Migraine: from pathophysiology to treatment

J Neurol. 2023 Jul;270(7):3654-3666. doi: 10.1007/s00415-023-11706-1. Epub 2023 Apr 8.

Abstract

Migraine is an extremely disabling, common neurological disorder characterized by a complex neurobiology, involving a series of central and peripheral nervous system areas and networks. A growing increase in the understanding of migraine pathophysiology in recent years has facilitated translation of that knowledge into novel treatments, which are currently becoming available to patients in many parts of the world and are substantially changing the clinical approach to the disease. In the first part of this review, we will provide an up to date overview of migraine pathophysiology by analyzing the anatomy and function of the main regions involved in the disease, focusing on how these give rise to the plethora of symptoms characterizing the attacks and overall disease. The second part of the paper will discuss the novel therapeutic agents that have emerged for the treatment of migraine, including molecules targeting calcitonin gene-related peptide (gepants and monoclonal antibodies), serotonin 5-HT1F receptor agonists (ditans) and non-invasive neuromodulation, as well as providing a brief overview of new evidence for classic migraine treatments.

Keywords: CGRP; Migraine; Neuromodulation; Pathophysiology; Treatment.

Publication types

  • Review

MeSH terms

  • Calcitonin Gene-Related Peptide
  • Calcitonin Gene-Related Peptide Receptor Antagonists / therapeutic use
  • Humans
  • Migraine Disorders* / drug therapy
  • Migraine with Aura* / drug therapy
  • Receptors, Calcitonin Gene-Related Peptide

Substances

  • Calcitonin Gene-Related Peptide
  • Calcitonin Gene-Related Peptide Receptor Antagonists
  • Receptors, Calcitonin Gene-Related Peptide