted 50 ms were driven by a picospritzer. Pipette resistances were 2 0.2 Mn when filled with 3 M KO.
[001371 Electrophysiological. Recording Methods: Extracellular recordings were carried out using a MultiClamp 70013 (Axon Instruments) with Clampex (v. 9), filtered at 1 kHz and digitized at 3 kHz. Low resistance (1-2 MO. after filled with ACM recording electrodes were made from thin-walled borosilicate glass inserted into the apical dendritic region of the Schaffer collateral termination field in stratum radiatum of the C,A.1 region, at approximately 150 mm distance intervals from the SD initiating pipette, to monitor the spread of SD. The submerged recording chamber was mounted on a Zeiss A.xioskop 2FS upright microscope equipped with infrared differential interference contrast (DIC) optics. A 10x objective was used to image slice luminance change caused by SD. Luminance changes were imaged every 100 ms with a cooled CCD camera (CoolSNAP HQ) controlled by a PTI -master system.
Electrophysiological data were analyzed with Cla.mpfit 9. Imaging data were digitized and reconstructed with imageJ (NTH). All experiments were conducted under an approved protocol in compliance with National Institutes of Health guidelines [001381 The findings of Example I are investigated relating to women and adolescent patients. The experimental protocol was used to initiate spreading depolarization (Si)) in the CA1 region of the hippocampus inbrain slices in vitro. To better observe the distance of spreading depression from the initiation site and SD propagation speed over a longer range visually, the 1.0x objective of Example 1 was replaced with a 4x objective to enlarge the viewing domain to 1.6 mm. The recording chamber was modified to perfuse the slice from both sides, more efficient perfusion not only provided sufficient oxygen to the brain slice, but also helped to maintain stable extracellular milieu since each episode of spreading depression causes a dramatic ion composition change both extracellularly and intracellularlly.
[001391 Two groups of 2 month-old, uvariectomized Sprague-Dawley female rats were included in the current cohort study. One group of ovariectornized rats were provided with daily injections of estrogen for 7 days since the 7th post-operation day, while the others were only injected with oil vehicle as controls for 7 days before conducting experiments.
[001401 The luminance changes were visually categorized following a puff of 3 M
potassium as failure (<100 mm), local spreading (>100.mm; <800 mm); or full spread (>800 mm). SD induction was attempted in 39 slices from 8 oil--treated rats and 35 slices from 7 estrogen-treated rats. Table I summarizes the frequency of occurrence of SD
evoked by the same method in the two groups. in the oil-treated group, the failure rate was significantly higher than in the estrogen treated group (Chisquare test, P-0.014), indicating that estrogen itself enhances the propensity of brain tissue to exhibit SD upon focal depolarization.
Table 1 Group Non-SD Localized SD -Full SD Total Oil Treated 13 21 5 39 Estrogen Treated 6 23 6 35 [001411 Luminance changes were used to estimate the transmitting velocity of spreading depression as shown in Figure 7 below. Propagation velocities were calculated from both localized and full SD induced by focal 31M. potassium puffs, by dividing the distance of SD
between observation sites by time that SD took to travel between these observation sites. As illustrated in Figure 7, mean spreading speed in slices from estrogen-treated rats was 0.121+
0.013 minis, significantly faster than the speed of propagation in slices from of oil-treated control rats (0.083 0.005 mm/s, P<0.05, Student's t-test. These data indicate that estrogen plays a significant role in enhancing both the propensity and speed of SD in hippocampus, and probably in neocortex as well.
in [001421 Testing of how estrogen affects the severity of SD by measuring the maximum distance of propagation of SD away from the initiation site was conducted. As shown in Fig 8, the spreading end point along the Schaffer collateral pathway estimated by averaging the distance of the observation site that showed minimum detectable luminance changes (>5%
change from baseline) from the initiation site with the distance of the close neighboring observation site that exhibited undetectable luminance changes, and measuring this distance from the initiation site. As shown in Figure 8, the SD in slices from estrogen-treated rats traveled a significantly longer distance (0.594 0.071 mm; n=18) than SD in slices from oil-treated rats (0.394 + 0.051.mm; n=16, P<0.05, Student's t-test). Hence, SD in estrogen-treated rats was not only more readily elicited, but propagated longer distances.
00143[1 10 11\4. GLYX-13 was then added to the perfusate after 2 &is were induced 10 minutes apart, and continued to induce SD each 10 minutes to determine whether the velocity and scale of SD were affected. Figure 9 shows the typical differences of evoked SD in a slice from an estrogen-treated rat before application of GLYX-13 and after a 50 minute exposure to 10 1,1\4 bath-applied GLYX-13. The luminance changes at 10 observation sites were measured to assess the effects of GLYX-13 on SD. Although SD was still readily evoked, as shown in Figure 9B, Figure 9A clearly shows that luminance changes associated with SD
were delayed in the presence of GLYX-13. A. paired t-test showed that GLYX-13 significantly reduced mean SD transmission velocity from 6.56 0.57 mm/min to 4.96 0.28 mm/min (n=5, P<0.01, paired nest). The same experiments in hippocampal slices from oil-treated rats were conducted.
3 0 While GLYX-13 decreased mean SD transmission velocity from 5.09 0.61 min/min to 4.50 +
0.39 nunlinin (n=5), this decrease did not reach statistical significance.

