Tackling migraines head-on : insights into pathophysiology, management and treatment

Abstract

Migraines are complex neurological disorders characterised by recurrent episodes of moderate-to-severe headaches, often accompanied by sensory disturbances. Globally, migraine is one of the leading causes of disability and is classified into various subtypes based on individual characteristics and symptoms. Clinical presentation and diagnosis rely on the identification of specific symptoms and stages of migraine attacks, distinguishing them from other types of headache disorders. The pathophysiology of migraine involves a complex interplay between neurological, vascular, and biochemical factors, with the trigeminovascular system playing a central role. Migraine management includes both non-pharmacological and pharmacological approaches. Non-pharmacological strategies involve lifestyle modifications, dietary adjustments, and sleep and stress management. Pharmacological treatment involves therapies such as triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and calcitonin gene-related peptide (CGRP) antagonists, as well as preventive medications such as antihypertensives, antidepressants, antiepileptics, and newer biological therapies. Key challenges in migraine treatment include the accessibility of advanced therapies, the role of pharmacogenomics in personalised treatment, and the development of emerging therapies through clinical trials. Further research is needed to better understand the complex pathophysiology of migraine for the development of more effective and targeted treatment strategies.