[001441 A two-way repeated ANOVA was also carried out to explore the effect of GLYX-13 on SD propagation speed across the two groups. As Figure 10 illustrates, the first significance comes from estrogen treated rats before and after application of (F(1,8)=3.1;p<0.05); and the second significance arises from preexposure of between the two groups (F(1,8)=4.2; p<0.05). These results indicate that GLYX-13 has a stronger effect in estrogen treated rats, significantly slowing transmission velocity of SD to the level of oil-treated rats.
Example 3 Methods Animals [001451 Adult male (2-3 month old) Sprague-Dawley (SD) rats were purchased from Harlan (USA). Rats were housed in Lucite cages with aspen wood chip bedding, maintained on a 12 hour:12. hour light:dark cycle (lights on at 5 AM), and given ad libitum access to Purina rat chow (USA) and tap water throughout the study.
Traumatic brain ii-ijury induction [001461 Single blast-induced traumatic brain injury was induced, modified for use in rats according to the protocol of Goldstein et al. (Goldstein, LE, et al. (2012) "Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neuratrauma mouse model,"
Science Translational Medicine 4:134ra160.) Adult male Sprague-Dawley rats were anesthetized by isofturane, ear plugs were inserted into both of the rat's ears, and the rat received a single ¨ 42 PSI blast of helium generated by puncturing, 0.014 inches of polyester films Sham controls were placed outside of the blast radius. As follows Animals were dosed with rapastinel (3 mg/kg IV) or 0.9% sterile saline vehicle (1 milkg IV) 1 hour post-blast Rats were first anesthetized using 3.5-4% isoflurane, then their ears were protected with 1.5 x 1.5 mm foam plugs (Pura-Fit ear plugs, Moldex-Metric INC, Culver City, California). The rats were placed into head access rodent thoracic restrainers (Stoelting, USA) to protect their bodies while allowing the heads to move freely, with the heads 10 cm from the end of the aluminum shock tubes (183 x 61 cm; L-3 Applied Technologies, USA). Rats received a single ¨42 PSI
blast of helium generated by puncturing 0.014 inches of polyester film. Sham controls were placed outside of the blast radius. Animals were dosed with rapastinel (3 mg/k2 IV) or 0.9%

sterile saline vehicle (1 mIlkg, IV) 1 hour post-blast. Latency to recover from anesthesia was recorded (Figure 11A). Recovery was defined as displaying eyeblink and righting reflexes, and normal ambulation (normal rhythmic gate, non-circular gate, fully supporting body weight, evidence of some sniffing and exploratory behaviors). Animals were dosed with GLYX-13 (3 5 mg/kg IV) or 0.9P/0 sterile saline vehicle (1 mUkg IV) 1 hour post-blast.
N ¨ 4-6 per group; * P
<0.05 (Figure 11A) ANOVA..
1001471 Positive emotional learning (PEL) Figure 11B shows the results of a single 3 min Positive Emotional Learning (PEL) test session conducted 24 hours post-blast using a between subjects design. N -= 4-6 per group. Fisher's PLSD post hoc test was used to evaluate results 10 (rapastinel TBI vs. vehicle -H TBI).
1001481 Heterospecific rough-and-tumble play was conducted as previously described (Burgdorf, J., et al. (20.11) "Positive emotional learning is regulated in the medial prefrontal cortex by G1uN2B-containing NMDA receptors," Neuroscience 192:515-523), and testing occurred 3 hours and 2 weeks post-dosing. Heterospecifie rough-and-tumble play stimulation 15 was administered by the experimenter's right hand. Animals received 3 mm of 1-3eterospecific rough-and-tumble play that consisted of alternating 15 sec blocks of heterospec,ific play and 15 sec of non-stimulation. High frequency ultrasonic vocalizations (USVs) were recorded and analyzed by sonogram with Avasoft SA.Slab Pro (Germany) as previously described (Id.).
Frequency modulated 50-kHz USVs that occurred during each of the non-stimulation periods 20 were quantified to measure PEL. Animals were not habituated to play stimulation before testing.
Results 1001491 As shown. in Figure 11A, animals that received TBI showed longer recovery times from anesthesia in comparison to sham control animals 13) = 4L7 , P < 0.05]. As shown in Figure 11B, rapastinel (3 mg/kg IV) rescued TBI-induced suppression of positive emotional 25 learning [F(2, 12) ¨ 10.0, P < .05; Fisher's PLSD post hoc test rapastinel TBI vs. vehicle sham vs. vehicle Tat vs., P <0.05]. In addition, anesthesia recovery time was not significantly correlated with rates of PEI., [r(15) = -0.14, P > .05]. in a positive emotional learning test, a single dose of rapastinel (3 mg/kg IV) completely rescued the deficits in learning and emotion induced by TBI. Thus, in this preclinicat niodel, rapastinel was effective in treating the core cognitive and affective symptoms of TBI and rapastinel appears the have therapeutic potential for the treatment of PTSD.
EQUIVALENTS
[001501 While specific embodiments of the subject disclosure have been discussed, the above specification is illustrative and not restrictive. Many variations of the disclosure will become apparent to those skilled in the art upon review of this specification.
The full scope of the disclosure should be determined by reference to the claims, along with their full scope of equivalents, and the specification, along with. such variations.
[001511 Unless otherwise indicated, all numbers expressing quantities of ingredients, reaction conditions, parameters, descriptive features and so forth used in the specification and claims are to be understood as 'being modified in all instances by the term "about"
Accordingly, unless indicated to the contrary, the numerical parameters set forth in this specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the disclosure.
[001521 All publications and patents mentioned herein, including those items listed below, are hereby incorporated by reference in their entirety as if each individual publication or patent was specifically and individually indicated to be incorporated by reference.
in case of conflict, the present application, including any definitions herein, will control.

Claims (26)

What is claimed is:

1. A method for treating migraine in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
or pharmaceutically acceptable salt thereof.

2. The method of claim 1, wherein the compound is administered to the patient with a dose of about 0.01 mg/kg to about 1000 mg/kg of about 1 mg/kg to about 500 mg/kg of the compound.

3. The method of claim 1 or 2, wherein the migraine is episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, migrainous disorder, menstrual migraine, abdominal migraine, childhood periodic syndromes, or duster headache.

4. The method of claim 1 or 2, wherein the migraine is episodic migraine, chronic migraine, retinal migraine, ophthalmoplegic migraine, acephalgic migraine, or cluster headache.

5. The method of any one of claims 1-4, wherein the migraine is migraine with aura (classical migraine).

6. The method of any one of claims 1 -4, wherein the migraine is migraine without aura (common migraine).

7. The method of any one of claims 1-6, wherein the migraine is accompanied by allodynia.

8. The method of any one of claims 1-7, comprising administering about 1 mg/kg to about mg/kg, about 10 mg/kg to about 250 mg/kg, about 20 mg/kg to about 150 mg/kg, about 30 mg/kg to about 125 mg/kg, about 40 mg/kg to about 110 mg/kg, about 50 mg/kg to about 100 mg/kg, about 60 mg/kg to about 90 mg/kg, or about 70 mg/kg to about 90 mg/kg, of the compound.

9. The method of any one of claims 1-7, comprising administering about 1 mg/kg, about 2.5 mg/kg, about 5 mg/kg, about 10 mg/kg, about 20 mg/kg, about 25 mg/kg, about 30 mg/kg, about 50 mg/kg, about 75 mg/kg, or about 100 mg/kg of the compound.

10. The method of any one of claims 1-9, comprising administering the compound twice a day, about every day, every 2 days, every 3 days, every 4 days, every 5 days, about once a week, about every two weeks, or about once a month.

11. A method of treating, suppressing, and/or preventing cortical spreading depression in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
or pharmaceutically acceptable salt thereof.

12. A method of treating or ameliorating long-term post migraine sequelae in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
or pharmaceutically acceptable salt thereof.

13. The method of any one of claims 11-12, wherein the compound is administered to the patient with a dose of about 0.01 mg/kg to about 1000 mg/kg or about 1 mg/kg to about 500 mg/kg of the compound.

14. The method of any one of claims 11-12, comprising administering about 1 to about 20 mg/kg, about 2 to about 15 mg/kg; about 5 to about 10 mg/kg, about 10 mg/kg to about 250 mg/kg, about 20 mg/kg to about 150 mg/kg, about 30 mg/kg to about 125 mg/kg, about 40 mg/kg to about 110 mg/kg, about 50 mg/kg to about 100 mg/kg, about 60 mg/kg to about 90 mg/kg, or about 70 mg/kg to about 90 mg/kg, of the compound.

15. The method of any one of claims 11-12, comprising administering about 1mg/kg, about 2.5mg/kg, about 5 mg/kg, about 10 mg/kg, about 21 mg/kg, about 25 mg/kg, about 30 mg/kg, about 50 mg/kg, about 70 mg/kg, or about 10 mg/kg of the compound.

16. The method of any one of claims 11-15, comprising administering the compound twice a day, about every day, every 2 days, every 3 days, every 4 days, every 5 days, about once a week, about every two weeks, or about once a month.

17. The method of any one of claims 1-1 6, further comprising co-administration with an opioid, an antidepressant, an antiepileptic, a non-steroidal anti-inflammatory drug (NSAID), a serotonin 5HT1B/1D agonist, an N-methyl-D-aspartate antagonist, or an anti-inflammatory compound.

18. The method of any one of claims 1-17, wherein the patient is a human.

19. The method of any one of claims 1-18, wherein the patient is female.

20. The method of any one of claims 1-19, wherein the patient is a pediatric or adolescent patient.

21. A method of treating or ameliorating traumatic brain injury in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a compound represented by:
or pharmaceutically acceptable salt thereof.

22. The method of claim 21, wherein the compound is administered to the patient with a dose of about 0.01 mg/kg to about 1000 ma/kg or about mg/kg to about 500 mg/kg of the compound.

23. The method of any one of claims 21-22, comprising administering about to about 20 mg/kg, about 2 to about 15 mg/kg; about 5 to about 10 mg/kg, about 10 mg/kg to about 250 mg/kg, about 20 mg/kg to about 150 mg/kg, about 30 mg/kg to about 125 mg/kg, about 40 mg/kg to about 110 mg/kg, about 50 mg/kg to about 100 mg/kg, about 60 mg/kg to about 90 mg/kg, or about 70 mg/kg to about 90 mg/kg, of the compound.

24. The method of any one of claims 21-23, comprising administering the compound twice a day, about every day, every 2 days, every 3 days, every 4 days, every 5 days, about once a week, about every two weeks, or about once a month.

25. The method of any one of claims 21-24, further comprising co-administration with a steroid, antidepressant, an opioid, an antiepileptic, an anti-seizure drug, an anti-convulsant, a non-steroidal anti-inflammatory drug (NSAID), a serotonin 5HT1B/1D agonist, a diuretic, and/or an anti-inflammatory compound.

26. The method of any one of claims 21-25, wherein the patient is a human.